New Beginnings: Reimagining Psychosis Services & Systems in the US

Over the past decades, participatory methods and lived experience/service user involvement have gained substantial traction in mental health research and policy.  While the United States arguably lags well behind countries such as the UK, Australia, and New Zealand, there has nevertheless been a marked uptick in interest and investment in involvement.    Unfortunately, as a nominal emphasis on involvement grows, so too have tokenism and cooptation, mirroring longer-term trends in peer support.  This panel brings together three international leaders in the lived experience research space – Andrew Grundy (University of Manchester & University College London), Nev Jones (University of Pittsburgh) and Alison Branitsky (University of Manchester)—two of whom are based in the UK, in a panel that will reflect on the deeper, transformative value of lived experience leadership, the harms of cooptation, and the possibilities of work that truly reflects the values, methods and priorities of those historically marginalized in psychosis-relevant knowledge production.

Innovative Approaches in Assessment, Treatment, and Residential Care (3 x 30 minute sessions)  

• The Utility of Psychological Assessment in Detecting Psychosis: A Case Illustration - Connor Adams, PsyD
• EMDR and Psychosis: Nudging the United States Into the Modern Age of Trauma Treatment - Chris Perry, MS, MA, LMFT
• Creating an effective natural team based on the Windhorse approach - Eric Friedland-Kays, MA Victoria Yoshen

The Utility of Psychological Assessment in Detecting Psychosis: A Case Illustration - Connor Adams, PsyD
This presentation with utilize a clinical case to illustrate the utility of psychological assessment when detecting psychosis and creating an individualized treatment plan. The case will feature Mr. G, who was referred for psychological assessment by his therapist to better understand what factors were contributing to Mr. G feeling “stuck” in both life and therapy. Mr. G initially sought therapy due to feeling he was experiencing a “failure to launch” as a young adult. Specifically, he reported starting and stopping graduate school several times, finding it difficult to maintain friendships and romantic relationships, and struggling to engage in daily self-care activities such as personal hygiene and meal prep, despite having previously been successful in all these domains. After approximately one year of therapy both he and his therapist felt their work was not progressing and sought a psychological assessment to gain a deeper understanding of any cognitive difficulties, behavioral patterns, or intrapsychic conflicts that might contribute to his “stuckness.” Mr. G completed a multimethod psychological assessment. Multimethod assessment procedures included a thorough record review, a clinical interview, the Bender-Gestalt, Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF), Rorschach Performance Assessment System (R-PAS), Projective Drawings, Rotter Incomplete Sentences Blank (RISB), Thematic Apperception Test (TAT), Woodcock-Johnson IV Achievement (WJ IV ACH), and Wechsler Adult Intelligence Scale (WAIS-IV). This case presentation will highlight the role of psychological assessment in bringing to light previously unrecognized disordered thinking that notably contributed to Mr. G’s difficulty getting “unstuck” in his life. Moreover, the assessment provided information regarding the conditions under which Mr. G’s thinking was more vulnerable to becoming disorganized, such as during instances of emotional flooding. This presentation will provide an orientation to the utility of psychological assessment, in particular for individuals experiencing psychosis, emphasizing the utility of this intervention in addition to psychotherapy.

EMDR and Psychosis: Nudging the United States Into the Modern Age of Trauma Treatment - Chris Perry, MS, MA, LMFT
The most cursory glance at the literature regarding trauma and psychosis demonstrates a strong correlation between the two. Given this, it would seem axiomatic that a trauma-informed system of care would make evidence-based therapies for posttraumatic sequelae readily available to people who have experienced both trauma and psychosis. In the United States, however, the opposite is true: psychosis is often considered an exclusionary criterion for the exact modalities of trauma treatment that have the strongest evidence base.

This presentation will focus on Eye Movement Desensitization and Reprocessing Therapy (EMDR) as a specific example of an evidence-based treatment for trauma that is systematically denied to people who have had experiences of psychosis and are seeking care in the United States. This reality contrasts sharply with the literature and with clinical practice in other parts of the world. There is a robust literature demonstrating that EMDR is both safe and effective for individuals with past and present experiences of psychosis. A review of this literature identifies clear geographic delineations: of all the available published works on this topic, only a few have been written by authors based in the United States, and none of these are systematic reviews or based on new research. In fact, almost all are cautionary tales about the use of EMDR in the context of psychosis.

This divide in the literature is reflected in clinical training and practice in the United States, which rests on unsubstantiated beliefs about the risk-benefit ratio for this practice and excludes individuals who have experienced psychosis from receiving EMDR treatment. This presentation will present a review of the literature about this practice and a case study of the process of introducing EMDR as a clinical tool in an early psychosis program at UCSF. 

