“It was the epoch of belief, it was the epoch of incredulity…” So begins Dickens’ “A Tale of Two Cities,” and in the case of behavioral health conferences, the cities were Orlando for the electrifying National Council and Atlanta for the soulful American Association of Suicidology. The former hosts community behavioral health leaders and the latter hosts suicide researchers, policy makers, family members, crisis centers, and people with lived experience.
This was the first year that I can recall the two spring conferences being held back-to-back in continuous exhausting fashion. In years’ past, only a handful of us participated in both, but 2015 saw the largest contingent yet depart the AAS gathering of 1,250 in Atlanta on Saturday, April 18 and marathon it directly to Orlando, joining nearly 5,000 attendees for sessions that kicked off the very next day.
There were so many amazing highlights! Here are my top five.
#1. Belief! I remember exactly where I was when I first read the 2011 New York Times’ coming-out article describing Marsha Linehan’s lived experience (Expert on Mental Illness Reveals Her Own Fight). The anticipation was palpable and we were riveted when the international research giant and inventor of Dialectical Behavior Therapy took the stage four years later to share her own deeply personal and intimate story. It was spellbinding, reluctant at moments, and always courageous.
“I want to know if you are one of us.” This question, posed by her DBT clients over the course of years, encouraged her to share her experiences, including a two year psychiatric inpatient stay. But stigma and fear of being defined by her mental illness kept her from it. She insisted that mental illness not be the definition of her life, and she avoided telling her story in the past in part because of her fierce protection of the credibility of DBT.
Yet her story explains, in part, her amazing expertise. Dr. Linehan described her own personal hell: “there is screaming in a white room; no one hears; and there is only one way out of pain.” (This imagery was strikingly close to the pain Ashley Judd would articulate just days later in Orlando.) She shared with the AAS audience her vow to find a way out of hell to return and help others.
At last year’s conference, AAS formally recognized a Division for individuals who were suicide attempt survivors. Lived experience found a safe place. But this year, Dr. Linehan and the AAS leadership pressed further, and a brave new space emerged, evidenced by the lived experience writing contest, won by Dese’Rae Stage (read her entry here), who followed Dr. Linehan’s talk. Dese’Rae focused on the power of community. The contest lets individuals tell their stories, giving strength to so many people who say, “me too.”
#2. Incredulity! Ezekiel Emanuel was the smartest guy in the room in Orlando… healthcare policy expert, political animal, unmatched provocateur, and persuasive author and public speaker. He appeared to be the ordained Old Testament prophet in Reinventing American Healthcare, with dire warnings if we don’t change course: our American healthcare system is larger than the economy of France, which is the 5th largest in the world!
Yet, he also authored the JAMA article, “Bring Back the Asylum.” I was eager to learn more about his unique message behind “Improving Long-Term Psychiatric Care,” and anticipated a novel twist that would drive forward the future and BH Version 3.0. Not so much. Instead, he shared his flat-earth belief that in a population the size of the US, there are 500,000 to one million people who need to be permanently institutionalized due to the danger to themselves and/or others and their complete and lifelong inability to care for themselves.
I was thrilled to run into Dr. Lloyd Sederer immediately following, as both had book signing tables set up at the front of the enormous Potomac Ballroom where Emanuel had just keynoted. Dr. Sederer invited me to join a backstage debate between himself and Emanuel over this issue (see the YouTube Video here). Dr. Sederer is the Medical Director of the New York State Office of Mental Health (OMH), the nation’s largest state mental health system. As New York’s “chief psychiatrist,” he provides medical leadership for a $3.6 billion per year mental health system that serves over 700,000 people annually and includes 24 of the hospitals Emanuel wants to return. Despite Sederer’s credentials, if you went by the lines queued for book signings, all bets were on the healthcare reform guru, Emanuel.
Throughout the debate, Emanuel simply repeated his mantra that the number of individuals who require lifelong and permanent institutional care “is not zero,” while Dr. Sederer called for the political will to strengthen a robust community system that can provide intensive, intermediate care. He ended strong: “What is missing from this conversation is the perspective of the person who is ill… We need to understand what people value, and what they are willing to do to advance their own health.” In other words, Dr. Sederer promoted recovery in communities where people live, work, and play; where their families and friends live; and where meaning and purpose thrive.
It’s just my opinion, but I scored a Mayweather/Pacquiao unanimous decision for Dr. Sederer in this championship bout. Collectively, as a field, we have fought since the 1960s to supplant BH Version 1.0 with something more grounded in community. I was inspired to see one of our leading voices insist on pressing forward, rather than returning to “romanticized views” of the past.
#3. Enforce the law! I’m sure none of us had ever experienced anything like the State of the Union on behavioral health, held by the stunning actress and activist Ashley Judd, former Surgeon General Dr. David Satcher, and former Congressman Patrick Kennedy.
