The National Mental Health Consumers’ Self-Help Clearinghouse is now affiliated with the Temple University Collaborative on Community Inclusion!
Study Finds Psychiatric Diagnosis to Be “Scientifically Meaningless”
“A new study, published in Psychiatry Research, has concluded that psychiatric diagnoses are scientifically worthless as tools to identify discrete mental health disorders,” Neuroscience News reports. “The main findings of the research were: Psychiatric diagnoses all use different decision-making rules; there is a huge amount of overlap in symptoms between diagnoses; almost all diagnoses mask the role of trauma and adverse events; [and] diagnoses tell us little about the individual patient and what treatment they need.”…‘Although diagnostic labels create the illusion of an explanation, they are scientifically meaningless and can create stigma and prejudice,’” lead researcher Dr. Kate Allsopp, University of Liverpool, said. “‘I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.’” For the article, click here. The study was covered in a variety of other publications, including Science Alert (click here).
Free Webinar Series Continues on July 30 with “…Key Elements in Progressive Peer Workforce Practice”
The third in a series of free one-hour webinars on “Peer Workforce and Mental Health System Change: Promise and Practice” will be offered at 11 a.m. ET on July 30 via The Central East Mental Health Technology Transfer Center. The webinars were developed by Jessica Wolf, PhD, Senior Advisor, Yale Group on Workforce Development. The third and final topic is “Chop Wood and Carry Water: Key Elements in Progressive Peer Workforce Practice.” To register for the July 30 webinar, click here to register on the website of The Central East Mental Health Technology Transfer Center, which is recording and archiving all three webinars.
Social Determinants Are the Best Way to Address Mental Health, Says UN’s Top Health Envoy
“Austerity, inequality and job insecurity are bad for mental health, and governments should counteract them if they want to face up to the rising prevalence of mental illness,” as The Guardian paraphrases a statement by the UN’s top health envoy in connection with his recently issued report to the UN. “Dr. Dainius Pūras said measures to address inequality and discrimination would be far more effective in combatting mental illness than the emphasis over the past 30 years on medication and therapy. ‘This would be the best “vaccine” against mental illness and would be much better than the excessive use of psychotropic medication, which is happening,’ said Pūras.” For the Guardian article, click here. For the UN report, click here.
Free Webinar on “Discharge and Step-Down in Coordinated Specialty Care (CSC) for Persons with a First Episode of Psychosis (Part I)” on August 1
“As Coordinated Specialty Care (CSC) services for persons with First Episode Psychosis have expanded and matured, awareness of the challenges surrounding discharge planning and interest in step-down programming have grown substantially.” Thus begins the description of a free, 90-minute, SAMHSA-sponsored webinar on “Discharge and Step-Down in Coordinated Specialty Care (CSC) for Persons with a First Episode of Psychosis,” on August 1, 2019, at 2 p.m. ET. The expert presenters—Nev Jones, Ashok Malla, Irene Hurford, and Jill Dunstan—will address these issues from a variety of standpoints. For details and to register, click here.
“Virtual Summit on Homelessness, Serious Mental Illness, and Substance Use Disorders” on August 7-8
On August 7-8, 2019, from 10:30 a.m. ET to 5:30 p.m. ET, SAMHSA will host a “Virtual Summit on Homelessness, Serious Mental Illness, and Substance Use Disorders.” SAMHSA’s Homeless and Housing Resource Network invites you to join “The Way Home, a 2-day online conversation about the most effective approaches to ending homelessness for individuals with serious mental illness and/or substance use disorders. This virtual summit will feature more than two dozen national experts, providers, and policy makers who are making real progress toward ending homelessness across the nation…No travel required...Join us for the whole summit or drop in to only those sessions that most appeal to you.” For more information and to register—SAMHSA says that space is limited—click here.
Courtesy of Jacek Haciak
CMS to Host a Free Webinar on Demonstrating the Impact of Supportive Housing
CMS’s Medicaid Innovation Accelerator Program is hosting a free, 90-minute national learning webinar on August 7, 2019, at 2 p.m. ET, on “Demonstrating the Impact of Supportive Housing.” “During this webinar,” CMS writes, “a framework and measures to demonstrate the impact of supportive housing will be presented. The webinar includes a discussion on the benefits of undertaking this type of work, as well as specific measures used across the country to assess the impact that providing supportive housing can have on health care utilization costs, homelessness, criminal justice, and other systems…” For more information and to register, click here.