Creating an effective natural team based on the Windhorse approach - Eric Friedland-Kays, MA, Victoria Yoshen
Imagine someone you love needs support because they experience extreme states of mind that make it difficult to cope with their life in an independent, functional way. Their mind makes it difficult to navigate basic tasks, and causes difficulty in relationships with friends, family, and at their job. You find them a well-meaning outpatient therapist who may not have the skill or time to engage with your loved one sufficiently. This situation becomes increasingly isolating and chaotic. What might you do to establish an effective therapeutic environment for your loved one outside of sending them to a hospital or residential program?

Now imagine creating a comprehensive mental health support system in the community for your loved one so that they can continue to engage with their life as it is. This support system consists of providers who establish one-on-one safety with this person, coach them in the real world, and all communicate weekly. This team consists of a therapeutic housemate,a skilled and humble facilitator, therapeutic mentors, and can include a psychiatrist and family members. The team is cohesive and the conflicts that arise within it are held in a therapeutic context. These relationships are consistent and flexible enough so that your loved one has enough support in the world to continue to lead a functional life with a trajectory of healing and growth.

This presentation from Windhorse Integrative Mental Health explores the unique elements of a community-based Windhorse team for individuals in psychiatric distress. For over forty years, our approach has been utilized at sites in North America and Europe with impressive results. This presentation will describe the key elements of a Windhorse team, explore its usefulness, and will cultivate dialogue about its applicability in home and community settings independent of enrolling in a Windhorse program.

Sanctuary in the Forest: An Australian Peer-led Respite for Post-Psychosis Integration Using a Bio-Psycho-Social-Spiritual Approach - Louisa Dent Pearce, MSW (Masters of Social Work)

The Sanctuary in the Forest is an Australian respite model for people who have experienced psychosis, mania or non-ordinary states of consciousness. The service was inspired by the presenter’s own lived experience of psychosis, her early career in peer support, and trauma-informed models of care such as Dr Sandra Bloom’s Sanctuary Model.

Australia’s mainstream treatment for psychosis focuses on stabilisation of symptoms while often minimising or denying a person’s personal meaning and spiritual aspects of the experience, hence the healing opportunity may be truncated and the person may be left with unresolved trauma, unanswered questions, unprocessed emotions and internalised stigma.

This respite offers a post-psychosis integrative experience where participants can explore worldviews of psychosis and mania, reflect on personal meaning, share stories in conscious ways, process emotions, learn grounding skills, and reduce internalised stigma.

We use an adapted bio-psycho-social-spiritual framework, along with Intentional Peer Support, the Hearing Voices Approach, Acceptance and Commitment Therapy, somatic therapy, and grief and loss theory. We also use non-psychoactive spiritual and shamanic practices, appropriate to the participants’ worldviews.

We created a healing map called The Connected Self which invites deeper connection to six domains: self/body; nature/earth; family/friends; community/society; ancestors/guides; and God/Universe. The map can be adjusted for different worldviews and language preferences.

Our design logic uses embodied participation within the therapeutic milieu of a rainforest setting, with scaffolding activities such as discussion, teaching, story-telling, ceremony, creative arts and celebration.

Participants and peer facilitators report significant improvements in motivation, insight and confidence in personal choices and values, and a reduction of negative emotions and thoughts related to their experiences of psychosis/mania. This respite may provide a learning template for other such services or research which seeks to bridge the gap between mainstream mental health and broader cultural and spiritual views of non-ordinary states of consciousness.

Psychotherapy training rarely addresses work with individuals diagnosed with psychosis, and often actively discourages trainees from pursuing long-term, relationship-based or in-depth work with people who carry this diagnosis.  This two-session workshop aims to address the questions and concerns of students and early career professionals who are interested in learning more about psychological approaches to psychosis by combining an open forum for discussion with a walk-through of clinical transcripts that can form the basis for commentary that can reveal the richness and efficacy of this often life-giving work.

Incorporating the voices of individuals with lived experience of psychosis into medical education, particularly in psychiatry, has the potential to profoundly enrich the training of future mental health professionals. Individuals with lived experience have important perspectives to share about the nature of psychosis, its treatment, and the mental health system itself. By doing so, trainees and seasoned physicians alike gain invaluable insights into the personal and social dimensions of mental illness, which are often underrepresented in traditional medical training.

Evidence suggests that incorporating lived experiences into education fosters empathy, reduces stigma, and enhances the communication skills of psychiatric trainees. Students report a deeper understanding of the complexities of mental health conditions and a greater appreciation for patient-centered care. Furthermore, this approach encourages future psychiatrists to view patients as partners in the therapeutic process, promoting a more holistic and collaborative approach to mental health care.

