Title: Message from the Chair
Author:
Section/SPIG: Mental Health
Issue Date:
Dear Friends and Colleagues,
From The Cup Half-full
I am very pleased to share some good news - that you have many reasons to be excited if you are coming to San Francisco for the APHA Annual Meeting November 15th - 19th, 2003. We have designed an outstanding program including some firsts for the Mental Health Section. Our Program Chair, Michael Stoil, Ph.D., has assembled 30 sessions from a smaller, but still high quality number of abstracts submitted this year. He has done a remarkable job of integrating our larger membership into the program and together with the Alcohol, Tobacco, and Other Drugs Section was successful in promoting our recommendation for one of the Plenary Sessions.
We are very proud to be sponsoring Norman Sartorius, MD, PhD, former president of the World Psychiatric Association and past director of the World Health Organization Mental Health Division as keynote speaker for the APHA plenary session, “The Impact of Urbanization on Mental Health.” Sartorius will also be the discussant for the Mental Health Section invited session, “Making Public Health Whole: Integrating Behavioral Health and Primary Care.”
Rex Green, PhD, our outcomes guru, has organized another first for the Section, a Saturday continuing education institute, “Implementing a Mental Health Evidence-based Practice in Your Setting: ACT, Dual Diagnosis, or Supported Employment.” This program features distinguished faculty from around the country, including past section chair, David Shern, PhD, and Neal Adams, MD, MH, medical director of the California Department of Mental Health, who will help promote the program statewide.
In response to the recent release of the New Freedom Commission (NFC) Report, we will be sponsoring two events featuring Michael Hogan, PhD, Ohio DMH Commissioner and chair of NFC, and Steve Mayberg, PhD, California DMH Commissioner and NFC member. There will be a full-day pre-meeting workshop on Friday and a special breakfast meeting discussion on Monday morning in place of a previously scheduled SAMHSA breakfast.
On Wednesday morning, Richard Nakamura, PhD, and Ronald Kessler, PhD, will host a NIMH "New Research" Breakfast on the neurobiology and epidemiology of psychiatric disorders. At least five local and national consumer survivors, including our Consumer Survivor Committee Chair and program participant, Sylvia Caras, PhD, have received scholarships funded by Mental Health Section membership to attend the Annual Meeting
In keeping with tradition, Gloria Jane Thornton, MA, MFT, and I are planning a Monday night Gala and Awards Dinner at the historic and elegant San Francisco War Memorial and Performing Arts Center. It promises to be a wonderful evening. We will be honoring Mental Health Section Award recipient Margarita (Maggie) Alegria, PhD, and acknowledging others who will be receiving special Mental Health Section Achievement Awards. There will be lots of good food, dance and listening music, which in combination with our membership and guests should generate enough enjoyment to maintain our social's legendary reputation.
From The Cup Half-Empty
In this last message to you as Chair, I also want to share what I consider some not so good news. There are serious contradictions in our field that throughout my ten years with the Mental Health Section have remained conspicuously in the background. One is a disturbing dichotomy between our field's emphasis on best and evidence-based practices and the dominant trends in government policy and practice that contain this work.
Such trends include grossly inadequate funding for our already dismantled public health system and increasing abandonment of good science to politically and fear-driven authoritarianism. Trends include the wasting of funds allocated for public health due to mismanagement and a striking lack of governmental and professional accountability where non-enforcement of minimum quality standards and acceptance of major corporate influence on health care delivery are the norm. It is a terribly sad state of affairs when consumer leadership is so desperate as to advocate for the unraveling of our safety net (i.e., privatization of Medicare and Medicaid) in exchange for badly needed, but unacceptably compromised, prescription drug benefits.
For one to accept the implementation of evidence based practices as a realistic solution to our public health crisis, even in part, one must assume that such implementation will be managed competently and within a systemic environment driven by good science and a commitment to principles of recovery. One must assume that within the politico-economic environment described above, implementation of one or more discrete interventions within a system of care will make a real difference in outcomes for the primary stakeholders receiving services in their community. Given all these assumptions, those who believe that proper and meaningful implementation of evidence-based practices is possible subsequently face an even more fundamental contradiction.
This paradox involves the promotion of formal and often involuntary mental health services and treatments in the face of overwhelming international evidence that "less is more" when it comes to good outcomes for people suffering from schizophrenia and serious mental illnesses. Well-conducted systems-level outcomes research in the United States over the past 25 years has likewise produced a consistent, but more benign finding of "no difference" in outcomes based on amount or type of formal health services received.
These findings suggest what some have proposed all along - that economic and social factors outside the domain of our primary professional and clinical activities may be the main predictors of good outcomes. Others argue that these findings also suggest that certain formal mental health interventions actually do harm. Regardless of one's particular interpretation, we need to begin to seriously address these contradictions and questions. Until then, we cannot honestly claim to be promoting the best outcomes for consumers and clients nor serving as effective advocates for the public mental health of our nation.
In support of public health,
Your Chair,
Janice E. Cohen, MD