World Hearing Voices Congress 2013 in Melbourne

The main annual global event for the hearing voices movement is to be held in Melbourne this year. The themes for the conference are:

1. Madness has meaning
2. Inviting curiosity about voices
3. A new era in leadership by those with lived experience
4. New practice and research for working with voices
5. Opening new doors for families and carers of voice hearers

In my view, the hearing voices movement is at the forefront of real psychiatric reform. Hopefully the conference will be a great success and have some beneficial knock-on effects for reform in Australia.

Included as a speaker is the inspiring Dr Rufus May,  who quotes :

      The truth is like a lion; you don’t have to defend it.

 

Let it loose; it will defend itself.

 

 

St. Augustine

Government Report endorses Soteria

In March 2011 the Department of Health and Aging in March 2011 published its Early Psychosis Feasibility Study Report.

The report  " is based on an exhaustive review of all available published and unpublished scientific evidence, detailed consultations with national and international early psychosis experts, and a panel of clients and carers" and makes recommendations "to provide an effective national system of early psychosis care".

In addressing alternatives to admission, the report makes the following comments regarding Soteria-based services:

"With respect to step-up step-down or "youth PARC" facilities and other forms of residential care, there was agreement that when properly resourced and run these are able to keep young people in the community and also provide respite to families without the need for a hospital admission. Various examples from around the country and the world were discussed, including the Soteria approach which has been partially evaluated (Bola et al., 2006, Bola and Mosher, 2003, McGlashan, 2006). A common theme was that without being adequately resourced and integrated with expert clinical care, such schemes often break down over time. It was discussed that they may work well where health services had partnered with NGOs with the latter providing the service."

and

"The discussion of inpatient units led to a discussion of alternatives to admission. In particular it was noted that the provision of step-up/down facilities, Soteria-style facilities, respite admissions and intensive home treatment needed to be considered when setting up an ideal early psychosis service."

The report's  overall recommendations include the "availability, and use of, evidence-based medical treatments and a wide range of evidence-based psychosocial interventions".

So it is now up to policy makers to follow the recommendations of their own report and consider Soteria based facilities in framing early psychosis interventions.

Of course, the wheels of change turn painfully slowly when it comes to psychiatric reform, but this recognition is at least a movement in the right direction.

Why is change so slow?

I suspect that part of the reason for the sluggishness in reform of psychiatic services, apart from the power of the pharmaceutical industry, is that non-medical treatments of psychosis evoke a deep seated fear in many that perhaps those experiencing psychosis are not so much different from them - if the "mentally ill" have brain diseases then "normal" people have nothing to fear in themselves.

In this respect, two recent books are of relevance.

Unshrinking Psychosis by Australian John Watkins and Rethinking Madness by Paris Williams both give a different perspective, which humanises rather than medicalises psychosis.

Paris Williams is an ex hang gliding world champion who completed a doctorate in psychology after having his own experiences of extreme states. He posits that psychosis is a natural growth-oriented process which, given the right environment, can leave one in a better, more positive state of being.

If Williams' thesis is correct, and I think it probably is, then it is a crying shame and waste that society is not yet ready to provide places of sanctuary where this process could unfold in the most beneficial way possible.

Soteria Letter writing campaign

Further to my previous post, I encourage those interested in the development of Soteria based alternatives in Australia to write a letter to a relevant politician.

Anyone is welcome to copy or adapt the text of the letter in the previous post. I had originally intended to get a petition style letter going, but now believe that individual letters would be more effective.

According to this website, handwritten letters are best and e-mails are the least effective method of getting politicians' attention.

Below are links to relevant politicians addresses. The letter I have written addresses policies of the federal government, so would need some adaptation for State government politicians. Writing to your local MP would also be very worthwhile, as they are the ones who want your vote.

Go for it!

Letter to Mental Health Minister

Below is the text of a letter I have sent to Mark Butler, the Minister for Mental Health and Ageing on 8 May 2011:

Dear Minister,

I write to you in relation to the current care facilities for people experiencing psychotic illnesses.

I welcome the commitment of your government to reshape mental health services and would like to draw your attention to an alternative to the current hospitalisation practises for people experiencing such illnesses.

Hospital environments are often not optimally conducive to recovery and can be stressful, crowded,  and overly reliant on heavy doses of medication.  For too long the importance of psychosocial care in an empowering and recovery oriented environment has been neglected for those experiencing psychosis. 
Thus, I  believe consideration should be given to a model of care based upon that of Soteria Berne in Switzerland.

