Replace labels with love

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scott3Every once in awhile I meet someone who reminds me that the advocacy movement for children's mental health is in good hands with the up and coming generation. This past week, while walking through the lobby of the hotel where the Federation of Families for Children's Mental Health conference was being held, a young man named Wilton Johnson approached me and asked if I would pose for a picture holding a sign that said "Replace labels with love." He clearly knew the quickest way to my heart. The unfortunate stigmatizing labeling of the past has roared back with a vengeance on the coattails of the buzz around mental health reform in the halls of Congress. I am all for anything that helps stem the cancerous tide of stigmatizing language!

wiltonWilton Johnson is a dynamo, pure and simple, and we need more people like him. The campaign that he is promoting, "Replace Labels with Love," is an Anti-Stigma Campaign launched in May of 2015 by M.O.V.E. Wisconsin during Children’s Mental Health Awareness Month. The premise behind the campaign is to remind people that labels put people in boxes and dismiss capabilities. Love empowers and promotes growth because everyone needs to be loved and not labeled. By replacing labels with love, we are reminding our community to use first person language when engaging and interacting with other members of our community.

move2Sounds pretty darned good to me. Contact MOVE Wisconsin to learn more about their efforts and maybe even score a cool button like I did!

Want to learn more about Wilton Johnson?
You can start by watching this video of a speech by Wilton Johnson from the Wisconsin Family Impact Seminar in February 2015. As well, read the article by Jabril Faraj of the Milwaukee Neighborhood News Service, on Mr. Johnson's participation in an innovative housing program for homeless young adults:

  • New housing program provides ‘optimism and hope’ for homeless young adults
    June 11, 2015, by Jabril Faraj, Milwaukee Neighborhood News Service

    Wilton Johnson walked into his new home for the first time last week. Johnson, 24, lived in foster care from ages 9 to 14 and was homeless, off and on, for a period after that. Until recently, he worked at the airport assisting wheelchair-bound passengers get to their destination.

    “We all know that housing for young adults is a huge need,” Johnson told a crowd gathered at a grand opening event for the six-unit house, part of Journey House’s Campus Housing Initiative. The initiative provides housing for “motivated youth” — young people ages 18 to 25 who have aged out of foster care and are going to school or working.

    “This initiative reaffirms my faith in my city and my county,” Johnson said, adding that the program will provide “optimism and hope for me and many of my peers.” Milwaukee Mayor Tom Barrett and Milwaukee County Executive Chris Abele also made remarks at the event.

    In addition to Johnson, who will serve as a peer advisor for the program, five other youths between the ages of 18 and 22 have been identified by Milwaukee County Wraparound to fill the property at 741 S. 23rd St. Brian McBride of Project O-YEAH, which provides services to young people transitioning out of foster care, said the program identified individuals who “showed motivation, who stayed engaged within their treatment plans … and have struggled with the housing piece.”

Well, Network faithful, was I right about Wilton? We are indeed in good hands. We are fortunate to have a host of young adults like Wilton Johnson doing strong advocacy work across America. Take a moment to celebrate the Wilton Johnson in your life and let them know that you appreciate what they do.

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Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

Innocence Lost: Tooth Fairies and School Lockdowns

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Morning Zen Guest Blog Post ~ Eliot Brenner

The Truth About the Tooth Fairy
My 9 year-old daughter ran into the kitchen, shouting, “Mommy is the tooth fairy. Look, it’s Mommy’s handwriting on this note.”

I looked away from her. I am a lousy liar and I knew that if I looked my daughter in the eye I would have to tell the truth.

She persisted: “Mommy is the tooth fairy, isn’t she?”

She had me. I put my index finger to my lips. “Shhh,” I said, “don’t let your brother and sister hear you.” At 8 years old and 4 years old, they did not need to have their bubble burst any sooner than necessary.

Later that night, as I tucked my daughter into bed, she had more questions for me. “Does this mean that for all of my friends their parents are the tooth fairy, too?”

“Yes,” I replied. “But I think it would be best if you kept that secret and let them find out on their own. ”

She agreed. That evening she had grown wiser and more mature. Now she was keeping an “adult” secret.

I realized that night that my daughter had begun the process of losing her innocence. Next would be Santa Clause, then the Easter Bunny. There was no turning back.

Little did I know just how quickly her innocence would unravel.

Our First Lockdown
A month later my wife and I received text messages from our children’s elementary school. A series of ‘credible threats’ were made toward several schools in our town. All 17 public schools serving 10,000 students were placed in lockdown.

My wife and I waited for additional information. All we could think of was Sandy Hook. After two hours, we were told that although schools were still on high alert, all students were safe and would be dismissed early. Several schools had received bomb threats and threats of someone showing-up with a gun.

How are our children doing, we wondered?  How would we explain this to them?

Of course, being mental health professionals, we were well versed in the recommended advice following any scary or potentially traumatic situation:

  • Ask your child for her understanding of what happened.
  • Ask your child how she is feeling. 
  • Reassure her that teachers, police, and parents will be there to keep her safe
  • Make sure she does not repeatedly overhear television news, which can inadvertently prolong the event or make her feel as if the event is happening again.

We knew all of this, but we still weren’t sure how our children – who did not know about the tragedy of Sandy Hook - would react to the lockdown.

The Reunion
When my wife picked-up our son and daughter at school, their reactions could not have been more different. He was nonplussed and his mood was upbeat because he got out of school early; she was shaky, tense, and preoccupied.

At home, my son was well aware of how frightened some of his classmates were, but he seemed unaffected by the event. My daughter, on the other had, repeatedly retold the event, emphasizing how she was “shaking for two hours until the police came.”

How, I wondered, could my daughter who just stopped believing in the tooth fairy, make sense of someone wanting to bomb her school or shoot her classmates? How could we, as parents, help her make sense all of this?

“Why would anyone do this?” my daughter asked.

“Because,” I said, “there are some people in the world who do bad things. And that is why the school went into lockdown today – to make sure that you will be safe if someone tries to hurt you.”

She listened, asked more questions, and we tried to reassure her that the world was safe and that the adults in her life would do everything possible to protect her.

The Aftermath
As parents, we reassure our children who are facing school lockdowns that they are safe, but we know that is not entirely true.

Because lockdowns are relatively new, we don’t know much about their lingering effects on children, parents, and teachers. Following a 2014 school shooting, a New York Times Headline read “In The Age Of School Shootings, Lockdown Is The New Fire Drill.” But is it? Growing-up in the Midwest, I endured plenty of fire and tornado drills and warnings – evacuating the school or kneeling against the wall with my classmates while waiting for the siren to end. These just don’t seem the same as the uncertainty and horror of a murderer with a bomb or a gun.

The day after our school lockdown, children were offered access to crisis counselors. Did the children that most needed support see the counselors? When children did see counselors, was it helpful? More importantly, is offering counseling the best way to help fearful children following a lockdown?

It would be reassuring if we could turn to the research literature to help us design school lockdown procedures and mitigate their potentially traumatic effects. Unfortunately, there is almost no mental health research to guide our efforts. One qualitative study of middle and high school teachers found that while teachers had a thorough knowledge of lockdown procedures, they were not trained in how to adjust their implementation of procedures to account for “the human response to crisis.”

Given the paucity of research about the effects on children’s mental health of school lockdowns, it behooves us as parents and citizens to advocate for greater resources for this area.

For a week following my children’s school lockdown, police roamed the hallways and playgrounds. My daughter was nervous and did not sleep well. My wife and I continued to reassure her. Within two weeks, my daughter’s nervousness had passed. But how about the other 10,000 children in our town?

The Future
This month, my daughter stopped believing in the tooth fairy and experienced her first school lockdown. She started to grapple with the idea that somewhere out there, someone might be trying to hurt her. This month, she surrendered a bit of childhood innocence.