This panel, comprised of two clinicians and two people with lived experience of psychosis, will share ways in which those voices have been incorporated into medical education within the Department of Psychiatry and Behavioral Sciences at Emory University. This has occurred in multiple formats including guest lectures, small group discussions, and a Grand Rounds presentation. We will share relevant institutional background leading to the development of these programs, firsthand accounts of the experience of presenting in these settings, and a discussion of ways to expand this work throughout our department.

The presentation also addresses the challenges of integrating these voices into medical education, including potential ethical concerns, the need for appropriate support for participants with lived experience, and institutional resistance to curriculum changes. We discuss strategies to mitigate these challenges, such as providing training for individuals sharing their experiences, ensuring a supportive environment, and demonstrating the value of these programs through research and feedback.

In conclusion, incorporating voices of lived experience in psychiatric education enriches the learning experience, better prepares future psychiatrists for practice, and ultimately contributes to more compassionate and effective mental health care. This presentation calls for a concerted effort to make these programs an integral part of medical education, highlighting their transformative impact on both students and the broader mental health system.

2 x 30 minute Sessions:

1. Highlighting family members’ experience of psychosis-REACH in an early psychosis setting: A qualitative analysis - Melanie Lean, Katie Benitah, MSc, MA
2. Oral Health Recovery: A Peer Specialist-Led Dental Education Program - Adrienne Lapidos, PhD

Highlighting family members’ experience of psychosis-REACH in an early psychosis setting: A qualitative analysis - Melanie Lean, Katie Benitah, MSc, MA
Background: Outcomes in early psychosis are greatly improved by intervening at the earliest possible point using a Coordinated Specialty Care (CSC) model that facilitates comprehensive, multi-disciplinary care for individuals who are exhibiting early signs and symptoms of psychosis. However, there is little guidance on family interventions that best compliments the care the client is receiving, and that meets the unique needs of the family, within CSC. Psychosis REACH (Recovery by Enabling Adult Carers at Home) is a Family Intervention for psychosis (FIp) that delivers psychoeducation, evidence-based Cognitive Behavioral Therapy for psychosis (CBTp)-informed skills and peer support to family caregivers in the community. This study examines family members’ qualitative experiences receiving the pREACH intervention in a CSC setting. Method: 20 Family members, whose loved ones are receiving care in an early psychosis clinic, received training in the pREACH model, attended follow-up monthly coaching calls and peer family ambassador support for 6 months. Ten family members participated in a 45min semi-structured interview to provide feedback on the intervention. A Reflexive Thematic Analysis (RTA) was conducted using NVIVO by three team members not involved in intervention delivery. Results: Three principal themes emerged from the RTA: (1) confidence (i.e., building internal resources), (2) connection (i.e., building external resources), (3) improvements for future cohorts. Discussion: This study is the first qualitative exploration of the integration of pREACH in an early psychosis service. Challenges and opportunities for integration will be discussed and areas for future study presented.

Oral Health Recovery: A Peer Specialist-Led Dental Education Program - Adrienne Lapidos, PhD
Introduction: The link between oral health and mental health is well established, leading advocates to declare that there is “no mental health without oral health” (Kisley, 2016). But people with psychotic disorders are subject to significant oral health disparities, driven by psychological factors; medication side-effects (chiefly xerostomia, or “dry mouth”); and social determinants of health impacting dental care utilization. This presentation will review the bidirectional relationship between mental health and oral health, and describe the results of a pilot study which implemented a Peer Specialist-led oral health education and referral program.

Methods: Community-engaged methods were utilized. Randomized parallel assignment was used to compare two arms: (1) group viewing of an oral health educational video (VC), and (2) a peer-led one-time class providing education and motivation to access dental care (Oral Health Recovery Group, OHRG). In both arms, Peer Specialists followed up with participants to facilitate scheduling dental appointments and reinforce goals. Oral health knowledge, at-home care, motivation, and appointment scheduling were ascertained. Qualitative interviews assessed barriers and facilitators.

Results: Sixty-two people participated. Participants were dentally vulnerable, with 27% reporting they had 9 teeth or less, 55% reporting their teeth caused discomfort in the past 12 months, and 48% reporting xerostomia. Pre/post-intervention survey results did not significantly improve or differ between arms. At follow-up, 25 (68%) in OHRG and 14 (56%) in VC attributed meeting a dental goal to the program. Ten (27%) in OHRG and 9 (36%) in VC attributed making a dentist appointment to the program. Participants were comfortable with Peer Specialists in this role, yet access barriers remained.

