The first Tuesday of each month from 4-6 pm Arizona time, except for holiday weekends, ACMI will have a featured guest to discuss a relevant Behavioral Health topic; after the speaker, we will discuss current issues with the Behavioral Health System attendees. This month, hear about Psynergy Healthcare from co-owner Arturo Uribe and Executive Director Lynda Kaufman. Psynergy Programs operates with the shared belief that recovery happens, especially when a cohesive set of supports and services are available to support and sustain it. Based in Morgan Hill, California, our organization has grown from one facility to four over the last four years, with a fifth now in development. Each campus offers clinical and residential services in a safe and supported residential area. This way, we can emphasize the best elements of a community-living experience for individuals facing various mental health challenges. We hope they expand to Arizona!

Arturo Uribe is the President & CEO at Psynergy Programs Inc. in Morgan Hill, California, United States. His vast experience includes assisting and Advocating for Individuals and Families who are navigating the California County Mental Health System•, Supervising Intensive Case Management Teams responsible for moving clients into less restrictive placement in Santa ClaraCounty• Managing clinical resources, Supporting community integration for clients previously residing in state hospitals, acute inpatient settings, and locked institutions• Individual Therapy, Couples Therapy, Family Therapy, and case management.

He has worked in various mental health systems, including:• Community Organizations•, Government Agencies• School Settings. At Psynergy Programs, I have been able to leverage my position as CEO to provide leadership with the philosophy that individuals have the power to do better when everyone works together. At Psynergy Programs, we have transformed communities and individuals by developing licensed adult residential facilities that provide a home-style setting coupled with both care and supervision and Mental Health treatment. At Psynergy Programs facilities, individuals can celebrate hope, promote personal growth, build social networks, and realize their full potential.

Psynergy Programs Inc.
President & Chief Executive Officer
January 2006 – Present (17 years 9 months)
Morgan Hill, California, United States

Santa Clara County Mental Health
24 Hour Care (Team Lead, LCSW)
June 1999 – December 2005 (6 years 7 months)

Santa Clara County Narvaez Mental Health Clinic
Psychiatric Social Worker I
June 1998 – May 1999 (1 year)
San Jose, California

Community Companions (Alliance for Community Care
Clinical Case Manager (Team Lead)
June 1990 – May 1998 (8 years)
San Jose, California

Santa Cruz County Office of Education
Teacher Assistant (CA Mini-Corps)
January 1985 – May 1990 (5 years 5 months)
Watsonville, California

San Jose State University
Master’s degree, Social Work · (1995 – 1998)
San Jose State University
Bachelor’s degree, Clinical Psychology · (1989 – 1992)

Lynda Kaufmann is Director of Government and Public Affairs, managing Admission, Contracts, and Supported Housing w/ ACT + FSP
San Francisco Bay Area. She is an Experienced Public Affairs Specialist with a demonstrated history of working with individuals with SPMI (Severe Persistent mental illness) in community settings. Skilled in contract management, coaching, government contracts, policies related to behavioral health, and MediCal practices. Strong community and social services professional.

Treatment Advocacy Center
March 2023 – Present (7 months)

Director of Government and Public Affairs
April 2010 – Present (13 years 6 months)
Morgan Hill, California

Topic: ACMI Stakeholder’s Meeting

Time: October 3rd, 2023, Psynergy Programs– CoOwner Arturo Uribe and ED Lynda Kaufman

November 7th, 2023, Greenbuurger’s Hope House, a secure treatment facility by ED Cheryl Roberts

December 5th, 2023, Secure Residential Treatment in San Mateo County by Terry Rittgers, Yessa Calderon, and Louise Rogers

January 2nd, 2024, TBD

February 6th, 2024, Terros Program and Offerings by COO Jennifer Nye and CEO Karen Hoffman Tepper

March 5th, 2024 Home Inc. by Charles Sullivan

Every month on the First Tuesday until December 25th, 2025

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By Shannon Osaka

Erin Patrick O’Connor and 

John Muyskens

Reporters from the Washington Post came to Arizona to research the heightened risk for those living with Schizophrenia in our extreme desert summer heat.

Shannon Osaka and Erin Patrick O’Connor reported from Phoenix during its historic July 2023 heat wave to capture the impact on the city’s most vulnerable residents. John Muyskens, in Washington D.C., mapped Stephan Goodwin’s movements in his final hours.

Published Sept. 6 at 6:00 a.m.

Image from Washington Post Sept 6th 2023 article, Photography by Caitlin O’Hara

Extreme heat poses heightened death risk for those with schizophrenia – Washington Post

The first Tuesday of each month from 4-6 pm Arizona time, except for holiday weekends, ACMI will have a featured guest to discuss a relevant Behavioral Health topic; after the speaker, we will discuss current issues with the Behavioral Health System attendees. This month, hear about Joel R. Conger of Connections Health Solutions. He will be discussing the services they provide (psychiatric screening as well as the recent addition of Court-Ordered-Evaluations (COE),

Joel Conger is a highly experienced professional with a distinguished career spanning over 30 years in the behavioral health community in Arizona. He holds the esteemed position of Arizona Market President for Connections Health Solutions, a leading organization dedicated to serving the behavioral health needs of individuals in the state. Under his leadership, Connections Health Solutions successfully serves approximately 30,000 Arizonans each year who are facing behavioral health crises.

Before joining Connections Health Solutions, Joel served as the Associate Vice President of Behavioral Health for Molina Healthcare. During his tenure, he played a pivotal role in the procurement of integrated healthcare contracts across multiple states, including Iowa, Nebraska, Indiana, and California. His strategic contributions were instrumental in expanding the reach of behavioral health services and ensuring the seamless integration of care for diverse populations.

Joel’s expertise lies in the domain of public sector behavioral health service delivery, where he possesses acute knowledge from both the health plan perspective and as a network provider. This comprehensive understanding allows him to navigate the complexities of braided funding mechanisms, encompassing state, federal, and grant funding. His ability to navigate and optimize these funding streams has resulted in enhanced access to vital behavioral health services for countless individuals in need.

Throughout his career, Joel has demonstrated exceptional leadership and accountability, consistently driving positive change and improving the lives of those with behavioral health challenges. His extensive experience and in-depth understanding of the field make him a trusted authority in the behavioral health community in Arizona and beyond.

Joel Conger is committed to making a difference in the lives of individuals facing behavioral health crises, and his contributions continue to shape the landscape of behavioral healthcare delivery in Arizona.

Topic: ACMI Stakeholder’s Meeting

Time: September 12th, 2023, 04:00 PM Arizona, Connections Health Solutions by Joel R Conger,

October 3rd, 2023, Psynergy Programs– CoOwner Arturo Uribe and ED Lynda Kaufman

November 7th, 2023, Greenbuurger’s Hope House, a secure treatment facility by ED Cheryl Roberts

December 5th, 2023, Secure Residential Treatment in San Mateo County by Terry Rittgers, Yessa Calderon, and Louise Rogers

January 2nd, 2024, Home Inc by Charles Sullivan

February 6th, 2024, Terros Program and Offerings by COO Jennifer Nye and CEO Karen Hoffman Tepper

Every month on the First Tuesday until December 25th, 2025

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Indeed, finding cures for serious mental illnesses is a complex and multifaceted challenge. Even the experts at the National Institute of Mental Health (NIMH) and other institutions globally often do not agree on various aspects of mental health treatment for several reasons: they cannot agree on the diverse manifestation, the biology is complicated, there are psychosocial factors, and there are philosophical differences in researcher and practitioners.