Courtesy of Jacek Haciak
Mad In America Publishes “Twenty Years After Kendra’s Law: The Case Against AOT”
In a recent 11,000+-word Mad In America article—Part 1 of 2—award-winning journalist Robert Whitaker and freelance mental health care reporter Michael Simonson meticulously examine the rationale behind Assisted Outpatient Treatment (AOT)—also known as involuntary outpatient commitment—and debunk the myths that support its use. The article highlights the story of Andrew Rich, a young man who died by suicide after being subjected to a seemingly unending AOT order. The order had been supported by his mother, Elizabeth, a longtime civil and criminal defense attorney. “Looking back on it,” [she] said, in an interview with MIA, “I made so many mistakes in how much faith I had in the mental health system to help my son.” For the article and a link to Part 2, click here.
American Journal of Public Health Devotes Its June 2019 Issue to Mental Health
The June 2019 edition of the American Journal of Public Health (AJPH) is all about mental health. The open-access issue includes a variety of editorials and articles grouped under the headings AJPH Perspectives, AJPH Policy, and AJPH Research, and further divided into such topics as a Call to Action, Depression, Technology, Genetics, Gun Violence, Psychosis, Substance Use, and others. For the issue, click here.
Courtesy of Nev Jones
2018 Peer Respite Essential Features Survey Reports Are Now Available!
Live & Learn, Inc., “a social enterprise specializing in partnerships between community members/service users and behavioral health researchers in public and academic settings,” recently issued reports from its 2018 Peer Respite Essential Features (PREF) Survey, examining aspects of peer respite operations, funding, staffing, and guest experience. “This year, the survey results were broken down into two separate reports: Program Operations, e.g., budgets and staff training; and Guest Stays, such as policies about housing status.” For highlights from the survey, click here. For the reports, click here.
“Storytelling Beyond the Psychiatric Gaze” Is Explored in a New Paper, in a Special Edition of the Canadian Journal of Disability Studies
A paper recently published in the Canadian Journal of Disability Studies—“Storytelling Beyond the Psychiatric Gaze: Resisting Resilience and Recovery Narratives”—“explores the politics of resilience and recovery narratives by bringing critical ethnography and auto-ethnographic methods to bear on [the author’s] experiences with storytelling distress in different contexts. Inviting people with lived experience to share their stories is now common practice in education, mental health, and broader community venues. Yet…it is difficult to hear such stories beyond the psychiatric gaze...” For the abstract and a link to the paper, which is available for free download, click here. For the entire special edition of the Canadian Journal of Disability Studies” (Vol. 8, No. 4, 2019), which includes 18 original works that “expose, resist, and rupture unexamined relations to difference and adversity,” click here.
Courtesy of Nev Jones
Call for Submissions: ISEPP Annual Awards
“Each year ISEPP [International Society for Ethical Psychiatry & Psychology] recognizes three people who have made significant contributions to the critical psychology/psychiatry movement. These awards will be presented at our conference in Baltimore, October 11-13, 2019. Please send submissions to firstname.lastname@example.org. Deadline is September 1st. You can nominate a candidate in each category.” For details, click here.
“Friendship Benches” Help New Yorkers in Need of Peer Support
“On the streets of New York, the city supports a program, first used in Zimbabwe, of having peers offer an ear to people who are suffering but are not in a position to seek professional therapy.” So begins a New York Times article about “Friendship Benches,” a project of ThriveNYC, founded by Chirlane McCray, New York City’s First Lady. The program involves peer supporters who sit on the benches and talk to people about their problems. “Their most important credential is something you can’t teach—they’ve been there,” the Times notes. “A study published in the Journal of the American Medical Association found that Friendship Bench treatment effectively cured depression. It’s one of many studies showing that even lay people with little education can quickly learn to treat depression and anxiety.” For the New York Times article, click here. For a related story, “For Mental Health Support, NC Hospital Hires Those Who Live with It,” click here.