Conclusions: Surveys did not significantly improve, suggesting that more intensive interventions are needed. Nevertheless, 19 highly vulnerable people successfully scheduled dentist appointments after only a one-time class and light-touch peer navigation. Oral health integration shows promise, meriting further research.

Madness and the Real: Recentering the Unconscious in the Clinic of Psychosis - Elan Y. Cohen, PhD
This presentation problematizes classical assumptions about the relationship between dreams, madness, the unconscious, and reality. I critique an adaptationist psychoanalytic perspective that interprets psychosis as resulting from a defective ego, failing to regulate an excess of unconscious activity. I argue that the classical interpretation prioritizes ego functioning and emphasizes the subject’s adaptation to a defective social reality. In contrast, this presentation offers a psychoanalytic conceptualization of psychosis that aspires to liberate, approaching psychosis as a resistance to processes that efface subjectivity. As such, I advocate for a combined social and psychoanalytic approach to psychosis that recenters the unconscious, which I define as the psychic apparatus that buffers the subject from unmediated proximity to the Real. The presentation will review Freud’s two principles of mental functioning; Bion’s concepts of psychic metabolism, beta-elements and the alpha-function; and the Lacanian registers of the Real and the Symbolic. In each of these frameworks, psychosis can be understood as stemming from a traumatogenic reality that resists symbolization or alpha-betization. The presentation will highlight the utility of each of these frameworks in clinical practice.

In this panel, we will be sharing, discussing, and thematizing preliminary results from an ongoing, grant-funded, qualitative research study which looks at how those experiencing homelessness and housing precarity interact with, negotiate, and navigate mental health services in the City of Pittsburgh.  

From this foundational research, we will tentatively imagine how humanistic, phenomenological, and psychoanalytic perspectives could challenge and transform what is widely accepted as mental health services for those experiencing homelessness in the City of Pittsburgh.

Recent work within bioethics has engaged with the question of palliative care for mental illness. In particular, recent arguments for palliative psychiatry make the argument that recognition of individuals’ ability to make determinations about care can extend to giving individuals the option to choose palliative care in the face of long-standing, treatment-refractory illness.

While arguments within bioethics have engaged with the question of autonomy here, perspectives from Mad Studies have been noticeably absent in this discourse. This presentation will interrogate the question of autonomy and palliative care from the perspective of Mad Studies, asking how framing and understanding of determinations of futile care, as well as arguments for offering palliative care as a way of respecting agency, change when lived experience perspectives are centered. In so doing, it will argue that these perspectives offer vital, and previously uninterrogated, points of consideration.

From Crack to Psychedelics: Frontiers in Psychosis Work  - 2 x 45 minute sessions

•  Swimming to the Horizon: Crack, Psychosis, and Street-Corner Social Work: Zak Mucha, LCSW
•  The Psychedelic Therapy Train Wreck: Ethical Responses To A Corrupt Industry - Will Hall, MA, DIplPW, Phd Candidate

Swimming to the Horizon: Crack, Psychosis, and Street-Corner Social Work: Zak Mucha, LCSW
Working with a population suffering severe psychotic symptoms, homelessness, and addictions, a non-traditional clinical frame can allow for psychodynamic work. The patient’s relationship to a clinician is more than meds and case management and can be created in a clinical frame not limited to the corners of a physical office. This presentation will consider Bionian and Lacanian structures to examine the possibilities of joining with a patient in their worlds, both internal and external, to understand how psychotic symptoms can hold a narrative of past trauma and possess the hope for an emerging self.

The Psychedelic Therapy Train Wreck: Ethical Responses To A Corrupt Industry - Will Hall, MA, DIplPW, Phd Candidate
Drugs are winning the war on drugs, and it's time to end criminalization of underground psychoactive substances, including psychedelics, less socially accepted than alcohol and nicotine (or psychiatric medications). Harm reduction policies are essential. But proposed medicalization schemes betray the informed consent vital to harm reduction: the new "psychedelic revival" peddles psychedelic exceptionalism hype based in shoddy research, driven by a corrupt decades-old network of new age zealots with a glaring track record of abusing patients under the cover of a code of silence.

"Psychedelic therapy" would put powerful suggestibility, disinhibiting, and vulnerability drugs in the hands of status and money hungry professionals already proven to systematically misuse their power. As the psychiatric system struggles with the decline of the SSRI brand and a lack of products for the PTSD market, are new drugs to play with the solution, or just a repeat of everything wrong with psychiatry? And if commercialization, as tried with cannabis, risks disastrous Brave New World implications in a dystopian capitalist society already desperate to escape and tranquilize, what is the way forward?

