Yesterday the president of the University of Missouri resigned because student pressure and a hunger striker and some faculty in the football team all asked for the president’s resignation. The University of Missouri has a long-standing history of racism. Over five years ago one of the students from UM held an open mic in Columbia, Missouri that our organization hosted. Her poem was about racism.
Similarly, in our community, the University of Colorado has a long history of discrimination against people with lived experience of recovery from mental health labels. One Colorado advocate has made attempts for over 20 years to interact successfully with a faculty member who was a leader in the mental health community. Several of the CU faculty members are leaders in disease-mongering, or causing people to have false positive mental health diagnoses. This is what happens when clinical services are emphasized and recovery is unheard of.
My email to the CU president explains the research behind these problems and explains why it is important to address this issue. Many people at CU are getting false positive diagnosis because they don’t know of alternatives. Many are being exposed to unnecessary discrimination and getting medications that may in the long term do more harm than good for themselves.
My Science-Based Response:
Hi University of Colorado marketers,I am a professional ex-Patient advocate for mental health. I am also a graduate of UC Colorado Springs. I was deeply concerned about your lack of accuracy in this system-wide marketing email that University of Colorado just sent out. Your email is not at all evidence-based. You are quite out-of-date and wrong on most of the research you mentioned. I will show you the problems line by line.My suggestions are in orange.
Corinna West, MS, CPS
Poetry for Personal Power program manger
There are few areas of health care more important and less understood than mental health.
The Helen and Arthur E. Johnson Depression Center at the CU Anschutz Medical Campus aims to change that. The 7-year-old center has been making substantial progress with its multifaceted approach of clinical care, research, education and community outreach.
Um, you can’t be up to date if you are not talking to recovery model advocates.
Much credit for that progress goes to my longtime friend George Wiegers, who was the catalyst and primary benefactor responsible for the center’s founding. George knew of the tremendous need for mental health services from experience within his family, but he also knew the stigma long attached to mental health was the biggest barrier to people accessing care….
No, actually, research on stigma and help-seeking says stigma is only the fourth largest barrier to help-seeking. More important are disclosure concerns, employment discrimination, and negative social judgement. Google Clement et al 2015, Psychological Medicine.
The need is great in our community, our state and around the country. An estimated 19 million Americans are afflicted with depression…..
Afflicted is a disempowering and stigmatizing word….
A measure of the depth of the issue is that clinics are at capacity, many with waiting lists. We have added staff to address the demand and are entering into partnerships such as one we recently started with our colleagues at Children’s Hospital Colorado. But clinical care is not enough. We need to grow our capacity.
If clinical care is not enough, why is this email all about clinical care and adding capacity to clinical care? Unfortunately, clinical care may do more harm than good. Look at madinamerica.com for extensive data on this.
One of the great successes of the Johnson Depression Center is the community partnership effort it has created and sustained. We collaborate with businesses, schools, churches and other organizations, providing services free of charge….
See the UK Resilient Communities Guide and the Movember Foundation’s Making Connections for Men’s Mental Health report if you want to do effective collaboration. Providing disease model services is not the only or best way to use those collaborations. There are at least twenty better ways to do those collaborations.
Our partners engage in practical efforts such as suicide prevention and steering people toward appropriate care…
OK, again, current research shows that Suicide prevention in not just about referring people to clinical care. Google “The Way Forward” for a review of what actually works.
We are working to expand the circle even further, engaging key constituents such as pediatricians, primary care physicians, educators, community organizations, anywhere that feels the impact of mental health.
Where are your recovery model advocates? From organizations like Foundation for Excellence in Mental Health Care, National Empowerment Center, to the Colorado Mental Wellness Network? If you only promote diseases, that’s what you get. If you want recovery, you need to ask the people who recovered. Where are your people with lived experience? It is easy to tell we are absent by the entire tone of this email.
CO Colorado Mental Wellness Network PO Box 6336
Denver, CO 80206
Executive Director, Amanda Kearney-Smith
Stigma emerges from a lack of understanding. Just like physical diseases, mental health is a real illness – it is not a character defect or a weakness. The more we talk about it, the less the stigma…
Not actually true; knowledge and exposure don’t reduce stigma unless the story is hopeful and the person is not a celebrity. The work must be advocacy-based to address the key barriers.