Given these challenges, it is not surprising that experts in the NIMH and other institutions often do not agree on the best approaches to treating serious mental illnesses. Some have focused on stigma reduction, and as the article below states, that seems to have been effective as more prominent people (athletes, actors, and politicians revealed personal struggles). If we could agree to focus on finding effective treatments and funding research on cures, we could achieve better outcomes. However, ongoing research and collaboration among experts are essential to improving our understanding and developing more effective treatments for mental illnesses.

Laurie Goldstein



What COVID Revealed About American Psychiatry

The pandemic destabilized us—and exposed the fractures in our country’s approach to mental health.

By George MakariJuly 13, 2023

What COVID Revealed About American Psychiatry | The New Yorker

Illustration by Timo Lenzen
Illustration by Timo Lenzen

As the COVID-19 pandemic eases, a mental-health crisis still has us in its grip. My fellow-psychiatrists and I continue to be flooded with referrals, desperate calls, emergencies, and relapses—likely the consequences of years of isolation and grinding anxiety, loss, school disruption, and who knows what kinds of viral assaults on the brain. Preliminary studies report elevated rates of suicide, anxiety and depression, addiction, developmental delay, and psychiatric E.R. visits. Socially marginal people, health-care workers, and the young all seem especially at risk.

COVID has left us destabilized, in the midst of what might be thought of as a psychiatric pandemic. How bad will this be? Who will escape harm, and who will suffer the most? With the virus, we eventually understood the answers to these questions and focussed our public-health efforts accordingly. But the psychiatric consequences of the pandemic will be intrinsically more complex, varied, and obscure. First, there are millions of mourners whose loved ones succumbed to covid, often in terrible, sudden ways. Then there are some who may be suffering from subtle neuropsychiatric effects of the infection. In addition, there are those stuck in chronic states of fight or flight, or helplessness—mental modes that affect our sense of time. Such people may be jumpy, irritable, violent, trigger-happy, drugged out, avoidant, defeated, morose, or self-harming, for reasons that no one can recall. Doug won’t acknowledge that he’s getting high so often because of the stress of the pandemic. Jen will be incensed if you imply that she’s cutting herself because of the difficulties of the past three years. As with traumas suffered by soldiers in war, the covid past will slip into the present, darkening the future.

How should our psychiatric-health-care system respond? “We don’t have a psychiatric-health-care system,” the public-health expert Rosemary Stevens reminded me. She’s right. Americans suffering from mental illness routinely tumble through gaping cracks in our “system.” Homeless encampments, with many people in need of psychiatric help, sprawl along beaches near Los Angeles. Vast stretches of our heartland remain mental-health-care deserts. Chicago’s Cook County Jail has in recent years been our proud nation’s largest provider of psychiatric services. As for our struggling children, good luck finding help. The other day, I ran into a pediatrician who told me that she had just sent another suicidal teen to the emergency room; the kid was eleventh in line for a bed.

If by mental-health system we mean integrated parts working together, then it’s true that America doesn’t have one. Still, we do have an array of governmental agencies, nonprofits, biotech and pharmaceutical companies, hospitals, clinics, and medical colleges—in addition to an army of researchers, epidemiologists, psychiatrists, psychologists, social workers, and therapists—that could be called upon to meet whatever post-covid challenges we face. The National Institute of Mental Health sits at the center of this constellation. Founded in 1949, the N.I.M.H. was originally charged with leading America’s mental-health research, prevention, and treatment efforts after the Second World War, when startling numbers of veterans had “become mentally unbalanced in fighting for their country,” as the Post put it at the time. Since then, as the self-proclaimed largest funder of psychiatric research in the world, the N.I.M.H. has dominated the mental-health-and-illness ecosystem; its priorities nourish growth or extinguish it. One might imagine that comprehending and responding to the mental-health effects of the pandemic would skip to the front of that line.

Few of my clinical colleagues believe that will happen. Their pessimism reflects not just the current state of mental-health care in our country but decades-old trends that have reshaped how we think about mental illness—shifts that have blinded us to cataclysms like the one we have just endured. What should we do to correct our course?

Psychiatry has always been a “Rashomon”-like affair, with triumphalists and vilifiers, sincere testimonials from the saved and tragic ones from the lost. It is held by some to be humane and a force for progress, yet it has offended, at varying times, religious believers, libertarians, Marxists, Foucauldians, and “hard” scientists. Critics have never been in short supply.

So I should have been prepared to have my head spin when I interviewed clinicians, historians, and prominent leaders in the field about our capacity to respond to a post-COVID mental-health crisis. One day, I spoke to Allen Frances, the editor of the fourth Diagnostic and Statistical Manual of Mental Disorders, who was not optimistic and looked back in regret. “For me, the tragedy is that, on my watch—the last sixty years I’ve been involved in psychiatry—we have seen the care of patients deteriorate, not improve,” he said. The next day, Herbert Pardes, a former N.I.M.H. director, was more upbeat. Surveying the same time period, he noted that the stigma long attached to mental illness had diminished, and that new knowledge and treatments had blossomed.

Both, it turns out, are right. Psychiatry is composed of three intertwined enterprises: community care for sufferers; a medical specialty devoted to diagnosing and treating patients; and research programs focussed on mind/brain science. At their best, all three efforts aid and constructively challenge one another. But, in this country, during the past few decades, each has gone its own way. This fragmentation has been dramatic, tragic, and certain to compromise our capacity to respond to the post-covid crisis.

The availability of community care—essentially, food, shelter, and support for people with mental illness—is shaped by social values regarding those in need. Those ethical commitments have fluctuated over time. In the early nineteenth century, enlightened Western nations built asylums that were mostly justified in humanitarian terms, but those places of respite eventually became too-big-to-care institutions that warehoused and brutalized their occupants. In postwar America, as the welfare state came under increasing attack, and criticism of these so-called snake pits grew louder, state asylums closed. The sickest and poorest never made it to underfunded—or often unfunded—community mental-health centers. With the emergence of managed-care insurance, in the nineteen-eighties, shockingly short in-patient hospital stays led to still symptomatic patients’ being routinely discharged to the street or swept up into prison. There wasn’t funding for anything better. That is still the case. Should a mental-health epidemic strike us, there is no one to provide care at that scale.

This grim picture is made more painful by contrast with what the medical field of psychiatry, along with its allied disciplines, now can do. Médecine mentale, as it was once called, has long sought to stabilize itself with clear diagnoses and treatments; owing to the mysteries of the mind and brain, it didn’t get too far. Forty years ago, however, American psychiatry found its footing: the third edition of the Diagnostic and Statistical Manual cut free speculative claims about causation, sticking to diagnostic categories based on reliable and coherent clusters of symptoms and signs. Clinicians of all stripes now shared a common language. In reaction to orthodox Freudians and eager lobotomists, a “biopsychosocial” perspective took root, which encouraged practitioners to shun ideology and pragmatically address the biological, psychological, and social aspects of mental illness. Psychoanalysis grudgingly made room for an array of empirically validated psychotherapies. Medications such as Prozac, Effexor, and Risperdal emerged; they were mostly safe and, if not curative, often very helpful.

All these changes were accompanied by publicity campaigns attacking stigma. Mental disorders, we were reminded on billboards and in commercials, were no different from diabetes or any other illness. This work paid off. Today, princes, athletes, senators, and celebrities no longer hide their psychic struggles. And so, paradoxically, around three decades ago, as our commitment to care for the poor and uninsured evaporated, clinical psychiatry could boast of increased social acceptance and tools that were more effective than ever.

Many disorders remained far from cured; some were fully treatment resistant. But, for those patients, there was still hope. Psychiatry’s researchers were tasked with discovering the causes of these disorders. It was a gargantuan job, and a lot depended on its success. In the eighties, Senator Pete Domenici, a loyal supporter of mental-health efforts, told the Stanford neuroscientist Jack Barchas—a point person in the effort to stop cuts to mental-health spending by the Reagan Administration—that, although the country could not afford to care for all of its mentally ill, it could support finding cures for their diseases. During the nineties, which President George H. W. Bush declared the Decade of the Brain, hundreds of millions of dollars were directed to the N.I.M.H. in that effort.