“Mental Health for US” Is Launched in Time for 2020 Presidential Election Season
Eight national mental health and addiction organizations have launched Mental Health for US, a nonpartisan initiative which, according to the press release, is “intended to elevate mental health and addiction in policy conversations during the upcoming election season.” The eight founding coalition leaders are the Kennedy Forum, the American Foundation for Suicide Prevention, the Jed Foundation, the National Alliance on Mental Illness, the National Council for Behavioral Health, Mental Health America, One Mind, and the Thomas Scattergood Behavioral Health Foundation. Additional coalition members include 18 behavioral health organizations, among which are at least one peer-run organization, Active Minds. The three main focus areas of Mental Health for US are prevention, access and intervention, and recovery. For the press release, click here. (Editor’s note: This effort is reminiscent of a project initiated by Illinois-based mental health advocate AJ French in 2016, which was reported in the January 2016 edition of the Key Update. “I was listening to the news when one of the Presidential candidates said something that really disappointed me,” French wrote, adding, “…it caused me to wonder about the mental health policy positions of our next President and prompted me to write each candidate the following questions.” For the questions, click here.)
Courtesy of Amy Smith
Latest TU Collaborative Newsletter Highlights Its Bike Sharing Pilot Project
The new edition of the Temple University Collaborative on Community Inclusion says: “Get on a bike and get to riding!” The newsletter includes feedback from participants in the bike share pilot project, along with a manual about the project, and more! For the newsletter, click here.
“Guidelines for the Successful Transition of People with Behavioral Health Disorders from Jail and Prison”
Policy Research Associates (PRA) has recently released a newly revised publication offering “10 guidelines to promote the necessary partnerships between behavioral health and criminal justice professionals to ensure an individual’s successful transition from jail or prison to the community.” Recommendations include universal screening, individualized treatment plans, continuity of care, and data sharing across agencies. To download the free 38-page “Guidelines for the Successful Transition of People with Behavioral Health Disorders from Jail and Prison,” click here. (For the monthly digest of articles about the criminal justice system, in which many individuals with mental health conditions are incarcerated, see below.)
Part 3 of SAMHSA’s GAINS Center’s “Advancing Early Diversion Summer Series” to Be Held August 19
“Many early diversion programs experience challenges around engaging individuals in services following the warm hand-off to mental health professionals,” SAMHSA’s GAINS Center writes. “Early diversion programs have employed follow-up engagement strategies led by a variety of professionals, including law enforcement officers, emergency medical services, mental health professionals, and peer support specialists. This webinar will examine follow-up strategies implemented in several jurisdictions to improve treatment engagement.” To register for the free one-hour webinar, August 19 at 1 p.m. ET, click here. The webinar will be immediately followed by a one-hour discussion with the presenters. To register for the discussion group, click here.
2019 Annual NYAPRS Conference, Sept. 24-26, Announces Keynotes and Schedule
The New York Association of Psychiatric Rehabilitation Services (NYAPRS) recently announced the keynotes and topics of its 37th annual conference, which will be held in Callicoon, NY, September 24-26. Among the keynote presentations is a panel featuring Lindsey Sizemore of the Georgia Mental Health Consumer Network; Sarah Felman of the Mental Health Empowerment Project, in New York; and Vesper Moore of the Central Massachusetts Recovery Learning Community. In addition, Luis Lopez, of the Center for Practice Innovations in New York, will make a presentation on “Healing Trauma.” The theme of this year’s conference, which annually attracts presenters and attendees from around the U.S., is “Integrate, Innovate, Advocate, Celebrate: Keeping Our Eyes on the Prize! To register, click here.
Four Free “Tips for Providers” Fact Sheets Are Available from PRA
Policy Research Associates (PRA) Well-Being recently published four new Tips for Providers fact sheets. PRA writes: “The fact sheets highlight how providers can support individuals with mental health conditions to enhance their well-being in each of the eight dimensions of wellness. The newly released fact sheets focus on four dimensions of wellness: intellectual, occupational, physical, and social…” These new, free resources—each including numerous links to other resources—are now available for download. For “Intellectual Wellness,” click here. For “Occupational Wellness,” click here. For “Physical Wellness,” click here. For “Social Wellness,” click here.