As a parent, I was powerless in the face of someone threatening to harm my children. I did what I could to support my children following a potential trauma, but I do not know if it was enough. And I have no idea about how other children in the community are faring.

Like fire and tornado drills, lockdowns aren’t going away. We may be powerless, but we must not forget our responsibilities as citizens to advocate for research into finding better ways to mitigate the traumatic effects of lockdowns on the mental health of our children, parents, and teachers.


eliot brennerDr. Eliot Brenner is a nonprofit executive with 15+ years’ experience leading program operations and change management in child welfare, mental health, healthcare, and philanthropy.  He is also a licensed clinical psychologist with a private practice. Most recently, Dr. Brenner was Type 1 Diabetes Program Director at the Helmsley Charitable Trust, which is the largest private foundation funder of type 1 diabetes research, treatments, and support programs.  At the Trust, he led staff and strategy for a portfolio of 200+ grants totaling more than $200 million. Prior to joining the Trust, Dr. Brenner was Deputy Executive Director at Casey Family Services, the direct service agency of the Annie E. Casey Foundation. At Casey Family Services, he directed all program operations and training, and led a staff of 290 that served more than 4,000 children annually. Dr. Brenner also worked in the public sector, where he was Chief Consulting Psychologist for the Illinois Department of Children and Family Services. He has published peer-reviewed articles in children’s services and mental health. Dr. Brenner currently serves on the Children's Mental Health Network Advisory Council.

Disproportional rise in student suspensions among Black and Latino students and students with disabilities - Time for a wake-up call

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Morning Zen Guest Blog Post ~ Kevin Dwyer

If you are a teacher and have 20 children in your secondary school classroom and they are representative of the nation’s school population then, statistically one or two of them, will be suspended at least once this school year. Almost universally, suspension means no instruction and no academic learning for more than three (3.5) school days. According to a well documented report titled: “Are We Closing The Discipline Gap? (February 2015 The Center for Civil Rights Remedies) suspension is used arbitrarily, in racially biased ways and that suspension is an unproven disciplinary intervention and doesn’t positively change behavior. In study after study the negative impacts of suspension are evident. 

The report reminds us of the serious impact of suspension on academic learning:  

  • “Loss of classroom instruction time damages student performance. For example, one recent study (Attendance Works, 2014) found that missing three days of school in the month before taking the National Assessment of Educational Progress translated into fourth graders scoring a full grade level lower in reading on this test.”   

A full grade level of lost reading proficiency! This Center for Civil Rights Remedies report also presents the alarming statistic that, in the United States, each year, 180 million days of instruction are lost to exclusionary discipline such as suspension (ibid. page 4). We also know that suspension is correlated with the juvenile justice pipeline to prison, dropping out, lower employment and lower post high school education.     

The “discipline gap” in the title of this report focuses on ethnic, racial and disability disparities in the use of exclusionary discipline of suspension. So, for example, in the 2011-12 school year more than 23.2% of Black high school students were “out-of-school suspended” at least once whereas 6.7% of White students were suspended. Remarkably, 18.1% of students classified as disabled were out-of-school suspended that school year. Latino students are also suspended at higher rates than their White peers.

Students with disabilities who have an individualized educational program/plan fare even worse than their racial/ethnic White peers with IEPs. Black male students with disabilities top the suspension rates with one in three (33.8%) being suspended. One would think that these students with disabilities, particularly those with emotional/behavioral disabilities, would have their behavior properly addressed as a component of their IEPs. Think of the positive impact of group counseling, cognitive behavioral treatment, social emotional learning, individualized instruction and related services that should be incorporated in their IEPs. I have never seen an IEP that had suspension as an intervention or a special education service. Nor have I seen the effectiveness of suspension as an intervention that has been monitored or reviewed. In fact suspension blocks all special education services for the number of days the IEP is not implemented! I know that there are regulations that limit total days suspended for students with disabilities, but those regulations do not address the disparity.     

One surprise for me was the report’s finding that suspension, as a tool for discipline and safe schools has increased over the past four decades. So, Black k-12 students suspensions have moved from 6% in the 1972-3 school year to 16% in 2012-13. Research over those decades has consistently shown that outcomes for suspension are extremely negative for suspended students and also that schools with high rates of suspension are not seen as any safer by either students or staff. 

I am particularly alarmed by these data showing that year after year, up until 2012 there has been an increased use of this failed disciplinary intervention. More alarming is this failed intervention is used disproportionally for Black and Latino students and students with disabilities when so many educators and mental health professionals known that effective alternatives to suspension are available - and have been for decades. Yes, alternatives and effective academic and behavioral techniques might cost a bit more money and would require reframing policies and practices but the status-quo is costing us far more in both dollars and lost populations of students. It is bad practice and a violation of equal educational opportunity for both Black students and children with disabilities. It screams of institutional racism as well as prejudice against the disabled, particularly those with emotional disabilities. 

On the very bright side there are many examples of changes in state laws, district policies and practices designed to address the folly of suspension and its prejudice use. The White House even held a summit on the disparity (see:

The “Are We Closing The Discipline Gap?” report, among others gives school systems, school administrators, staffs and families ways to examine their discipline policies and directs readers to examples of successful initiatives to reduce disparities and suspension rates for all students. You can also find out where your state is on the discipline disparity report card. 



Kevin P. Dwyer, M.A., a Nationally Certified School Psychologist, is an education and child mental health consultant.  He recently served as a principal research associate for the American Institutes for Research. For over 30 years he practiced school psychology in public schools and held several local, state and national leadership positions in the fields of mental health and education, being responsible for the design, development, implementation and evaluation of programs and practices, for improving school climate, safety, and wellbeing for the education, and mental health of children.  He has helped school staff in many districts use data to inform decisions on improving caring and connectedness with students and professional peers.  His work, publications, presentations, and practices have influenced public policy and the development of efficient, family focused collaborative child service systems.  During his 30 years as a public school psychologist he worked directly with over 10,000 children and their families as well as trained over 6000 educators. He provided psychological services to children, including those with disabilities and those whose anxiety and mental health problems blocked learning and adjustment.  He assisted teachers and staff in supporting a caring, inclusive school climate for all children.  In 2007 the Maryland Coalition of Families awarded Mr. Dwyer and his wife for their work in making schools more family friendly.  He served as president of the National Association of School Psychologist and was given its highest honor, the Life-time Achievement Award.  In 2000 he received the Tipper Gore “Advocacy award for improving the lives and mental health of America’s children” from the National Mental Health Association.

Integrating behavioral health with primary care for timely access gets results

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Morning Zen Guest Blog Post ~ COL (Ret) George Patrin, M.D.

The article on integrating care for mental health and substance use problems within primary medical care for children and adolescents, highlighted by SPRC, from the UCLA Newsroom – Health and Behavior Section (Meg Sullivan | August 10, 2015) - "Kids, teens win when mental health providers team with pediatricians, family doctors, UCLA study finds" - is touted as the "First meta-analysis of integrated care for youth (validating) the increasingly popular approach."


The author writes "for the past decade, cutting-edge health care providers and researchers have increasingly pushed to integrate care for mental health and substance use problems within primary medical care for children and adolescents." This statement is true. In fact, insightful practitioners are well aware children have been unable to gain audience with behavioral health colleagues and have been attempting integration since 2000. I know - we were making these attempts during my time in the USArmy. "Their 'hope' is children and teens (suffering) from mental and behavioral disorders (will) fare better if pediatricians (and) family doctors took an active role in linking them with mental health care." This comment smacks of the insinuation that primary care givers haven't been trying to be involved and get such services for their kids. This is usually a perception put forth by the very behavioral health care specialists making themselves unavailable for consult under a guise of being overwhelmed and swamped. With this article, we are supposed to be surprised that "a team of UCLA researchers has studied a wide range of published research on the approach and found that children and adolescents who receive integrated mental health and medical treatment are 66 percent more likely to have a good outcome than those who receive more traditional primary care." I'm sorry, but we needed a meta-analysis study to tell us this?