Mental health will remain one of the most important health care issues we face, but in time it will also be among the best understood.
Seems like you have a long way to go….you never once used the word recovery in this email, you never talked about people getting on with their lives. What a lost opportunity.
For feedback, contact [email protected]
Here is Dr. Benson’s Science Denial:
Dear Ms. West,
Thank you for your recent email. While I appreciate your constructive criticism and I can see you are obviously steeped in the field, my email was not intended to be a scientific paper or “evidence based” approach to the issue. My goal was to call attention to the issue of mental health and our university’s efforts to address it. I did so after consultation with CU professionals in the field, who contributed to the piece’s focus. Given the record number of responses it received, I think we were able to highlight the issue.
Bruce D. Benson
And My Continued Pleas for Science:
Hi Dr Benson,
Thanks for getting back to me.
I’m glad you got a good response count. However, research shows that responses to disease-model mental health materials tend to be mostly from people who already believe in the disease model of “mental illness” — As are probably the professors you consulted to write the newsletter.
However, the disease model is pretty much old-school thinking in community health and in prevention, the two areas it seemed you were trying to promote. So the email inadvertently showed how behind the times CU actually is. More current thinking — the recovery model — looks at life situations, trauma, social determinants of health, and wellness strategies.
The disease model has also been shown to be counterproductive in increasing help-seeking, which I believe was another one of your desired outcomes for the email. Although you may have seen a short-term increased demand at the Depression center, again research shows that this demand will be from people already reached by disease model services. It will be a low rate of people unfamiliar with their own need for help, which are actually the ones truly in need.
You may not have intended the email to be “evidence-based.” But what I am saying is that there is clear research evidence to support that the email, and CU’s approach to mental health as a whole, could have been much more effective in whatever your desired outcomes were.
If you included recovery-model advocates and approaches, and not just disease-model approaches, you could have higher rates of illness prevention, higher rates of help seeking from those truly in need, and higher rates of recovery from the people who do get services.
Those three outcomes should be a top priority for CU, not just promoting old-school thinking and spreading mediocre services. This is my concern. If you want the best and most up-to-date mental health information on campus, you need to include recovery-model approaches as well as disease-model approaches.
Please let’s continue this conversation. Please pardon any typos as I am healing from a concussion. I want CU to be the best, like it was when I attended CU-The Springs. One of the best Science Learning Centers in the nation.
Hi Dr. Benson,
Here’s another breakdown of the problems in this email. I will provide references for all statements. Ask your professors to do the same some time. If they can’t, it’s time to hire new professors for mental health.
Basically you and your professors didn’t know about stigma. It’s only the fourth largest barrier to help seeking. And the two largest sources of stigma are mental health labels and mental health professionals. So you can’t reduce stigma by pushing clinical care.
Also, increasing access to clinical care, as you pushed so heavily in the email, doesn’t reduce suicide, and doesn’t improve long-term outcomes or recovery rates. And prevention is about increased connection and better social supports, not early access and treatment. Social determinants of health. It’s a public health issue, not a fluke that hits people out of the blue. Challenge yourself, challenge your professors. Think outside the box.
So you were basically preaching to the choir, the already-diagnosed people. Or those who like thinking of their situation as an illness. But this is a tiny subset of the actual population, so on the whole this was actually worsening the situation for people with mental health challenges.
So “promoing awareness” and “promoting your programs” are only useful if you are doing more good than harm. And the research in fact shows the message you sent and the programs CU provides are doing more harm than good.
When you and your professors step away from your pre conceived notions, as you ask your students to do, and acually look at the science, you will begin to know something about mental health recovery.
Please continue this conversation. If my science is all new to you, ask your mental health professors to look at it. If none of your professors know this research I quote, it’s time they do. Our lives depend on it, so their jobs should depend on it. They should be doing more good than harm. They pledged it.
Dr. Benson, Don’t keep letting your professors make you look uneducated. Look at the real science in this industry, the current science, not 20-year-old assumptions.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.