Abstract: The growth of the peer workforce in behavioral health services is bringing opportunities to organizations and institutions that serve people living with mental and substance use disorders and their families....For the article, click here.
Cognitive Behavioral Therapy Los Angeles is a psychotherapy group comprised of psychologists specializing in cognitive behavioral therapy (CBT) for depression, anxiety, and a numerous other psychological concerns. All of our therapists are experts in the field, some of whom are or have been psychology faculty at top universities. We specialize in evidence-based treatments, those whose effectiveness has been proven by the most current scientific research. Our expert psychologists and clinically-proven methods make us the premier treatment center in Southern California. At Cognitive Behavioral Therapy Los Angeles, we are proud to serve West Los Angeles, Beverly Hills, and Santa Monica.
This letter, by Susan Rogers, Director, National Mental Health Consumers' Self-Help Clearinghouse, was published in JAMA in response to an article by Dominic Sisti, Ph.D., et al., about bringing back asylums. For the letter, which begins at the bottom of the first page of the PDF and continues on the second page, click here.
Testimony of Joseph A. Rogers. President for Policy and Advocacy, Mental Health Association of Southeastern Pennsylvania
Senate Public Health and Welfare Committee, Public Hearings for Senate Bill 226 Hearing Room 1, North Office Building. State Capitol, Harrisburg, PA, October 2, 2007
My name is Joseph Rogers, and I am the President for Policy and Advocacy of the Mental Health Association of Southeastern Pennsylvania. Thank you for the opportunity to speak to you today.
I urge you to reject S.B. 226, which would amend the Mental Health Procedures Act to provide for involuntary outpatient commitment, also called “assisted outpatient treatment.”
I believe that the bill has grown out of a sincere desire to help people with mental illnesses. Unfortunately, if it became law, it would have exactly the opposite effect. It would allow the state to force treatment (usually involving medication) on people living in the community, under threat of involuntary hospitalization if they don’t comply. This is a very bad idea.
I have been involuntarily committed and force-medicated, and I can tell you from personal experience that coercive treatment methods simply do not work — and they represent a poor substitute for building comprehensive, community-based mental health and social support services. In fact, force and coercion have been proven to drive people away from treatment, and such methods are ineffective and expensive. Particularly horrible is the use of physical force, coercion, or intimidation in the administration of psychotropic medications. Yet mandatory outpatient treatment statutes seem to invite such violations.
There is an alternative to force and coercion. By fostering trusting and stable relationships while emphasizing choice in clinical decisions, it is possible to achieve extraordinarily high rates of adherence to treatment plans. For example, the success of the Mental Health Association of Southeastern Pennsylvania’s peer-to-peer services is dependent upon a combination of innovative thinking and the exercise of free will – not coercion.
It is vital to note that outpatient commitment statutes are not widely viewed as helpful in the public mental health system. Although many states have such a statute, most states use it only rarely, according to a survey of state mental health commissioners by the National Association of State Mental Health Program Directors. There is a good reason for this. Many states, in fact, choose not to implement their outpatient commitment statutes because they possess a woefully inadequate system of community-based services.
In addition, the cost of enforcing involuntary outpatient commitment diverts resources away from those mental health consumers already receiving care. The harsh reality is that improving care for people who have mental illnesses costs money; and no legislative mandate will get the job done without expanded resources. If you do enact S.B. 226, then you will also need to increase the mental health services appropriation by a huge percentage.
An alternative to involuntary outpatient commitment is a statute already on the books in Pennsylvania, giving psychiatric advance directives the weight of law; and we applaud the General Assembly for having passed this legislation in 2005. Psychiatric advance directives are written documents in which an individual expresses his treatment preferences so that, if he later is not in his sound mind, his preferences can be adhered to. The individual can also identify someone to act as a health care agent who can make sure his wishes are respected. The use of such documents should be promoted through establishing avenues to help people create them, rather than just providing people with information about them. A study published in 2006 in the American Journal of Psychiatry found that 61 percent of participants in a facilitated advance directive session completed such a document or authorized a proxy decision maker, compared with only 3 percent of people in a control group, who only received written information about advance directives.
The most compelling argument against S.B. 226 is that outpatient commitment is not effective. A controlled trial study at Bellevue Hospital in New York City found that what helped clients was intensive services; whether they received the services voluntarily or under court order was not significant.
According to the Bazelon Center for Mental Health Law, other studies that have been cited as evidence that outpatient commitment leads to better outcomes have serious methodological flaws, and their results have been misunderstood and misrepresented. A Rand research team’s review of the experience of eight states with involuntary outpatient commitment statutes – Michigan, New York, North Carolina, Ohio, Oregon, Texas, Washington and Wisconsin – found “significant problems” in all eight. The Rand researchers found that the mental health systems in states with such laws were inadequate to the task of implementing court-mandated treatment. As a result, the laws often fell into disuse. In addition, the Rand report stated, “There is no evidence that a court order is necessary to achieve compliance and good outcomes, or that a court order, in and of itself, has any independent effect on outcomes.”
