The Mad in America Continuing Education Project is preparing for takeoff after months of planning by a 5-person Board of Directors led by Bob Whitaker. This project is organized as a fund within the Foundation for Excellence in Mental Health Care, a 501c3 non-profit organization. I have the honor and challenge of serving as the executive director of Mad in America Continuing Education.
Our purpose is to provide online courses by internationally recognized leaders on unbiased research regarding the short- and long-term effects of psychiatric medications, as well as alternative approaches to an over-reliance on pharmaceutical interventions. These courses will be available on-line for ease of access and will qualify for Continuing Medical Education credits (CMEs) and Continuing Education Units (CEUs). The project will provide classes on the full range of psychiatric medications — the ways in which they affect the neurology, physiology and outcomes for people taking them. The overarching goal is to change the standard of practice so that it becomes consistent with well-designed research.
One key practice (among many others) that we anticipate will be impacted by the courses is the informed-consent process that all programs must use when prescribing psychiatric medications. In a 2000 article in the Journal of Humanistic Psychology, David Cohen and David Jacobs pointed out that there is a notorious lack of truly informed consent in North American programs. They propose a model consent form four pages long (!) which includes many — but not even all — of the elements that I believe research since then would support.
In my own decades of experience, typical informed consent practices are bureaucratized routines that provide minimal information, lead to perfunctory form-signing, are largely driven by a few regulatory obligations, and are overly focused on limiting personal and program liability. Short-term side-effects, while discussed, are too often glossed over. Tardive dyskinesia is lightly touched on; metabolic syndrome largely ignored. The “black box warning” on anti-depressants is similarly minimized — if mentioned at all. If there is any real dialogue about these issues, I would be surprised.
Unbiased, well-constructed research on short-term adverse effects and long-term outcomes rarely informs the discussion — not because of deliberate attempts on the part of clinicians to hide information, but mostly because such research has not been widely publicized. The same would be true for any real ongoing discussion about reducing or even withdrawing from psychiatric drugs.
I’ve tried to understand how we came to this state of affairs in our mental health systems. No one that I know wants to deliberately cover up important information. As a part-time faculty member of a public psychiatry residency training program, I’ve become sensitized to the difficulty of getting critical information on psychiatric medications into the minds of extremely tired, stressed and fragmented psychiatric residents. My experience as a local and state-level administrator of mental health programs has driven home the parallel point that most public mental health professionals are also engaged in high-wire balancing act of meeting multiple work demands — coding services, documenting progress notes, filling out treatment plans, and on and on. I am told by friends in the field that paperwork and meetings now take up 50% of their work time.
So, by taking advantage of the fact that even overworked, overburdened professionals must fulfill continuing education requirements, our project will place this vital information where everyone with professional license requirements is actually required to attend to their professional growth and development.
The Mad in America Continuing Education Project is developing a series of courses that will be reasonably priced and accessible from home or office, any time day, or night. The initial offering, starting today, is a series of modules on neuroleptics by Dr. Sandra Steingard, the medical director of the Howard Center in Burlington, Vermont. Dr. Steingard is a prolific blogger on several websites, including this one. She will present the best available information on how neuroleptics (aka antipsychotics) work. A 30-minute introductory module is followed by a 60-minute presentation on short-term effects of these drugs, both their efficacy in reducing psychotic symptoms and their side effects.
The third module, also 60 minutes, will walk through the research on the drugs’ long-term effects. CME credits are approved by the American Academy of Family Physicians for MDs who take and complete the course; CEUs are available for social workers, marriage and family counselors, nurses, and alcohol/drug counselors through Portland State University (social workers only) or Commonwealth Educational Seminars.
Additional courses are under development to provide internationally known researchers such as Dr. Martin Harrow of the University of Illinois Chicago Medical School, who will present their data and conclusions on the best long-term outcomes studies of people who have been diagnosed with “schizophrenia.” Virtually all these studies show conclusively that people do recover their lives more often than not, even though most are hindered in their journeys by “poor prognoses” and frightening bureaucratic terms like “serious and persistent mental illness.”
In 2015, you can expect more courses that focus on the other classes of psychiatric drugs — antidepressants, mood stabilizers, and ADHD medications used with children and adolescents.