By Jenny Westberg, Portland Mental Health Examiner

On Thursday, Feb. 10, award-winning journalist Robert Whitaker, along with a panel of experts, will speak at a community forum titled, “Moving Mental Health Recovery Forward / Rethinking Psychiatry.” Whitaker’s previous visit to Portland on August 19, 2010, filled three venues to capacity, addressing some of the hottest topics in current mental health care.

In his book Anatomy of an Epidemic, Whitaker took on some of the basic assumptions of modern psychiatry, such as the idea that many people need medications for their entire lifetime. Whitaker’s question was simple: “Is it working?” To find out, he looked at scientific studies, conducted interviews and analyzed disability statistics. Again and again the answer was, “No, it’s not.” It was, in fact, making many people worse.

Whitaker’s argument is not anti-medication; he points out that some people do benefit. He does argue for treatment based on outcomes – in other words, treatment that helps people recover and gain self-sufficiency over the long term. And the routine use of psychiatric drugs, he says, may be leading in the opposite direction.

On Thursday, Whitaker will be joined by the following panelists:

• Beckie Child, director of Mental Health America of Oregon
• Cindi Fisher, Movement of Mothers Standing Up Together (The M.O.M.S. Movement)
• Chris Gordon, assistant professor of psychiatry at Harvard Medical School, medical director of Mental Health Advocacy
• Will Hall, Portland therapist, director of Portland Hearing Voices, national leader in peer recovery
• Gina Nikkel, director of the Oregon Association of Community Mental Health Progams

The forum’s title has two parts: rethinking psychiatry, and moving mental health forward. Here’s what Robert Whitaker and Beckie Child say about each of them:

Rethinking psychiatry: Why?

Robert Whitaker: The current paradigm of care we have clearly isn’t working for our society. All we have to do is look at the number of adults and children on federal disability rolls due to a mental illness. The number of adults on disability rose from 1.25 million in 1987 to 4 million in 2007. Meanwhile, the number of children and youth under 18 years of age receiving an SSI check due to mental illness soared from 16,200 in 1987 to more than 600,000 today. Now when those youth hit age 18, many are going right onto the adult disability rolls, and once on those rolls, most will stay there.

Our society needs to figure out how to stem this “epidemic” of disabling mental illness because it can’t afford it. We need treatments that will help people get well and stay well, and that means thriving in a robust way.

Beckie Child: With the state of mental health care treatments available today, why is it that disability from mental illness is increasing at such an alarming rate? Why do people who experience the public mental health system also experience such a deprivation of dignity and hope? Why do people diagnosed with mental health challenges die 25-30 years earlier than people who are not diagnosed? To say it is only because of our lifestyle does a disservice all of us who’ve been so diagnosed.

Many of the second-generation antipsychotic medications are only studied for brief periods of time, usually six weeks to six months. There are only a handful of studies that evaluate these medications for longer periods of time. And how long do they study them? Not more than two years. Antidepressants don’t fare much better–and yet we’ve told people that they have to take these medications for a lifetime.

Psychiatry has been so polluted by Big Pharma.  Medication is a tool.  [Psychologist] Abraham Maslow is credited with saying that if the only tool you have is a hammer, then every problem starts to look like a nail. What we are asking from psychiatry is to employ additional tools. The analogy I often use is that a tire iron is really helpful to change a tire. But that very same tire iron is not so helpful when your task is to wash dishes – just as the dishrag is not all that helpful for changing your tire.

Moving mental health forward:  How?

Beckie Child: To move mental health recovery forward, we need to sing at the tops of the mountains that being diagnosed with a mental illness is not the end of a person’s hopes and dreams. People do get better from all kinds of mental illnesses, including schizophrenia and bipolar disorder. There are tools and strategies that people can use to make their lives better.

The other part of recovery is getting providers and practitioners and systems people to believe that people can recover so that they use their learning to facilitate recovery rather than impede it.

Some of it is learning how to talk to treatment providers about what our most valued roles are. If someone walks into a psychiatrist’s office and says to the doctor that she is hearing voices and that same person walks into the same psychiatrist’s office and says that the most important thing to her is being a good mother and that these voices are preventing her from being a good mother–I’m pretty sure that she will come out with two very different prescriptions.

Robert Whitaker: This obviously is the big challenge. If our society comes to an understanding that our current paradigm of care isn’t working, then a new paradigm of care needs to be developed. I think the Portland conference is a first step toward doing just that. I believe that the challenge is to develop programs that help build and strengthen social connections for those who are struggling with psychiatric symptoms, and help promote physical health too. You need programs that instill hope, rather than pessimism. And then psychiatry needs to think about how to best use psychiatric medications to complement that process. That means figuring out when to use the drugs, and with whom, and for how long. I think the disability data is telling us that the current “drugs-for-life” paradigm of care isn’t working.

Mark your calendars:

Moving Mental Health Recovery Forward / Rethinking Psychiatry community forum

• Thursday, Feb. 10, 2011
• First Unitarian Church of Portland
• 1011 SW 12th, Portland
• Reception: 5-6:45 p.m.
• Forum: 7-9 p.m.

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Want a different viewpoint? On Saturday, a conference will explore children’s mental health from a more traditional perspective, including benefits of medication. Come to both events and decide for yourself!

Oregon Children’s Mental Health Conference

• Saturday, Feb. 12, 2011
• University Place at Portland State University, 310 SW Lincoln St., Portland
• Morning session (health care providers, teachers and other professionals) begins at 7:30 a.m.; afternoon session (families and general public) starts at noon
• Registration fees: $10 and up
• For more information, call NAMI Multnomah at 503-228-5692