Meanwhile, the institute shed some of its original congressional mandate for treatment and prevention, by giving the job of funding mental-health services to a new federal entity, the Substance Abuse and Mental Health Services Administration. From then on, as one former N.I.M.H. director told me, undertreatment and homelessness were samhsa’s responsibilities. As the Human Genome Project launched, and brain-scanning technology leapt forward thanks to functional MRI, pressure to find genetic and brain signatures for psychiatric illnesses grew. Yet, as the new millennium commenced, a specific scan for disorders such as schizophrenia remained elusive. Dreams of single genetic causes were dissipating. A crisis was brewing.

History holds a large, unmarked graveyard filled with the ideas of those who tried to pin down the ultimate causes of mind/brain illnesses. Critics and scholars have portrayed some of the memorable failures—a procession of phrenologists, degeneration theorists, germ enthusiasts, wild psychoanalysts, political revolutionaries, and sexual liberationists. All of them pushed for their cherished notion, only for it ultimately to be found misguided, wanting, or worse.

There’s an underlying reason for all this zigzagging. Picture an archer’s target; at the bull’s-eye, place the most basic of possible causes for mental illness—say, genes. Huntington’s chorea, a fatal disease that affects cognition and movement, is solely genetic: it sits wholly at the center of the target. But other, more common conditions, such as schizophrenia and bipolar disorder, can only partly be predicted in terms of genetic risk, and, in most other forms of mental illness, genetic determinism further diminishes. To fully understand those diseases, we have to start looking to the next ring in the target. What else might be at work? We may now take aim at neurons, then jump out to neural circuits and networks, then to the entire brain with its hundred billion neurons and trillions of synapses. At any of these different levels of biology, a pathogenic event might disrupt us.

As if that were not enough to overwhelm us, there is much more to consider. Next, our psychiatric archers must move their focus from the brain to the mind, bump up against the mind-brain problem, hurry past dozens of philosophers, and simply grant that minds, in part, can cause things to happen. After that, they must turn their attention to the other outer rings, such as the self, individual behavior, the social world, and the nonhuman environment. Each of those holds the possibility of specific kinds of trouble: negative thought patterns; chronic affects like fear or shame; relationships filled with abuse; deprivation, poverty, and our catchall term for many horrors, trauma; and then, in that very last circle, poisons, bacteria, and viruses.

By taking up all of the rings on that target as potentially interacting causes of illness, psychiatry captures a rich set of human possibilities, from errors in our molecules to forces like racism. Clinicians can take a shot at any of them, unleashing as many arrows as they need. Prozac, psychotherapy, leaving a brutal spouse? Yes, yes, and yes. But experimental science requires studies that reduce a vast field of variables to an independent one whose effect can be tested. Unlike a psychiatrist working with a patient, a scientist in search of a soluble problem must limit herself to only one spot. And so psychiatry has long been a scientifically unstable discipline; it has veered back and forth between different explanatory models because its object of study, the mind/brain, presents the most overwhelming array of epistemological problems in all of medicine. In our quest for valid and reliable answers, it’s easy to get lost.

In 2002, at a moment when the clinical promise of the Decade of the Brain remained unfulfilled, it came time to choose a new N.I.M.H. director. Thomas Insel, a leader in the quest to find biological explanations for complex behaviors, got the job. Insel was brilliantly successful, famous for illuminating the role of the hormone oxytocin in eliciting bonding behavior in voles—an important finding in the emerging field of social neuroscience. Frustrated by the weaknesses in the nation’s mental-health-research program, he concluded that they stemmed from one of the foundations of clinical work: DSM-III was serving practitioners and patients well enough, but its categories were sometimes too muddy for researchers in search of well-defined scientific targets. How many specific kinds of depression lurked in “D.S.M. 296.31, Major Depressive Disorder, Recurrent, Mild”? Most experts would guess that there were many. And, if one did not tease apart those variants, how could anyone figure out what caused Jim’s depression but not Jane’s, why Zoloft worked on Amelie but not Eli?

In 2010, Insel and his team unveiled the Research Domain Criteria, or rdoc, a new framework for the study of mental disorders that introduced its own nomenclature and benchmarks. The move seemed to separate scientific research from the language and culture of patient treatment—a divorce made more bitter when Insel suggested that DSM categories were mere constructs “based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”

rdoc’s influence was felt across the institute’s research portfolio. It aspired to be objective. It also prompted scientists to ask questions about disorders in a very specific way. You could study problems like hyperactivity in kids, post-traumatic stress disorder in rape victims, or self-harm in adolescents—but, to maximize your chances of being funded, your study had to incorporate a measurable characteristic, such as a gene or neural circuit, that reflected an underlying biological process. In a 2013 ted talk, Insel, standing before mesmerizing brain scans and images of neurons, assured his audience that new knowledge based on this approach—he had previously called it “clinical neuroscience”—would soon sweep away two centuries of psychiatry.

Since then, this new paradigm has powerfully altered what psychiatric scientists look for—and what they look past. For example, researchers have discovered hundreds of genetic loci associated with schizophrenia and with major depression, and more than fifty for bipolar disorder and autism. Each time a new correlation is found, geneticists celebrate. But, as E. Fuller Torrey, an advocate for the severely mentally ill, told me, so much success has added up to failure. “They have identified a lot of risk genes, not any that cause a disease,” he said. “That’s very embarrassing to them.”

Insel left the N.I.M.H. in 2015, and later confessed that one of the reasons he did so was this same dispiriting realization. In a 2017 interview, he elaborated on his departure. “I spent thirteen years at N.I.M.H. really pushing on the neuroscience and genetics of mental disorders,” he said. “And when I look back on that I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness. I hold myself accountable for that.” When I spoke to Insel recently, he said, of rdoc, “I think it became an academic exercise. . . . You want to pick up measures that actually are of value to patients, families, and providers. And rdoc got way too complicated. It wasn’t really tied to clinical outcomes in a way that would matter.”

Meanwhile, a decade spent in search of so-called biomarkers crushed clinical investigators who had been trained to use descriptive DSM categories and who aimed their studies at symptom relief and therapeutic impact. By 2015, only around ten per cent of the N.I.M.H. budget was directed toward clinical research. Psychotherapy researchers, who had made much progress before rdoc, saw their funding dry up. Barbara Milrod, of Albert Einstein College of Medicine, told me, “I am angry, as a psychiatrist and as a clinical researcher, because we are doing nothing for our patients and losing generations of researchers and methods.”

Imagine a lighthouse keeper whose beam and horn guide ships in storms. Imagine that this operator, in an epiphany, realizes that all the difficulties he encounters come from water and air. He determines to study the chemistry of H2O and O2. This steward is no eccentric but rather a prestigious and powerful voice in his field; thanks to his financial largesse, many others follow his lead. They all stop worrying about their beacons and foghorns, and no longer bother with weather reports, tides, or distress signals from vessels. When called to task, they assure those whose loved ones have drowned that, though it might take fifty or a hundred years, the riddle of water and air will eventually be solved.

Sound ludicrous? But where were our psychiatric sentinels as opioids, alcoholism, and suicide ripped through the struggling towns of middle America? It took two economists, Anne Case and Angus Deaton, vacationing in Montana, to notice the early mortality of white males around them, and, in 2015, alert us to the shocking numbers of what they called “deaths of despair.” Why did the mental-health-research community fail to notice this? One reason, perhaps, is that there is no gene for social collapse.