This 'news' was published by the UCLA in the current issue of JAMA Pediatrics. We have been trying to tear down these silos and get same-day evaluation and treatment for children, rather than send them to the Emergency Room for a crisis evaluation and temporary hold, for 20 years! I weary of continued funds put forth by leading organizations, in this case, the National Institute of Mental Health and the American Psychological Association’s Society for Clinical Child and Adolescent Psychology (31 studies comparing outcomes in an integrated model covering outcomes for 13,129 children and adolescents) and reported on by SPRC, instead of stating what we already know: access works, increasing the likelihood of a positive outcome by putting those funds to work helping practices transform their processes to same day, integrated care. "The take-home message is that integrated care works,” said lead author Joan Asarnow." Duh. True, "we have a huge mental health problem in this country.”

The authors point out “(in primary care) mental health was often not addressed, or if it was, patients were referred to a mental health specialist, and the child’s health insurance determined whether or not the child had access to the mental health specialist as well as the quality of that care.” A study on why insurance companies are violating the 2008 Parity Law withholding care would be a better use of these research dollars. Hopefully, times ARE changing, but only if we stop allowing mental health coverage by insurance providers to be inadequate. Remove hurdles primary care doctors have faced in joining forces with psychologists, psychiatrists, and social workers by changing our entire appointment and referral processes and take the insurance companies totally out of these decisions. Period. 

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george patrinCOL (Ret) George Patrin, M.D., spent over 23 years as an Army Pediatrician and Healthcare Administrator concentrating on Family Advocacy and Healthcare Process Improvement. His final assignment was as Northern Regional Command Special Projects Officer for Patient-Family Centered Healthcare assisting in writing DoD Patient Centered Medical Home (PCMH) Guidelines and Training. He has been a staunch advocate for both soldier and family member readiness and timely access to health care throughout his military career. He is a sought after speaker on parenting education, child abuse prevention, school learning and behavior problems, and healthcare administration optimization. Dr. Patrin is a member of the Children's Mental Health Network Advisory Council. He can be contacted at

RAISE-ing some Questions

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Morning Zen Guest Blog Post ~Wayne Munchel

All the media hubbub surrounding the recent publication of the RAISE study has been somewhat confusing. A sampler of headlines includes; Game Changer? (HuffPo); New Approach Advised to Treat Schizophrenia (New York Times); New York Times Issues Correction on RAISE Study Report; Landmark Study Recommends More Therapy etc…

What is one to make of all the fanfare and conflicting commentary? One of the central conclusions from the study is that providing personalized medication management, family education, recovery-oriented talk therapy and supported employment and education produced modestly better outcomes than treatment as usual (TAU) in a two-year period. This is not exactly a hold the phone!, stop the presses! kind of revelation. The deflated response from many providers in psychiatric rehabilitation and Recovery model programs has been; “now we know what we already knew”. Connecting with people experiencing psychosis, helping them to find hope and meaningful roles at work, school, and the community is what we’ve been doing for the past 25 years. It’s nice to be validated and to have research dollars focused on non-medical interventions. The Recovery model has long recognized that symptom-reduction and meds alone seldom result in recovery.

The breathless announcements may also provide a sad perspective on the abysmally low bar for treatment (TAU) of psychosis in the U.S. It is disgraceful that the predominant treatment for too many people in extreme distress remains meds only. Perhaps the RAISE findings can be seen as an encouraging step away from the entrenched medical model that reduces so much human suffering into diseases that can be successfully medicated away.

If the RAISE study can begin to alleviate some of the pervasive hopelessness and helplessness regarding this “death sentence” of a psychiatric diagnosis, it will be worthwhile. I’m referring to the hopelessness and helplessness among the youth being diagnosed; among their families and the professional staff hired to help them; and amongst the general public. Recently there has been high levels of fear added to this pernicious stigma, due to the exploitive linkage of mass killings and “untreated mental illness.” When you come to the understanding that psychosis is solely a chronic, relapsing brain disease requiring life-long medications with many adverse side-effects – it is tough to remain optimistic. One can speculate that the high drop-out rates encountered in the RAISE study could be partly due to this approach. Informing youth that they have a chronic brain disease is probably not a winning engagement strategy.

There are several studies that raise significant questions about the RAISE emphasis on youth taking neuroleptic medications indefinitely and consenting to long acting injectables (LAI’s). Studies on the long term outcomes of people who remain on neuroleptics are exceedingly poor. When Martin Harrow conducted a long term, naturalistic study (2013) of a group of people who remained on anti-psychotics, he found striking contrasts between the group who continued taking them (5% functional recovery) versus those who discontinued or substantially reduced them (40% functional recovery). In a randomized control trial (RCT), Wunderink (2014 ) reported a 40.4% recovery rate among med discontinuers vs. 17.6% of those who remained on them after seven years. According to a study by Bola ( 2003), 40% of people diagnosed  with psychosis can be successfully treated  without the use of anti-psychotics.

The hope of early intervention efforts is to alter the all-too-common trajectory of youth diagnosed with psychosis from entering a life-time of disability and poverty. There appears to be substantial evidence that indicates that the use of neuroleptics may actually hamper recovery in the long term. (When a participating psychiatrist in the RAISE study (Sandra Steingard) asked “when is a good time to try stopping the meds?”, the stark answer she reports was; “NEVER”.) Based on the available evidence, shouldn’t there be explicit, planned “exit ramps”, careful tapers off the neuroleptics to evaluate whether they are still needed and helpful? (abrupt cessation may induce an intense “psychosis rebound”.) For instance, the Early Assessment and Support Alliance (EASA) approach to psychosis in young people living in Oregon recommends an automatic med discontinuation/re-assessment in one year.  

Before the RAISE model becomes firmly enshrined as the best practice for early intervention psychosis in the U.S., (NIMH reports already taking steps to implement RAISE elements), a deeper, longer term analysis seems in order. The RAISE study will continue for an additional three years, and this would be a crucial variable to investigate further in the coming years. Slowing the rush to premature adoption appears warranted. Researching and reporting on other promising practices, such as EASA and Open Dialogue, should also be supported. 


1. Bola, J., Lehtinen, K., Cullberg, J., & Ciompi, L. (n.d.). Psychosocial treatment, antipsychotic postponement, and low‐dose medication strategies in first‐episode psychosis: A review of the literature. Psychosis, 4-18.
2. Bola, J., & Mosher, L. (n.d.). Treatment of Acute Psychosis Without Neuroleptics: Two-Year Outcomes From the Soteria Project. The Journal of Nervous and Mental Disease, 219-229.
3. Harrow, M., & Jobe, T. (2013). Does Long-Term Treatment of Schizophrenia With Antipsychotic Medications Facilitate Recovery? Schizophrenia Bulletin, 962-965.
4. The Recovery After an Initial Schizophrenia Episode (RAISE) Study: Notes from the Trenches. (2015, November 4). Retrieved November 9, 2015.
5. Wunderink, L., Nieboer, R., Wiersma, D., Sytema, S., & Nienhuis, F. (n.d.). 5:30 Pm Recovery In Remitted First-Episode Psychosis At 7 Years Of Follow-Up Of An Early Dose Reduction/discontinuation Or Maintenance Treatment Strategy. Schizophrenia Research.
6. Wunderink, L., & Sytema, S. (2014). Early Medication Discontinuation on Long-term Recovery Outcome in First-Episode Psychosis—Reply. JAMA Psychiatry,208-208.

