New Beginnings: Reimagining Psychosis Services & Systems in the US

From 2002-2020, The Icarus Project developed a network of peer support groups and a creative media outlet that provided a home for folks who experienced mental health struggles and a deep alienation from society. Drawing inspiration from anarchism, anti-psychiatry, permaculture, and other counterculture movements, we aimed to normalize discussions of altered states, intense emotional distress, and suicidality and foster solidarity among people with experiences that were often diagnosed as “serious mental illness” and “psychosis.” At its height, The Icarus Project had thousands of online forum community members, dozens of local peer support/mutual aid groups, and a series of DIY publications that made their way into public mental health systems and became texts for academic analysis. At the same time, we also struggled greatly with interpersonal conflict, leadership burnout and turnover, issues related to identity politics and structural oppression, technological system management, and other challenges common to small social movement organizations.

More than 20 years since its founding, The Icarus Project has left a complicated legacy of ideas and creative visions, influencing individuals and organizations across North America and the world. Former members have gone on to play significant roles in transformative mental health practices, advocating for approaches that prioritize human connection, social justice, and the de-stigmatization of mental health experiences. Others left the organization with the sense that their efforts were underappreciated and lacked recognition in public narratives.

This panel will delve into the origins and impact of The Icarus Project, exploring how its creative grassroots approach has influenced contemporary mental health movements. Attendees will learn about the project's innovative use of language, its critique of the mainstream medical model of “mental illness,” and its commitment to fostering mutual aid communities. Panelists, including co-founders and long-time collaborators, will reflect on the project's successes and challenges, offering insights into how its legacy can inform future efforts in mental health social movements.

Enhancing Early Psychosis Care  - 2 x 45 minute sessions

• Voices of practitioners learning a combined OD and CSC model: Exploring content and research processes - Beth Broussard, MPH, CHES, Emily Griner, MPH, Melissa Uehling, MA, Jen Van Tiem, PhD, Chris Okpor, BS, CPS-P, CTC, CTRS,
• M-PATH: A Statewide Effort To Decrease DUP and Increase Psychosis-Informed Care - Emily Gagen, PhD

Voices of practitioners learning a combined OD and CSC model: Exploring content and research processes - Beth Broussard, MPH, CHES, Chris Okpor, BS, CPS-P, CTC, CTRS, Emily Griner, MPH, Melissa Uehling, MA, Jen Van Tiem, PhD
Two recovery-oriented approaches for early psychosis, Open Dialogue (OD) and Coordinated Specialty Care (CSC), have been developed to address individual needs of young adults. OD is founded on seven principles and fosters dialogue among networks of support (Seikkula and Olson, 2023). CSC provides evidence-based treatment through a multidisciplinary team while emphasizing shared decision making and collaboration (Bello et al., 2017). In Atlanta, Georgia, team members of Project ARROW have incorporated these two models as the foundation of its early intervention program since 2019.

This presentation will introduce OD and CSC to the audience, as well as discuss recent qualitative work with practitioners at Project ARROW. We will discuss experiences of team members learning and implementing the combined OD/CSC model. Lessons learned regarding program implementation and the importance of peer voices will be offered. Additionally, ideas for creating better research practices to promote inclusion of all voices, including peers, will be discussed such as trauma informed interviewing and techniques from the OD framework. The panel will also use the OD framework for presenting; being open to uncertainty and utilizing reflections. Small group discussions will be incorporated, as well as time for larger group discussion and questions.


M-PATH: A Statewide Effort To Decrease DUP and Increase Psychosis-Informed Care - Emily Gagen, PhD
Specialized early psychosis programs aim to decrease the duration of untreated psychosis (DUP) by treating adolescents and young adults soon after the onset of their symptoms. In Massachusetts, several of these programs exist but many families find it difficult to access them, due to lack of awareness, difficulty navigating the mental health care system, and sometimes strict eligibility criteria. Additionally, community providers like outpatient therapists, high school and college counselors, and behavioral health clinicians embedded in pediatric and primary care offices often report a lack of sufficient knowledge and confidence in talking with families about psychosis. The Massachusetts Psychosis Access and Triage Hub (M-PATH) was created to support young people and their families with accessing specialized treatment programs; this includes care coordination, psychoeducation, and family partner and young adult peer mentor services. M-PATH also offers outreach, consultation, and education to community providers in order to help them provide psychosis-informed care. We will discuss the development and launch of this program, its successes and challenges thus far in its first 2 years of existence, and its plans for future growth and expansion.