The covid pandemic, with its complex biopsychosocial effects, was a cataclysm that emerged from our environment, and its psychiatric consequences have only begun to be understood. Much of its impact, I fear, might simply be ignored, because many of our lookouts remain intently focussed on threats from the opposite end of the causal spectrum. While we concentrated on things like neural circuits, a viral menace attacked. The fear, helplessness, and isolation that it created roiled our communities and families, put great pressure on our emotional and psychic lives, and deeply affected our children. We need to pivot so as to better comprehend those realms, for the pandemic has thrown overly reductive assumptions about neuroscience into contradiction. Yes, malfunctioning brains can make us ill, but three years of death, uncertainty, and angst have demonstrated a homespun truth: the world can really mess you up.

The United States has the most funding for psychiatric research in the world, arguably the greatest array of professional talent, and significant private and public capacities. And yet the rising tide of mental illness after covid will only highlight how our social contract with those patients has long been broken. The idea that shelter and humane care are human rights has dedicated advocates but little political power. In addition, although clinicians are armed with medications and therapies, they have long been pleading for new and better tools. Guidance about what this once-in-a-century pandemic might bring their way should come from our scientific and public-health leaders in Washington, but they are divided, with separate fiefdoms for psychiatric research, alcohol abuse, drug abuse, epidemiology, and the delivery of services. We suffer from systemic failures that seem to be no one’s responsibility.

A notable exception, Vivek Murthy, the Surgeon General, has called attention to the post-pandemic psychiatric crisis, citing burnout among frontline health workers, a spike in teen suicide, and an “epidemic of loneliness and isolation.” But who will take up his call? The National Institutes of Health has created the recover initiative, which will support studies of the medical aftereffects of covid, and Congress has allocated a small amount of money directly to the N.I.M.H. for covid-targeted research. It’s not obvious what will happen when those funds run out.

To be clear, no one I spoke with advocated for calling off the Mars mission to understand the brain; exciting work is being done in optogenetics, in circuit dynamics, and in mapping the brain’s structural network (the “connectome”), to name just a few domains. It is critical that the U.S. invest in such basic research. Similarly, it would be unconscionable not to pursue solid, clinically relevant neuroscience. But there needs to be an adjustment. When I spoke to the present N.I.M.H. director, Joshua Gordon, he admitted that the introduction of rdoc had come at a cost. “It wasn’t communicated to the scientific community in a way that they understood. They took it as a kind of severing of the N.I.M.H. from diagnostic frameworks,” he said. “In my opinion, what should have been said was that it’s clear that there’s heterogeneity within our disorders, and there’s overlap across our disorders. The diagnostic labels are useful. But they have not proven tremendously useful in terms of uncovering biology.” Since Gordon’s appointment, in 2016, the N.I.M.H. has somewhat relaxed its focus on rdoc methodology. When I queried him about its value, he said, “Certainly I emphasize it less than my predecessor did.” Yet rdoc’s adoption reflected decades of at times quite strident belief that the causes of all “real” psychiatric illness could be captured by clinical neuroscience. These may not be commitments that can be easily undone.

Surrounded by this jarring disjunction between high-minded science, clinical urgency, and human suffering, I was reminded of my year as a medical intern, when a different terrifying infection was sweeping the country. On New Year’s Eve, 1987, I held a young man’s feverish hand as he fought to breathe. By then, scientists had isolated H.I.V., and the National Institute of Allergy and Infectious Diseases, led by Anthony Fauci, had begun research on a vaccine. Access to possible drugs was stalled, while gay men perished. A community rose up in protest. Fauci now recalls meetings that he had with act up and one of its leaders, Larry Kramer, as critical to the realignment of his priorities. Thankfully so. If the government had bet the house on an H.I.V. vaccine, we would still be waiting. Instead, accelerated and liberalized clinical protocols, “short-term” fixes, and deeper collaboration saved countless lives.

Today, the covid pandemic may be over, but our psychiatric crisis continues. It should serve as an alarm that shakes us out of our slumber and reframes our thinking. We need to balance our mental-health efforts to include funding more clinical trials, actively researching sociological and psychological determinants of mental health and illness, revitalizing and refining public-health efforts for early treatment and prevention, and looking for innovative ways both to care for the underserved and to provide humane asylum. Will we? Indifference, bureaucratic rigidity, and ideological opposition will likely resist such changes. Back in 1987, months before I sat up with my dying patient, act up formed. What will it take this time, I wonder, to remake our future? ♦

Medicaid is our social safety-net program in the United States that provides health coverage for some of the country’s most vulnerable citizens. It is essential for people with serious mental illnesses. Sadly, Medicaid law contains the IMD exclusion provision, which excludes payment for services for those unfortunate people needing long-term in-patient care. The IMD exclusion is a significant barrier to meaningful treatment for people with serious mental illness (SMI).

In addition, failing to recognize that involuntary treatment is required for many people with SMI has led to many individuals living lives without dignity on the streets or being punished in our jails and prisons.

There are many reasons why more Medicaid services are needed for the seriously mentally ill:

  • Rising Prevalence: The number of people diagnosed with serious mental illnesses is rising. As the population increases and the stigma around mental health starts to fade, more individuals seek help. This calls for a proportional increase in services. We have not seen this happening in AZ.
  • Complex Needs: Individuals with serious mental illnesses often require comprehensive, long-term, individualized care that can include therapy, medications, crisis services, and sometimes even inpatient care. The current inpatient stays are relatively short, almost always under the 15-day IMD cap. There is no artificial capitation for other medical conditions.
  • Coexisting Conditions: Many people with serious mental illnesses have co-occurring physical health issues or substance use disorders. They need integrated care services that can address all their health needs simultaneously. There is an attempt at integrated care, but there are no shining examples I am aware of.
  • Societal Benefits: Comprehensive services can reduce societal costs, such as homelessness, incarceration, and emergency medical care. Individuals with untreated mental illness often end up in emergency rooms, the criminal justice system, or living homeless, which are more costly interventions than preventive and therapeutic services.
  • Economic Considerations: Early and consistent treatment can help individuals with serious mental illnesses maintain employment and contribute to the economy. Without adequate services, these individuals are at a higher risk of unemployment and homelessness, increasing the economic burden on society.
  • Crisis Prevention: Regular access to treatment can help prevent mental health crises. Crises not only endanger the individual but also place a strain on emergency services, hospitals, and the broader community. Unfortunately, there are many police encounters with individuals in crisis who end up injured, incarcerated, or dead due to the symptoms of their disease.
  • Housing Stability: Stable housing is crucial for recovery. Sadly Medicaid does not pay for housing, only treatment when medically necessary. Refer to the ASU Morrison Institute Housing is healthcare to understand that it is not only the right thing to do for the patient but also saves society about 30% over the cost of treating unhoused people with serious mental illness.
  • Better Outcomes: Continuous access to mental health services has led to better health outcomes and quality of life. Medicaid can fill the gap, ensuring the most vulnerable have consistent access to these essential services. Providing the entire continuum of care is available.
  • Stigma Reduction: By increasing the availability of services and prioritizing mental health, society takes a step toward reducing the stigma surrounding mental illness. This can encourage more individuals to seek help when they need it. Receiving care early is essential to stopping episodes of psychosis and protecting the brain.
  • Future Savings: Investing in mental health now can lead to savings in the future. Providing comprehensive mental health services through Medicaid makes individuals less likely to require more intensive and costly interventions later on. Again refer to the ASU Morrison Institute study.

New York and California have seen the results of not enforcing treatment. Each is now taking small steps to reverse the substantial number of homeless people with serious mental illness. In summary, expanding Medicaid services for the seriously mentally ill is not only a moral imperative, considering the vulnerable nature of this population, but it’s also a wise investment. It can lead to better health outcomes for individuals, reduce societal costs in other sectors like criminal justice, and result in a healthier, more productive, and safer society.

