Announcing the Mad in America Continuing Education Project

Robert Nikkel, MSW
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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.

We look forward to providing these on-line learning experiences and will value your feedback on them once we’re moving ahead.  Our intention is to eventually have 5-10 courses available at any time so that professionals can pick and choose those most relevant to their work.  [Through this website and others, you will see specific information for each course along with instructions on how to register, pay the reasonable course fee, access and complete your training — and receive your CME or CEU credits.]
Stay tuned to this and the MIACE website for more information and share this information with all of your colleagues and friends who need CMEs and CEUs for their respective professional licenses.
MIACE Website with links to course registration: http://madinamericacontinuinged.org/

32 COMMENTS

  1. Not being a “mental health” professional, but a psychiatric survivor activist, these courses are not for me. I do think it is a good thing for MH pros with an open mind to be able to find out what the facts are about psychiatric interventions.

    And I think it’s fine for MIA to offer this. It will certainly help, some, if there are more professionals in the field who are less abusive.

    But I don’t see real change coming from within. Why should it? While undoubtedly there are a few decent people working in the field, those who have real power in the “mental health” system are not going to give it up because we “educate” them. Does anyone here really believe that these people don’t know what effect their behavior has on the troubled people that society has turned over to them? These are not the kind of folks who are about to see the error of their ways. They demonstrate their lack of concern for other human beings every day, and this lack of concern brings them great rewards.

    I wish MIA had more focus on the need to face psychiatry’s gross violation of human rights. Everyone in America is threatened by psychiatric power, and this threat needs to be brought to their attention.

    Again, I support this initiative to strengthen the knowledge of the few decent people in the field, but we need a movement that reaches out to everyone, not the tiny percentage of MH professionals that already realize that something is wrong in the field in which they work.

    We need a vigorous human rights movement. The psychiatric system won’t change until there is one.

    • I have to agree with you. The money and the power in mental health lies with the shrinks, the insurance companies and the phama industries. All of whom are at the top of the food chain in the mental health complex and not about to give up their positions or their profits.
      Psychiatry, IMHO, should be charged with crimes against humanity starting with their psycho-surgeries and ECT right up to the present where they prescribe medications by the millions that use the human species they are trusted with as lab rats. They are not physicians. They are quack still selling snake oil.
      I’d like to be able to take these courses. I bet the information is accurate and well presented.

      • Ted: How to we reach out to left progressives? Amy Goodman on Democracy Now reported on the death row case of a “schizophrenic.” It is good that they are reporting on the barbarity of the criminal justice system, but why incorporate the terminology and standards of psychiatry, another unchecked institution in our society? Film maker Lois Proyect also puts in a plug for the insanity defense and the old psychiatric hospital system. Isn’t the insanity defense often forced on people and also results in longer times of incarceration than prison sentences. Szasz stresses that deinstitutionalization threw many onto the streets who knew nothing but the institutional life, but hasn’t research debunked that homelessness is more directly related to high rental prices and unstable work situations than alcohol, drug abuse and “mental illness.”

    • Ted,

      I understand your concern, and I agree that a few decent people inside the mental health system will not be what it takes to get rid of the system.

      But I do think that educating the public at large could go a long way in receiving much-needed support. I’m convinced the average person on the street knows nothing about what happens every day in the mental health system; nor are they fully aware of what the long-term use of neuroleptics; the memory loss that occurs with ECT; the trauma that results in so-called hospitalization.

      Fortunately, these things take pace for only a minority of people; unfortunately, the majority needs to be educated, before support can be gained, making the movement powerful, with the numbers needed to outlaw forced “treatment” once and for all.

      Duane

    • Things have been getting worse for some time now. You can see that worsening concretely in the mortality rate. One of the institutions in which I spent time now has an elaborate computer surveillance system, and patients are required to wear wrist bracelets with computer chips that track their whereabouts throughout the day. This is called “state of the art” mental health treatment. I don’t think it will be too long before this kind of technologically based control, one could call it slavery, creeps out of the institution into the community at large. If what is going on at that institution is “state of the art” then I can’t help thinking we’re in a lot of trouble. Freedom is under threat, and when it goes, there are many people who will not have seen it coming.

      • Frank, I’m not sure what breaks my heart, the most: the fact that this type of thing is being practiced at the facility where you spend time or the fact the leading, national ‘consumer advocacy’ organization is doing absolutely nothing to stop it! When are we going to get NAMI into a national debate?

