Bill Gye
Clifford’s Story
The history of the treatment of people with
mental illness is full of cruelty and compassion
Psychological Medicine / Volume 22 / Issue 01 / February 1992, pp 131-145
Copyright © Cambridge University Press 1992
The International Pilot Study of Schizophrenia: fiveyear follow-up findings
RESULTS
Clinical and social outcomes were significantly better in
third world countries than those in developed countries.
J. Leff, N. Sartorius, A. Jablensky, A. Korten and G. Ernberg
World Health Organization, Geneva, Switzerland
IMPACT
W.H.O. Global Morbidity Study
(Productive Years lost for 15-45 year olds)
MentalMental
Illness
Illness*
Injuries
Injuries, including self-inflicted
Alcohol
drug use
Alcohol
&andDrugs
Cancer
Malignant neoplasms (cancer)
Cardiovascular
disease
Cardiovascular
disease
Respiratory
disease
Respiratory
disease
Musculoskeletal
Musculoskeletal
disease
SenseSense
Organ
disease
organ disease
Digestive disease
Digestive disease
0
5
10
15
20
25
30
35
Mental Illness and Mortality
1. In Australia at least 2,000 people per year die
from suicide, 90% related to mental illness
– Cf. Road accident deaths = 1,193 (2013)
2. People with severe and persistent mental
illness die 20-25 years earlier than average
Mental Health in Australia:
a Review of Expenditure
and System Design
Summary of DIRECT health expenditure to
support people with mental illness
$ 13,829
Summary of NON-DIRECT health expenditure
to support people with mental illness
$ 14,757
Health expenditure to support people
with mental illness
Annual Expenditure
$1M
$ 13,829
Direct
Indirect
$ 14,757
Total
$28,586
Mental Health Service Channels
Some Drivers of the Future Direction
of Mental Health Services in Australia
• National
– National Disability Insurance Scheme (NDIS)
– National & State Mental Health Commissions Plans
• International
– Mini-breakthroughs from Research Initiatives such
as the NIMH’s Research Domain Criteria (RDoC)
– International Consumer and Carer Movements and
ongoing efforts at De-stigmatisation
Schizophrenia Research
Volume 127, Issue 1 , April 2011
Moving ahead with the schizophrenia concept:
From the elephant to the mouse
Several converging lines of research are
deconstructing the entity of schizophrenia,
into overlapping components and dimensions
The Fellowship
• 60 sites across NSW
• 250 staff (a significant proportion are consumers or carers)
• 500 volunteers
• 3,000 members
• Enmeshed in numerous service networks
• Funded by a patchwork of State & Federal Grants and Contracts
• Partners in several research projects
• Own Research Trust Fund
• Key partner of the Australian Psychosis Research Network
• Part of the Mental Illness Fellowship of Australia (MIFA)
What do we do
•
•
•
•
•
•
Advocacy and Influence
Bring the service to the people
At home, in the community, phone, online, etc.
One to one and/or in groups
Health, Housing, Employment, inclusion, etc.
There is a very fuzzy boundary now between
“clinical work” and “community support”
Shifting Politics
•
•
•
•
Reversal of traditional hierarchies
Empowerment
Uniqueness
At the edge – greater tolerance of diversity
and “deviance”
• Recovery Approach
“Psychosocial Recovery”
Two Definitions:
Being able to live a meaningful and contributing life
with or without the presence of mental health issues
OR
Where a person feels and believes that they are
making progress in one or more areas of life that are
significant to them
Macro view of
Cycles and Interventions
To Break the Remission Cycle
Crisis
Long term
problem
unaddressed
Discharged
Admission to
Emergency
Department
Scheduled in
Psychiatric
Ward
Circuit Breaker
Crisis
(i.e. harm to
self or others)
Address
problems
to prevent
Crisis
Long term
problem
unaddressed
Discharged
Admission to
Emergency
Department
Scheduled in
Psych Ward
for 1+ days
Recidivism Cycle
Crisis
(i.e. Crime)
Long term
problem
unaddressed
Released
Arrested
Detained
Self-Perpetuating Illness Cycle
Stress and
negative
emotion
Not meeting
needs in
area(s) of life
Inability to
function well
Vicious
Cycle
Vulnerable
Person
Aggravation
of brain
disorder
Shift into a Benign Cycle
Decreased
Stress
Meeting
needs in
life
Functioning
Improved to
better meet
own needs
Recovery
Cycle
Vulnerable
Person
Neuroplastic
Repair
Intervention
Points
Psychological
Techniques
Decreased
Stress
Social and
Practical
Support
Meeting
needs in life
Skills and
Initiative
Development
Functioning
Improved to
better meet
own needs
Recovery
Cycle
Vulnerable
Person
Neuroplastic
Repair
Early
Identification
Improve
Physical
Health
SFNSW and ARC Centre for Excellence
in Cognition and its Disorders
Some wild ideas….
