Good and Bad mental health programs

Thanks for this important post and sharing your guidance!! This line of conversation and discussion is critical. Somewhere between evidence based medicine (EBM), evidence based public/social policy, and "good people with good intentions and lots of experience trying something based on theory" (my words), there HAS to be a new science that helps guide us with understudied but urgent issues like this.  Help! I'm hoping others will chime in. Someone must have a (evidence based, studied??) framework for things like programs for elementary schools (Mind Up???), workplaces, positive parenting, etc. 

What works depends on what you are trying to accomplish and for whom, and what they want to accomplish.

Corinna:

THANK YOU!!! There is so much information here. I'm going to share some of this over at Parenting with ACEs, especially since this is really good stuff for parents to know about. If we can be more informed as parents (and in general), so that kids don't get diagnosed or treated in ways that hurt rather than heal., there will be less re-education to do later. I still like I'm still learning so much.

Thank you for posting so many links and resources. 

Cissy

Hmmm. I respectfully disagree that the Mental Health First Aid course facilitated by NAMI is damaging. I have read your links and come away with confusion as to why you feel that  educating the general public on: "  Learn basic first aid skills needed to help a person who is experiencing a mental health problem or crisis. Learn about common mental illnesses and co-occurring disorders. Understanding and recognizing the signs that someone needs help, is the first step in getting that person appropriate care and treatment. " is damaging.  In fact, many experts who I respect and admire disagree( and side note, they are not getting payouts from big pharma, which seems to be alluded to often in a few of the links).

Disagreeing with the words mental health or mental illness and the labeling is another issue.  Having worked in government agencies where having a listed diagnosis allows us to fund services for a client, it is something I have tried to embrace rather than fight against.  If I don't call it chemical dependency, it does not make it less so anymore than if I don't call my hypothyroidism by it's given diagnosis.  Having a name or a label for it gives me more options to research and treat it.  Again, just my opinion and how I have wrapped my brain sideways to embrace diagnosis/words/labels.  I, myself, proudly wear many, many labels.

Everyone is entitled to their opinion, of course.  But blasting accredited programs based on our own opinions on a "professional" site such as this, seems wrong somehow.

Just my opinion.

Lori I think this is a hugely important conversation. Thank you for adding your opinion. It would be great to have some sort of framework. Government will have certain priorities or main concerns/beliefs etc; community agencies, schools, etc may have different ones. Bottom line, "evidence based policy" means different things outside of purely technical questions (e.g. clinical medicine or building a bridge I guess) and it is really problematic for "wicked problems" - so what are we going to do about that?/what can and should we do?  I say that with the belief that most of us on here are wanting to find new/better ways forward to help folks and with the hope to be part of a conversation around that.  Thanks again to all for posting.

Thank you. I agree that it is a very important discussion to have.  Our collaboration in MN has struggled with these issues, and honestly, often times our opinion or view are decided by what hat we are wearing.  My ultimate goal is to continue to have the conversation; to have these discussions. In my opinion, there is no "one size fits all" answers in any of this-other than perhaps prevention is key!!  Thank you for sharing your thoughts.

Basically, getting people indoctrinated into the biomedical view of emotional distress greatly hampers their ability to seek social, life situation, resilience, trauma-informed solutions.

Go from problem (trauma) to solution (resilience) without giving people a biochemical fiction to navigate in the middle. Give people fully informed consent before exposing them to psych drugs that work no better than placebo, cause huge withdrawal problems, and reduce people resiliency.  The disease model is dead. The disease model is counter to trauma informed care. The disease model is outdated science. MHFA is heavily dependent on indoctrinating people into the disease model. 

Let's talk some ACEs Science....

How many of you are familiar with Stephen Porges Polyvagal Theory and the Autonomic Nervous System (ANS). Quick Lesson: Sympathetic Nervous System (SNS)= threat response system Para-sympathetic Nervous System (PNS)= rest, relax, restore (resilience).

I agree that creating a distinction between "those people" who have mental illness or addiction does more harm than good. Labeling in and of itself is stigmatizing. We know relationships help heal through creating a decrease in the SNS, the system that gets our muscles tensed up (fight/flight/freeze) and releases the chemicals that make it impossible to store memories in sequence or access the thinking brain. When there is lots of danger (of violence, disconnection including conditional love, unmet needs), the stress becomes Toxic Stress. 

