With great regularity, I receive emails from people—“patients,” family members, and mental health workers—who are frustrated by this fact: the psychiatrists they meet, and the larger psychiatric community, are simply not aware of research that questions the merits of psychiatric medications. Many providers, for instance, do not know of Martin Harrow’s long-term study of schizophrenia outcomes. We at Mad in America started Mad in America Continuing Education to produce online courses that will fill in this knowledge gap. And now that we have our first courses up, we need your help.
Our newest course, Psychiatric Medications and Long-Term Outcomes in Schizophrenia, is taught by Martin Harrow. As many readers of this website know, Harrow enrolled 200 patients with a diagnosis of schizophrenia or other psychotic disorder into his study, and he found that those who stopped taking antipsychotic medications had significantly better “global outcomes” at the end of 15 and 20 years. The off-med group was also much less likely to experience psychotic symptoms at later follow-ups. His is the best prospective study ever conducted that focuses on how schizophrenia outcomes vary according to medication use, and his findings completely upset common wisdom.
In the online course, Harrow presents his 20-year findings in a series of slides. That part of the course takes about 30 minutes. Then, he and his collaborator, psychiatrist Thomas Jobe, discuss the clinical implications of their findings, and review the possible biological reasons that antipsychotics may impair long-term functioning and increase psychotic symptoms over the long term.
The pharmaceutical industry, of course, has long funded CME and CEU courses in psychiatry. Those industry-funded courses, which provide the mental health community with updated “educational material,” are not presenting this type of material. In addition, even when CME courses are not directly sponsored by pharmaceutical companies, they still regularly present information that supports prevailing prescribing practices. As a result, research that challenges that conventional wisdom—such as Martin Harrow’s long-term study—remains off the radar of most mental health professionals.
Our goal, in founding Mad in America Continuing Education, is to put such information on their radar. We need your help—the readers of his website—to do that. We need you to help promote these courses to psychiatrists and other mental health professionals.
We are just getting this initiative underway. Mad in America Continuing Education is operating as a project within the non-profit Foundation for Excellence in Mental Health Care.
The first course we put online, Antipsychotics: Short and Long-Term Effects, is taught by psychiatrist Sandra Steingard, a well-known blogger on MIA. In the course, she reviews the history of the development of antipsychotics, their mechanism of action, and the evidence base for their short-term and long-term use. Her three-part course ultimately provides a rationale for prescribing antipsychotics in a more selective, limited fashion, particularly over the long-term, and what gives her course a particular relevance is that Dr. Steingard works in a public mental health setting.
Now we have Harrow’s course ready to go. After this, our next course will be taught by Courtenay Harding, who, during the 1980s, published the first good long-term study of schizophrenia outcomes in the modern drug era. She concluded that it was a “myth” that people diagnosed with schizophrenia needed to be on antipsychotics all their lives. She will present her findings from that study, and also from other research and work she has done related to promoting good long-term outcomes.
As I think you can see, when we have these three courses up, we will have a CME/CEU curriculum that will provide an “evidence-base” for rethinking the use of antipsychotics. We have plans to create a similar roster of classes for other types of psychiatric medication, and to also develop courses on other important topics—the DSM, alternatives to medications, and peer-taught courses.
I should note that our executive director, Robert Nikkel, was Oregon state commissioner for mental health and addictions from 2003 to 2008. His leadership and experience has been vital to our development of these courses, and to obtaining the CEU and CME credits.
And now we need your help. We need to promote these courses, which are reasonably priced ($15 or so per CEU/CME credit) to the professional mental health community. We have no advertising budget for doing that. But we do have you—readers who, I think, share our commitment and desire to see this research known, and incorporated into clinical practice. And so we hope that you will familiarize yourself with the MIA Continuing Education courses, and help us make them known to professionals. We believe it is a step toward fostering a dialogue that could help change the prevailing “wisdom” that drives psychiatric care in the U.S. and beyond.