A Marshall Project Article Makes a Case for Psychiatric Hospital Beds; but Sometimes “Not Guilty” Is a Life Sentence
Under the headline of a recent Marshall Project article—“Mentally Ill and Languishing in Jail”—was a provocative subhead: “A Pennsylvania case illustrates a national problem: People with psychiatric illnesses often remain incarcerated while they wait for a hospital bed.” The “nut graf”—editorial slang for a paragraph that tells readers why the story matters—reads: “But Pennsylvania is one of many states that [have] far too few hospital beds for the mentally ill defendants who need them, leaving people…to languish in jail while they wait for a spot…a nationwide problem that experts say may be linked to the downsizing of psychiatric hospitals and inadequate mental-health resources.” The article highlighted the painful story of a 34-year-old woman who had been studying for the Law School Admission Test before ending up cycling between jail and a state hospital, despite her mother’s determined efforts to help her. But a 2017 New York Times Magazine article—“When ‘Not Guilty’ Is a Life Sentence”—asks, “What happens after a defendant is found not guilty by reason of insanity? Often the answer is involuntary confinement in a state psychiatric hospital—with no end in sight.” For the Marshall Project article, click here. For the New York Times article, click here. For “I am insane,” by Reid Bertino, who is locked up in Western State Hospital in Washington for what he fears may be the rest of his life, click here. (For the monthly digest of articles about the criminal justice system, in which many individuals with mental health conditions are incarcerated, see below.)
The Rwandan Prescription for Depression: Sun, Drum, Dance, Community
“We had a lot of trouble with western mental health workers who came here immediately after the genocide and we had to ask some of them to leave,” said a Rwandan talking to a western writer, Andrew Solomon, about his experience with western mental health and depression. “They came and their practice did not involve being outside in the sun where you begin to feel better; there was no music or drumming to get your blood flowing again; there was no sense that everyone had taken the day off so that the entire community could come together to try to lift you up and bring you back to joy; there was no acknowledgement of the depression as something invasive and external that could actually be cast out again. Instead, they would take people one at a time into these dingy little rooms and have them sit around for an hour or so and talk about bad things that had happened to them. We had to ask them to leave.” To read this statement online, click here.
The July 2019 Digest of Articles about the Criminal Justice System, in Which Many Individuals with Mental Health Conditions Are Incarcerated (and the Key Update continues after this Digest)
Here is the July wrap-up of stories about the criminal justice system. (Note: Some of the titles and other language are not politically correct but are reproduced as written.) For “A judge is accused of dismissing mental illness. These lawyers want him off their cases,” click here. For “Changes to Help Those Lost in the System Because of Mental Illness,” click here. For “Judge to Fulton: Fix repulsive jail conditions for mentally ill women,” click here. For “Atlanta nonprofit to spearhead criminal justice push,” click here. For “Taking Stock of Pell Grants Behind Bars,” click here. For “A Second Chance After 27 Years in Prison: How Criminal Justice Helped an Ex-Inmate Graduate,” click here. For “Rikers Island Dilemma: Stop Taking Addiction Meds, or Stay Behind Bars,” click here. For “Philadelphia D.A. Larry Krasner Argues PA Death Penalty Is Unconstitutional,” click here. For “Prison does almost nothing to stop violent crime—study,” click here. For “States Passed Record 94 ‘Restoration’ Laws So Far This Year,” click here. For “Jail Deaths and the Elected Sheriff,” click here. For “The Badge: Spotlight on Sheriffs—Part 2: The Opioid Crisis,” click here. For “Humanities classes can rewrite life script of incarcerated Georgians,” click here. For “ ‘You don’t know what you did for me’: Released from prison by Obama, now on the Dean’s List,” click here. For “Does Reform Matter? The Hopelessness of a Life Sentence,” click here. For “Bryan Stevenson on His ‘Not Entirely Rational’ Quest for Justice,” click here. For “Digital Jail: How Electronic Monitoring Drives Defendants into Debt,” click here. For “Inmates Freed as Justice Department Tries to Clear Hurdles of New Law,” click here. For “Would You Let the Man Who Killed Your Sister Out of Prison? In Ohio, a project called ‘Beyond Guilt’ aims to press prosecutors, judges and victims of crime to more quickly embrace the possibility of early release for prisoners who admit their culpability but whose prison careers are marked by redemption and rehabilitation,” click here. For “The stink, the mice, the yelling. My time in solitary was the ‘most savage moment of my life,’ Rutgers grad recalls,” click here. For “ ‘Confirmation Bias’ Called a Key Reason for Wrongful Convictions,” click here.