Laurie Goldstein



Bill aims to support people with serious mental illnesses ( published August 1st 2023

The bill was introduced by Sen. Kirsten Gillibrand and Rep. Dan Goldman. (Spectrum News NY1)


N.Y. bill aims to bolster services for people with serious mental illnesses


PUBLISHED 3:30 PM ET AUG. 01, 2023

Sen. Kirsten Gillibrand, Rep. Dan Goldman and Rep. Jerry Nadler on Tuesday touted legislation aimed at strengthening access to medical care for people living with serious mental illnesses.

The “Strengthening Medicaid for Serious Mental Illness Act,” if passed, would generate new services under Medicaid designed specifically for people living with mental illnesses like schizophrenia, bipolar disorder and major depressive disorder, the lawmakers said during a news conference at Manhattan’s Fountain House.

What You Need To Know

·   A bill introduced by Sen. Kirsten Gillibrand and Rep. Dan Goldman in June, the “Strengthening Medicaid for Serious Mental Illness Act,” aims to strengthen access to medical care for people living with serious mental illness
·   Gillibrand, Goldman and other New York elected officials touted the legislation during a news conference at Manhattan’s Fountain House on Tuesday
·  The legislation, if passed, would generate new services under Medicaid designed specifically for people living with mental illnesses like schizophrenia, bipolar disorder and major depressive disorder

The legislation would also set a national standard for care for people with serious mental illness and incentivize states to provide services to treat them.

“Those with serious mental illness have often found themselves in a devastating cycle: going from hospitals to jails to the streets, and back around again,” said Gillibrand, who first introduced the legislation along with Goldman in June.

“Frankly, it’s unacceptable and it’s inhumane,” she added. “It’s a major issue for public safety and it’s a major issue for caring for our families.”

The legislation would provide states with the ability to offer services that would help people with severe mental illness get and keep jobs. It would also allow states to provide access to support services and mobile crisis intervention teams.

States would also be required to abide by certain standards of care, such as tracking disparities in treatment, according to a news release from Gillibrand.

“We are still struggling in the aftermath of COVID, which interrupted mental health treatment for so many, especially the low-income and underprivileged individuals in our community who rely on government services, the community services that were halted,” Goldman said.

“And that’s why this bill is so important,” he added. “It’s important that we get people the treatment they need in a way that works.”

The Institutions for Mental Diseases (IMD) exclusion is a policy that restricts Medicaid funding for certain residential facilities with more than 16 beds, primarily focusing on those providing mental health and substance abuse treatment. While the policy aims to regulate and improve the quality of care, it inadvertently creates discrimination and prejudice against individuals with serious mental illness (SMI). This case highlights the adverse effects of the IMD exclusion policy on vulnerable individuals and the need for reforms to ensure equitable access to mental healthcare.

Case Summary: John, a 32-year-old man diagnosed with schizophrenia, resides in a state that strictly enforces the IMD exclusion policy. Due to the limited availability of community-based mental health services, John has been repeatedly denied admission to residential treatment facilities due to their size exceeding the exclusion threshold. This policy restriction exacerbates John’s condition, denying him access to appropriate care and causing a detrimental impact on his overall well-being.

  1. Limited Access to Intensive Treatment: John requires intensive psychiatric care and monitoring due to the severity of his symptoms. However, as a result of the IMD exclusion, the only available options for him are outpatient clinics or smaller residential facilities that lack the resources and staff to provide the level of care he needs. This restricted access prevents him from receiving adequate treatment and support to manage his condition effectively.
  2. Increased Risk of Homelessness and Incarceration: Without access to appropriate residential treatment, John’s mental health deteriorates rapidly, leading to frequent hospitalizations or encounters with law enforcement. The lack of suitable options under the IMD exclusion policy forces individuals like John into a cycle of homelessness or incarceration, where their mental health worsens, perpetuating the stigmatization of mental illness.
  3. Disproportionate Impact on Low-Income Individuals: The IMD exclusion disproportionately affects low-income individuals who rely on Medicaid for their healthcare needs. Private residential facilities, not subject to the exclusion, often charge exorbitant fees, making them unaffordable for those with limited financial resources. Consequently, the policy further entrenches socioeconomic disparities and denies individuals from lower-income backgrounds equal access to critical mental health services.
  4. Inequity in the Healthcare System: The IMD exclusion policy perpetuates a two-tiered healthcare system, with individuals with SMI receiving suboptimal care compared to those with physical health conditions. While patients with chronic medical conditions can access specialized facilities without similar restrictions, individuals with mental illnesses face discrimination due to the arbitrary limitations imposed by the exclusion policy, denying them their right to equitable healthcare.

Conclusion: The IMD exclusion policy, though well-intentioned, inadvertently perpetuates discrimination and prejudice against individuals with serious mental illness. The policy’s impact on individuals like John highlights the urgent need for reforms to ensure equitable access to comprehensive mental healthcare. Revisiting the IMD exclusion and advocating for increased funding, expanding community-based treatment options, and encouraging parity between mental and physical health services are essential steps towards dismantling the systemic barriers faced by those with SMI.

Laurie Goldstein


After deinstitutionalization, California has tragically come full circle on mental illness treatment – CalMatters


A person sits in a makeshift tent along a barbed wire fence near Highway 99 in southwest Fresno on Feb. 11, 2022. The fence blocks out a grass area that used to be a homeless encampment. Photo by Larry Valenzuela for CalMatters/CatchLight Local
A person sits in a makeshift tent along a barbed wire fence near Highway 99 in southwest Fresno on Feb. 11, 2022. The fence blocks out a grass area that used to be a homeless encampment. Photo by Larry Valenzuela for CalMatters/CatchLight Local


California psychiatric hospitals began closing their doors in the 1960s, starting a nationwide movement known as “deinstitutionalization.” Today, most inpatient treatment for severe mental illness occurs behind bars. Two changes could help rectify this tragic reality.


Alice Feller

Alice Feller

Alice Feller is a psychiatrist and writer based in Berkeley. Her work has appeared in the Journal of the American Psychoanalytic Association, East Bay Express, Laney Tower and the opinion pages of the San Francisco Chronicle and New York Times.

Robbie, our young patient at the county hospital in San Mateo, believed his parents were trying to poison him. 

He refused to come into the house and foraged in the neighbors’ garbage cans for all his meals. Nevertheless, since he was able to survive on garbage, he was judged no longer in need of treatment. 

I was shocked. It was so callous – such a breach of our usual standard of care. But then I spent a year working as a staff psychiatrist at the county hospital in Oakland. I learned that Robbie’s experience was not out of the ordinary; it was the usual state of care in California.

In the 1960s, American psychiatric hospitals began to close their doors. The movement began in California, first with the large state hospitals and then the small community hospitals as well.

By 1994 nearly half a million former patients had been sent back to live with their families, who were often unable to care for them. A quarter million newly discharged patients ended up on the streets or behind bars. 

So many were incarcerated that jails and prisons have become our de facto mental hospitals. Today, the vast majority of inpatient psychiatric care in America is provided behind bars.

Deinstitutionalization,” as the movement to close these hospitals is known, began as a cost-saving measure. In 1965 the federal government abruptly withdrew its financial support for the state hospitals, as well as the small community hospitals providing psychiatric care. 

This was accomplished through a little-known law, the Medicaid IMD exclusion, passed by Congress in 1965 along with the creation of Medicaid. The provision forbids the use of Medicaid dollars to pay for care in a mental hospital. Any psychiatric hospital with more than 16 beds is forbidden to take Medicaid.