Fortunately, new voices are breaking the psychedelic hype bubble: an emerging "critical psychedelic studies" provides a crucial new perspective with wide implications for everyone engaged with the social response to psychosis. In this context, two central myths about psychosis need to be overcome - that anyone with a psychosis diagnosis or history cannot use psychedelics meaningfully in their lives, and that psychosis is just another diagnostic market to benefit from the magic powers of these new wonder drugs. Join us for a sober check-in on how survivors, clinicians, researchers, and policymakers can respond to the new psychedelic revival, and what visions we need for decriminalization of psychedelics from the perspective of innovating our systems and responses to psychosis, not just reinforcing them.

Resources: https://willhall.net/ispspsychedelics2024/

Hearing Voices Implementaiton - 2 x 45 minute sessions

•  Veteran Voices and Visions: Adapting the Hearing Voices Approach to an Urban VA Healthcare System - Ippolytos Kalofonos MD PhD MPH, Erica Hua Fletcher, PhD, Carol Jahchan, PhD, Sahastri Hercules, Cindy Hadge
•  Online Hearing Voices Groups in the NHS: A Feasibility Study - Alison Branitsky, Mres

Veteran Voices and Visions: Adapting the Hearing Voices Approach to an Urban VA Healthcare System - Ippolytos Kalofonos MD PhD MPH, Erica Hua Fletcher, PhD, Carol Jahchan, PhD, Sahastri Hercules, Cindy Hadge, Tim Laprade
The Veteran Voices and Visions (VVV) project is an adaptation of the Hearing Voices approach to the Greater Los Angeles Veterans Affairs Healthcare System that serves 1.4 million Veterans. The VA has officially adopted the recovery model and employs over 1400 peer specialists nationwide. The VVV project uses virtual support groups, co-facilitated by a clinician and a Veteran peer who is an “expert-by-experience,” to normalize experiences such as hearing voices and seeing visions. We are trying to build an evidence-base to get this approach recognized and available for use across the VA. Thus, VVV includes a research component to 1) study the adaptation of a Hearing Voices Facilitator training to the VA and 2) to understand how participating in VVV groups may help Veterans live with their voices and make meaning from their experiences. Our approach has involved multidisciplinary collaborations - including perspectives and contributions from Veterans who hear voices, Veteran peer support specialists, social workers, psychiatrists, psychologists, social researchers, and national Hearing Voices leaders. Group members explore personal understandings and contexts of so-called “unusual” experiences commonly diagnosed as psychosis rather than privileging biomedical framings; we also encourage and support Veterans in engaging with their experiences as potentially meaningful rather than only interpreting them as symptoms of an illness to be eliminated. In VVV groups, Veterans share their stories, coping strategies, and worldviews, and often end up supporting each other in their ongoing life projects.

This panel brings together some of the participants of the project to share our perspectives and experiences, including researchers, clinicians, Veteran participants and facilitators, and trainers. We will explore some of the successes, challenges, lessons learned, possibilities, and contradictions of bringing this community-based, peer-driven approach into a large, bureaucratic health system.

Online Hearing Voices Groups in the NHS: A Feasibility Study - Alison Branitsky, Mres
Over the past 40 years, Hearing Voices Network Peer Support Groups (HVGs) have proliferated across the globe. HVGs are built on the ethos of self-determination and collective liberation, positing that voice hearing is a normal human experience and that individuals who hear voices are best positioned to determine how to understand and respond to their experiences. While HVGs exist widely in the community, they are also being run within statutory services, whose ethos are at times at odds with those of the Hearing Voices Network (HVN). This presentation will explore both preliminary findings and personal experiences of running the first feasibility trial of online HVGs within the UK’s National Health Service (NHS). The presentations will cover how the group was adapted to run in the NHS while maintaining the values of HVN; qualitative and quantitative outcomes of group participation; challenges and opportunities arising from the online medium; the practical and philosophical possibilities and contradictions that arise from implementing survivor-led initiatives into public healthcare systems; and considerations for implementing these groups in a US-context.

Phenomenological psychopathology has traditionally applied the methods and concepts of phenomenology to clarify the experience of those with psychiatric diagnoses, including psychosis. While this has prioritized the lived experience of persons with psychosis and broadened the scope of what psychiatry and other mental health disciplines pay attention to in diagnostic and treatment practices, the focus of phenomenological psychopathology, with some exceptions, primarily been limited to an emphasis on alterations in isolated individuals.