Belief Formation
Stage 2 Belief Evaluation
The power of a “trusted peer group” to strengthen:
(a) weak or dysfunctional belief evaluation processes
and/or
(b) alternative (competing) beliefs
Trust
• The slow development of interpersonal trust, increases
trust in other views
• If much thought is “internal” conversation, the
development of a more benign “internalised other” is a
key component of improved meta-cognition
• I.E. Put a dysfunctional individual in a functional group
they can trust and the dysfunction begins to self-correct
Belief Formation – Stage 1
• Stage 1 involves impairment of perceptual or
interpretative processes
• A component of the above can be anomalous experience
• These may consist of voice hearing; hyperaesthesia;
synaesthesia; mystical experience; hypnogogic
experiences; lucid dreaming, etc.
• By acknowledging, discussing and sometimes even valuing
these experiences it is possible to decrease anxiety and
increase more realistic meta-cognition in relation to them
• E.G. Voice Network movement (www.hvna.net.au)
Language
1. Accessible usable online procedures for assessing
language disorders (from the grammatical to the
“pragmatic”) and tailored individualised remediations
2. It is hypothesized that “voice hearing” is a break
down of the “efference copy” when “thinking in
words”,
–
–
This begs several questions such as whether “thinking in
words” is an implicit language activity
More light needed on the possible role of the Efference
Copy dysfunction in the experience Voice Hearing
Memory
• Why the process of “benign forgetting”
(usually during sleep) to “clear the emotional
slate” is diminished and how to restore it.
• What’s needed to shift emotionally charged
episodic memories into less emotionally
charged autobiographical memory.
• What is the relation between not being able
to forget negative events and an overly active
negative scenario imagination
Person Perception
• Are disorders of person perception in people
with “schizophrenia” primary disorders (i.e.
causative) , OR are they...
– downstream effects of social hyperaesthesia &
anxiety and leading to habits of perceptual avoidance
– Manifestations (or symptoms) of more general
sensory processing disorders
We need:
• Continued research on the underlying
biological factors and epigenetic triggers
• Global models of cognitive function that
combine social, affective and general cognition
• Accessible online procedures for assessing
specific cognitive functions and tailoring
individualised cognitive remediations
What really need:
• A usable evidence-based macro-theory of
human functioning. A bio-psycho-social
Theory Of Everything (TOM). The equivalent of
the Standard Theory in Physics.
Dymphna’s Story
The Town of “Geel” in Belgium
GEEL
The Social Component of the
Bio-Psycho-Social Model
• A Group = family, peer group, work team, community, etc.
• A dysfunctional group is one with too much conflict, little
altruism or coordination to achieve common goals.
• A functional group is the opposite
• A dysfunctional group can trigger and amplify potential
dysfunction in vulnerable individuals
• Put a dysfunctional individual in a functional group setting
and the dysfunction often self-corrects
Geel
•
•
•
•
•
St. Dymphna is the patron saint of the mentally ill, psychologists and psychiatrists.
Dymphna was born in the early 7th century of the King and Queen of Oriel in Ireland. When
she was 14 years old, her mother died. It is said that in the aftermath of her death her
father’s mental health sharply deteriorated and he desired to marry his daughter who
resembled her mother. Dymphna fled with two servants and a small sum of money to the
town of Geel in Belgium where she built a hospice for the mentally ill. The bad news is that
her father tracked her down and killer her.
The real punch line is that the tradition of supporting the mentally ill continued on in Geel.
For at least the last 700 years the people of the town have taken the mentally ill from all
over Europe into their homes as guests. In Geel the term for people with mental illness is
“boarders”. A boarder is treated as a member of the family and involved in everything,
including work and child care, and may live with the family for years, or even a lifetime.
In 1794 Philippe Pinel, the founding father of French psychiatry, who was legendary for
‘striking the chains off the mad’ at the Salpetrière asylum in Paris, wrote in his “Treatise on
Insanity” that ‘the farmers of Geel are the most competent doctors in France and provide
the only reasonable treatment of insanity‘.
By the late 1930s, there were almost 4,000 boarders among a total population of 16,000.
Sadly today, there are only 300 boarders now in Geel. What changed was the economy.
Families no longer work on the land or need help with manual labour. Most citizens are now
employed in the business parks outside the town and the march of modernity has
irreversibly loosening traditional community ties and customs.
Clifford Beers
• In 1876 Clifford Beers was born in Connecticut USA as one of five
children, all of whom would suffer from mental illness and all died in
mental institutions.
• In 1897 at the age of 21, Beers graduated from Yale with honours.
• In 1900 to 1906 he was confined to several mental institutions for
depression and paranoia. During these periods he experienced
significant trauma and torture, including 21 days in a Straight Jacket and
other forms of confinement. He also experienced many kindness and
fellowship.
• In 1908 his autobiographical book A Mind That Found Itself became a
bestseller.
• In 1909 he founded the "National Committee for Mental Hygiene", now
named "Mental Health America".
• In 1913 he opened the first outpatient mental health clinic in the United
States and became the Honorary President of the World Federation for
Mental Health.
• He died in 1943.
The history of the social treatment of people with
mental illness is full of cruelty and compassion