Hospital treatment for severe mental illness can mean the difference between life and death, but because of this law such treatment is specifically denied to the people who need it most. No other severe illness is subject to such discrimination.

We have come full circle from the early 19th century, when Dorothea Dix campaigned to rescue the mentally ill from the prisons where they languished, often under shockingly inhumane conditions. Due to her work, people with mental illness were rescued from prisons and cared for in hospitals. 

But today that trend has been reversed. Once again, Americans with serious mental illness are being warehoused out of sight in our prisons. And many more are living unsheltered on our streets. A third of our homeless population today suffer from untreated severe mental illness, most commonly schizophrenia.

Schizophrenia is a brain disorder. It affects 1 out of every 100 human beings on Earth. Good parenting doesn’t prevent it, and bad parenting doesn’t cause it. It begins in adolescence or early adulthood, and without treatment it will be permanently disabling. It leaves the afflicted person living in a psychotic world, unable to tell reality from delusion. 

Lives are derailed. Suicide is common.

Treatment requires early intervention by a specialized team of clinicians who collaborate on patient care. Unfortunately these dedicated programs are rare. Despite mountains of evidence showing their effectiveness, insurers refuse to cover early intervention programs.

While hospital care can provide stabilization and enable the patient to use outpatient treatment, insurance coverage for inpatient treatment is rare.

California can rectify this situation by obtaining a waiver of the IMD exclusion. We need to restore hospital care to stabilize our patients and enable them to use outpatient treatment. We need to mandate early intervention programs and require insurance coverage for this vital treatment. 

These two interventions would do more than anything else to help our mentally ill homeless citizens. It is not a simple lack of housing that leaves so many homeless. Like Robbie, our patient who ate out of garbage cans, they are unable to use available housing due to their mental illness.

Society Helping
Photo by Etactics Inc on Unsplash
Society Helping, Photo by Etactics Inc on Unsplash

Caring for people with serious mental illnesses, such as schizophrenia, bipolar disorder, or major depressive disorder, who also have anosognosia (a lack of awareness of their illness) is crucial for numerous reasons, and not providing necessary care can have detrimental effects.

  1. Preservation of Human Rights: All individuals, regardless of their mental health status, have a right to health and well-being. This right includes access to healthcare and social support. Ignoring or denying care to someone because they lack insight into their condition due to anosognosia infringes upon these rights.
  2. Health Consequences: Without proper care, individuals with serious mental illnesses and anosognosia are at risk of worsening symptoms. This can lead to significant health consequences, including higher rates of hospitalization, physical health problems, homelessness, and suicide.
  3. Social Consequences: Failure to provide care for individuals with serious mental illness and anosognosia has broader societal impacts. It can lead to increased homelessness, as individuals may be unable to maintain stable housing. Furthermore, untreated mental illness can also contribute to an increased burden on the criminal justice system, as these individuals may engage in behaviors that get them into legal trouble, often because they aren’t receiving the care they need. They typically are crimes related to their illness, such as trespassing, public disturbance, or petty crime, but they can sometimes be violent crimes.
  4. Economic Burden: Treating individuals with mental illnesses early and effectively is cost-effective. Hospitalizations, incarcerations, homelessness, and emergency services are all costly societal burdens. Providing continuous, comprehensive care reduces these costs in the long term.
  5. Family Impact: The family and loved ones of those with serious mental illness often bear a substantial burden when adequate care is not provided. This can strain relationships and cause emotional, physical, and financial hardship for the family members involved.
  6. Potential for Recovery: Many individuals with serious mental illness, once appropriately treated, can lead meaningful, productive lives. By providing necessary care, even when anosognosia is present, we increase the chances of these individuals gaining insight into their conditions, adhering to treatment, and experiencing recovery.
  7. Ethical Responsibility: As a society, we have an ethical responsibility to care for those who are most vulnerable, including individuals with serious mental illness. Anosognosia, as a symptom of these illnesses, should not exempt these individuals from receiving the care they need.

In conclusion, while anosognosia presents unique challenges in the care of individuals with serious mental illness, it is imperative that we continue to advocate for and provide necessary support and treatment. The human, societal, and economic costs of not doing so are simply too great.

Laurie Goldstein


Posted by Twisted Sisters Advocacy & Activism for Serious Brain Disorders July 9th, 2023.

Anosognosia affects between 50% and 98% of people with schizophrenia, about 40% of people with bipolar disorder, and more than 80% of people with Alzheimer’s disease.

For a disease that demands treatment above all else, leaving someone with anosognosia alone on the streets until they die is a cruel and unusual punishment for a disease. Why do civil rights activists and disability activists keep harming our family members?  What’s the point of letting them deteriorate and preventing them from getting basic medical care?  In pursuit of an ideal?  Does it matter?  In my experience as a family member of someone who died as a result of severe mental illness and anosognosia symptoms, I am offended to my core by those who wish to maintain the status quo.

Civil and disability rights activism has a human cost here. It is of the utmost importance to recognize the suffering and struggles of those affected. It is also important to ensure that those who need medical care receive it. We do not let our Alzheimer’s patients with anosognosia roam the streets. We speak for them. We care for them. We need to demand more humane treatment for people with anosognosia from severe mental illnesses.

Activists for civil rights and disability are strangers to our loved ones.   They do not understand the pain and suffering we have been through.  There’s no personal connection between them and our loved ones.  No professional connection exists between them. They are not privy to the suffering of my loved one or have intimate knowledge of it.  Because #FamiliesLikeMine don’t have a right to treatment before tragedy strikes, the activists for civil rights can sleep soundly at night despite the pain they cause those whose loved ones die a slow, agonizing death.  What do citizens of this magnificent nation do when tragedy strikes beyond the individual suffering from a brain disorder? They scream, “Why didn’t the family act?  But, what can a family do if the law does not recognize their right to treatment?

As defined, anosognosia is not denial. Anosognosia is a mental illness in which the sufferer is unaware of their condition. A denial of anosognosia’s legitimate importance in the medical community and in our laws and policies is to ignore it. That is a denial.

It is not a denial of the experience of those with anosognosia, but rather a denial of the reality of anosognosia as a medical condition. We need to recognize anosognosia as a legitimate medical condition and ensure that our laws and policies reflect this understanding. This will ensure that individuals with anosognosia can access the care and treatment they need. 

#RIPMarkRippee #TreatmentB4Tragedy #HousingThatHeals #PassSB43ToSaveLives

Untreated psychosis can have severe and long-term effects on an individual with serious mental illness. Here are some potential dangers:

  1. Symptom Progression: Without treatment, symptoms of psychosis, which include delusions, hallucinations, and disorganized thinking, can become more severe and frequent. This exacerbation can interfere significantly with a person’s ability to function daily and may lead to an increased risk of hospitalization.
  2. Physical Health Deterioration: People with untreated psychosis are often unable to take care of their physical health, neglecting things like nutrition, exercise, and sleep. This neglect can result in physical illnesses, from general malaise to chronic conditions like heart disease and diabetes.
  3. Suicidality: Individuals with untreated psychosis may have a higher risk of suicide due to a combination of depressive symptoms, feelings of hopelessness, and difficulty distinguishing between reality and their delusions or hallucinations.
  4. Substance Abuse: Some people may use drugs or alcohol to cope with their symptoms, leading to substance abuse problems. This can exacerbate psychotic symptoms and make treatment more challenging.
  5. Impaired Social and Occupational Functioning: Psychotic symptoms can make it difficult to maintain relationships or hold down a job, leading to social isolation and financial instability. This situation can further worsen mental health and hinder recovery.
  6. Chronic Condition: When left untreated, psychotic disorders can become chronic, meaning that they persist over a long period. This situation can result in a continuous cycle of illness and recovery, leading to a lower overall quality of life.
  7. Cognitive Impairment: Long-term untreated psychosis can lead to cognitive impairments affecting memory, attention, and problem-solving abilities. Over time, these cognitive deficits can make it harder for a person to engage effectively in their treatment and can limit their ability to live independently.

