Here is why this makes me happy: The research fund will enable the Foundation to support studies and pilot projects of a type that aren't being funded today (studies, for instance, that involve using psychiatric medications in a selective, limited way.) This, I believe, is the very endeavor that could lead to a new paradigm of care that truly promotes long-term recovery and wellness.

While I helped the Foundation get started, once it was up and running I resigned from the board (for reasons I will explain later in this blog.) Since then, I have been waiting for the right time to write about the Foundation, and yesterday's news provides the perfect opportunity to do that.

The Roots of the Foundation

The Foundation came to be in a rather roundabout way. After Anatomy of an Epidemic was published in April of 2010, I began to hear from a number of mental health professionals who wanted to discuss its implications. Several psychiatrists in the Boston area contacted me, and they formed a group that began meeting on a semi-regular basis. I heard from Jack Rockefeller, who was then director of Windhorse, a provider of care in Western Massachusetts, and we discussed forming an "institute" that would fund research and "evidence-based" pilot projects that might involve using medications in a more selective way. Most important, leaders of several provider organizations and peer groups in Oregon began taking steps to publicize the issues raised in Anatomy of an Epidemic. The book looks at how psychiatric medications shape long-term outcomes, and the Oregon discussion soon focused on this question: Did our drug-based model of care need to be rethought?

I am not sure why this discussion took root in Oregon, but I think one factor was the influence of the "peer voice" in that state. MindFreedom, which is led by David Oaks, is headquartered in Eugene, and while MindFreedom may be seen by many providers in Oregon as a "radical" group, "radicalism" can be a potent force for changing the dialogue about a subject and opening minds to new possibilities. In Portland, Will Hall, who nearly a decade ago co-founded the Freedom Center in Northampton, MA, has set up a Hearing Voices group, and thus he is now bringing his considerable organizational talents to that community. Finally, there is a well-established peer organization in Portland, Empowerment Initiatives, that has been very ably led by Amy Zulich, Kristi Jamison and others, and this group also appears to be a potent voice for change.

Three providers of mental health services in Oregon took the lead in pushing forward this discussion. They were Bruce Abel, director of LaneCare, a state-funded organization that manages public mental health services in Lane County; Gina Nikkel, executive director of a state association of community mental health programs; and Bob Nikkel, who served as Oregon's commissioner of mental health for a number of years. They -- and the various peer groups -- brought me to Oregon to speak on several occasions, and then, last fall, Bruce, Gina, and Bob began talking about organizing a "medication optimization" symposium. Their thinking was that psychiatrists and others would be invited to lead workshops that would focus on investigating the evidence base for psychiatric medications, both short-term and long-term, and that these workshop groups would then try to set forth "best-use" protocols. I knew others around the country who had expressed an interest in a symposium of this type, and soon, with Gina Nikkel taking the lead in organizing the symposium, the interested parties were all chatting via email about the proposed meeting (and sharing, I must add, their often wildly divergent opinions about the merits of psychiatric medications.)

Enter Virgil Stucker. Virgil has been a leader in running and developing "therapeutic communities" for more than thirty years, first at Gould Farm in western Massachusetts, and more recently at CooperRiis in North Carolina, which was founded eight years ago with the financial support and leadership of Don and Lisbeth Cooper. After reading Anatomy of an Epidemic, Virgil called to say that he was committed to "acting" on the issues raised in the book. He immediately became involved in the planning of the proposed symposium in Oregon, and as he threw himself into this effort, he got Don Cooper involved as well.

Now the challenge became how to fund the proposed symposium. Another reader of Anatomy of an Epidemic, Louisa Putnam, is a trustee for The Putnam Foundation, and that philanthropic organization stepped forward to provide the necessary grant. We then set up a non-profit to receive that funding, and we asked Virgil Stucker, who had experience running non-profits, to serve as chairman of the newly named Foundation For Excellence in Mental Health Care.

The Oregon Symposium

Because of financial constraints, the symposium had to limit the number of people who could attend. Fifty-four people from 13 states participated in the two-day event (February 11 and 12), including 22 psychiatrists. The other participants included administrators and directors of mental health programs (private and public), and leaders from peer groups.

The symposium featured four "workshops." One was devoted to developing "medication optimization" guidelines for antipsychotics as a treatment for psychotic disorders; a second to developing such guidelines for antidepressants; the third for developing medication-tapering protocols; and the fourth for how such medication-optimization protocols could be introduced and covered by public and private insurance programs.

The psychiatrists who led the two medication-related workshops have yet to finish their research and write their conclusions. When they do so, their papers will be posted by the Foundation on its website (which has yet to be developed.) However, at the end of the conference, both workshop groups presented a "consensus statement" that reflected their investigations of the outcomes literature, and both statements, if incorporated into protocols, would provide a departure from current standards of care. This is particularly so in the case of the schizophrenia group.

That workshop was led by two Massachusetts psychiatrists, Chris Gordon and Mark Green. They and the others in the workshop concluded that there is a subset of first-episode psychotic patients who can recover without being put on antipsychotics, and thus, in certain instances, delayed administration of the drugs could prove useful (to that subset of patients.) In addition, the group concluded that there is a subset of schizophrenia patients (and patients with other psychotic diagnoses) that can do well off medications long-term. The group did not come up with any recommendations on how to incorporate such findings into drug protocols, but the consensus statement nevertheless established a rationale for funding pilot projects that would try to do just that. 

The depression workshop was led by Jonathan Betlinski from Oregon Health Sciences University and other Oregon psychiatrists. After its review of the outcomes literature, the group concluded that the prescribing of antidepressants as a first response to "mild depression" was not recommended (but rather alternative treatments should be tried first), and that there was a lack of evidence showing that antidepressants provided a long-term benefit (beyond 12 months). That consensus statement, while not at all radical, nevertheless would provide support for a protocol that sought to taper people from antidepressants after an initial period of use.

The Future of This Initiative