FROM PREVIOUS EDITIONS OF THE KEY UPDATE BUT STILL FRESH!
The Five Federally Funded National TA Centers Collaborate on a Free Webinar Series
The next two webinars hosted by the Peer-Run Organization Learning Collaborative will be on August 21 and September 26, at 2 p.m. ET. The Peer-Run Organization Learning Collaborative is a joint effort of the five federally funded National Consumer/Consumer Supporter Technical Assistance Centers: the CAFÉ TA Center, Doors to Wellbeing, the NAMI STAR Center, the National Empowerment Center, and Peerlink. The centers take turns presenting the webinars. To register, click here. To respond to a brief survey “to learn about the needs and priorities of peer-run organizations,” click here.
If You Have Experienced Psychosis, “Psychosis Beyond the Box” Wants to Hear From You.
“Psychosis Beyond the Box” seeks to gather anonymous descriptions of “aspects of psychosis that are often neglected, such as felt presences, visual or quasi-visual experiences, and alterations of space, time or distance,” as well as strategies to help with any distressing or challenging aspects of the experiences. The narratives will be compiled and shared in early psychosis programs and other service settings across the U.S. A major aim of the project—which is not a research project—is “to validate the diverse range of things people with psychosis experience, and help people, especially young adults experiencing psychosis for the first time, feel less alone and isolated (in these experiences).” For more information about the project, based at the University of South Florida, or to share your story, click here. Questions? Write to Nev Jones (email@example.com) or ShannonPagdon@gmail.com.
“Experiences with Hospitalization” Survey Seeks Participants
“The purpose of this survey is to help us understand people's lived experience with voluntary and involuntary treatment because of suicidal thoughts. It was created by people with lived experience…We are planning to use this information to facilitate discussions with suicidologists and the suicide prevention community about the impact of the use of these interventions, particularly within marginalized populations. We feel the voice of people with lived experience with these interventions has not had adequate opportunity to be heard, and hope that by completing this survey anonymously, people who have been most impacted can find a safe way to share their experiences. Please note that this is not a research project.” For more information and/or to participate, click here.
Thanks, Leah Harris
Researchers at Trinity College Dublin Seek Participants for Depression Study
Trinity College Dublin researchers write: “We are a team of psychologists at Trinity College Dublin who are trying to better understand depression. We are interested in using language to predict the occurrence of depression early. Our hope is that in doing so we can one day be able to help doctors provide treatments earlier and maybe even prevent depression altogether. In order to participate, you must be at least 18 years old, have had a Twitter account for at least one year, [and] have at least 500 Tweets. Interested in participating? Learn more by clicking. If not, thanks for taking the time to read about our research.” For the “continue” link to more information, click here.
Mental Health First Aid Australia Seeks Research Participants to Update MHFA Guidelines
Mental Health First Aid Australia is inviting people from Australia, UK, Canada, Denmark, Finland, Ireland, the Netherlands, France, Switzerland, New Zealand, Sweden, and the USA who have expertise in the field of psychosis to participate in research whose goal is to update the Mental Health First Aid guidelines for psychosis, which were last updated in 2008. Invited participants include people with lived experience of psychosis, people who have cared for or provided significant support to someone with psychosis, and professionals with research, education, or clinical experience related to psychosis. For more information, click here.
International Survey on Antipsychotic Medication Withdrawal Seeks Respondents
“Have you taken antipsychotic medication (such as Zyprexa, Seroquel, Abilify, Risperdal, Haldol, Geodon, Stelazine, and others), for any condition or diagnosis, with or without other medications? And did you ever stop taking antipsychotics, or try to stop taking them? Are you 18 years or older? If yes, you can take this survey about antipsychotic withdrawal and attempts to withdraw, including if you stopped taking them completely or if you tried to come off and still take them. The survey aims to improve mental health services by better understanding medication withdrawal. Lead researcher is Will Hall, a therapist and Ph.D. student who has himself taken antipsychotics. Service users/survivors/consumers from around the world also gave input. The study is sponsored by Maastricht University in the Netherlands; co-sponsors include the International Institute for Psychiatric Drug Withdrawal. Questions? Please contact firstname.lastname@example.org.” For more information or to take the survey, click on www.antipsychoticwithdrawalsurvey.com
What Is a Peer Support Specialist? Your Opinion Is Wanted
“On behalf of iNAPS, a national workgroup has developed a proposed definition for peer support specialist to submit for federal standard occupational classification through the U.S. Department of Labor,” iNAPS writes. “We are asking you to complete this short survey regarding the proposed definition...The proposed title, Peer Support Specialist, does not prevent the use of other job titles, such as Recovery Coach, Peer Bridger, Peer Navigator, etc.” To complete the survey, click here.