Supporting Students with Extreme Experiences - Olivia Willis, LCSW
In this presentation, mental health professionals, caregivers, friends, and nonclinical professionals will be given a practical and principled approach to supporting college students, in a college setting, with extreme experiences. It will convey best practices in the form of a framework, the SUCCESS framework, to help health professionals, friends, and caregivers to feel empathetic and skillful in the instances where folks have these extreme experiences. In addition to the SUCCESS framework, presenter will review: challenges that folks with extreme experiences face on college campuses, prevalence information, resources, ethical considerations, and treatment approaches for this population.

Anti-Carceral Crisis Care: Cultivating Agency and Self-Determination for those Experiencing Altered States -Jessie Roth, Noah Gokul, Jazmine Russell
Mental health services for those experiencing psychosis in the United States are largely rooted in coercion and control. Driven by individual provider fear and the system's emphasis on liability, mainstream responses often involve stripping people of their rights and agency. A common example is forced psychiatric commitment, which is expanding rapidly across the country as we speak. Not only are involuntary services an ineffective solution for people experiencing trauma and systemic oppression – research demonstrates that they actively perpetuate cycles of violence. They also disproportionately affect multiply marginalized community members, including the poor and unhoused, BIPOC, and disabled communities.

Lived experience wisdom can help challenge outdated assumptions about care for those experiencing psychosis and altered states, and has the potential to guide us into a more liberatory future. Unfortunately, this knowledge is often silenced in education, service delivery, and policy contexts. This session will weave together diverse lived experience perspectives on psychosis, such as firsthand experience with altered states, working in the system as a peer specialist, and witnessing psychiatric harm as a family member and trauma survivor. The presentation will be rooted in lineages of activism across movements that have birthed countless anti-carceral approaches to crisis care that cultivate agency and self-determination.

Through a brief presentation and interactive conversation with the audience, presenters will challenge dominant narratives that bolster coercive care approaches (e.g. people experiencing psychosis lack “insight” into their condition, also known as “anosognosia”), explore what becomes possible when crisis is redefined as an opportunity, and introduce a plethora of trauma-informed care approaches that exist within and outside the system. Participants will leave with new skills and strategies for “being with” and caring for those experiencing psychosis in ways that divest from the mental health industrial complex.

Psychoanalytic Legacies and Innovations (In-Person Only)

• Lessons From the Lodge, Riggs, Sheppard Pratt, McLean, and Menninger - James E. Gorney, PhD
• After 40+ Years of Analysis: New Beginnings in Treatment Leading to a Successful Outcome - Martin Cosgro, PhD

Lessons From the Lodge, Riggs, Sheppard Pratt, McLean, and Menninger - James E. Gorney, PhD
Dr. Ann-Louise Silver, psychiatrist, psychoanalyst, a founder of ISPS, and the esteemed and revered past-President of ISPS-US ,long proposed writing a book to be entitled - "Lessons From the Lodge". This would have been a monument to her years of work at Chestnut Lodge treatment center in Rockville, Maryland. Her untimely death a few years ago thwarted the completion of this project. This presentation will memorialize Dr. Silver's intent through an account of long-term psycho-dynamic and psychoanalytic hospital based treatment settings for psychosis, which flourished during the last half of the Twentieth Century.These institutions provided a unique setting for clinical research, milieu treatment, and intensive psychotherapy in regard to extreme states. The unique therapeutic philosophy of patient care developed within these extended stay hospitals will be examined in detail. Numerous clinical examples will be provided to demonstrate the innovative and courageous approaches which arose here in regard to the therapeutic understanding and care of psychosis.

Within the context of currently prevalent managed-care, short-term hospitalization, and over utilization of anti-psychotic medication, it is now particularly important to commemorate lessons learned by the daring clinicians who worked within those noble past institutional settings. Consequently, key insights of Frieda Fromm-Reichmann, Harold Searles, Otto Will, and Ann-Louise Silver in regard to the treatment of psychosis will be explicated here via their own clinical accounts.

This model of humanistic, psycho-dynamic treatment for psychosis, trauma, and other extreme states developed within long-term milieus, provides an alternative, and antidote, to the current, broken mental health system now pervasive within the United States. Treatment wisdom, so painfully gained over so many years, has almost been forgotten. Ann-Louise Silver always encouraged us at ISPS to keep this humane, concerned, benevolent flame alive.