Symptoms of mental illness that are labeled in the DSM 5 (and versions before) make sense for anyone who is experiencing toxic stress. THIS IS THE RE-FRAME AND THE ACES MOVEMENT!!! When we begin to understand behaviors as adaptions to stress, a whole new understanding opens up. Attempting to engage the thinking brain when someone is in their SNS is unreasonable. Trauma-informed care is built on the foundation that the professional is most effective when they can hold hope for recovery and healing as the foundation for interventions. Also, that they recognize their role is not to "fix" a "broken" person but to guide and empower those who have experienced adversity.

We are moving from "behaviors are learned" to "behaviors are adaptions to perceived safety or threat." I act different if I am on my couch watching a scary movie vs if I am watching a comedy. If i am scared- Internally, my heart rate increases, my muscles tense, and adrenaline is released. Externally, I tuck my toes under the blanket and hug my sweetie or the pillow or close my eyes.

These are simple examples that assume no trauma is involved.

Yes, there is an epigenetic piece to this as well. We are not born with a disease as the medical model would suggest, but rather the expression of our genetics is influenced by our environment.  This is great because it empowers communities and parents to be the change and to provide low-stress environments.  

A link to ACES Connection intro on ACEs Science is here: https://acestoohigh.com/aces-101/

Hope this instigates further conversation. I am working on materials that discuss these topics so please provide any questions or if you are interested in learning more, follow me. 

~Andi~

A lot of ACES types aren't willing to challenge the old view of things. They just want to promote this a "new" info. Sometimes people have to point out the old info is wrong.

Here's some debunking:

https://www.madinamerica.com/2...d-false-information/

Andi, Thank you for your illustration and the clarification that encompasses the biological and environmental aspect of toxic stress.  As you work more on this topic, can you touch on and help explain the effects of toxic stress on the fetus during pregnancy? To me that is a dimension that I often don't see discussed, and since we know that the pathways are physically altered as we are exposed to toxic stress, does that same phenomenon happen prior to birth?  So, in essence, are some actually born with "the disease" or whatever we choose to call it?

I very much look forward to following you and your work!

Lori

Hi, Lori: Attached are three research papers about ACEs and maternal/fetal health.

Here's a nice lit review of the problems with identifying with the disease model, Ie, focusing on "what's wrong with you," vs "what happened to you."

A Comment by Matt Stevinson on, madinamerica.com:

Lori,

Here is a link to a resource at the Harvard Center for the Developing Child that might help answer some questions for you. 

http://developingchild.harvard...Term-Development.pdf

Hope this helps!

Andi

ACEs science is all about focusing on "what happened to you" instead of "what's wrong with you". In fact, those words originated with the co-founder of the Sanctuary Model, which has integrated ACEs science into its work.

In reply to the original statement. I to have taken the 8 hour class on Mental Health First Aid. I compare the relevance  of the course to Emergency CPR. Training of the general public to take away the stigma of not knowing what to do in the event of a cardiac arrest. Image in the original curriculum where you would make mouth to mouth contact with a stranger.

Mental Health First Aid will contribute to the removal of the stigma of, what do I do when someone is having a meltdown from issues related to mental health.

I have taken two courses on "Suicide Prevention" and "Suicide Intervention". After completing both courses I thought "They want me to do what?". The courage for intervention will only meet the level of the comfort of the student.

So what I'm tiring to say is, fewer people will turn a blind eye to someone in need of mental health first aid, emotional first aid or what ever buzz phrase you would want to use.

Thanks Peter for your comment (& Corinna for getting dialogue it started.)  I tend to agree w/ Corinna's argument & disagree w/ Peter's bottom line; that "fewer people will turn a blind eye to someone in need of mental health first aid"   Studies indicate that when we dispense w/ the label (and corresponding baggage of diseased brains) - people are more empathetic & compassionate responding to distress, suffering, painful things have happened in others lives (like they do in our own.)  Medicalizing misery & disease-ifying distress don't result in less stigma.  

Wayne, as I am a simple person, I will start with a story. Last year I watched a 2 minute video on dyslexia. I hit all the markers. I discussed this video with my daughter. Her reply was "Dad, we thought you knew". So I now know why I can't remember names. I don't have to shy away from groups of people who's names I should known. 

I believe most people stay away from uncomfortable encounters. Anything that allows the general public the tools to handle these encounters will further the removal of the stigma. After all the stigma comes from public perception.

