New Beginnings: Reimagining Psychosis Services & Systems in the US

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Lived experience wisdom can help challenge outdated assumptions about care for those experiencing psychosis and altered states, and has the potential to guide us into a more liberatory future.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.

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.

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.