After 40+ Years of Analysis: New Beginnings in Treatment Leading to a Successful Outcome - Martin Cosgro, PhD
Effective psychodynamic/ psychoanalytic psychotherapy for psychosis has been around for a century and is still considered the treatment of choice by some, as the late Bertram Karon suggested. However, at times, this approach has led to limited progress and no resolution of underlying issues. This case presentation will demonstrate how 40+ years of “traditional” psychoanalysis was ineffective, and the modifications in a subsequent 3 year psychoanalytic therapy led to integration and significant improvements in all areas of life. Dealing with underlying trauma, the subsequent emotions and on-going object relations interpretations will be presented as the treatment components that appeared to be missing in the prior treatment and which led to a successful outcome.

The shadow of groups and organizations - corruption, ethical misconduct, mistreatment, cooptation - is like a family taboo, growing worse with avoidance and silence. Workplace and community injustice create toxic stress that crushes idealism and inflicts crazymaking dilemmas on staff and activists, leading to group dysfunction, burnout, and failure. Early career activists and staff conform or leave, and innovations implode, while normalized misconduct incentivizes conformity and enables a corrupt status quo. The most vulnerable - BIPOC and LGBTQIA, trauma survivors, economically disadvantaged - are impacted most. What's the way forward?

Standing Together To Respond with Empowerment Against Misconduct (STREAM) is a simple model that breaks the silence in a trauma informed, empowered, and sustainable way. STREAM provides a simple community leadership roadmap for engaging group and organization ethics violations with sustainability and compassion. (This trauma-informed workshop will not name specific instances, but offer follow-up resources.)

In this talk, I’ll discuss some of the challenges faced by the tradition of phenomenological psychopathology and how internationally we may be able to address some of these going forward. In this, I’ll draw on the recent Renewing Phenomenological Psychopathology project and the work of global and lived experience scholars in the field. For the latter part of the presentation, I’ll introduce the concept of Epistemic Injustice and how this relates to phenomenology, and how striving toward epistemic justice may further help us in flattening hierarchies of knowledge and increase democratization in mental health research and practice.

Diagnosis-Related Group 885 (DRG 885) is significant and pivotal in the healthcare system, particularly for classifying inpatient hospital cases involving psychosis. The causation for psychosis can range from being sleep deprived, a mental health misdiagnosis to a physical injury that manifests symptoms related to mental health As a component of the Medicare Severity-Diagnosis Related Group (MS-DRG) system, DRG 885 is extensively relied upon and utilized for billing and reimbursement. This ensures hospitals are compensated. Medicare and Medicaid are major payers for hospital services in the United States of America. As one with lived experience, a psychosis diagnosis is a gateway that leads to inpatient psychiatric care, whether needed or not. DRG 885 remains a leading cause of psychiatric admissions, underscoring its importance in the prospective payment and healthcare reimbursement landscape in psychiatric care. This is problematic, as it can create systemic fraud through the overuse of psychosis, shifting patient-centered care to a medical mode conflated payer-centered model. DRG 885 is an overused classification, reflecting the high prevalence of inpatient admissions for psychosis. It plays a crucial role in clinical reporting and analysis enabling healthcare organizations to monitor the quality of care, manage resource allocation, and improve clinical outcomes. Hospitals track DRG codes to analyze trends and enhance the efficiency of psychiatric services, and used to manipulate the judicial system. Medicare & Medicaid data consistently show DRG 885 among the top four used DRGs. In 2008, DRG 885 was recodified from the longstanding psychosis DRG 430 in use since 1983. Over the past 20-years psychosis remains in the top four for hospitalizations, demonstrating excessive use and the need for system reform. In conclusion, DRG 885 is essential for funding inpatient psychiatric care, whether needed or not. The widespread excessive use of psychosis signifies the substantial need for comprehensive system reform.

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.

