{"id":49726,"date":"2014-09-14T22:18:32","date_gmt":"2014-09-15T02:18:32","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=49726"},"modified":"2014-09-17T16:14:17","modified_gmt":"2014-09-17T20:14:17","slug":"the-other-guy","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/09\/14\/the-other-guy\/","title":{"rendered":"the other guy…"},"content":{"rendered":"
The gist of this posting by the APA president is a complaint that the current SAMHSA Strategic Plan leaves out the medical specialty of psychiatry. And he correctly notes the influence of the Recovery<\/em> movement in the SAMHSA document<\/a>:<\/div>\n
\n
SAMHSA Strategic Plan Falls Short on Serious Mental Illness<\/a><\/div>\n
From the President<\/font><\/strong><\/div>\n
Psychiatric<\/font>News<\/font><\/strong><\/div>\n
by Paul Summergrad<\/div>\n
September 11, 2014<\/div>\n

… At the same time, when looked at from the outside — from the perspective of observation and syndromic coherence — these disorders are highly correlated with genetic and neurobiologic abnormalities as well as disruptive environmental events. Two recent studies [among many] — one on the genetics of schizophrenia based on the largest pool of genomewide studies and a smaller study of the genetic and neuropathologic basis of autism — reinforce this understanding. <\/p>\n

Why is the tension between the experience of these illnesses and their etiology so important? In part because it is easy for psychiatry, and more broadly the mental health community, to come down strongly on one side or the other of this divide. This split can influence the research and public policy we need to develop treatments for mental illness and provide access to care. <\/p>\n

Moreover, when this divide — which is sometimes inaccurately framed as a battle between the recovery community and a misunderstood “medical model” — affects the Substance Abuse and Mental Health Services Administration [SAMHSA], the impact can be of even greater significance. SAMHSA is the principal federal agency dedicated to leading public-health efforts to improve mental health and reduce the impact of mental illness, including substance abuse, on America’s communities. As a central component of its directive, SAMHSA recently released a draft of its FY 2015-2018 strategic plan, titled “Leading Change 2.0: Advancing the Behavioral Health of the Nation<\/a>”.<\/p>\n

There is much to support in SAMHSA’s draft. Efforts to reduce disparities in access to care, which disproportionately afflict minority communities, are laudable, as are efforts to reduce the number of those with mental illness in the criminal justice system. However, for an agency with such a broad responsibility, the proposed plan is striking for what it leaves out: a focus on the appropriate medical care of patients with serious mental illness and the development of a physician workforce that is essential for their care. In APA’s letter to SAMHSA Administrator Pamela Hyde, J.D., responding to the draft strategic plan, our CEO and medical director, Saul Levin, M.D., M.P.A., noted, “APA is strongly concerned about the lack of explicit recognition of the psychiatric treatment needs for Americans suffering from mental illness and substance use disorders, and in particular for the 13 million Americans who suffer from debilitating serious mental illnesses [SMI].” In addition, we urged SAMHSA to develop explicit goals for evidence-based medical care for serious psychiatric illnesses…<\/div>\n<\/blockquote>\n
I like Dr. Summergrad. He doesn’t lead with the arrogance of his recent predecessors, doesn’t make assumptions about the primacy of psychiatry in the mental health cosmology, and while he wears a white coat – he wears it loosely. But it will take more than a long absent humility to achieve "explicit recognition of the psychiatric treatment needs for Americans suffering from mental illness and substance use disorders, and in particular for the 13 million Americans who suffer from debilitating serious mental illnesses<\/em>" primarily because for thirty years, psychiatry has itself had a monocular view of those needs. He speaks against SAMHSA coming down on one side of "the divide,<\/em>" yet psychiatry itself has helped to create and both actively and passively nurtured the division.<\/div>\n

Absent some lofty rhetoric along the way, psychiatry proper has offered the same treatment option for chronic psychosis since the arrival of Thorazine – antipsychotic medication maintenance – and ignored the social problems.  While decrying the long-term effects of medications, the recommendations haven’t changed to take that into account. Psychiatry’s other offering has been an expensive and non-productive research effort to chase down a biological etiology and\/or new biological treatments. In practical terms, that effort has yielded nothing. During this period, the deinstitutionalization of mental patients has resulted in the reinstitutionalization of mental patients [what they’re for…<\/a>, justification for “what they’re for”…<\/a>], again often decried in rhetoric, but otherwise unaddressed. So the search for etiology and for new treatments has failed and the actual fate of these patients has been ignored.<\/p>\n

The Recovery Movement arose outside of psychiatry, and is premised on the idea that an intense focus on the interpersonal, societal, and cultural needs of the chronically mentally ill will lead to recovery. In this model, traditional diagnosis takes a back seat [or is considered detrimental]. It is the official approach of SAMHSA [Substance Abuse and Mental Health Services Agency<\/a>], focusing on block grants to the States for community programs following the Recovery model.<\/p>\n

<\/a><\/p>\n

For many, the Recovery Movement has the additional meaning of recovering from<\/em> psychiatry itself – hospitalization, antipsychotic medication, commitment, the ‘disease model’, the ‘medical model’, etc. And many of them feel that this request, "we urged SAMHSA to develop explicit goals for evidence-based medical care for serious psychiatric illnesses<\/em>" is part of the problem rather than the solution. So the "divide" is increasingly an active process being fueled from both "sides" – often driven by intense ideological conviction. Meanwhile, as this controversy rages, resources dwindle and our prisons fill [see George Dawson’s recent Shut Down The Psychiatric Gulags – Don’t Build More!<\/a>].<\/p>\n

If there’s anything that can be counted on in this seemingly endless harangue, it’s that whatever anyone says about it, it’s mainly about what the other guy says or does being wrong. I doubt that discussions of this topic can or will be meaningful until there’s a clear consensus that no-one really knows quite what to do at this point. Until then, the dialog will continue to be about the other guy<\/em>, and like a pendulum, any balance point will be a virtual position seen only in passing…
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The gist of this posting by the APA president is a complaint that the current SAMHSA Strategic Plan leaves out the medical specialty of psychiatry. And he correctly notes the influence of the Recovery movement in the SAMHSA document: SAMHSA Strategic Plan Falls Short on Serious Mental Illness From the President PsychiatricNews by Paul Summergrad […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-49726","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/49726","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=49726"}],"version-history":[{"count":28,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/49726\/revisions"}],"predecessor-version":[{"id":49883,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/49726\/revisions\/49883"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=49726"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=49726"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=49726"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}