Wednesday, February 19, 2020

Comments by Marcello Maviglia

Showing 12 of 12 comments.

  • Hi Dr. Francisco, I read with the utmost interest your study. First of all congratulations!
    The review the study has triggered in my mind the following observations/questions , which I would like to share with you and the site members:
    -You stated that…. almost 500 people were invited to participate in the program. Three-hundred-fifty accepted (70%). Do you have any feedback about the main reason(s) as why 25% did not accept? This could be extremely important data to develop insight about consumer’s engagement in withdrawal practices.( It looks like you are reporting some of the reasons for about 50 participants).
    – You stated that..None of the 350 people in the program needed to be admitted to the hospital as a result of withdrawal or relapse symptoms. To me this is impressive, and I feel it would be beneficial to know about what contributed to the high retention rate, high level of functioning, and stability of these consumers.
    – Your cost saving figures do not include savings from prevention of episodes of inpatient care. That would be a very valuable piece of information, needless to say. Can you elaborate on that?
    – Also you referred to the need to….Facilitate coordination with professionals, family members, and caregivers. Can you be more specific on how you accomplished that? This is a very important aspect without question.
    – I TOTALLY AGREE WHEN YOU SAY” Maybe we should ask the patients what their needs are and what they would choose to do.. Indeed this should be common practice… Also , I would speculate that including in the process Peer Specialists, could benefit the path of withdrawal in many ways, including symptoms management, and relationship building at different levels.
    Thanks you ! Marcello Maviglia,MD,MPH, Albuquerque, NM

  • Thanks Pacific for expanding on the meaning of moral improvement Model. I had to make sure, since the adjective “moral” has been used in different contexts in behavioral health.
    In reality, when I learned about the model ,years ago, as a psychotherapy framework, I had my doubts due to the fact that the definitions of morality , moral development, and moral improvement, are very subjective and bound to cultural, social and class issues. Therefore, I do not agree with the approach.
    In my view, real Recovery happens when the individual experiencing psychological distress drives his/ her own efforts and decides, at time with assistance, where to go with it.
    Thanks for your insights.

  • Thank Alex! If can join the site Mad In Italy and then sent us your SPILL/ ARTICLE about the topic you would like to address regarding emotional distress/ mental health to [email protected], we will translate it and also provide the original version in English. Best, Marcello

  • Hi,

    I agree that is very challenging to get off neuroleptics, but it is possible, as shown by multiple positive experiences, which I have personally witnessed , heard , and read about. THX!

  • Hi Alex, your questions are well taken. I hope you will continue to challenge every clinician who claims knowledge in the field of Recovery.
    Indeed, for a clinician is not easy to truly respect the independence of individuals with “lived experience” and Peer Specialists, without assuming the role of the “expert”.
    In this vein, I believe that the process may require that the clinician would accept the role of mentee under the guidance of a seasoned peer specialist. or “individual with lived experience”; learning about the wisdom and nuances of Recovery is not intuitive for clinicians. When I perceived my inadequacies, I decided that to foster my knowledge in the field of Recovery, I should seek assistance from Peer specialists. One of my most valuable mentors of many years has been a very knowledgeable Peer Specialist here in New Mexico, Donald Hume, who has been extremely kind and patient to correct my bias and misperceptions in the area of Recovery. For several years , we have met on a daily basis to discuss issues related to individuals with emotional distress , mental health and Recovery strategies and policies. I am very thankful to him for his assistance in this journey, which will never stop since I am aware that it may easily reverse to the narrow logic of the medical model. The clinician cannot be “in charge” of the path to Recovery , since it would be against the principles and the spirit of Recovery itself, which is a self driven process. But, as you stated, this is a real complex topic which cannot be delved into, in one sitting and in few messages.
    Anyhow, if you agree, I would like to invite you ,in the near future, to write your thoughts on this subject on Mad In Italy. This would be of great help for our readers , who may need more clarity on the subject.
    Your challenging and insightful comments are always welcome. Please let me know. Thanks. Marcello