Approach to Balance was one of 560 organizations and individuals who submitted comments on the draft stragetic plan. These comments and suggestions were apparently taken quite seriously, as the new stragetic plan is a much better document. While it has a few flaws, notably the lack of mention of peer services, this was apparently due to SAMHSA, which is preparing a report on the proofs of peer services aiding recovery, having missed a deadline.
Below is the critique submitted by us.
IN SEARCH OF SILVER BULLETS
A (partial) Critique of NIMH’s Strategic Plan
While NIMH’s Strategic Plan has some good points, we fear that in the quest to discover the sources of mental illness, and lacking sufficient focus on Recovery, NIMH may miss the forest for the trees. While the search for the silver bullets can expand the knowledge of the brain and its workings, it will do little to determine the efficacy of environmental and social programs aimed at transforming the mental health system as directed by the President’s New Freedom Commission. We are especially disappointed on the omission of peer services in Section 3.3.
In Strategic Objective 1.1 it is stated that environmental factors are challenging to define and measure, as well as that stress may be a risk factor for multiple disorders. After seven decades of research, NIMH should have had time to better identify these factors and stresses.
In the field of Geography, the environment is defined as everything, except yourself. To aid NIMH in defining and measuring these environmental factors, it is suggested you seek qualified post grad students with a background in this often misunderstood field. Measuring the dynamics of system(s) interactions is a function of Geography.
One value of peer services is that we are capable of delivering services with less stress on the recipient. Having experienced first hand the oft bizarre behaviors that characterize mental illness, we are much less prone to display facial gestures (or noises) of dismay and disgust during delivery of services. We may even be able to make light of them, putting the person at ease.
This is not to say that all; or even most providers, are guilty of adding to the stresses involved in achieving recovery in this way, but those who exhibit these behaviors can make the recovery mountain harder to climb.
One’s feelings and perceptions determines, to a large extent, the quality of one’s life. When those in a position of power have determined that an individual will achieve nothing in life, the attitude is conveyed, whether the words are spoken or not. One reason Peer programs are valued is that hope for a better future is conveyed.
To assist in identifying some sources of stress existing in the environment of those diagnosed with a mental illness (which generally are not present for those not diagnosed) we submit the following partial summary of stresses and environmental causes that need to be acknowledged and measured:
Grief at the perceived loss of a future is a serious obstacle to recovery. The diagnosis (one which is often given with the expressed or implied caveat that homelessness, jail, prison and a substandard life is the most one should expect) given without referring the individual to a Recovery program. The NAMI Peer to Peer program helps an individual recognize his or her own symptoms and take appropriate steps to minimize them. Other programs exist as well [including 3 offered by Approach to Balance- Recovery 101, An Into to Recovery; Recovery: A Path for Difficult People (on transforming anger); as well as one on alternative and complementary services available].
The journey through grief; from shock, to denial, to bargaining, then anger, guilt and finally acceptance may be the largest obstacle to recovery. Especially when the majority of providers seem oblivious to the effect they have on the environment of those diagnosed.
Published sources (A Dose of Sanity by Sydney Walker III, MD.) cite instances where toxins (including various heavy metals) found in the body, that once eliminated have caused symptoms to diminish or to be eliminated completely, yet these are not regularly tested for (hair test to determine their presence are relatively inexpensive).
The threat or actual use of force by staff: This includes, but is not limited the use of Restraint and Seclusion. Many individuals cite this as a reason for avoiding treatment facilities. Here, we wish to favorably acknowledge the Road Map for the Reduction and Elimination of Restraint and Seclusion and the effect it has had on reducing fear and stress.
War, of course is one of the prime stresses that affect the mental health of individuals, both combatants and innocent victims. As you are aware, many Vietnam era veterans have been homeless for decades, and the wars in Iraq and Afghanistan are adding many more. The war on our own population, the war on drugs, is another environmental stress, even for those who do not use forbidden drugs.
The severity of jail and prison sentences for those with mental illness, or any neurological impairment is another environmental stress. Here, the MacArthur Foundation’s The Law and Neuroscience Project is the first systematic effort to bridge the fields of law and science in considering how courts should deal with the topics of addiction, brain abnormalities, and decision making as they relate to complex issues such as criminal responsibility. Each working group will be directed by a neuroscientist and a legal expert and include up to 15 neuroscientists, legal scholars, philosophers, and practitioners involved in the legal system, including a judge. Each group will review current research, identify gaps in knowledge and understanding, and develop specific research proposals that would contribute to improved law, policy, and legal proceedings. We urge that you help to disseminate their recommendations as they become available.
Those who were raised in environments where stress was not handled well, learning ineffective techniques for handling it, may be at greater risk of delaying recovery from any mental illness. Here we note the success of cognitive therapy in aiding the recovery of individuals.
We are pleased that NIMH acknowledged (Strategy 1.4) that diagnosis are based on clinical observation and does not include current scientific knowledge. Hopefully in the near future diagnoses will be based on the portion of the brain that is malfunctioning, rather than the stigma laden labels that are currently used.
We submit this with the hope you will seriously take our comments and open the door to the study of environmental stresses, only a small portion of which have been identified here, as well as for the study of the programs designed to ameliorate these stresses.
IN SEARCH OF SILVER BULLETS