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Notes on the APA, NAMI and NARMH Conventions

Our president was offered consumer scholarships to attend the American Psychiatric Association 2005 Annual Convention in Atlanta, the NAMI National Convention in Austin, TX, and the National Association for Rural Mental Health in Honolulu, Hawaii.  The following are her notes on what she learned.

Advance Directives
Evidence Based Practices
Prevention and Psychosis
Crisis Intervention Training
Mental Health Courts
Treatment of Cogntive Deficits
Magnetic Stimulation
Vagus Nerve Stimulator
Certified Consumer Specialists

Advance Directives
Advance Directives are documents that people can use to express their preferences for care in the event that they are considered no longer competent to make those decisions themselves.  They are called "living wills" when they are used in an end of life situation, and usually psychiatric advance directives when they are for psychiatric issues.  The state of Wisconsin does not recognize advance directives as legally binding documents when they are used for psychiatric purposes.  Wisconsin does allow someone to name a power of attorney for health care that is binding in mental health crises.  The Wisconsin Coalition for Advocacy provides forms that can be used to create a healthcare power of attorney and a nonbinding advance directive for mental health and end of life care. 

Advance Directives are binding for mental health care in 21 states.  Recent research reported at the meeting showed that consumers use advance directives responsibly and provide worthwhile information on their medical histories and values.  They are also a critical way for consumers to take control of their own health. 

Evidence Based Practices 
Evidence Based Practices is a new buzzword in medicine.  In general, it means that doctors should be trained in evaluating the value of the evidence for particular treatments and use those with empirically proven value.  While this is a noble outlook, it holds several potential problems, particularly for mental health consumers.  Newer treatments, naturally, are backed by less "evidence" in the form of previously conducted studies, so a focus on Evidence Based Practices may reduce availability of newer and more experimental treatments.  

Prevention and Psychosis
There is a new emphasis on preventing psychotic breaks in people who are at high risk for suffering one within the next 1-2 years.  This is called the prodrome of psychosis.  As better prediction of psychotic episodes becomes possible, those who are vulnerable can be treated before an event occurs, and psychotic episodes may be delayed or even prevented. 

CIT
Crisis Intervention Training for Law Enforcement officers and others who work with the mentally ill is receiving more and more attention as mental illness is increasingly being criminalized.  NAMI Fox Valley in Appleton has been taking the lead in this area in Wisconsin, and can be reached at: (920)954-1550.

Mental Health Courts
Special courts to handle offenders with mental health problems are increasingly used around the country, and are showing good results.

Treatment of Cognitive Deficits
There are new strategies coming to fruition in the treatment of cognitive deficits in mental illness.  Cognitive functioning is impaired in most mental illnesses in some ways.  Cognitive Deficits are important.  The largest predictor of the degree to which a person with schizophrenia will recover is their cognitive functioning.  A group in Ohio has designed Cognitive Enhancement Therapy, a computer, homework and group therapy system for schizophrenics.  Rivastigmine and Galantamine are Alzheimer's drugs being studied for effectiveness in schizophrenia.  Other new drugs are believed to be within four years or so of coming to market.

Magnetic Stimulation
There are a number of new forms of magnetic stimulation to treat mental illnesses, primarily depression.  Repetitive Transcranial Magnetic Stimulation (rTMS) is the closest to approval for patients not affiliated with research studies.  All forms of magnetic stimulation act as electrical fields, but pass through the skull unimpeded.  Slow levels of stimulation increase activity in the areas pinpointed, and fast doses decrease it. 

Vagus Nerve Stimulation Therapy
This treatment for epilepsy has been recently approved by the FDA for use in depression.  Electrodes stimulate the vagus nerve, which travels from the chest to the brain.  It has been used for some time for epilepsy. 

Certified Consumer Specialists
Hawaii and Georgia have certification systems for consumer peer counselors.  There are eighty hours of training required.  Wisconsin is examining its options for peer specialists.

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