        • NAMI is a part of the problem not a solution. They do more advocating for the status quo than anything else. I tried presenting information that would open up some avenues for communication and was banned from commenting at all on their page. Yet, they were ready to pander to me for donations for their cause. And yes, NAMI has it’s own agenda and it isn’t advocacy for anyone but themselves.
          The doors need to be opened. Consumers need to advocate themselves and the others like them. It’s a hard step, but nothing will change without it happening.

    • Ted, thank you for your comments and your questions and even skepticism about whether this will be a useful project. I agree that it’s not something that will correct the many many problems in the field. My sense (and I understand I could be off base) is that more people working in the mental health field are uncomfortable and looking for better information. There’s actually a lot of doubt, whether it’s expressed openly or not. I hope the continuing education courses will help. And I agree completely that we need the vigorous human rights movement that you and others have championed for many years.

  2. If something great happens for one person who gets fresh perspective on their meds, that’s just tremendous. But if they don’t get the whole picture of what’s wrong with the insanity defense, forced “treatment”, and that psychiatry is not a genuinely medical enterprise, then they won’t know what they’ve been through. It’ll be past for them, or the worst of it will, but it won’t ever be over, and they won’t know what they don’t know.

    I have met no professionals who would question or straighten out a “diagnosis” except to deepen it–the label just couldn’t ever have been wrong from the start, it had to be a stepping stone and if the complaint came from the patient, then it must have been something psychotic that they refused to explain. I have seen so much nonsense go down as doctors “informed” people, for instance about the meaning of their dreams as psychotic indicators, and watched psychologists just reinforce all the nonsense and rejection of patients’ own doubts about the effective validity of their label.

  3. Here in Florida NAMI is pretty strong, and compliance among “consumers” tends to be the rule, or else you’re, like me, and outside of the system. Given this situation, I can’t see the continuing education courses as such being a bad thing. A similar situation exists in Virginia where I resided before I moved down here. The system is damaging people with pharmaceuticals, and there is nothing in place to act as a counter weight or an antidote to that damage. You’ve got a high mortality rate, too, as a result. I would like to see some of these people who couldn’t imagine life without their neuroleptic drugs start to imagine life without their neuroleptic drugs. I’m thinking maybe such a Continuing Education Project as you are offering might, indeed, help in this regard.

    • I agree. I think this project is a subtle undermining of Big Pharma’s power.

      The legitimacy of an accredited course and the depth of the research could significantly undermine Big Pharma – probably not in a big way, but in an important way.

      Mad in America is not the be all and end all of challenging psychiatry but it is a growing force: a book, another book, Bob touring and talking constantly, this webzine, a film festival and now this course.

      While Ted sees limitations I think that this steady growing focus and growing community might lead to other projects spining off lead by others that take other approaches. I hope so anyway.

  4. I see it as an excellent and very important thing. While I acknowledge that it is not the entire solution, it is an important step in getting the information out independently of drug companies and their advocates.

    Also, as a recognised and registered course with validated research it leaves psychiatrists with fewer places to hide when patients are injured. It adds weight to arguments that psychiatrists ought to know and can find out about the impact their treatments are having from an independent and accredited source and, therefore, they should know and can be held responsible for not knowing.

    While older, established psychiatrists might have too much to lose to acknowledge the error of their ways, I suspect that trainee doctors who have not yet been fully corrupted by the prevailing paradigms could use it as a resource and hopefully start generational change….perhaps by seeing the dangers and opting into another specialization while they are still young enough to do so!!

    Ideally, I’d like the community to see the underlying prejudice and criminality on which psychiatry is based ASAP. However, realistically, I think it will be a slower process in which education both on drugs and their harms and on the social, political and economic paradigms underpinning psychiatry will play a pivotal role.

    Congratulations on getting this program underway!

    • Thank you for your comments…I think that the courses can help fill a vacant spot in academic psychiatry training programs. I teach in a medical school’s department of psychiatry and see the difficulties in getting these kinds of perspectives into the curriculum.

  5. Bob this is wonderful news…and a very smart way to change the standard of practice for prescribers as well as forward the conversation about long term implications of psyhciatric drugs.

    Eventually I think mainstream media, APA and those taking these meds will have to catch up to the implications of the Harrow and Wunderink studies (as well as other studies on other classes of psych drugs) and this is another way to press the issue.