However, there have been some recent trends to expand the discipline to a consideration of systems of care and how they may impact or be involved in the experience of psychosis. Along these lines, one line of work has explored using the tools of phenomenology to explore the meaning-making process in the psychiatric encounter, recognizing the ways certain narratives and explanations may be privileged while others ignored or pathologized. Another set of literature has used phenomenological research methods to explicate encounters with various systems of care and opportunities for enhancing shared decision-making among those with psychosis. A third has pushed for user-led research to further broaden the range of experiences considered in phenomenological approaches to psychosis, while also interrogating the impact of stigma on accessing care. Others have focused on the ways that psychosis is embedded in and takes up particular cultural and political landscapes, and on the impact of contextual factors in experiences of and responses to various interventions.

In this panel, we will hear from several panelists on the ways they view the potential for phenomenology to consider experiences of and within healthcare systems, and on the challenges phenomenological psychopathology still faces in its current conceptualizations of psychosis. Commentary and discussion will follow, with an emphasis on linking these initiatives with the history of phenomenological psychopathology and on the relevance of this work for conferences attendees.

While there is new neuroscience research that validates an approach to helping individuals manage extreme states by incorporating awareness of the embodied experience with meditation and mindfulness techniques I would like to propose combining this awareness with a curriculum that also includes engaging in creative flow experiences either in the production of visual art or movement of the body. These approaches have been on the margins of the alternative psychiatry movement for years. Sculpt.Your.Mind™ —future 501(c)(3)—has designed a way to provide alternative therapeutic interventions for those experiencing extreme states and for those wanting to learn their own mind. The value of this approach is coming into the light given neuroscience and interests psychedelics. This needs only one's own mind. The founder of Sculpt.Your.Mind™ -Samantha Dorian- lead an experiential workshop at the annual conference of NSGP at Lesley University. She aims at integrating the embodied experiences of sense perception with the awareness of the here & now, i.e. bridging the meditative technique of concentration with group psychodynamics. There is a third component to this unique curriculum and that is the embodied experience of the visual components with action and production by the participant. Therefore, three aspects of engagement are: group psychodynamic, pro-social priming, meditative concentration on the felt sense of being, and finally the creative production in a state of flow. These organically ignite the prefrontal cortex while engaging the amygdala in a pro-social group experience. Potentially allowing participants to create psychic space and learn their observe their inner landscape rather than be caught by it. This freedom of expression allows for an experience of agency as well as awareness of one’s uniqueness. Stimulating neuropathic reconstructions through imagination & visual representations is nothing new, but this specific curriculum adapts these for extreme states in order to allow the brain to bloom new possibilities for positive sublimation & integration. Neural plasticity ranges from functional to structural and the possibilities for better care for this population are endless with the tools from Sculpt.Your.Mind™

Identifying and Addressing Stigma in Mental Health Care - 2 x 45 minute sessions

• Stigma in professional psychology advice-giving - Philip T. Yanos, PhD, Dan Bernstein MHS, Soo Min Kim, MA
• Destigmatizing Psychiatric Care: Listening to Lived Experience - Dorothy Clare Tessman, MSN, APRN, DNP Pending

Stigma in professional psychology advice-giving - Philip T. Yanos, PhD, Dan Bernstein MHS, Soo Min Kim, MA
Although research generally supports that mental health professionals endorse less stigma toward people diagnosed with mental health conditions than the general public, there is evidence that stigma persists in this group (O'Connor & Yanos, 2024). Further, when expressed by mental health professionals, stigma may be more impactful. Recently, with the growth of online advice-giving platforms (which allow professionals to take on the role of "influencer" [see White and Hanley, 2022]), expressions of stigma by mental health professionals may also be impactful if they are read by members of the general public, who may then feel emboldened to enact stigma (such as social rejection or the expression of demeaning comments) toward people diagnosed with mental illnesses that they encounter in their daily lives. Psychology Today (psychologytoday.com) is a major platform of professional "advice-giving" which at times publishes articles expressing problematic statements which could impact behavior toward people diagnosed with mental health conditions. The purpose of this study is to survey persons who contribute to Psychology Today on their views regarding a number of problematic statements that have been made on the platform. 500 contributors listed on the Psychology Today website will be randomly selected and emailed an invitation with a survey link using publicly available information. The survey includes demographic questions, questions about a series of problematic statements made by Psychology Today contributors, and the Opening Minds stigma scale for health care providers (Modgil et al. 2014). We anticipate that a significant proportion of advice-givers will agree with problematic statements about people with mental health conditions, and that agreement with these statements will be associated with stigma as measured by the Opening Minds scale. Data collection for the project is currently ongoing and we anticipate that it will be complete by July 2024.