New Virtual Group Is Launched to Advance Peer Research Capacity, Leadership, and Involvement
Nev Jones, Ph.D., and Emily Cutler, a doctoral candidate, have launched a new listserv dedicated to building research capacity, leadership, and involvement among peers, survivors, and service users. Dr. Jones, assistant professor, Department of Mental Health Law & Policy, University of South Florida, was part of the team that developed “User/Survivor Leadership & Capacity Building in Research: White Paper on Promoting Engagement Practices in Peer Evaluation/Research (PEPPER),” published by the Lived Experience Research Network. For the white paper, click here. Anyone interested in joining the virtual group can email Nev at email@example.com.
Do You Supervise Peer Support Workers? Then Researchers Have Some Questions for You
Researchers in the University of South Florida’s Department of Psychiatry and at Magellan Health are investigating the backgrounds, training, and experiences of individuals who currently supervise at least one peer support worker in a behavioral health setting or agency. “To the best of our knowledge, this will be the first comprehensive research study of the landscape of peer support supervision practices in the United States,” writes Dr. Nev Jones, the primary investigator of the study (Protocol Number 00040223). Participants must be at least 18 years old and work in the United States or U.S. territories. An online survey lasting approximately 10 minutes will ask about respondents’ backgrounds, training and preparation for supervision, perspectives and practices, and views on barriers and facilitators to high-quality supervision. There is no monetary compensation. Questions? Contact Dr. Nev Jones (firstname.lastname@example.org) or the co-primary investigator, Dana Foglesong (email@example.com). To access the survey, click here.
Save the Date! NARMH Conference in Santa Fe, NM, August 26-29, 2019
The 2019 National Association for Rural Mental Health (NARMH) annual conference will be held in Santa Fe, N.M., August 26-29, 2019. The conference will focus on “Surviving to Thriving, Workforce Issues, Innovations in Service Delivery, Dilemmas in Addressing Trauma, Rural and Frontier Workforce Development Strategies, Embracing the Reality of Behavioral Health in Rural Communities—Struggles, Responses and Successes, Co-Occurring Substance Use Disorders and Other Topics.” For more information and/or to register, click here.
Save the Date! NARPA Annual Rights Conference September 18-21 in Hartford, Connecticut
“For more than 30 years, NARPA [National Association for Rights Protection & Advocacy] has provided an educational conference with inspiring keynoters and outstanding workshops. We learn from each other and come together as a community committed to social justice for people with psychiatric labels & developmental disabilities.” For more information, click here.
What Happens to People after Discharge from First Episode Psychosis/Early Intervention Programs? New Study Seeks Answers—and Participants
A study led by Dr. Nev Jones at the University of South Florida seeks current and former clients as well as family members of clients previously enrolled in early intervention in psychosis (EIP)/coordinated specialty care (CSC) services. The study aims to better understand what happens after discharge from EIP/CSC programs, including in the areas of school or work and access to/use of other mental health services. Eligible participants must be at least 18 years old and must be “current clients within one month of discharge from an EIP/CSC program, former clients discharged at least six months (at the time of the scheduled interview), and the family members of former clients.” In exchange for a phone interview of approximately 1.5 hours, each participant in the study (Protocol Number 00035193) will receive a $75 money order. Questions? Contact Dr. Jones at 813.415.5532 or by email at firstname.lastname@example.org.
Disclaimer: The Clearinghouse does not necessarily endorse the opinions and opportunities included in the Key Update.
About The Key Update
The National Mental Health Consumers’ Self-Help Clearinghouse is now affiliated with the Temple University Collaborative on Community Inclusion!
The Key Update is the free monthly e-newsletter of the National Mental Health Consumers’ Self-Help Clearinghouse. Volume 16, No. 1, July 2019. For content, reproduction or publication information, please contact Susan Rogers at email@example.com. Follow Susan on Twitter at @SusanRogersMH