Book Sparks Mental Health Movement

A group of psychiatrists and mental health experts kicked off a national effort in Portland last month to improve the use of mental health drugs

March 15, 2011 – Gina Nikkel said she couldn’t read a book like Robert Whitaker’s Anatomy of an Epidemic and not “do something about it,” she told a crowd at the First Unitarian Church of Portland last month.

Whitaker – sitting a few feet away onstage – grinned proudly. His book looks at the outcomes of mental health patients over the past century, concluding in part that long-term use of mental health drugs could be making patients worse.
What Nikkel, the executive director of the Association of Oregon Community Mental Health Programs, along with Whitaker did about it was help create the Foundation for Excellence in Mental Health, which plans to raise several million dollars toward non-biased research into the use of psychiatric medication.
“The whole thought is to empower our docs and our psychiatrists to use medication in the manner that it’s supposed to be used,” Nikkel said. “A lot of the research we have now is funded by different entities that have a stake in the outcome of that research. We want to make sure there is research focused on medications and focused on recovery and what are the best protocols for recovery.”
The Foundation already has significant funding for a series of symposium’s beginning with one in Portland last month that brought together more than 50 psychiatrists and mental health experts. In October, the Foundation plans a symposium on child psychiatry in Boston.
Nikkel said the Foundation was inspired by stories of physicians who say they face pressure from the public for a “magic pill.” Others have seen that medication isn’t always the best answer. Meanwhile, doctors are getting other messages that certain mental health conditions could require lifelong medication.
In Whitaker’s book, he describes patients that successfully recovered from mental illnesses by perhaps using medications periodical while relying on community support and other therapies.
“In some ways this is not a new way to think about things,” said Dr. Maggie Bennington-Davis, chief medical officer of Cascadia Behavioral Healthcare, who attended the two-day conference. “In some ways we’re going back to what community mental health was always meant to be when first envisioned in the 60s.”
She blames decades of reduced funding that have led payers to require that doctors invoice for specific practice codes. Patients end up in certain categories they may not belong, which can easily lead down the path of medication, Bennington-Davis said.
“It’s like shopping for a menu. If what you need isn’t on there, you’re out of luck,” she said.
Cascadia is the largest mental health provider in the state with most of its services located in and around Portland. It treats roughly 13,000 people with anything from therapy to secure residential housing. The organization itself has weathered perennial reductions in government funding, pushing the non-profit in recent years near bankruptcy.
“For Cascadia it’s a reminder that we’re here to help people to recover by whatever that looks like for each person,” Bennington-Davis said. “That may or may not include medication. It certainly doesn’t automatically require medication.”
The Oregon Psychiatric Association held a two-day conference in Portland earlier this month around the strengths and limitations of evidence-based medicine in terms of various therapies as well as medications, said John McCulley, executive director.
“I don’t think there is ever any question that psychiatrists want to improve their education and skills in the area of medications,” McCulley said. “It’s so very complex and so individually patient determined. There needs to be continual research in all these areas.”
Dr. Chris Gordon, assistant professor of psychiatry at Harvard University, told the crowd at the Unitarian Church last month that the causes of mental illness are still unknown.
“I have the greatest respect for the profound suffering that whatever this is that we call mental illness actually is,” Gordon said. “I do acknowledge that many people have suffered grievous harm at the hands of psychiatrists, and my profession has unfortunately greatly compounded the suffering of many people. We have grossly under-appreciated the possibility for recovery.”

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For more about the first symposium in Portland click here.
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It's about time someone pointed out what should be obvious - medications treat the manifestations, but they don't cure mental or emotional difficulties. While they may help a person feel better temporarily, they don't really solve the problem underlying the symptoms, and as Whitaker relates in the book, can also make a person biologically MORE vulnerable to relapse. We need to look at the wide range of causes and possible interventions, including nutrition, exercise, support groups, various interactive therapies, community "cafes," spiritual counseling and spiritual practices, alternative medicine, employment programs, peer support, and natural community supports. We also need to start to recognize that a certain amount of emotional distress and upset is a NORMAL REACTION to stressful situations, and start to validate people for their strengths and capabilities in the face of difficulties, rather than labeling their particular style of coping as a "mental illness." Diversity is the key to species survival, as any population biologist will tell you. We need to start embracing people for who they are, biologically and spiritually, and start crafting interventions that value people instead of reducing their complex response to their experience as an "illness" any time it becomes inconvenient or uncomfortable for us "normal" people. Let's help folks find their own path to happiness and enlightenment and stop trying to force everyone into the same box. Medications may be workable for some people - by all means, let them use this approach if that's what works! But why not offer the whole range of alternatives and let people find what works for them? Perhaps that's too complex. Or maybe it's just too damned simple to make a lot of money with... ---- Steve

Adverse drug reactions to psychiatric and other drugs are caused by genetically determined diminished metabolism Cytochrome P450 family, polypharmacy and co-prescribing of CYP450 inhibitors. I have tested well over 100. This debate needs to go into the desirability of educating doctors in recognising side effects, learning genetic pharmacology and understanding drug-drug and drug-gene interactions. And then forcing drug companies, who knew this all along, to their knees for their fraudulent promotion of "a pill for every ill". A gene test for CYP 450, 25 alleles, by buccal swab costs $200 in Australia. One third of the cost of a day in hospital. Then slow safe supervised withdrawal is necessary, and pills cam be compounded to do that reducing slowly weekly over many months,

We must do better. The practice of putting emotionally upset people in ER rooms with equipment they can damage or use to harm themselves is the height of irrationality. Then one or two police standing by the door? Where is the maladjustment in this picture? Could we arrange anything more fraught with risk and cost? The government has under-used buildings that are heated and do not contain this equipment. Veterans have offered to fund use of the Coliseum, and many emotionally upset people are veterans. As a social worker, I found people want work and connection. We need to find respite places for people, that are not medicalized, that have sorting, reading, and writing, working out, and other activities to help people work through their sadness and other challenges. People dealt with loss and pain before these medications. Yoga, and other practices have thousands of years of testing. We have enormous interest in healing here. We have an opportunity to put into practice the best practices from all over the world. It is time to take this on, with the charitable and friendly spirit Portland people are noted for.