In conclusion, timely treatment of psychosis is vital for better recovery outcomes. This can involve medication (like antipsychotics), psychotherapy, social skills training, and supported employment programs, all of which can significantly improve the prognosis for people with psychotic disorders. Untreated psychosis has far-reaching implications that extend beyond mental health to all aspects of a person’s life. Early intervention is essential to prevent the progression of the disease and maintain the highest possible quality of life. This can often involve involuntary treatment.

Laurie Goldstein

Being an American Canadian Mother of a Daughter With Schizophrenia

Being an American Canadian Mother of a Daughter With Schizophrenia (

Jul 6, 2023

Susan Inman

This mother shares her experience of having a loved one with schizophrenia and the difference location can make in treatment.



My younger daughter has lived with schizophrenia for 23 years. During that time, I have connected with families in similar situations in both Canada and the United States. My daughter’s life has been positively and negatively impacted by mental illness policies in both countries.

My education in the United States left me ill-informed about illnesses like schizophrenia.1 I knew much more about Freud and RD Laing than I did about the growing knowledge base in contemporary psychiatry. This problematic education in many social sciences and humanities also continues to exert a powerful influence in Canada. Both countries share a lack of appropriate public mental illness literacy campaigns. But what differentiates them?

Canada vs the United States

Ignorance led my husband and me to make serious mistakes in selecting a therapist when our daughter began floundering as a teenager. After I wrote a memoir2 about these poor choices, I heard from many families in both countries who made the same mistakes. Our daughter’s therapist’s lack of appropriate science-based training led to an unnecessarily longer duration of untreated psychosis.

Fortunately, we live in British Columbia and when my daughter became fully psychotic, she received the medically based treatment she needed. British Columbia continues to have a strong mental health act that enables individuals with psychosis to receive the involuntary treatment they often need. This access is limited in Canada, as in the United States, by a shortage of acute psychiatric beds.

Additionally, the 23 years of treatment our daughter has received in British Columbia, which have included some lengthy hospitalizations, have not cost us anything. Early on in our daughter’s illness, when I began to attend the national conferences of the US National Alliance on Mental Illnesses, I was horrified to meet too many families who had been bankrupted by their family member’s illnesses. These financial catastrophes were caused either by medical bills or by lawyers’ fees when untreated illnesses led to involvement in the criminal justice system.

Expenses for lawyers have grown among the Canadian families I have met in recent years because the same trends that negatively impacted the United States have spread in Canada. For instance, the powerful peer movement has successfully lobbied to have their training programs exclude any education about illnesses like schizophrenia while they expand their role in service delivery. It is a movement that teaches its practitioners that individuals must always choose their treatments while simultaneously not allowing individuals to learn about the brain-based illnesses that can make real choice impossible.

This is an alarming time in British Columbia. The laws that have allowed individuals like my daughter to lead a satisfying life are in jeopardy. Some provinces have adopted mental health legislation that makes it much more difficult for individuals with psychotic disorders to receive the involuntary treatment they often need to become stabilized and the follow-up involuntary treatment that they may need as outpatients. The Council of Canadians with Disabilities has launched a Charter of Rights and Freedoms challenge against British Columbia’s Mental Health Act. If successful, British Columbia will follow the dangerous direction that Ontario took; those who are a danger to themselves or others can be admitted to the hospital involuntarily, but they or a substitute decision maker must agree to treatment.

Positive Changes

Individuals with schizophrenia and their families have suffered in both the United States and Canada because of persuasive but misguided ideas emanating from human rights lawyers and disability rights movements.3 These groups refuse to acknowledge the existence of anosognosia and the widespread lack of medically based treatment for psychotic disorders, which leads individuals with psychotic disorders in both countries to become homeless, addicted, and incarcerated.

I am inspired by the positive changes I see in the United States as a growing number of governors and mayors push back against the narrative that homeless individuals with severe mental illnesses must be allowed to choose whether they want treatment. My community in Canada is not seeing much of this well-informed political leadership, even though the growing homeless encampments in our cities and towns are full of the suffering of individuals abandoned to their psychotic delusions.

My community is also inspired and guided by the families in the United States who have developed a much stronger voice. I was able to tap into this kind of powerful advocacy last summer when Democrats Abroad and their Global Disability Caucus invited me to organize a webinar on mental illnesses for their annual celebration of the passage of the Americans with Disabilities Act.4 Using helpful resources available from the US Treatment Advocacy Center, American mother and advocate Leslie Carpenter helped an eager audience understand the origins of the current crisis and the further steps that need to be taken. American Canadian psychiatrist Randall White, MD, provided the much-needed, medically based information this group wanted. I helped others understand why the psychiatric survivor movement, which shapes the positions of most disability rights groups, should not be seen as the legitimate voice of individuals with illnesses like schizophrenia.

Concluding Thoughts

As I see it, the bold initiatives in the United States acknowledge the reality of severe mental illnesses and respond in genuinely helpful ways. These efforts can provide the guidance we increasingly need in Canada.

The opinions expressed are those of the author and do not necessarily reflect the opinions of Psychiatric Times®.

Ms Inman is the author of After Her Brain Broke: Helping My Daughter Recover Her Sanity.


1. Inman S. Personal accounts: becoming the mother of a child with schizophrenia. Psychiatr Serv. 2016;67(12):1290-1291.

2. Inman S. After Her Brain Broke: Helping My Daughter Recover Her Sanity. Bridgeross Communications; 2010.

3. Inman S. Disability rights groups should accept schizophrenia. Medium. June 14, 2020. Accessed June 28, 2023.

4. Carpenter L, Inman S, White R; Democrats Abroad. Americans with Disabilities Act Panel. Facebook. July 26, 2022. Accessed June 28, 2023.

The report from Treatment Advocacy Center has reported a two to three times higher prevalence of schizophrenia than previously reported. That’s indeed a significant update. It’s important to understand that schizophrenia spectrum disorders, which include schizophrenia, schizoaffective disorder, and schizophreniform disorder, are complex mental health conditions that can significantly impact a person’s thoughts, feelings, and behaviors. These disorders often emerge in early adulthood, and their symptoms can include hallucinations, delusions, thought disorders, and movement disorders, among others.

While alarming, this increase in reported cases may actually reflect improved diagnostic procedures, better awareness, and a decrease in stigma around mental health issues rather than an actual increase in the prevalence of the disease. As mental health issues become less stigmatized, more people might seek help and receive an appropriate diagnosis.

It’s also crucial to point out that a more accurate estimation of prevalence can lead to a more effective allocation of resources for treatment, support, research, and interventions. Understanding the true scale of a problem is the first step toward addressing it more effectively. Hopefully, this groundbreaking data can help steer the conversation toward more inclusive and comprehensive mental health services.

However, this data also highlights the urgent need for continued research into these disorders, as we still have a lot to learn about the exact causes, risk factors, and most effective treatments. Support from families, communities, and healthcare providers is crucial for those affected by these conditions. Furthermore, as societies, we must continue to work towards eradicating the stigma associated with mental health conditions and ensure access to necessary care and support.

Laurie Goldstein

RESEARCH WEEKLY: More people with schizophrenia in the U.S. than previously reported – Treatment Advocacy Center

By Elizabeth Sinclair Hancq

(June 28, 2023) Groundbreaking new data  released this week suggests there are 3.7 million adults living with schizophrenia spectrum disorders, including schizophrenia, schizoaffective disorder, and schizophreniform disorder. These results suggest that the number of individuals with schizophrenia spectrum disorders is two to three times higher than previously reported.  