How might we develop an "Evidence Exchange" similar to the EENet of Ontario Canada, and their validating "PWLE's" (People With Lived Experience), and/or the Financial Influence of the Pharmaceutical Industry ? ? ? If we also consider the contributions of Neuroscience, how do we effectively critique "Evidence" ? ? ?

Does MHFA reduce stigma? 

This depends on how you define stigma. Many disease-model advocates define stigma as "making labels acceptable." Whereas a better definition is, "reducing prejudice and discrimination against people in distress." MHFA obviously chooses the first definition.

Specifically, MHFA used clinical vignettes to measure social distance, which means they gave a person a story about someone obviously in mental health crisis and said, "Would you want to hang out with this person, live next to them, hire them or marry them?" This type of research has a lot of weaknesses, but the biggest one is that really we should measure if someone is willing to hang out with/marry/employ someone NOT in crisis, maybe someone who recovered. (Am J Psychiatry 167:11, November 2010 p.1289)  But more so, the number #1 and #2 sources of stigma are the disease labels and the mental health professionals. So why would re-inforcing a need for mental health labels and a need for mental health professional actually reduce stigma? It doesn't. There are scads of research articles, starting with this one, showing that disease label identification only increases stigma.

When you do research on stigma, the #1 most cited article, Pescolido et al, shows that saying "mental illness is a disease like any other," increases stigma.  This article has over 190 citations. Lots of people have proven that identification with the disease model increases stigma. Mental Health First Aid's definition of stigma was more about "making labels acceptable," than about "making people who have distress acceptable." And if they labels are the problem, the they weren't reducing stigma. Most updated campaigns now define stigma as "discrimination and prejudice against people," 

Does MHFA increase confidence in help provision?

1. Does Disease-label Education Increase Confidence in Providing Help? The biggest barriers to help-seeking are fear of labels (32%), negative social judgments (22%), employment discrimination (21%) and stigma (9%). So, education on disease labels will actually REDUCE help-seeking. Another study by Morrison showed that countering the biogenetic model made it easier to provide help. I have started replicating that study with good results in the community. All the disease-label, chemical, genetic stuff makes this a lot more scary.  We tell our trainees that everyone goes through hard times, and they already have the answers. We use the infographic below and say the four corners are peer support, dealing with trauma, building wellness stuff, and addressing social causes. All the nonprofits in town already know how to do that stuff. So this is an empowering rather than a disempowering message.
   
   The MHFA message is, "This is a complex illness, you need to refer it to the experts," whereas our message is, "If you know something about trauma, you can help right now." 
   
   Much more empowering for the outcome of "increase confidence in help provision."

Beautifully put.

"The MHFA message is, "This is a complex illness, you need to refer it to the experts," whereas our message is, "If you know something about trauma, you can help right now." 

ACEs Science aims to increase connectedness and healing in this regard. An important point when differentiating how our work is different and more inclusionary. 

We took death out of "Cancer", death out of "Aids" and now we have to take crazy out of "Mental Health". MHFA is another attempt to bring the public into awareness. 

I am unclear why this has to be an either/or answer.  Yes, being trauma informed and increasing connectedness can facilitate healing. Sometimes.  But sometimes, being able to identify a severe mental health episode as such, and knowing that what they are currently experiencing has a name and it is beyond my capability to keep them safe at that moment, and then to get them the appropriate expert care is going to be the difference between life and death. Literally. Isn't there room for both tactics to be correct?

I work in corrections. I have enough training respond differently when I meet an offender in the hallway who has eyes down, slow gait, and wiping tears from his eyes. I will calmly and quietly approach, ask him about his day, offer to listen, offer to contact his therapist if he has one, the chaplain, crisis intervention specialist. I will be sure he is not feeling as though he will harm himself or others, that he doesn't have a plan for harm. I will make sure that staff in his cellhouse are aware.  When I meet an offender in the hallway who is having a loud and contentious conversation with himself, yelling that the voices won't stop, pounding his head upon the wall, I will immediately make a radio call for help from the experts.  And yes, I will likely not say that Bob is having a bad day. I will likely say that Bob is having a mental health crisis, so that mental health and nursing staff respond. 

I think so much of our opinion on this depends on our experience.  Peter, I see you are a fire fighter/EMT, so you likely see people in crisis, as I do, and often these are people we have no long term relationship with, unlike those who work in education or non profit where perhaps you have a long term relationship that you are able to connect and help heal in that regard.