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munchelWayne Munchel, LCSW is a leader in mental health programs designed for transition age youth. He was also a founding staff member of The Village, an innovative recovery program located in Long Beach, CA. Mr. Munchel provides trainings and consultations for services to young people, including trauma informed care and supported employment.

Saving Congressman Murphy from Fraudulent Information

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 Morning Zen Guest Blog Post ~ Dennis Embry

Shakespeare writes eloquently about the dangers of flattery and lies to great leaders. I’ve worked in Congress for Gerry Ford and Bob Dole, for Secretary Cheney during the Gulf War, various governors, and legislatures and at high levels for other national or provincial governments. Lies and fraud are often delivered in fat envelopes of flattery. I’ve come to realize that the very good intentions of Congressman Murphy to fix an obviously not-working mental health prevention, intervention, and treatment “system” has caused him to be swarmed by a flock of flatterers flogging fraudulent “facts.” Honest-to-God facts are the hardest thing for great leaders to get their hands on, for great decisions. This is why in all my counsel to leaders, as a scientist, is couched carefully and grounded in facts as best I know, even if I know the leader—of whatever party or persuasion—may or may not like it. Otherwise, a great leader cannot make a great decision.

Thus, I wrote a letter to Congressman Murphy, who is obviously a leader for issues of mental health, at the behest of my colleague. My letter was delivered to him personally, and I share much of it here. The more I thought about the pickle the Congressman is in—surrounded by people either flattering him or yelling at him—the more compassion I have for him as a human trying thread his way through the siren songs. So I ask that faithful readers of Children’s Mental Health Network hold their judgments lightly as you read this letter.


Dear Congressman Murphy:

I am writing you at the urging of a colleague who is quite familiar with my work as child-psychologist and scientist bringing evidence-based practices and programs up from high-quality research studies to real use in the United States, Canada, and Europe. You may or may not know I am the person, behind the scenes, who helped Brian Stettin from the Treatment Advocacy Center get AOT on the NREPP list directly and indirectly, by contacting the people who do the work at NREPP.

Congressman, I wish to be blunt, based on verifiable facts that can be checked out. That is always my mode when I worked for Secretary Cheney as a GS-15 during the Gulf War, when I have done work for governors or their cabinets of different political parties, policy groups or foundations. Too often people slant “info” in such a way to obscure the truth for their own ends. I will give you the objective facts that you can verify, and you can be the judge of the veracity of the data.

I am specifically writing you about erroneous, false information you’ve been given about the National Registry of Evidence Base Programs and Practices. That erroneous information is likely to cause serious problems, which have been withheld from you.

You were led to believe that only four (4) evidence-based programs out of 300 were for seriously mentally ill persons. Seriously mentally ill (SMI) is not a DSM label; it’s a legal definition, such as found in state agencies found services (e.g., Oklahoma).[1] Now, what are the DSM disorders that meet the legal definition of SMI? Here are the actual DSM diagnoses that can meet the legal definition of SMI:

  • Schizophrenia
  • Paranoid and other psychotic disorders
  • Bipolar disorders (hypomanic, manic, depressive, and mixed)
  • Major depressive disorders (single episode or recurrent)
  • Schizoaffective disorders (bipolar or depressive)
  • Pervasive developmental disorders
  • Obsessive-compulsive disorders
  • Depression in childhood and adolescence
  • Panic disorder
  • Post-traumatic stress disorders (acute, chronic, or with delayed onset)
  • Bulimia Nervosa 307.51
  • Anorexia Nervosa 307.1

No one told you to look up some of these actual DSM definitions on NREPP. If they had, you would have found many more actual evidence-based practices on NREPP out of the 300 listed related to major mental illnesses. I have attached PDF’s for several such searches: bipolar (6), schizophrenia (18), and psychosis (4). These name searches are underestimates of actual powerful evidence-based practice that are absolutely proven to affect major mental illnesses. The reason is that some of the randomized trials or other high-quality studies have major results on the legal diagnoses for SMI, yet be missing from the search just because the web-search engine cannot reach into the actual scientific articles, only the limited number of descriptors provided by the authors or drafts of the NREPP posting. For example, the single most powerful evidence-based strategy (randomize control, longitudinal study) to reduce relapse/re-hospitalization from psychosis in the scientific literature to date is on NREPP [1, 2]. Could the search engine logic be improved? Probably, as such things are moving targets based on software and artificial intelligence.

It gets worse, how you were misled. As a clinical psychologist who has worked with military vets, I know that you know that substance abuse figures powerfully some of the most violent, fatal events related to persons with serious mental illnesses. In fact, multiple studies show that serious violence involving major mental illnesses that makes headlines rarely happens without significant substance abuse and early history of aggression. One of these cases is personally well known to me that of Jared Laughner, which I am happy to detail to you. The very, very best strategies in the world to prevent or treat substance abuse are NREPP; and the very, very best proven strategies in the world to prevent or treat aggressive behaviors are on NREPP.

Witnesses to Your Committee
Your witnesses were disingenuous for reasons I cannot fathom. For example, on May 29th, 2014, D.J. Jaffe provided both written and oral testimony on HR 3717 (the precursor to HR 2646), at a briefing by the Energy and Commerce Oversight and Investigations Subcommittee Majority Staff, that there was no evidence for the prevention of serious mental illness, as a criticism of SAMSHA. Oddly, he cited the 1994 Institute of Medicine Report [3], not the 2009 Institute of Medicine Report [4]. The 1994 IOM Report said there was only suggestive evidence that mental, emotional, and behavioral disorders might be prevented; the 2009 IOM report was clear on pages 1-2 that mental, emotional, and behavioral disorders ARE preventable including the most serious ones, but not in every case—just like cancer. Please note that DJ Jaffe is neither a scientist nor a licensed clinician, and Mr. Jaffe has never published a peer-reviewed scientific study on either the treatment or the prevention of mental illness. All this would have been quite different if you had called key members of the 2009 IOM members, such as acclaimed psychiatrist William R. Beardslee or the equally famous psychologist, Anthony Biglan. These are witnesses with powerful, randomized control studies that neither Mr. Jaffe, nor even Dr. Torrey has remotely achieved in terms of treatment of mental, emotional, or behavioral disorders who were witnesses who were so caustic in your hearings. In fact, Dr. Torrey has never been the first author of any randomized control trial or even quasi-experimental study of either the treatment or the prevention of serious mental illnesses. All of this is easily verified by a search of the National Library of Medicine at Dr. Torrey is most famous for his studies on the role of Toxoplasma Gondi in schizophrenia, a parasite carried by cats that can infect humans and cause schizophrenia.

Submissions To NREPP
The terrible misdirection has been perpetrated on you, Congress and American citizens in other ways. Two examples come to mind.

First, government agencies like SAMSHA and the FDA don’t pick which evidence-based programs or medical devices or drugs get submitted to NREPP or the FDA. The inventor/ company/ scientist(s) must initiate the submission. The reason AOT was not on NREPP was because nobody with authentic skin in the game had ever submitted it for review, until I agreed to help Brian Stettin at the Treatment Advocacy Center. There are probably hundreds of things in the scientific literature that a good and should be on the list, but they do require a proven dissemination and training mechanism to get a good grade and the scientist(s) or entity responsible for submitting it. Now, AOT is on the list, though its scientific evidence-base is not as robust as Dr. Torrey and others lead members of Congress to believe or their messaging to the general public would support; one only need to review the politically and scientifically neutral Cochrane review [5]. Successful AOT depends on the quality of T (treatments), and the NREPP list is chock-a-block full of exceedingly well-proven strategies to ramp up successful treatments. They could be indexed better arguably, but that is a software/conceptual user problem that the contractor for any such list has to work on.