Destigmatizing Psychiatric Care: Listening to Lived Experience - Dorothy Clare Tessman, MSN, APRN, DNP Pending
Stigma is a barrier to care for people who hear voices and have disrupted salience regulation, leaving healthcare needs unmet, and healthcare workers reporting helplessness, a factor in burnout. Psychiatric evaluations focus on risk, prompting fearful thoughts for vulnerable patients, instigating stigma, and exacerbating symptoms, a concern for causing more harm than they prevent. Rapport with clinicians reduces repeat admissions and unnecessary emergency visits for mental health. Rapport development with the Maastricht Approach (MAp) is a therapeutic intervention, aiming to improve the quality of healthcare experiences for service users and care teams.

Healthcare workers in psychiatric settings seek less stigmatizing, supportive methods to build therapeutic rapport while also meeting the systemic needs of ensuring safe, effective care. Healthcare reform, widely recognized as a desperate mandate, includes the Quality Improvement aims of reducing burnout by improving care teams’ experiences as well as reducing disparities, and improving the quality and value of care, all of which are factors addressed by this project.

This Quality Improvement project is empowering healthcare workers to use MAp, offering prompts for rapport-building evaluation. Participants completed Continuing Education questionnaires and Adapting Practice forms indicating intent to use MAp in encounters with service users. Aims are to improve healthcare workers’ confidence using open curiosity and compassion to build rapport and therapeutic alliance, reducing stigmatization and harm to service users from assessment processes.

The involuntary hospitalization of people experiencing mental health crises is a widespread practice across the US, as common as imprisonment in state and federal prisons.  In spite of persistent concerns from service users and advocates, the impacts of involuntary treatment have been difficult to characterize, and causal inference limited by structural and ethical barriers.  This panel will lead with important new research led by Dr. Welle utilizing administrative data from Allegheny County, Pennsylvania, and leveraging the quasi-random assignment of evaluating physicians in order to estimate causal effects of involuntary hospitalization on post-discharge death by suicide or overdose, violent crime and employment.   For individuals whom some physicians would hospitalize but others would not, the team has found that hospitalization nearly doubles the probability of being charged with a violent crime or dying by suicide or overdose in the three months after evaluation.  Remaining panelists – Drs. Morgan Shields, Awais Aftab, and Travis Donohoe – will reflect on these provocative findings and share their own adjacent work.  Specifically, Dr. Shields will focus on inpatient psychiatry, including common experiences in inpatient settings, and the potential role of inpatient iatrogenic harm with respect to post-discharge outcomes.  Dr. Awais, a community psychiatrist and philosopher of psychiatry, will discuss ethical and political implications, as well as potential ways forward. Finally, Dr. Donahoe will reflect on methods-related challenges and next steps to advance policy research across the US.  

Psychosis and the Reproductive Body - 2 x 45 minute sessions

• Reconceiving Peripartum Psychosis: Developmental, psychosocial, and phenomenological perspectives - Elizabeth Pienkos, PsyD, Marie Brown, PhD, Tate Hudson, MA
• Not Just Hot Flashes: Navigating Extreme States in the Menopausal Transition - Leah Harris, MA

Reconceiving Peripartum Psychosis: Developmental, psychosocial, and phenomenological perspectives  - Elizabeth Pienkos, PsyD, Marie Brown, PhD, Tate Hudson, MA

Peripartum psychosis is a largely underresearched condition, and interventions vary widely. In the U.S., it is primarily attributed to biological causes, and treated via medication, often in inpatient psychiatric settings. The narratives of women who face peripartum psychosis, however, reveal the significant role played by communication about idealized states of motherhood, and their conflict with women’s real experiences of motherhood, in the development of distress and ultimately psychiatric symptoms. In this panel, we will highlight these frequently unheard stories of psychosis and motherhood, and the potential for interventions to either enhance or disrupt attempts at integrating a wide range of experiences found in pregnancy and early motherhood. Presentations will offer reflections on: the experience of peripartum psychosis and encounters with medical and psychiatric institutions; phenomenology and its potential to illuminate two recent narratives of peripartum psychosis, Inferno (Cho, 2020) and Setting the wire (Townsend, 2019); multidisciplinary perspectives on peripartum psychosis that help to escape a purely biomedical vision of this condition, drawing specifically on a developmental (i.e., matrescence) and socio-political lens; the possibilities in feminist phenomenology to help unpack the progression of experiences reported by women with peripartum psychosis. From these talks, we hope to offer a range of ways to think about peripartum psychosis that can shape intervention to be more responsive to women’s lived experience.

Not Just Hot Flashes: Navigating Extreme States in the Menopausal Transition - Leah Harris, MA
The menopausal transition can be characterized by a wide range of embodied experiences, including new onset or intensification of voice-hearing and extreme states. Presenter + psychiatric survivor Leah Harris went through extreme states for the first time during this phase of life, and will share insights from documenting and researching this experience over the past five years. For example, there is a documented "second peak" in first onset of extreme states that occurs during the menopausal years of 45-55, as well as higher rates of psychiatric hospitalization and suicide. Yet there is little to nothing in the way of awareness and customized supports for people experiencing psychosis for the first time during midlife. This workshop will highlight holistic, de-pathologized, gender-inclusive, and social justice-based strategies for understanding and raising awareness about this complex, mysterious, and important facet of human experience. 