Treatment at Soteria Berne is based on the following therapeutic principles:

1. Small, relaxing, stimulus-protecting and as "normal" as possible therapeutic setting
2. Continual personalized "being with" the service user
3. Personal and conceptual continuity over the whole period of treatment
4. Continued close collaboration with family members and other important persons of reference
5. Clear and concordant information, for service users, family and staff, on the illness, its treatment and the existing risks and chances
6. Elaboration of common realistic goals and expectations for future housing and work
7. Consensual low dose neuroleptic strategies, with the aim of controlled self-medication
8. After-care and relapse prevention for at least two years.

Please refer to the attached documents for more information about Soteria Berne (http://www.ciompi.com/pdf/WP-2004-10-Soteria.pdf) and research outcomes on the Soteria model (http://schizophreniabulletin.oxfordjournals.org/content/34/1/181.full).

Research in relation to the Soteria model has found that continuous human closeness with the person experiencing psychosis (“being with”) in a small, supporting and protective non-hospital setting allows the achievement of similar or better therapeutic effects than conventional psychiatric settings for equivalent or cheaper cost, without the need for heavy doses of neuroleptic medication. The therapeutic focus on the sustained reduction of emotional tension has highly beneficial effects, whilst the accepting environment reduces stigmatisation and secondary psychosocial impacts associated with hospitalisation. Furthermore, in the relaxing Soteria atmosphere incidents of serious violence against self or others have been shown to be extremely rare.

I note that the federal government has made a  $1.6 billion commitment to deliver 1,300 new sub-acute care beds nationally by 2013-14. We believe that this presents an excellent opportunity to institute services along the lines of the Soteria Berne model.  Soteria based services would also align well with early intervention strategies to prevent relapse and reduce the long term impact of psychiatric conditions.

Such a model would work for the benefits of all Australians in terms of reduction in long term costs; humane and ethical treatment; and in encouraging social reintegration and recovery.

I urge you to consider this model and to take action to implement it in Australia and  look forward to your response.

Yours Sincerely, etc

The Sluggishness of Psychiatry

I was ruffling through some boxes in the garage the other day and came across the clipping below. It is an article regarding Tardive Dyskinesia from 1993 from Canberra's daily newspaper, The Canberra Times.

Besides the moving and tragic account of the sufferer in the article, I thought it was also of contemporary relevance due to the attitude and comments of the unnamed psychiatrist. The article, which is referring to older generation antipsychotics and not the newer atypical antipsychotics, states that the psychiatrist said "only 5 per cent of those taking neuroleptics would end up with mild forms of the disease and less than 1 per cent with severe forms of it." [edit: In line with the comment below, this is not meant to imply that newer atypical antipsychotics are any safer that older generation antipsychotics].

In fact, it was well known in 1993 that the incidence rate of Tardive Dyskinesia for those taking older generation neuroleptics was between 20 and 40%. For instance, refer to this article. Also, Jack Gorman's 1990 edition of The Essential Guide to Psychiatic Drugs stated a rate of between 20 and 40 %.

Linking Phenomenology and Neurobiology

In recent years, there has been considerable interest in research linking the phenomenological and biological aspects of mental illness ( for example, this paper co-authored by Patrick McGorry ). It is welcoming to see a rapprochement of these distinct but nevertheless complementary ways of describing and understanding human experience and behaviour.

Much of the recent work (including the paper above) focuses on the use of phenomenological investigation as a tool in identifying individuals at risk of psychosis. But of course, phenomenology is relevant not only to the identification of individuals at risk of psychosis, but also to shedding light on its development and progression. Phenomenological description gives clues as to the effect of environmental and psychosocial factors on neural processes, and perhaps to ways in which the control of the former factors can influence the latter. Thus, examining psychiatric hospitalisation from a phenomenological perspective can suggest what the neurobiological impacts of hospitalisation on the psychotic patient might be.

Irregular Behaviour and the Concept of Self in Bali

I wrote the following (long!) essay for a Medical Anthropology unit I did at Uni some time ago. The relevance to Soteria I think  is that it illustrates the importance of culture and the surrounding environment on the development and progression of 'mental illness'.

Also, of note on this topic is the recent book Crazy Like Us: The Globalisation of the American Psyche, By Ethan Watters. This book describes how the export of Western psychiatry and concepts of mental illness across the globe have impacted on local cultures, sometimes producing the illnesses it is supposedly combating. It is on my 'to read' list - looks very interesting.