    Thank you to all who are taking part in this.

  6. We can only hope that practitioners will internalize and act on the information presented. Sadly, taking a course, attending colloquium or a conference are often used to buttress the assertion that what is being practiced is consistent with the information presented. I wish I had a dollar for every time a provider agency asserted that training alone is evidence that significant even transformational change has occurred in practice.

    Locally, our state hospital went through over a decade where several full time university faculty members conducted countless trainings to improve staff skills. The conclusion of the university’s department chair included, “The more things change the more they stay the same” and “Things that are being offered to the patients who live there have not changed.” The state agency which runs the facility continues to assert staff training is evidence of wholesale change at this institution.

    I hope that the Mad in America Continuing Education Project makes a difference where so many other efforts effected only the veneer of change.

  7. Product
    ‘provide online courses’
    Author/s
    ‘by internationally recognized leaders on unbiased research’
    Content/s
    ‘regarding the short- and long-term effects of psychiatric medications,
    as well as alternative approaches to an over-reliance on pharmaceutical interventions’

    UNBIASED ?
    Does not exist. There is always social, professional, educational standpoints.
    Being explicit about the authors standpoint and values permits to situate what is presented
    with regards to authors from different standpoints.

    POWER to KNOWLEDGE and EDUCATION
    I assume the main goal of the new education project is the improvement of WHAT IN/ WITH people who experience severe emotional distress or unusual perceptions or beliefs.

    Therefore: Are people with personal experiences of severe distress and diverse experience-based education on biographies with extreme distress in a significant number (up to 50%) the experts who design and deliver the MIA online education?

    Are ‘experts by experience based education’ asked to co-select the range of relatively biased/ epistemologically located studies chosen for review?

    Are ‘experts by experience based education’ asked to analyse the hypothesis, design, data, interpretation, discussion and conclusions of selected studies?

    In the absence of participatory research on the experience of taking neuroleptic medication (I consider this absence a crime in oppressive and expert-biased education) are there being purposefully sampled focus groups held and the data interpreted by ‘experts by experience based education’, eventually alongside academic researchers not funded by pharma?

    For the online education on ‘alternatives’ is it being assured that priority is given to evaluations done of ‘consumer/survivor run projects’ and by ‘experts by experience based education’ or collaborative research projects?

    As long as the answer to my questions is NO, the academic or clinical experts seem to be doing their best to exclude the biased=situated and value based knowledge of ‘ex patients’ with insider and collective experience, of ‘experts by experience’ informed and designed knowledge production on what goes on and what is desired in support for learning and healing from severe distress and it’s many negative social, moral, legal, economic, vocational, educational, cultural etc: implications and consequences.

    Strictly academic or clinical experts b(i)ased – pls suggest a politically correct name for the exclusively dreamt up ‘validity’ of the pretended ‘unbiased’ education program offered.

    On behalf of the routinely excluded and silenced ‘experts by experience’, be them ‘clients’, activists, educators, authors, artists, film makers, ‘peer program’ leaders or ‘consumer/survivor researchers’. The invisible and silenced MADephant in the clinical and academic room.

    I wish I was retarded! Means: These practices of educational science fiction by exclusivist ‘medical elites’ about those silenced, labeled, stigmatized and excluded from knowledge production are never being to be produced on and by MiA.

    Apologies needed?

    • Ute, I appreciate the concerns and issues you’re raising. We do have several persons with lived experience on our board and our input has been and will be a critical factor in deciding which courses the project will develop. We’ve used the term “unbiased” to guide our review of studies and courses away from those sponsored or ghostwritten or influenced by commercial interests, mainly but not entirely limited to the pharmaceutical corporations. I believe an honest reading of the research literature leads in the direction that Bob Whitaker’s review of the field describes. Whether this is a bias or not, I’ll leave for others to judge.

      • Tootallbob,
        Thank you for the information about persons with experience of mental health problems on the board. It would strenghten the validity to have ‘consumer researchers’ participate as they bring the epistemological knowledge and have learned to critically appraise methodologies.

        I won’t do any name dropping here as I guess the board members have the opportunity to contact the ‘consumer researchers’ from the who have been publishing more widely. I understand it may take some time, however, at least in the UK, experienced ‘service user researchers’ have contributed significantly to shape the scope and interpretation of reviews, per example, by including ‘user/consumer research’ published in the grey literature and by informing the interpretation with knowledge rooted in and questions emerging from the lived experience of the treatments under review.