The new data is from the Mental and Substance Use Disorders Prevalence Study , a national epidemiological survey that was conducted by RTI International and created and funded in 2019 by the Substance Abuse and Mental Health Services Administration. MDPS is unique, because trained clinicians conducted interviews with not only people living in households, but also individuals housed in prisons, state psychiatric hospitals, and homeless shelters, who had not been taken into account in previous estimates. The broader scope of those interviewed reflects much more accurate estimates of the prevalence of severe mental illness in the United States. Additionally, the incorporation of clinical interviews in the study design allows for more precise counts of people living with severe mental illnesses. 

The study was created by SAMHSA’s Assistant Secretary for Mental Health and Substance Use from 2017-2021 Dr. Elinore McCance-Katz to address major knowledge gaps in our understanding of the number of people living with serious mental illness in the United States. This was in response to a report published  by Dr. E. Fuller Torrey and me in “Psychiatric Times” calling attention to the major shortcomings of current prevalence estimates and the National Institute of Mental Health changing their prevalence estimate of schizophrenia, despite no new data being published. The attention that Treatment Advocacy Center’s report received provided the support needed to get the notice of policymakers to address the miscounting of severe mental illness in the U.S. and directly resulted in the creation of the MDPS project. 

MDPS is a cooperative agreement between RTI International and SAMHSA in collaboration with Columbia University/New York State Psychiatric Institute, Duke Health, University of Washington, Harvard University, University of Chicago, and Treatment Advocacy Center. 

62823 graphic

A deeper dive into the schizophrenia results 

MDPS found that 1.8% of adults aged 18-65 in the United States have a lifetime diagnosis of a schizophrenia spectrum disorder. Approximately two-thirds of those individuals, or 1.2% of the adult population, have a past-year diagnosis of schizophrenia spectrum disorder, meaning they experienced psychosis symptoms in the 12 months prior to being interviewed for the study.  

This translates to 3.7 million individuals with schizophrenia spectrum disorders living in the United States, 2.4 million of whom had active symptoms in the past year. This means there are two million more individuals living with a schizophrenia spectrum disorder in the United States than what is currently listed on the NIMH website .  

MDPS also asked participants about their treatment history in the past year. Of those with schizophrenia spectrum disorder, 73% received some type of treatment in the previous 12 months, according to the results. For those with schizophrenia spectrum disorder:

·    66% received some outpatient treatment. 
·    12% received some psychiatric inpatient treatment.  
·    69% received some type of psychotropic medication.

However, it is important to note that these treatment rates do not represent adequate treatment. In order to be categorized as receiving any treatment, an individual needs to have received some type of mental health treatment with at least one outpatient or inpatient visit and any type of psychotropic medication, not necessarily treatment specific for schizophrenia or psychosis. Therefore, the prevalence of having received meaningful treatment for their disorder is likely much lower than this.  

Policy implications

The results from this study have several important policy implications. First, the results indicate that sensitive, ethical, and rigorous research methods can be implemented to ensure that people with serious mental illness are more accurately measured in epidemiological research, including those living in non-household settings. Second, the results show there are significantly more treatment and other social services needed for the almost two million more people living with schizophrenia in the United States than previously measured. Severe mental illnesses like schizophrenia often require intensive treatment that depends on local, state, and federal resources to fund and provide the services. Policy leaders should utilize this new data to understand their community needs and allocate resources appropriately.  

The implications of the mistakes of the past are profound – underestimating the number of people with severe mental illness almost certainly contributes to the lack of adequate treatment and other services for these individuals with the most severe of psychiatric disorders. While the MDPS results are a major step in the right direction for the prioritization of people with severe mental illness, it took the attention garnered by Treatment Advocacy Center’s spotlight on the miscounting to get us there. We will continue to work to ensure there are continued efforts to accurately measure how severe mental illness impacts people, families, and society.  

Each year, we honor our founder, Dr. E. Fuller Torrey, through the Torrey Action Fund. The Torrey Action Fund is an annual fundraising campaign that supports everything we do, including critical research into severe mental illness and the publication of ResearchWeekly. Please consider donating to the Torrey Action Fund and help us continue our important work.

Elizabeth Sinclair Hancq is the director of research at Treatment Advocacy Center.

Secure residential
Secure residential


Serious mental illnesses can be highly debilitating, affecting individuals’ ability to function in society and diminishing their quality of life. It is imperative to recognize the significance of secure facilities as essential tools for providing comprehensive care to those suffering from such conditions. By establishing secure facilities that prioritize treatment, insight, and rehabilitation, we can empower individuals with serious mental illness to gain invaluable insight into their conditions and facilitate their successful reintegration into the community. In this essay, we will explore the compelling arguments supporting the need for secure facilities as vital components of mental healthcare.

Safe and Controlled Environment:

Secure facilities offer a structured and controlled environment, ensuring the safety and well-being of individuals with serious mental illness. These environments provide a supportive framework to prevent self-harm, protect patients from external harm, and maintain a stable routine conducive to healing. By removing external stressors and triggers, secure facilities allow individuals to focus solely on their recovery journey, ultimately enhancing their chances of gaining insight into their illness.

Comprehensive Treatment and Rehabilitation:

Secure facilities are uniquely equipped to provide comprehensive treatment and rehabilitation programs tailored to the specific needs of individuals with serious mental illness. These facilities often employ a multidisciplinary approach involving psychiatrists, psychologists, therapists, and other mental health professionals. Through evidence-based therapies, medication management, counseling, and skill-building workshops, individuals can develop coping mechanisms, increase self-awareness, and acquire essential life skills. This comprehensive treatment approach empowers individuals to manage their conditions effectively and take steps towards reintegrating into the community.

Insight into Illness:

Secure facilities create an environment that encourages self-reflection, insight, and understanding of one’s mental illness. Through therapy sessions, group discussions, and educational programs, individuals can gain a deeper understanding of the causes, symptoms, and impact of their condition. This insight is a crucial stepping stone towards accepting their illness, embracing treatment, and making informed decisions about their recovery journey. By fostering self-awareness and providing psychoeducation, secure facilities empower individuals to actively participate in their own healing process.

Stigma Reduction and Community Reintegration:

Secure facilities play a pivotal role in combating the stigma surrounding mental illness and fostering community reintegration. By providing individuals with the tools to manage their conditions, secure facilities empower them to challenge societal misconceptions and stereotypes. The supportive environment within these facilities allows patients to practice and develop social skills, rebuild relationships, and establish a support network. As individuals gain insight into their illness and demonstrate progress, they are better equipped to reintegrate into the community, fostering understanding, empathy, and acceptance among society at large.

Long-term Benefits and Cost-effectiveness:

Investing in secure facilities for serious mental illness yields long-term benefits and is a cost-effective strategy for society as a whole. By providing intensive treatment and support, these facilities can reduce the frequency and severity of relapses, emergency room visits, and hospitalizations. As individuals gain insight, acquire coping skills, and reintegrate into the community, they are more likely to become productive members of society, contributing to the workforce, and reducing reliance on disability benefits. Furthermore, the overall economic burden of untreated mental illness, including lost productivity and increased healthcare costs, can be mitigated through early intervention and comprehensive treatment within secure facilities.


The establishment of secure facilities for individuals with serious mental illness is an essential aspect of a compassionate and effective mental healthcare system. By providing a safe and structured environment, comprehensive treatment, insight into illness, and opportunities for community reintegration, secure facilities empower individuals to reclaim their lives and realize their full potential. Investing in these facilities not only benefits the individuals themselves but also society as a whole, promoting well-being, reducing stigma, and fostering a more inclusive and understanding community.