The Rand researchers also conducted a literature review of research on the effectiveness of new models of public mental health care that provided clients with autonomy and choice. “In contrast,” the researchers noted, “the literature provides clear evidence that alternative community-based health treatment programs can produce good outcomes for people with severe mental illness.”
Another serious problem with S.B. 226 is that the criteria that are used to determine when someone can be committed on an outpatient basis are often much less stringent, and far less objective, than the inpatient commitment criteria (which involve deciding whether someone is a danger to self or others). This means that individuals are at risk of losing their fundamental human rights often due only to the fact that they have a mental illness and have not been offered effective treatment. Their supposed “lack of insight” may boil down simply to disagreement with the treating professional. In fact, the only standard for commitment that has been found constitutional by the Supreme Court is “imminent, significant physical harm to self or others.”
The mental health consumer advocacy community and citizen advocacy organizations are united in their opposition to outpatient commitment, which only results in more coercion and in the draining of vital resources that could be much better spent on enhanced community-based services and supports, such as employment, housing and case management programs.
Pennsylvania has a stated commitment to moving toward a recovery-oriented mental health system. S.B. 226 is completely inconsistent with this commitment.
Thank you for allowing me to speak here today and I am happy to answer any questions you may have.
Joseph A. Rogers, President for Policy and Advocacy, Mental Health Association of Southeastern Pennsylvania, 1211 Chestnut Street, Suite 1100, Philadelphia, PA 19107, 215-751-1800, ext. 273, Fax: 215-636-6312
In 1987, Prof. Mary Durham testified before the Pennsylvania Legislature about a five-year study in Washington state after Washington broadened its commitment laws in 1979. The result was a disaster. Click here for the testimony.
"Disaster Community Support Network of Philadelphia, a Program of the Mental Health Association of Southeastern Pennsylvania" was developed by Mark S. Salzer, Ph.D., now executive director of the Temple University Collaborative on Community Inclusion. The Disaster Community Support Network of Philadelphia (DCSN) was established by the Mental Health Association of Southeastern Pennsylvania (MHASP) to create settings in which self-help and mutual aid can occur in response to a traumatic community-wide event. The mission of the DCSN is to establish the groundwork for community meetings to take place in the event of national, state, or local events that impact, either directly or indirectly, Philadelphians and their communities. However, the lessons of the DCSN are broadly applicable to communities around the country. To download the free manual, click on Enclosure, below.
This manual was developed by Mark S. Salzer, Ph.D., now director of the Temple University Collaborative on Community Inclusion. "The Disaster community Support Network of Philadephia (DCSN) has been established by the Mental Health Association of Southeastern Pennsylvania (MHASP) to create settings in which self-help and mutual aid can occur in response to a traumatic community-wide event. The mission of the DCSN is to establish the groundwork for community meetings to take place in the event of national, state, or local events that impact, either directly or indirectly, Philadelphians and their communities. However, the lessons are broadly applicable to other communities.
On September 2, 2015, Doris Schwartz saw a Kenneth Cole billboard on the Henry Hudson Parkway in NYC that promoted prejudice and discrimination by perpetuating the false link between gun violence and mental health conditions. She quickly went into action! This is the story of how the advocacy community rose to the occasion and brought down the billboard! Click here.
The STAR (Support, Technical Assistance and Resources) Center presented this webinar on Tuesday, March 24, 2015 at 2 – 3:30 p.m. ET.
A recording is availalbe below.
Presenters: Shirley Montoya, Project Manager and Anthony Lee, Traditional and Culture Instructor, Healing Circles Wellness Center in Shiprock, New Mexico; Rudy Soto, Policy Analyst, National Council of Urban Indian Health.
Understanding and embracing indigenous healing approaches is an important way to move forward in addressing healthcare inequalities, especially in Native communities. In this STAR Center webinar, our presenters shared examples of self-care and healing approaches that are used in urban, rural and frontier communities, described the history, foundations, values and standards inherent in these approaches as well as offered recommendations for how these approaches may be better engaged by Native people in states, territories and tribal governments across the country.
We hope you are engaged, educated and empowered by this provocative and inspiring webinar presentation on approaches to eliminating the health and mental health disparities in our communities.
Consumers United for Evidence-based Healthcare (CUE) is a national coalition of health and consumer advocacy organizations committed to empowering consumers to make the best use of evidence-based healthcare (EBHC). CUE, organized in 2003 when the USCC invited advocacy groups to join a consumer advocate-scientist partnership, is a pioneering effort to improve consumers' ability to engage in and demand high quality healthcare.
Updated report of programs to train and certify peer specialists across the country. Compiled by the Texas Institute for Excellence in Mental Health.
Kaufman, L., Brooks, W., Bellinger, J., Steinley-Bumgarner, M., & Stevens-Manser, S. 2014.
View the document on the Web - http://sites.utexas.edu/mental-health-institute/files/2014/07/Peer-Specialist-Training-and-Certification-Programs-A-National-Overview-2014-Update.pdf - or download it below.