Championing transformational change at the VHA and The Mighty

Dr. Tracy Gaudet

Dr. Tracy Gaudet is the Executive Director of the Office of Patient-Centered Care and Cultural Transformation at the Veterans Health Administration, and she is the person who invited me to participate in a plenary panel discussion about how her team’s Whole Health Model is helping to re-conceptualize healthcare within the VHA by focusing on what matters most to the veterans rather than what is the matter with them.   This transformational approach to care delivery aims to improve the experience and well-being of veterans receiving healthcare services.  

Dr. David Shulkin

Our panel addressed the Secretary, and 600 other senior leaders from the VA, assembled for their annual leadership summit Monday and Tuesday of last week.  It was an honor and a pleasure to share the dais with the veterans, and to contrast my journey through the civilian mental healthcare system two decades ago, while in the midst of a suicidal crisis, with the stories of veterans experiencing care based on the Whole Health Model.  I was grateful for the opportunity to provide my insights to such an influential audience in service of helping veterans struggling with suicidal impulses.

photo credit: Eugene Russell, VA Photographer

A dear friend introduced me to Dr. Tracy Gaudet and her team’s unconventional approach for providing integrative, proactive, whole person-centered care to our nation’s veterans a couple of years ago.  Reading a document that describes their Whole Health Model, and how it could help with the fight to reduce suicide, changed the course of my life.

I had all but given up on working to be an agent of change committed to reforming our current healthcare system, but learning about her team’s approach to helping people maximize their well-being gave me hope that change was possible.  I was inspired, and within a year, I had left my full-time position as a project leader in  information technology to focus on suicide awareness and prevention and mental healthcare reform.  I became a board member of the Philadelphia chapter of the American Foundation for Suicide Prevention, and a Zero Suicide Champion for the Suicide Prevention Resource Center’s life-saving paradigm for helping care providers vitalize their suicide prevention regime.

My journey through a mental healthcare system that had placed my care provider and my problems at its center, revealed obvious opportunities for improvement.  The Whole Health approach places the healthcare consumer at the center of the care delivery model, and champions proactive measures to promote and sustain health and well-being, rather than reactive ones aimed at managing the symptoms of a malady.  You can read more about how Dr. Gaudet and her team are driving cultural transformation within the VHA via “well-being innovation” in her own words here,  and you can watch the entire Whole Health panel presentation from last Tuesday morning here.  I believe Dr. Gaudet included me on the panel, in part, because of my public criticism of the mental healthcare system that treated me subsequent to nearly dying by suicide two decades ago.  [“Mental Illness” is a Harmfully Misleading Phrase that Causes Suffering By Design ] It’s hard for me to express how grateful I am to have had the opportunity to share such unconventional ideas with such a powerful and influential audience.  

I am always grateful when people in positions of power enable me to reach an audience.  I was grateful when Michael Kasdan shared my writing with The Good Men Project audience.  I was grateful, and honored, when someone at Mad in America was compelled to share my writing with their readership.

 

Weeks before I shared some of my status quo-challenging ideas about mental healthcare with Secretary Shulkin and the senior leadership of the VA, I submitted a slightly modified version of the aforementioned article to The Mighty – a for profit media company aiming to help people “face disability, disease and mental illness together.”  They declined to publish the article.

In May of this year, I co-wrote an interview article entitled What is mental illness? with author and Guggenheim Fellow Christopher Lane, who wrote Shyness: How Normal Behavior Became a Sickness a decade ago. You can read an excerpt from that piece on my blog here.  I was in contact with an editor from The Mighty about the article via email while Chris and I were writing it.  I sent the editor a draft of the piece during the first week of June, and I have never heard back from her since.  I attempted to connect with her publicly about the article on Twitter, where we have communicated in the past, but she remains unresponsive.

I suspected that the reasonable criticisms of the biomedical narrative of “mental illness” throughout our What is mental illness? piece might not be well-received by The Mighty.  Reading article after article, on TheMighty, written by well-meaning, but arguably misguided advocates touting the validity of the biomedical narrative of “mental illness” convinced me that the media company’s leadership may be positioning themselves to profit from advertising psych meds to suffering people.  It concerns me that more people may be misled, like I was twenty year ago, to believe that their suffering necessarily stems from an impossible to pinpoint disease of the brain that is certainly responsible for their suffering.

It’s hard to believe how lucrative simply marketing pharmaceutical medications to people in psychological and emotional distress has become in this country.  The thriving multi-billion dollar direct to consumer (DTC) psych med advertising business increased almost 10% in 2016 to $5.6 Billion according to data from Nielsen, and that figure doesn’t even include money spent on digital advertising.  The impact of this reductionist narrative propagated by the manufacturers of psych meds is evident in many stories you’ll find on The Mighty.  Article contributors prone to blaming or scapegoating their ostensibly malfunctioning brains for their suffering are commonplace.  In fact, particularly eloquent advocates are celebrated and awarded for their activism.

Unfortunately, more often than not, stories published by The Mighty downplay, or completely ignore, evidence pointing to the complex interplay of biological, psychological and environmental factors that lead people to experience the symptoms commonly associated with the condition descriptions found within the American Psychiatric Association’s bible, the Diagnostic and Statistical Manual of Mental Disorders.  Sadly, it’s not hard to find evidence that giving people powerful psychoactive drugs often serves to increase people’s suffering in many cases.  See the chart above for billions of reasons why suffering people continue to pay for treatments that may harm them instead of help them.

I don’t know why the editorial staff who work for Megan Griffo, The Mighty’s editor-in-chief, were not inclined to publish the two aforementioned articles that I submitted, but I stumbled upon a Mad in America post by Twilah Hiari yesterday that may offer some insight.

Her account of a comment made by The Mighty’s Chief Revenue Officer confirmed that my suspicion about The Mighty’s strategy to profit from advertising psych meds may be accurate:
The Mighty’s Chief Revenue Officer’s comment reminds me of one made by a world renowned panic and anxiety expert, Isaac Marks, when he was telling Christopher Lane about a conference he attended in connection with the DSM-III task force he served on back in the 1970s.  Marks shared a recollection with Lane about a comment made by the CEO of Upjohn Pharmaceuticals.  He was discussing the potential inclusion of new disorders in the DSM when he said:
There are​ three​ reasons​ ​why ​Upjohn​ ​​is​ ​here​ ​taking​ ​an​ ​interest​ in​ these​ diagnoses.​ The​ first​ is​​ money.​​  ​The​ ​second ​​is​ ​money.​ ​And​ ​the ​third​ is money.
Like Ms. Hiari I don’t question the good intentions of the people working at The Mighty, but I am afraid that until we transform the way many people apprehend the role that psychological and environmental factors play in various forms of human suffering, our mental health care system will continue to harm many of the people it aims to help.

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