How do we use our lived experience as therapists in the clinical setting? How much mutuality is “too much”? Are there limits to the use of self-disclosure in the therapeutic dyad?

We are all therapists with various kinds of lived experience who have found our way to professional work as clinicians. To some extent, of course, all therapists have some kind of “lived experience” – which is another way of saying that all therapists use their own life experience in their work, regardless of whether they use explicit forms of self-disclosure in their treatments or not. With this in mind, this panel will ask the question: might explicit forms of self-disclosure regarding a therapist’s lived experience actually benefit the treatment? If so, how?

In this panel discussion, we will discuss our own journeys with respect to becoming clinicians who think deeply about mutuality and self-disclosure in our work – with our patients, clients, as well as our peers. We will explore the limits of self-disclosure and mutuality, depending on the clinical setting and the patient we are working with.

How to Discussion: Lived Experience Writing in Academia - Sirikanya Chiraroekmongkon, MD

Academia is a highly intimidating space, with much of its own technical language and nuances. A person with lived experience (including family members) outside of academia may find this space too foreign or unfamiliar and may struggle with feeling that their writing belong in this space. A person with lived experience (including family members) inside of academia may worry about sharing, with fears of vulnerability and potential repercussion.

This presentation invites all spectrum of feelings and nuances. It aims to walk through the internal and external steps into the undertaking and to create an open and safe environment for a discussion.

Decades after deinstitutionalization, mental health crisis care in the U.S. remains fraught with systemic challenges. Inadequate funding, fragmented services, and policy shortcomings contribute to persistent disparities. Crisis services are critically inadequate and increasingly carceral despite intentions to shift to community-based, person-centered approaches. People experiencing psychosis are more likely to face discrimination and harm within this carceral system. Additionally, underfunded social welfare services and rising living costs make meeting basic needs difficult. Consequently, crisis responses to unmet needs are often pathologized, leading to poverty, unemployment, criminalization, incarceration, housing precarity, and coercive interventions. These issues are exacerbated for historically marginalized populations facing additional discrimination.

Compounding these challenges is the increasing cooptation of peer-based services into the medical system. While peer support can offer holistic and effective care that normalizes experiences of psychosis, its integration into a medical model risks undermining its foundational principles of mutuality and lived experience. This shift can negate the efficacy of peer-based approaches, making it harder to address the root causes of mental health crises compassionately and person-centered.

Despite these systemic barriers, pockets of hope and innovation exist. Community-driven grassroots initiatives and novel research and advocacy efforts are beginning to reshape mental health crisis care. This highlights the potential for transformative change by challenging cultural narratives around psychosis and promoting inclusive approaches to wellbeing.

This roundtable will:
1. Explore how structural influences scaffold our mental health crisis care system and perpetuate adverse mental and social outcomes.
2. Foster substantive conversations about the current state of mental health crisis care.
3. Encourage collaborative efforts to address systemic barriers.

The stigmatization and criminalization of mental health crises often result in punitive rather than compassionate responses. Amplifying diverse lived experiences into leadership roles can help address a critical need to expand non-carceral interventions that prioritize recovery and dignity over punishment.

In September of 2023, James B. (Jim) Gottstein, Esq.; Peter C. Gøtzsche, MD; David Cohen, PhD; Chuck Ruby, PhD; and Faith Myers, published the Report on Mental Health Outcomes (Report).  See, https://psychrights.org/ReportOnImprovingMentalHealthOutcomes.pdf.  The Report documents that the current Mental Health System is reducing recovery rates for people who experience psychosis from a possible 80% to 5% and reducing life spans by 20-25 years.  This is primarily due to the over-reliance on drugs, but also from forcing unwanted psychiatric interventions on people which, incidentally, is a violation of International law.

The Report also documents non-coercive, humane approaches that should be used instead of the drugs and force, such as Open Dialogue, Psychotherapy, Peer-Respites, Soteria-Houses, Drug-Free Hospitals, Housing First, Employment, Warm Lines, Hearing Voices Network, Non-Police Community Response Teams, and emotional CPR (eCPR).

The Report was written specifically for policy makers and potential funders, with hyperlinks to the 12 pages of references. James B. (Jim) Gottstein, Esq., the lead author of the Report, will present its findings and invite discussion, including how to bring the Report's recommendations to fruition.