“People with serious mental illness are 10 times more likely to be the victim of a violent crime than the perpetrator”

28 02 2012

One of the most common beliefs about people with mental illness is that they are violent and  dangerous. Here is an article that was published today which reinforces what we already know: “Although research suggests that there are factors that may increase risks of violence – such as co-occurring substance use, or not being engaged in treatment – people living with mental illness are 10 times more likely to be victims of violence than perpetrators.” Would this fact reduce mental illness stigma? probably not…

The Psychiatric rehabilitation law in Israel

28 02 2012

In the past decades there have been substantial changes in the Israeli mental health field in general, and in the community based psychiatric rehabilitation in particular. These changes occurred both in policy making level and in practice level. Since 2001 the Israeli Ministry of Health has been in the process of developing community based psychiatric rehabilitation services as part of the implementation of the Rehabilitation in the Community of People with a Psychiatric Disability Law or “Psychiatric Rehabilitation Law”.

This law combines the rights of people with disability and the rights to dignity and liberty– in the psychiatric rehabilitation field prospective. The main goal of this law is “to work diligently for the rehabilitation and social inclusion of people with a psychiatric disability in order to allow them to achieve the maxim amount of independence and quality of life, while keeping their dignity according to the Basic Law: Human Dignity and Liberty” (2000).  Furthermore, this law emphasizes the importance of social inclusion of people with psychiatric disabilities as part of the rehabilitation process; and stated that all Israelis with a psychiatric disability will enjoy the right for community based psychiatric rehabilitation services provided by the country.

Nonetheless, while there are many developments in research and practice in this field in Israel, there are still many barriers that slow down the positive progresses in this field: the medical model approach is still dominant in policy and in budgets; the shift from the “protected” rehabilitation approach that encourages low functioning and social exclusion to “empowered” approach that encourages high functioning and social inclusion is slow; the passage from paternalistic attitude from many sectors in the system to a more self-definition attitude for the consumers and therapeutic practices and social attitude that maintain mental illness stigma and discrimination are still common; and still many people do not have access to psychiatric rehabilitation services.

For more information read these recent papers by Aviram, Ginat and Roe and by Drake, Hogan, Slade and Thornicroft.

For questions, clarifications and any other inquiries about this issue please feel free to contact me.

Have a great day!


Global Mental Health Challenges

27 02 2012

This time I will not use not too many words…. please find an interesting interview between Dr. Thomas Insel and Dr. Pamela Collins on global mental health challenges and the [American]National institute of Mental Health initiatives.

The Convention on the Rights of Persons with Disabilities

26 02 2012

The Convention on the Rights of Persons with Disabilities (CRPD) and its Optional Protocol was adopted on 13 December 2006 at the United Nations Headquarters in New York, and was opened for signature on 30 March 2007. The purpose of the Convention is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity. Follows decades of work by the United Nations to change attitudes and approaches to persons with disabilities. It takes to a new height the movement from viewing persons with disabilities as “objects” of charity, medical treatment and social protection towards viewing persons with disabilities as “subjects” with rights, who are capable of claiming those rights and making decisions for their lives based on their free and informed consent as well as being active members of society.

In light of Israel’s impending ratification of the CRPD, a comprehensive 2-day international conference will take place in, 13-14 March 2012, at Bayit VaGan Guest House, 8 HaPisga St., Jerusalem, Israel. Among the issues to be addressed – challenges of implementation; community living; education; employment; accessibility; legal capacity; access to justice; implementation experience in other countries.

Conference speakers include close to 50 distinguished experts and practitioners in disability rights issues – government officials, civil society leaders and academics, from Israel and abroad.

I will be there and will let you know how was it.


Eating disorders

25 02 2012

Eating disorders… do we fully understand the reasons for these disorders? Do we fully acknowledge the dire consequences of anorexia, bulimia, and binge eating disorder? Do we really know how many people cope/suffer from these conditions? Are there enough professionals that know how to assist people with eating disorders to cope with the disorders symptoms? Are there enough resources for research, treatment and rehabilitation in this field? Well my friends, the answer for these questions is absolutely NO!

As part of my professional work I have been facing, more than once, with the lack of services for people with eating disorders in Israel. Personally, I had to deal with the tragedy of a very early dead due to an eating disorder (outside of Israel).

I call policy makers to recognise how prevalence and dangerous these health conditions are, and to allocate [much] more resources to reasearch and practice in this field.  Fortunately, Dr. Thomas R. Insel,  Director of the [American] National Institute of Mental Health (NIMH) is aware of the situation and is seeking to improve it.