“Are we at a ‘Harvey Milk’ tipping point?” Kennedy asked as the group reflected on individuals “coming out” and exposing and erasing hidden bias. Both Dr. Linehan and Kennedy have courageously talked about their own lives in the same way Harvey Milk did as the first openly LGBT official elected in the US.
However, the phrase most remembered occurred in the context of a discussion of mental health parity. Kennedy referenced the civil disobedience of the civil rights movement, including Dr. Satcher’s involvement, which landed him in prison,to advance the cause and ultimately change the nation’s laws.
Kennedy added that he was over telling our stories in mental health and addiction as the path to social change. “I am over the anti-stigma stuff. I want to enforce the law.” In addition to parity, the group added that it was time, in conjunction with the 25thanniversary of the Americans with Disabilities Act, to apply these legal rights and protections to those with behavioral health.
Martin Luther King, Jr. said, “too many people fail to remain awake through great periods of social change. Every society has its protectors of status quo and its fraternities of the indifferent who are notorious for sleeping through revolutions.” Kennedy is becoming the statesman for a mental health civil rights movement, and we were all eyes-wide-open and inspired by the challenge of change.
#4. Science and Long Change. It’s been a decade since Dr. Thomas Joiner first rocked the suicide prevention field with a unifying theory, which has become the Interpersonal Model of Suicide (articulated in the 2005 book “Why People Die by Suicide”). At AAS in Atlanta, he again set the stage for a monumental change with his call for a new DSM6 category, Acute Suicidal Affective Disturbance (ASAD).
Dr. Joiner describes four criteria for ASAD:
- A sudden increase in suicidal intent over a short period of time (hours or days, not weeks or months);
- Social and/or self-alienation
- Hopelessly intractable
- Overarousal (insomnia, nightmares, agitation, irritability)
All of these are NOT due to an exacerbation of mood disorder or substance.
An audience member challenged the approach of a diagnosis given the similarity of a suicidal crisis to a heart attack or panic attack, and Dr. Joiner concurred. Because of the “state-like qualities,” the Florida State University team is suggesting a “disturbance,” not a “disorder.”
While there were concerns from some in the audience about an additional label and further stigma, the implications for changing the way we provide care were evident. The Zero Suicide approach suggests that we treat suicide directly, not as an afterthought of another DSM diagnosis. “I’m ready to start a conversation today that will require your help and might last a decade.”
#5. What’s that Whirrrrr Noise? Early on during Linda Rosenberg’s keynote “Fearless in the Face of Change,” the audience found themselves momentarily distracted by a very audible humming sound. Eyes scanned for the source of the whirring and buzzing, and honed in on the red eyes of the four-propeller drone hovering above the room and projecting on the front screen its airborne view of the National Council audience.
It was a novelty, but Rosenberg forecast the future of FedEx, UPS, and Amazon Prime, where packages are safely delivered to your doorstep in 30 minutes or less by small, unmanned aerial vehicles. Courier trucks will disappear from the roads. It brought to mind the Wright brothers first flight at Kitty Hawk. Many were skeptical that flying machines would do more than serve as a curiosity at the local county fair. We could not conceive how much their technology would change our world.
How much will the technology we already have in our hands today revolutionize our behavioral healthcare businesses and services over the next decade? It was only five years ago that the “early majority” of us traveled to these conferences with a smart phone. During the 2015 conferences, nearly 2,500 individuals tweeted out a comment about their experience (as tracked by the Healthcare Hashtag Project using #Natcon15 and #AAS15). Social media participants averaged 12 tweets each for a total of nearly 30,000 comments and comprised more than one-third of everyone who attended.
This ongoing online commentary (with pictures and video) also meant that individuals around the globe “participated” in these conferences despite not actually being present. A week after the conferences ended, a group of individuals with lived experience and supporters who attended the conference are still conferring through Facebook Messenger and sharing live-streaming video using a new app called Periscope. Natural and online peer supports in an emerging global community.
Monica Oss recently reported on “the wild west” of digital supports, with the bleeding edge of innovation being introduced by companies like Big White Wall, Ginger.io, Health Buddy, and myStrength. But, there’s a big crowd behind them.
International peer leaders like @Markoneinfour (editor of The New Mental Health) are calling for services that meet the needs of individuals with behavioral health challenges: meaning, purpose, community. And these activists are not waiting on those of us who lead traditional community mental health organizations to create them; they are programming them now.
Looking Ahead: Two Conferences in 2016
I returned to Phoenix exhausted but energized. The future of behavioral health is happening now, and it is inspiring to gather with the community of leaders in these fields that continue to merge closer. I hope many of you will join us for #Natcon16 in Las Vegas (March 7 – 9) and #AAS16 in Chicago (March 30 – April 2).