Crisis Response: From Critique to Action - Brian Nuckols and panelists TBD

The presentation develops a critical theory of psychiatric crisis response, addressing three fundamental levels: theoretical foundations, methodological choices for intervention, and measurement, evaluation, and outcome research. This critical theory establishes a comprehensive framework to critically examine current practices in crisis response and proposes an interdisciplinary and community-based approach to theory, intervention, and measurement. At the theoretical level, the presentation integrates critical perspectives from psychology, sociology, anthropology, theology, medicine, public health, and urban design, exploring the historical and socio-political contexts that shape current psychiatric crisis response systems. Methodologically, it advocates for approaches that have been ignored or erased by hegemonic psychiatric models, emphasizing creativity and experimental forms of narrative research to capture diverse experiences and perspectives on emotional crisis. For measurement and evaluation, the presentation proposes new metrics and evaluation criteria that reflect the complexity and holistic nature of psychiatric crises. A mixed-methods research approach combining quantitative and qualitative methods is suggested to provide a comprehensive evaluation, focusing on outcomes that are meaningful to service users and their communities. From this critical perspective the, the presentation proposes a swarm of movement-building interventions. The swarm, while ultimately uncontainable to any one objective, will stimulate itself through organizing an interdisciplinary consortium comprising service users, peers, and professionals from diverse fields such as art, psychotherapy, theology, medicine, sociology, anthropology, public health, and urban design. The consortium will collaboratively design, implement, and evaluate alternative community responses to emotional crises.

 

Family Narratives and Systemic Insights - 2 x 45-minute sessions

• Remembering Rachel a sisters perspective - Deborah Kasdan
• Straight From The Cuckoo's Nest: A Patient's & A Caregiver's Perspective - Perri Bach, BS, Ethan Back, AS

Remembering Rachel a sisters perspective - Deborah Kasdan
A personal account of the impact of the impact of failed psychiatric treatment on my sister Rachel, myself and our entire family of six, as recounted in my book, "Roll Back the World: a sister's memoir."

Rachel was healthy and vibrant during her gap year working on a kibbutz in Israel but when she returned to the U.S. her behavior was erratic and disorganized. She was unable to care for herself and our parents were unable to care for her. In 1965 at 23 years of age, Rachel was institutionalized with a diagnosis of schizophrenia; I was just starting college and was unable to process what was happening to her. My brother started college the next year. We had no family meetings or therapy to help and support us. Our parents wanted to keep Rachel safe, but we wanted her to be free. Our parents filed a Federal law suit to keep her in the hospital because she was assaulted and raped in boarding houses where she was discharged. Her siblings' attempt to free her from the hospital backfired and Rachel ended up on her own two thousand miles from home. She lived on the streets and in three state hospitals for years until a social worker was stunned by the quality of her poetry and got her into an outpatient program. Eventually, the staff found an ideal home for her and she found acceptance and respect in a synagogue. I explore my own feelings of shame and guilt, my inability to help her as I wished to, or share these feelings --until finally, in publishing the memoir about us, I brought them to light. This personal history suggests the need to include adult siblings in decision-making and help families deal with the host of conflicts that arise around hospitalization and treatment of a loved one.


Straight From The Cuckoo's Nest: A Patient's & A Caregiver's Perspective - Perri Bach, BS, Ethan Back, AS
Ethan has endured five psychotic breaks from 2012 to 2020, each profoundly shaped by The Truman Show Delusion. In his talk, he will delve into the factors that contributed to these episodes and this unique delusion. Drawing from a clip of The Truman Show, he’ll connect its themes to his lived experiences.
Ethan will also share a personal excerpt from the forward of his memoir, followed by a gripping passage that captures the intensity of a psychotic episode.
He’ll close on a hopeful note before introducing his mother, who was his caregiver during these difficult years. She will share her journey of caregiving through his struggles and reflect on the broader state of mental illness care in the U.S.

Integrating Psychoanalytic Theory - 2 x 45 minute sessions

• Archetypes of Home and Homelessness: Social Displacement,  Alteric Spaces, and the Trauma of the Unhoused - Claude Barbre, MDiv, PhD, LP
• Alfred Adler's Understanding of Extreme States - Thomas Federn, MDiv, MS