In the second example, both Mr. Jaffe and Dr. Torrey either explicitly stated or implied that major mental illnesses cannot be prevented, as an indictment of the Congressionally mandated block-grant efforts of SAMSHA and its contractor, NREPP. Ironically, Dr. Torrey’s non-profit that he directs, the Stanley Medical Research Institute, funded the single most scientifically proven strategy to prevent first episode psychosis—with effects over the span of seven (7) years [6-8]. How powerful is this strategy? You be the judge from the Randomized Control Trials that I presented as a graph to the most recent national conference on mental health research in Tampa:


Theoretically, this ridiculously low-cost strategy with huge epidemiological underpinnings documented by the National Institutes of Health could avert tens of thousands of first episode psychosis each year. Now, I am very troubled by the fact that Dr. Torrey refuses to submit this to NREPP, and I have begged him to do so with the promise of the full cooperation of the National Institutes of Health researchers who have been doing deep research on this, including with military service members funded by DOD. I have begged Dr. Torrey to submit this to NREPP, as he is the only person who can since the actual investigator is not an American citizen. Only American researchers can submit to NREPP, and Dr. Amminger, who was funded by Dr. Torrey, is not a US citizen. The potential impact of this study is huge, based on the fact that Dr. Insel from NIMH notes that 500,000 cases of first episode psychosis happen each year in the U.S. In theory, this simple strategy that costs about $15 could avert about 100K to 150K cases of first episode psychosis per year. I am happy to provide you with the correspondence I have had with Dr. Torrey. If funders or investigators DON’T submit to NREPP, powerful strategies for major mental illness cannot be known to providers or policy makers in government or the private sector. Dr. Torrey cannot blame SAMSHA and NREPP for this powerful prevention strategy for major mental illness for not being on NREPP, because he refuses to submit it or allow others to do so. I am puzzled, therefore, why the committee relies on his expert testimony. Presently, I am in discussion with other scientists at the National Institute of Health who are doing powerful research on omega-3 that Dr. Insel is aware of, so that NIH scientists might do the deed that Dr. Torrey has not.

Mr. Jaffe has been critical of NREPP for not reviewing medication regimens, both in public and personal communications with me—which I am happy to share with you. This is most peculiar, as SAMSHA has no statutory authority from Congress to have oversight of drug treatments. As you know, FDA approves medications, but not necessarily off-label or drug-treatment cocktail regimens. Mr. Jaffe insisted that NREPP should do so in private communications with me, and it was their “fault” for not doing so. These regimen studies are often published in medical journals, indexed in These drug-cocktail regimens as best practices would have to have new authority, and would raise many, many questions—given that the Wall Street Journal documented that 40.4 million children out of 75 million received one script for psychotropic medications in 2009 [9].

Potential Policy and Practice Chaos by Undoing NREPP
It’s wise to remember that medicine is failed prevention. What you don’t know, nor does your committee, is that grantees and states are supposed to use powerful, evidence-base practices and programs from NREPP for both treatment and prevention with block grant dollars. The notion that few powerful treatment protocols for “serious mental illnesses” are on NREPP is easily proven false, that a journalist intern could discover—if he or she did the proper homework. Your committee was misled for reasons I cannot comprehend, and I can assure you that I have personally trained hundreds if not thousands of grantees, providers, and state administrators in practices on NREPP to treat, reduce or prevent serious mental illnesses, often paid to do so by SAMSHA. (And SAMSHA folks will tell you I can be a thorn in their sides about this and other scientific, dissemination and policy issues). That does not mean providers use these powerful, proven strategies to treat, reduce, or prevent serious mental illness. If they did so, I wouldn’t be writing this letter.

The real issue is that the proposed legislation and existing legislation by Congress has created perverse incentives for NOT adopting these evidence-based practices. Creating some new entity to review and promote scientifically proven prevention, intervention, and treatment strategies will just foster bureaucratic mania with no change. Believe me, as I was the co-author of the largest single per-capita ($25 million in Wyoming) legislation and appropriation for the use of evidence-based practices ever adopted in the United States [7, 8]. That number is ½ of the dollar proposed in the bill for the whole country for AOT.

I would love to converse with you about the research on getting providers to adopt evidence-based practices for mental-emotional and behavioral disorders. That is the real problem, not the lack of them on NREPP or for current or proposed legislative remedies. We don’t have a scientifically, experimentally driven policy for getting providers to adopt evidence-based practices. These are issues that my colleagues have written about in the prestigious Brain and Behavioral Sciences Journal [10] as well as in the American Psychologist [11]. My paper for the special issue of Psychiatric Clinics of North America on implementing the 2009 evidence-based strategies from the IOM Report [4] on mental illnesses details key proven principles for a large-scale, successful public health model [12], which is what is needed given the huge rise in prevalence rates of mental, emotional, behavioral disorders happening that is documented in the 2009 IOM report and other data by the Agency for Health Care Research and Quality [13, 14].

You may know that Brian Stettin recommended that people visit the star AOT site in the U.S., Hamilton, Butler County, OH. I did so at my own expense. As you know, AOT’s benefits really arise from the “T” (treatment) and less from the AO. By American standards, the operation of the AOT project in Hamilton, OH was a gem. I’ve written a detailed report about it. They naturally relied on a lot of drug-court training to do it, which the presiding judge confirmed. They were kind, gentle and helpful using excellent therapeutic language and processes.

That said, their AOT effort lacked a whole bunch of evidence-based procedures that would have made their outcomes more efficient and effective, which are in fact listed on NREPP that I’ve trained sites to do. Almost all of the patients in the system have significant addictions, yet they were not using NIDA’s most scientifically proven and cost-efficient way to treat addictions and to improve overall engagement ( in the multiple, needed therapeutic services and activities being “assisted” by the court. Folks with serious mental illnesses are notorious for have\ing procedural errors (I know from first-hand experience working with even high-IQ folks with serious mental illnesses) at follow-through tasks, which is compounded if they are co-morbid for substance abuse. Dr. Petry’s studies cited in NREPP are helpful with that, especially when coupled with goal and behavior mapping found in Life Goals Collaborative Care (LGCC) also on NREPP, which is explicitly and successfully designed to treat serious affective and mania episodes.

No-Cost or Low-Cost Solution
Much of the problem you encountered in searching NREPP is simply a software problem of search terms, which could be fixed by the new NREPP contractors. That’s a management and software programming issue; it’s not a Congressional legislative issue. Looking up “serious mental illness” without a “Google Thesaurus” of terms is likely to have reduced returns, not because malice.

If the bill passes as is, there is a probability of huge chaos among the states, their rules and regulations for sub-awards. Almost all states require the use of NREPP strategies for treatment, intervention, and prevention—which are embedded in state and local laws, regulations and policies. Of course, some strategies are better than others. That can be addressed. If, however, the Congress requires a wholly new review of evidence-based practices, that will take at least three years to do. The states and providers will be left in chaos, and more patients and clients with all manner of problems that can lead to bad headline news.

How To Get More Treatment Strategies on NREPP
Testimony to your committee alleges that SAMSHA somehow blocks submissions of powerful programs to treat major mental illness. That might make a good TV; it is not true. SAMSHA cannot place things on NREPP. Investigators and developers like me must submit SAMSHA, just like a drug company must submit to FDA. It’s not just the research finding that is required; it is a powerful dissemination system that has to come with the request. Otherwise, people can simply search for good ideas, which have research but are not commercially available. Dr. Torrey is the key to submitting to NREPP for his funded project for the prevention of first episode psychosis. I cannot, nor can the administrator of SAMSHA any more than the head of FDA or a member of Congress submit a drug to an FDA review panel.

What can Congress do? I suggest that the legislation be amended to require SAMSHA to have several “calls” in the federal register each year (say quarterly) for proven strategies to resolves important prevention, intervention, and treatment issues. Further, most academics have little or no skill in bringing proven strategies to market that might significantly avert or treat major mental illnesses. Dr. Torrey, himself, is an excellent example of failure to bring his practical treatment protocol to national use. Perhaps, NIH and other federal grantees might be required to have training and coaching for how to bring powerful mental, emotional, and behavioral prevention and treatment protocols to NREPP registration and market—which is beyond SAMSHA’s charter.