        Read some not so ironical comment by a medical researcher recently who discussed the prevalent ‘biases’ inherent in the ways research has been restricted to fit the neo-liberal agendas of universities with dependancy on industry grants and the peer review procedures being shaped by adoption of similar limited research questions, objectives and often study designs.

        An ‘honest reading’ is an interesting point of view and merits discussion. Bringing in stakeholders from different knowledge production backgrounds makes the question of ‘whose knowledge and interests’ have been legitimated as worth of ‘scientific’ study more tangible.

        With regards to research into the multiple effects of taking neuroleptic drugs, of course RCTs bring in a ‘biased’ focus as power calculation for one main outcome and who defines what this outcome is, there is need of more longitudinal studies, as the ones you’ll certainly critically appraise, and more so, qualitative research into the wide range of effects of taking neuroleptics and SSRIs and other medical drugs.

        Joanna Moncrieff from University College London has done some published pioneer work about consumers’/ users’ experiences of taking medical drugs for mental health issues. The other projects, smaller and bigger, I know about have not been published yet, but are consumer/user researcher led. An expert by experience psychologist from Denmark has done a literature review on studies into consumers experiences with neuroleptics, and found scandanlous few, to inform here qualitative exploration. There may be more out there, be them less recent or published in less ‘biomedical’ journals?!

        It would be great the board informed how consumers/users/experts by experience contribute to inform and shape the foci, re-analyses and interpretations undertaken of the studies being reviewed in the MiA Educational Online Courses.

  8. Will this continuing education project teach people how to avoid psychiatry altogether in a customized individual way?
    Will they be taught how to make an herbal extract at home which can stop voices in their tracks ?
    Will they be taught how to step-down extreme states at home before they are brought to the attention of the psych juggernaut ?
    Will people be taught how to regain sleep if they can’t before being captured by the psych juggernaut?
    Will they be taught innovative ways to use niacin and mineral baths to avoid the psych juggernaut ?
    Will Robbert Whitaker ever investigate all this and more ?

    It is difficult to write generally about things that work best when customized for individuals. I’m talking about stuff that could also be used to transition out of meds, psychiatry , its harmful modalities and into freedom many have never known. There is much more I’m afraid that won’t be in these announced programs that was honed in the struggle to free ourselves from psychiatry that is not recognized by academia because it was developed and/or recognized outside of academia by one or few through the lived experience of escaping psychiatric oppression by people myself being one who would offer these solutions free ,and though they work, can still gain no credibility. Such is the bias among humanity and it’s respect for titles.
    There is value in turning a horrible psychiatrist into a less horrible one nevertheless ….perhaps. It is a perilous road to empower or lend credibility to psychiatry as so many have already found out .If only those buried in potters fields could be revived to weigh in with their insights on these matters for our benefit.

    • I think our goal is to provide really good information to practitioners and others who take the course so that they can make their own (hopefully) better informed decisions. We are planning some courses on alternatives including nutritional approaches to improving health.

  9. It’s a great progressive step, and, I must say, long overdue! MIA should have done this a long time ago, but I am glad you are finally doing this. All your accumulated knowledge and experiences of many psychiatric survivors have to be brought into a public eye and into professional communities. Otherwise, nothing will change. I am a professional and I look forward to taking your CEUs!

  10. We’ve heard it said that there are no such things as the side effects of so called psych meds , they are all effects .
    Wouldn’t we make more progress if we said that there are not really “alternatives” but there are just things that work or don’t work to varying degrees some causing harm some not.
    Since Bob Whitaker has proven to us his ability to identify real science , as well as pseudo science posing as science and given great hope to so many including myself, I would think it a natural progression of his talents and those around him and many here at MIA including of course survivors to after a call for solutions known or unknown from everywhere on earth especially those developed or discovered by individual survivors wherever they are or whatever they have come up with of whatever is said to be helpful and first causes no harm . To create an impartial flexible scientific methodology and group made up mostly of survivors to develop a way to investigate to create experiments and studies to find the truth of each and every submitted solution whether for home use or other without regard to whether or not something is marketable , and publish the results of such a scientific inquiry here on MIA so all can see . Yes you can do this . Thank You