Archetypes of Home and Homelessness: Social Displacement,  Alteric Spaces, and the Trauma of the Unhoused - Claude Barbre, MDiv, PhD, LP
Archetypes are often defined as universal, inherited ideas, patterns of thought, or images that are present in the collective unconscious of all human beings—literal, symbolic, and psychic. In essence, archetypes are the deepest paradigms of psychic functions, reflecting the perspective we have of ourselves and the world. As James Hillman notes, “all ways of speaking of archetypes are translations from one metaphor to another… and these perspectives offer the advantage of organizing into clusters of constellations a host of metaphors and events from different areas of life” (Hillman, 1989). In this presentation we will explore the archetypes of home and homelessness, and the social complexes that occur in response to these collective primordial images. The archetype of home as a container, or a place to which one can belong, also suggests a “narrative reality” (Hill, 2010) that describes how we attach to a place, a person, an object, a nation, a group, a culture or an ideal” (Bright, 2014). As Bright notes, “home is a word weighted with affect and associated with rootedness, attachment, belonging, shelter, refuge, comfort, and identity” (Bright, 2014). Conversely, a severed connection to home creates emotional and psychological implications. Homelessness symbolizes a state of disconnection, both externally and internally. As Lee says, “Homelessness ranges from temporarily unsheltered individuals between jobs or homes to chronically unhoused individuals who spend years without stable housing” (Lee, 2023) Hence, traumatic and psychological distress (e.g. Enreiss, or “tears in the psyche”) accompany conditions of homelessness, as found in the etymological meaning of the word “uncanny” that literally means “homelessness at home.” In this presentation we will explore the psychological and spiritual implications of home and homelessness, particularly the archetypal images of the Outcast, Stranger, and Scapegoat that reflect the power of personified images of alteric spaces and homelessness.

Alfred Adler's Understanding of Extreme States - Thomas Federn, MDiv, MS
Alfred Adler (1870 to1937) was one of the first four individuals to meet regularly with Sigmund Freud to discuss Freud’s ideas. These meetings began in 1902. Eventually, in 1911, because he disagreed with too many of them for comfort, he and some likeminded fellow members left what by then had become the Vienna Psychoanalytic Society and founded what became known as the second of the three psychological schools of Vienna, the Society for Individual Psychology. Like those of Freud, Adler’s ideas ended up being disseminated throughout the entire world.

Adler believed that all the emotional difficulties of a person stemmed from feelings of inferiority acquired during early childhood. In order to compensate for these at times devastating negative feelings, a person engaged in what Adler called “masculine protest,“ a socioeconomic term which refers to the unfortunately still very prevalent inferior position of women in society. Adler believed that the goal of all psychotherapy was to help the individual overcome their need to be superior to others and to replace this need with a sense of community that involved a feeling of self-worth grounded in belonging to one’s own family and community. In order to achieve this end psychotherapy needed the help of both of these to motivate the person to abandon their “masculine protest” against their feelings of inferiority. Last but certainly not least, Adler believed that the individual was not just an aggregate of individual mental and emotional actions but a unified whole. Hence the name of the school of individual psychology.

My presentation will be comprised of three parts. First a brief one, placing Adler in his historical context. Then a longer summary of his basic ideas and finally then an even longer description of how to apply these ideas when one assists persons experiencing extreme states.

The integration of lived experience within mental health systems has gained recognition as a crucial element in enhancing service delivery and outcomes. This panel will explore the multifaceted dimensions of meaningful involvement of individuals with lived experience (peers) in mental health systems, emphasizing the co-production of services, training, and research. Drawing from qualitative research and panel members' expertise we will examine best practices and barriers to effective involvement. Central to our analysis is the concept of "meaningful involvement," which transcends tokenistic inclusion, advocating for active and sustained participation that influences decision-making processes.

We investigate various models of engagement, including peer support roles, advisory boards, and co-researcher positions, highlighting successful implementations across different mental health settings. We seek to discuss how meaningful involvement contributes to a more empathetic and person-centered approach in mental health services, fostering trust and improving all elements of services. Key factors for success include robust training programs for peers, institutional commitment to culture change, and the creation of supportive infrastructures that value lived experience as essential expertise. However, myriad challenges persist, such as stigma, power imbalances, and the sustainability of peer roles within traditional hierarchies. We provide recommendations to address these challenges thorough different lenses, with a panel with four lived experience experts and one clinical expert. The panel seeks to underscore the necessity of embracing lived experience as a cornerstone in the evolution of mental health systems.

By systematically incorporating the voices of those who have navigated mental health challenges, we can co-create more responsive, effective, and humane systems of care. The perspectives gleaned from this panel aim to inform practitioners, policymakers, researchers, and individuals with lived experience in committed to fostering inclusive and transformative mental health services.