Congress might even require that grants have a better plan for product dissemination (not just scientific dissemination) that is presently embedded in grant announcements and rules across the departments of the federal government that fund research and practices related to the prevention of mental, emotional, behavioral and related physical disorders. Publishing a scientific article is good for tenure at universities, but it is not a potent product or service in the hands of providers and consumers. I know this very well, as an entrepreneurial scientist who has brought multiple well-proven strategies to population-level scale. This is why we’ve started the First Carbon Based Valley initiative (not the Next Silicon Valley) to develop proven, practical prevention, intervention and treatment strategies that can be scaled nationally (and internationally) as cost-effective products. The reason we call this the Carbon Based Valley Initiative is that our largest problems in society are other humans, which are all based on carbon atoms. Your bill is not about silicon transistor health; it’s about human mental health.

Congressman Murphy, I am happy to converse further about ways to improve the bill because of your noble intent. Scraping NREPP for a wholly new review won’t achieve your aims, as the rationale was based on completely misrepresented information to you and your committee. It is easy to fix your concern, without creating utter chaos in the states or providers with their allocations of funds based on reasonable long-term parameters, even though those parameters can be improved.

Note: Correction made clarifying DJ Jaffe testimony, adding CSPAN video and written remarks.


  1. Bach, P. and S.C. Hayes, The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. Journal of Consulting & Clinical Psychology, 2002. 70(5): p. 1129-1139.
  2. Bach, P., S.C. Hayes, and R. Gallop, Long-Term Effects of Brief Acceptance and Commitment Therapy for Psychosis. Behav Modif, 2011.
  3.  Mrazek PJ and H. RJ, Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. 1994, Institute of Medicine.
  4. O'Connell, M.E., T. Boat, and K.E. Warner, eds. Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults: Research Advances and Promising Interventions. 2009, Institute of Medicine; National Research Council: Washington, DC. 576.
  5. Kisely, S.R. and L.A. Campbell, Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Schizophr Bull, 2015. 41(3): p. 542-3.
  6. Amminger, G.P., et al., Long-Chain {omega}-3 Fatty Acids for Indicated Prevention of Psychotic Disorders: A Randomized, Placebo-Controlled Trial. Arch Gen Psychiatry, 2010. 67(2): p. 146-154.
  7. Amminger, G.P., et al., Longer-term outcome in the prevention of psychotic disorders by the Vienna omega-3 study. Nat Commun, 2015. 6: p. 7934.
  8. Amminger, G.P., et al., Predictors of treatment response in young people at ultra-high risk for psychosis who received long-chain omega-3 fatty acids. Transl Psychiatry, 2015. 5: p. e495.
  9. Mathews, A.W., So Young and So Many Pills: More than 25% of Kids and Teens in the U.S. Take Prescriptions on a Regular Basis, in Wall Street Journal. 2010, The News Corporation: New York.
  10. Wilson, D.S., et al., Evolving the Future: Toward a Science of Intentional Change. Brain and Behavioral Sciences, 2014. 37(4): p. 395-416.
  11. Biglan, A., et al., The critical role of nurturing environments for promoting human well-being. American Psychologist, 2012. 67(4): p. 257-271.
  12. Embry, D.D., Behavioral Vaccines and Evidence-Based Kernels: Nonpharmaceutical Approaches for the Prevention of Mental, Emotional, and Behavioral Disorders. Psychiatric Clinics of North America, 2011. 34(March): p. 1-34.
  13. Soni, A., The Five Most Costly Children's Conditions, 2006: Esitmates for the U.S. Civilian Non-nsitutionalized Children, Ages 0-17., A. Center for Financing, and Cost Trends, Editor. 2009, Agency for HealthCare Research and Quality: Rockville, MD. 20850. p. 5.
  14. Soni, A., The Five Most Costly Children's Conditions, 2011: Estimates for U.S. Civilian Noninstitutionalized Children, Ages 0-17, A.f.H.R.a. Quality, Editor. 2014, Agency for Healthcare Research and Quality: Washington, DC.

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Dennis Embry, President/Senior Scientist at PAXIS Institute – Dennis D. Embry is a prominent prevention scientist in the United States and Canada, trained as clinician and developmental and child psychologist. He is president/senior scientist at PAXIS Institute in Tucson and co-investigator at Johns Hopkins University and the Manitoba Centre for Health Policy. His work and that of colleagues cited in 2009 the Institute of Medicine Report on The Prevention of Mental, Emotional, and Behavioral Disorders Among Young People. Clinically his work has focused on children and adults with serious mental illnesses. He was responsible for drafting of the letter signed by  23 scientists, who collectively represent scores of randomized prevention trials of mental illnesses published in leading scientific journals. In March 2014, his work and the work of several signatories was featured in a Prime-TV special on the Canadian Broadcast Corporation on the prevention of mental illnesses among children—which have become epidemic in North America. Dr. Embry serves on the Children's Mental Health Network Advisory Council.

Alternatives Conference Update: Not the three-eyed monster some would report

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The Alternatives Conference, now entering its 29th year, was at the center of controversy last year in the often heated debate around the Helping Families in Mental Health Crisis Act (for brevity, we will refer to this as the 'Murphy bill'). Comments about the conference were often vitriolic, and the name 'Alternatives' was highlighted as an example of wasteful spending by SAMHSA. Conference workshops were chastised for being irrelevant to the needs of individuals with mental illness, and a poor excuse for the sharing of far-fetched treatment and support options for individuals with mental illness.

Alternatives Conference dragged through the mud in Wall Street Journal article
Before two weeks ago, I had never been to the Alternatives Conference. In fact, I had never heard of the Alternatives Conference until a little over a year ago when the Wall Street Journal published a scathing Op-Ed article that slammed the conference as an example of why SAMHSA needed to be reorganized and the Helping Families in Mental Health Crisis Act needed to be passed.

The examples in the Op-Ed piece came across as so egregious as to make anyone wonder how in the world public dollars could be invested in such an endeavor. Of course, after doing just a bit of digging, the truth of the matter became crystal clear. You can read my detailed analysis of the accusations made here.

And now, entering the month of November, the faulty rhetoric about the Alternatives conference is coming out again, both by politicians and pundits alike. Not coincidentally, the vitriol is picking up just as the House Energy Committee begins markup of the Murphy Bill today.

When I wrote the first Morning Zen post on Alternatives, I had to rely on researching the workshops and events at the conference from afar. Now, after attending the 2015 conference, I can write from first-hand experience. Which, by the way, is something I would encourage anyone who writes about the Alternatives Conference in the media to do. Nothing like seeing it for yourself to lend some credibility to your argument.

When I first arrived at the venue, I was greeted warmly and encouraged to take advantage of the many opportunities available. The atmosphere reminded me of the type of family gatherings I remember in the early days of the Federation of Families for Children's Mental Health. For those not familiar with the Federation, in the early days, conference participants included a small number of state and local officials, a few therapists, federal folks, but overwhelming families - many who had never been to a conference before. For those families, attending an early Federation conference was an empowering and legitimizing experience. I had not had that feeling in years until I walked into the convention hall at the Alternatives Conference. This was family. Not necessarily my family (the children's mental health world), but that didn't matter. It was family, and I was welcomed in wholeheartedly.

The workshops were varied and interesting. There was one activity session that sticks in my mind as a poignant metaphor for much of the vitriolic diatribe against this conference. The activity session went most of the day and was designed to engage any participants who wanted, to come in and draw, paint, or do other arts and crafts. I have no idea of the personal stories of the people in the room, but my guess is that many were in various stages of recovery themselves.