University as a Disabling Environment

24 02 2012

Here is another piece Dr. Nitsan Almog’s PhD dissertation. In this part, Dr. Almog highlights the difficulties that students with disabilities experienced due to environmental barriers and obstacles that are a direct result of an inaccessible educational environment. This barriers and obstacles include inaccessible learning materials, inequality in examination conditions, inadequate understanding of the students’ needs and lack of inclusive academic environment. In the summary of this part, Dr. Almog quotes one of her study participants with a visual impairment:

“Sometimes I look at my cognitive abilities, and at the things I know of myself regarding my disability, or whatever you want to call it. The concept of disability relates to the responsibility of society. Because in fact I am limited and disabled as a result of the responses from the society surrounding me. Then I tell myself, I might fit into something which supposedly this disability really hinders me from succeeding at. It might be that the academic environment is not adapted to my abilities and needs in some sense I still do not know how to define. I’m sure that something in here stops me.”

Have a great weekend!


Closeting and Coming Out – On the Way to Self-Disclosure

23 02 2012

Health and Disability-related stigma is a major barrier preventing people with disabilities from accomplishing many of their life goals. The professional literature that one of the most effective strategies to reduce stigma and discrimination is contact; that is, meetings between people with disabilities and their “healthy” or non-disabled peers increase empathy and decrease stigmatization.  However, in cases of invisible disabilities this effective strategy is possible only if people will disclose themselves – if they will come out of the closet!

While coming out of the closet may lead to a significant anti-stigma effect, there are also some potential risks. People with invisible health conditions and disabilities may be discriminated against in many life domains (e.g., workplace, insurance, and housing) as a reason of their disclosure.  Hence, a coalition that seeks to promote “coming out” must also aim to obtain interpersonal, legal, and other substantial support for those who step up to the challenge.

Please read this fascinating piece by Dr. Nitsan Almog about the disclosure issue among people visibility impairment. I want to thank Dr. Almog  for giving me the idea to write about this important issue.

Please feel free to share your thoughts and ideas about whether it is a good idea to come out of the closet and about the best ways to doing it.


The psychiatric services PARADOX

22 02 2012

“For consumers of all ages, early detection, assessment, and linkage with treatment and supports can prevent mental health problems from compounding and poor life outcomes from accumulating. Early intervention can have a significant impact on the lives of children and adults who experience mental health problems. Emerging research indicates that intervening early can interrupt the negative course of some mental illnesses and may, in some cases, lessen long-term disability. New understanding of the brain indicates that early identification and intervention can sharply improve outcomes and that longer periods of abnormal thoughts and behavior have cumulative effects and can limit capacity for recovery” (President’s New Freedom Commission on Mental Health)

Policy makers, clinicians and researcher highlight the importance of early intervention in the mental health field, as well as other medical areas. Furthermore, one of the main purposes of public awareness and anti stigma campaigns is to promote help seeking behaviors and treatment adherence among people who experience psychiatric symptoms. However, the call for early interventions and for help seeking behaviors is almost ironic in the present situation of psychiatric services (e.g., mental health departments/hospitals, ambulatory and community based rehabilitation services). For example, here in Israel, the situation of psychiatric services for children and teens is DIRE (!). In the same vein, most adults that need community based treatment and rehabilitation do not receive it due to lack of available services. So how can we call for people to go and get treatment when this treatment is not available for so many people?


21 02 2012

Following the previous post, here is an approach to understand the mind-body link. This approach, among others (that will be mentioned in future posts) may also provide an alternative to the term “mental illness”.

Panksepp & Solmsm, the founders of the Neuropsychoanalysis (NPA) approach, argue that NPA seeks to understand the human mind, especially as it relates to first-person experience while recognizing the essential role of neuroscience in such quests. However, unlike most branches of neuroscience, it positions mind and brain on an equal footing. It recognizes that the mammalian brain is not only an information processing device for behavior, but also the fount of the dynamics that is called mind, from joyous and sad feelings to banal cognitions and idiosyncratic flights of fancy. That is to say, it is impossible to explain complex behaviors without reference to neural networks that mediate subjective mental events: that is, the causal effects of thoughts and feelings.

Neuropsychoanalysis emerged during the 1990s as a response to the need to reconcile psychoanalytic and neuroscientific perspectives on the mind, with the goal of yielding a better understanding of the basic emotional foundations of psychiatric disorders, in the hope of promoting better nosology and therapeutics.

For more information click HERE and HERE 

Can a soul/spirit be ill??

21 02 2012

The Hebrew term for a psychiatric illness (‘machalat nefesh’) means the ‘disease of the soul’. By all means, this term is highly dissonant with current scientific concepts whereby mental disorders are recognized as bio-psycho-social entities. Using the word soul (‘nefesh’) may suggest that the spiritual essence of a person is affected by the psychiatric disorder and that the dreams, hopes, love and decisions of persons with mental illness are diseased. The ‘soul approach’ may also add to the metaphysical characteristic of mental illness.

In the past few years I called (together with some other colleagues) to find a better – more scientific and less stigmatic – term to MACHALT NEFESH. I believe that the new term should consider the multidimensionality and complexity of the illnesses, and reflect research findings about the etiology and mechanism of psychiatric illnesses.

Any ideas???