This is the type of session that politicians and pundits have railed against as an example of wasteful spending. It is beyond sad how wrong they are.

Watching the joy and activity in a room that felt so safe, I was reminded of my early days in this field, working on a locked ward, running a very similar activity with individuals with the most serious mental illnesses. In that setting, establishing opportunities for normalcy were an important part of the therapeutic milieu. Here, at this conference for individuals in recovery, similar principles were at play. From this most basic level on up, the theme appeared to me to be, you are valued, you are important, you belong.

I have talked to many of the most vocal proponents of the Murphy bill, particularly around the AOT debate. Unfailingly, when away from the spotlight of politics, they have told me that what they would have hoped for most for their child was that they could live in a community that valued them, helped them feel important, helped them feel like they belong.

Another moment from the conference that stands out for me was my interaction with a woman at one of the luncheons. We were sitting at the same table, and as part of the typical introduction, I asked the "What do you do?" question. Her story was amazing. Now the head of a small drop-in center, she recounted to me her many years of going in and out of hospitals, but finally, through a combination of accurate medication and strong family and community support, was able to regain her equilibrium, and eventually start the drop in center. Her goal with the center? Simple - to make space available to those who need a bridge between the most intensive type of service and the life of full independence they one day hope to achieve.

There was so much love and compassion that came from this woman. I asked her if she knew anything about the Murphy bill. "Nope, never heard of it," she said. "You mean like Murphy's soap?" I chuckled and said no, not like the soap. I explained to her that there has been an ongoing discussion about improving mental health services in America, and this was one of the bills that was currently being developed in Congress. I asked her what she would hope for most in a mental health bill. She said, "I don't get too involved in politics, so I don't know. All I know is that there has got to be some place safe for people to go when they get out of the hospital, so they don't have to go back."

Truer words were never spoken. What continues to get lost in the debate about the Murphy bill is that the two ends of the continuum of services for individuals with serious mental illness need each other. It would be unwise just to focus on increasing psychiatric beds and forcing treatment, just as it would be unwise just to focus on recovery. The fact is that there will be times when an individual needs services of the highest intensity. But to only focus on the most intensive services, while at the same time deriding the recovery movement that is there waiting to embrace the individual with serious mental illness and welcome them back into the community, is just plain foolish.

So there you have it, Network faithful. I can now say I have been to the Alternatives Conference. No, it's not the three-eyed monster that it gets portrayed as in the press and the halls of Congress. In my eyes, the conference appears to be one big family reunion of dedicated, compassionate individuals who are trying to make a difference for themselves and those around them. The people attending this conference are not politicians, policy wonks, and high paid lobbyists. They are the people of America.

Congressional members of the House Energy & Commerce Committee might want to remember that as they prepare their speeches for the markup session today and tomorrow.

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Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

Parents: Kids Spurn Emotional Help For Fear ‘They Might Think I’m The Next Shooter’

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Morning Zen Blog Post ~ Lisa Lambert ~

“He doesn’t want to take the risk and have someone think he could be a shooter,” one mother said, “just because he has a mental health diagnosis.”

I was at a meeting with other parents whose children have mental health needs. This mother told us her son was reluctant to leave his high school classroom for an important evaluation, which included psychological testing.

Like much of America, we were talking about the recent and not-so-recent shootings on campuses and in communities across the country. For this mother, as with many parents whose children have mental health issues, the conversation is far more personal and troubling than for most.

Some parents said that in response to recent shooting incidents, their children are dropping out of services or refusing school supports so they won’t risk their peers or teachers finding out why they get treatment.

As a parent, this breaks my heart. Young adults shouldn’t have to choose between the safety found in avoiding treatment and the healing found in seeking it.

During our discussion, another mother reported that her son was in his first year of college and struggling to complete all his coursework. Freshman year is a stressful time for many students and even more so for students with depression. Because her son had had special education services in high school, he could access supports there to help him manage his academic and emotional stress.

She encouraged him to go to the college student services office to get help. He responded, “I’d rather drop the classes I am most behind in. If I go there, the professors and other students will know I have mental health problems. They might think I could be the next shooter.”

Often, as a news channel covers the latest shooting, the speculation immediately jumps to mental illness. While the station waits for details or settles in before the next briefing from local officials, the link between the troubled shooter and mental illness is made and strengthened, often with scant evidence.

Sometimes that link is real. In our hearts, many of us feel that a person’s mental health has to be compromised to take the lives of others. The search for signs of mental illness is on with an unspoken conviction that this must be the tipping factor which led to violence.

Young people with mental health issues watch the same news stations, read the same news-feeds online and see the same tweets as the rest of us. Their families (and I am one of those parents) do, too. In recent weeks, I’ve been hearing repeated reports that one effect of that news is to prompt some young adults to turn away from treatment and services because they are worried about being eyed with suspicion. They would rather take the chance that their depression, mood swings or even psychosis could worsen than risk the judgement that can result from other people hearing about a diagnosis.

According to a 2012 survey by the federal Substance Abuse and Mental Health Services Administration, nearly 20 percent of young adults ages 18-25 have a diagnosed mental illness. In that same age group, almost nine percent have experienced a major depressive episode, and over seven percent have had thoughts of suicide in the past year.

Yet more than half of those with a diagnosable illness are not receiving treatment. In addition, dropout rates from outpatient mental health services are high in young adults, and they are far more likely to drop out of treatment than mature adults.

Decisions about whether to seek treatment for mental health issues continue to be strongly impacted by stigma. This is especially true for teens and young adults who are discovering what their minds can do and how their moods affect them. They are often reluctant to accept treatment. Mental health care works best when the person needing help feels engaged and can give the treatment enough time to work.

Now we have additional stigma, which is affecting young adults more than any other group. Because they are young, they can often benefit greatly from treatment. Yet some see the very care that might help them as a neon arrow pointing at a “risky” student.

In our haste to talk about the incredibly small group of young adults, often young men, who have access to guns, who decide to use those guns and, yes, may have mental health problems, we must not forget the very large group of young people who also have mental health problems and will never make those choices.

They live in a time when the options for treatment are expanding and often can be tailored to their needs and their lives. They might find short-term services, medication, traditional therapy or nontraditional approaches suit them best. What we need to do for them is encourage them to find what works for them, not eye them with suspicion.

Congress is considering mental health reform. New approaches for treatment of first-episode psychosis (when patients, usually in their late teens or early 20s, have a first break with reality) have caught public interest. Talking about mental illness can lead to positive changes and shrink the gap between identifying a need and getting care.

It’s unlikely we will stop wondering what drives a young person to become a mass shooter. It’s unlikely we will stop thinking there must be something like a mental illness that made him decide this option was okay. It’s allowing that conversation to stop young people from seeking treatment that worries me.

Note: This post appeared this morning on WBUR, Boston's NPR News Station. Way to go, Lisa!

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lisaLisa Lambert is the executive director of Parent/Professional Advocacy League (PPAL) and a Children's Mental Health Network Advisory Council member. Lisa Lambert became involved in children’s mental health as an advocate for her young son in 1989 through the CASSP family network in California. After moving back to Massachusetts, she began supporting families whose children and youth had behavioral health needs. Her areas of expertise include mental health policy, systems advocacy and family-driven research. Lisa is a nationally recognized blogger on family advocacy for children's mental health. You can read her blog posts here.

I was an antipsychotic zombie

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Morning Zen Guest Blog Post ~ Edward Opton

For Halloween, I bring you a personal recollection from a person well known to me.  My friend wrote:

Some years ago, I was, for one day, an antipsychotic zombie. It was an eye-opener that I shall never forget.

At the time, I was a clinical psychology intern working in a university-affiliated hospital. Salesmen's drug samples were a common sight, lying about on desktops and discarded in wastebaskets. I thought I should know what my patients were experiencing. I picked up an "antipsychotic" sample pill, peeled off the plastic wrapper, and swallowed it.

Eighteen hours later, I understood why people use the term "zombie" in connection  with "antipsychotic" drugs. I had not yet heard "zombie" used that way, but when I did, I understood to a degree that would not have been possible without the personal experience.

The "antipsychotic" rendered me almost as immobile as if I were dead, but I was awake, my mind slowly meandering in repetitive, uncontrolled directions, unable to focus on anything in an organized way, not even "get up--your bladder is full--you need to pee." I could think that thought, in fact I couldn't stop thinking it over and over and over, but my brain seemed to be disconnected from the muscles that had to move to get me off the couch and into the bathroom. It felt as if the connections between brain and body had been severed. I had become what is now known as a "couch potato."

Had I been an acutely disturbed psychiatric patient, I would have been rated "much improved," for I was exhibiting no symptoms of mental unbalance. I was not bothering anyone. I was not wandering, complaining, threatening, whining, boasting, talking incomprehensibly, or being obnoxious or troublesome. I was doing nothing at all. I would have been a relief to my caregivers.  For me, though, it was an 18-hour visit to hell.

The experience of a single dose enabled me to understand, as nothing else could have, why so many people say no to "antipsychotics."

Note: This recollection is published with my friend's permission.  It is not a recommendation to anyone to risk similar self-education.

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optonEdward Opton is of counsel to the National Center for Youth Law. A graduate of UC Berkeley School of Law, Opton was an employment and labor lawyer for the University of California from 1981 to 2006. Earlier, in his first post-law school job, he was an associate at Morrison & Foerster in San Francisco. Law is Opton’s second career. A graduate of Yale, he received his Ph.D. in clinical psychology from Duke University. He did research on psychological stress at UC Berkeley in the 1960s and ‘70s and was Associate Dean at The Wright Institute, a graduate school of psychology in Berkeley.

Edward Opton is of counsel to NCYL. He is the first attorney to work long-term with NCYL after retiring from full-time practice. Since January 2007, he has been working principally with Senior Attorney Bill Grimm on Child Welfare issues. A graduate of UC Berkeley School of Law, Opton was an employment and labor lawyer for the University of California from 1981 to 2006. Earlier, in his first post-law school job, he was an associate at Morrison & Foerster in San Francisco. Law is Opton’s second career. A graduate of Yale, he received his Ph.D. in clinical psychology from Duke University. He did research on psychological stress at UC Berkeley in the 1960s and ‘70s and was Associate Dean at The Wright Institute, a graduate school of psychology in Berkeley. - See more at:
Edward Opton is of counsel to NCYL. He is the first attorney to work long-term with NCYL after retiring from full-time practice. Since January 2007, he has been working principally with Senior Attorney Bill Grimm on Child Welfare issues. A graduate of UC Berkeley School of Law, Opton was an employment and labor lawyer for the University of California from 1981 to 2006. Earlier, in his first post-law school job, he was an associate at Morrison & Foerster in San Francisco. Law is Opton’s second career. A graduate of Yale, he received his Ph.D. in clinical psychology from Duke University. He did research on psychological stress at UC Berkeley in the 1960s and ‘70s and was Associate Dean at The Wright Institute, a graduate school of psychology in Berkeley. - See more at:

A tale of two letters: Members of Congress weigh in on the Helping Families in Mental Health Crisis Act of 2015

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Members of Congress sent two important letters regarding the Helping All Families in Mental Health Crisis Act of 2015 (H.R. 2646) to House Energy and Commerce Chairman Fred Upton and Ranking Member Frank Pallone this week - one on Thursday and one on Friday. I am including the letters at the end of this post and encourage you to read them. The letters will give you a sense of the position these members of Congress are currently taking on H.R. 2646.

The first letter encourages the markup of H.R. 2646, presenting the bill, apparently in its current form, as ready to go. The second letter, from a different group of congressional representatives, identifies many concerns about specific items in H.R. 2646, that, if enacted, would do more harm than good.

As always, read the letters and use the information to help guide your decision-making, but before you leave this post, I want to point out an interesting difference in the approach taken in the two letters, specifically the first paragraph of each. The first paragraph sets the tone for the rest of the message in each letter. And, as we all know, the conversation around H.R. 2646 is dominated by messaging. Let's take a look at both paragraphs.

  • Letter #1 - H.R. 2646 is good to go
    Once again our nation has been struck by gun violence. When mass shooters strike there seems to always be a severe mental health issue associated with the criminal engaging in such horrific acts. In fact, research has found that there is a direct link between serious mental illness and violence. By making mental health treatment a priority in America, we can better address these mass shooting situations by preventing them beforehand.

  • Letter #2 - H.R. 2646 needs more work
    We write to you as Members of the Committee who are deeply concerned with our nation’s broken mental health system. For far too long, mental health and mental illness have been left in the shadows, and we believe the only way we can fight stigma, improve access to services and treatments, and bring mental health up to parity with physical health is to start treating the brain as a part of the body. Our policies and systems need to reflect the fact that mental illness is a disease and that if the right services, supports, and treatments are available, people can and do recover.

Letter #1 - H.R. 2646 is good to go
The paragraph from the first letter hits the reader right in the gut, making a correlation between guns, violence and mental illness. The tone of this paragraph follows the formula being used in the weekly roll-out of editorials, newspaper endorsements, and various mental health blogs supporting H.R. 2646, that invariably invoke the all too frequent horrific mass shootings, gun violence, and mental illness.

The simple message of "Pass this bill and we can prevent mass shootings" has an incredibly strong general public appeal. The message is straightforward and suggests a direct answer to a complicated question. The more subtle message infused in the first paragraph comes in the form of a quiet whisper that grows louder on the heels of each new tragedy - Pass this bill and this type of horror will never happen again.

Now, of course, we know that the lock, stock, and barrel passage of H.R. 2646 would in no way prevent mass shootings. But in politics, that doesn't seem to matter. The messaging matters. And the messaging being used to promote full-scale passage of this bill is consistently on-point. Do you hear the whisper? Guns. Violence. Mental illness. Pass H.R. 2646 and you will be safe.

Letter #2 - H.R. 2646 needs more work
The tone of the first paragraph from letter #2 is significantly different from letter #1. The tone of this paragraph does not include the elements of fear in the first letter. There is a much more holistic feel to the paragraph, which is much more consistent with the reality that I hear expressed by mental health providers in communities across the nation. For me, the most important part of the paragraph is the last sentence:

  • Our policies and systems need to reflect the fact that mental illness is a disease and that if the right services, supports, and treatments are available, people can and do recover.

With letter #2, there is an upfront recognition of the need for a comprehensive array of services and supports, while also honoring the concept of recovery.

However, letter #2 faces the daunting challenge of not proposing a simple solution. Complicated solutions, no matter how on-target they may be with the realities of providing mental health services at the local level, tend not to be as embraced by the general public as something that is simple and straightforward.

Both letters raise important questions for children's mental health advocates
Are we, as children's mental health advocates, going to allow ourselves to be bullied and steamrolled into blindly accepting a bill that presents itself in such a way that preys on our deepest darkest fears and terrors of a lack of safety?

Or, are we going to question our politicians, compare their assertions with the realities we, collectively, know all to well at the local level?

The authors of the second letter that raise concerns about H.R. 2646 are right about a most fundamental truth - mental health reform is about a broad spectrum of approaches that honor each other and recognize the importance of their inter-connectedness.

Mental health reform is about seeking answers through collaboration, not domination. There are many parts of H.R. 2646 that could be helpful to improving mental health services in America. But there are equally many parts of the bill that need a serious rewrite. Let's not be hijacked by a brusque attempt to use fear-mongering to push a bill through without addressing its major flaws.

I vote for letter #2.

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Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

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