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.

An open letter to President Obama about suicide prevention | frank talk about mental health | episode 9

November 14th, 2016

Dear President Obama,

Beau Biden was my captain on the tennis team in high school, and Hunter and I nearly won a football state championship together back in 1988.  As a self-declared brother of their father, you are undeniably an honorary member of our extended Archmere family.

I remember the moment during the early morning hours of August 23rd back in 2008 when I got the text message announcing that Joe Biden was your running mate, and I will never forget the moment later that year when you were elected president.  It was that night that I committed myself to getting into a position to leverage my personal connection with Vice President Biden, before you both left office, to the benefit of an important but underserved cause in this country:  suicide prevention.

My namesake and paternal grandfather died in a mysterious explosion at the factory where he worked two days after Christmas in 1951.  Within a year my fourteen year old father-to-be was working two jobs, and giving $40 a month (about $350 in 2016) to his mother to help support her and his two younger sisters.  He joined the Army after graduating from high school where he learned how to be a land surveyor.  After returning from his tour in Europe, he met my mother-to-be, bought a small land surveying firm in Delaware, and started a family.  My father ran the business while my mother ran just about everything else at home.  My parents, two high school graduates, paid for every penny of their four children’s education, which included private grade schools, the same private high school attended by the Bidens, and the colleges of our choice.  Good luck, hard work and love have made the story of Judy and Franco Bellafante an unequivocal example of the American Dream.

I enrolled at the University of Notre Dame in the fall of 1989.  Archmere and AP tests gave me a 30 credit head start, and I earned a Bachelor of Arts in just three and a half years, graduating Magna Cum Laude with a Phi Beta Kappa Honor Society induction to boot.  Mr. Tom Brokaw closed his commencement address to the class of ‘93 in South Bend like this, “It’s easy to make a buck; it’s harder to make a difference.  We need your help.  Go Irish!”  Four years later I became the youngest Principal out of 350 staff at a financial IT consulting firm located a couple of blocks from Wall Street.  I was 26 years old, and my bill rate was $250 an hour.  I won’t deny that I worked hard, but Mr. Brokaw was right.  The advantages afforded me had made it easy for me to become someone who billed in excess of half a million dollars a year in consulting fees.  Back then being successful at my job was paramount to me, while “making a difference” had been temporarily relegated to a distant backburner.

Less than a year later and a few weeks before being accepted into UCLA’s Anderson School of Management, a foreman at a warehouse arriving for work in Secaucus found me clinging to life inside of a running rental car that I’d turned into a makeshift carbon monoxide gas chamber the night before.  I had a near death experience in the ambulance on the way to the hospital, and I woke up a couple of days later in the ICU.  Suffice it to say that my suicidal crisis stemmed from an unshakeable belief that I had become unable to live up to expectations I had for myself as a result of being the beneficiary of so many advantages and so much privilege.  Countless hours of introspection and study over the ensuing years have made me a “lived experience expert” regarding how some young people, with no prior trauma and with many apparent advantages, feel so self-loathing and so hopeless that they become suicidal.

In April of 2015 I left my day job in IT to work full-time in suicide prevention and mental healthcare advocacy.  I became a volunteer in the speakers bureau of the Greater Philadelphia Chapter of the American Foundation for Suicide Prevention.  I began to share some of the lessons I’ve learned since my suicidal crisis by giving talks at Philadelphia area schools and businesses aimed at lowering the suicide rate and reducing the stigma surrounding mental illness.

In June of this past summer, I was on Capitol Hill with hundreds of volunteers from the AFSP advocating for more federal funding for suicide prevention.  Thanks to Hunter and an assistant of the Vice President, I was poised to introduce the executive leadership of the AFSP to the Vice President and his policy staff when the mass shooting in Orlando derailed our plans to meet.  

You are taking questions from the press for the first time since the election as I write this message to you, and I’m compelled to share the following as if I was at the presser and you had just called on me.

Based on 2014 CDC statistics, about 58 Americans die from self-inflicted gunshot wounds every single day—a death toll nine lives greater than the deadliest mass shooting in U.S. history.  Annually that’s 21,334 lives lost to suicide via a firearm.  Comparatively just half as many Americans died by homicide via a firearm in that year, and only 18 Americans died in mass shootings in all of 2014 according to Mother Jones reporting. Imagine that at 12:00 noon tomorrow, 58 Americans simultaneously die by suicide via a firearm.  Imagine that twenty four hours later it happens again—58 simultaneous suicides via a firearm occur at 12:00 noon. Twenty four hours later it happens yet again.  

Am I right to assume that if this slight and absurd modification to the details surrounding the daily tragedy of firearm inflicted suicide occurred in reality, that you would be compelled to say and do things to try to prevent suicide that you have yet to say or do?

If so, why not consider adding more achievements to your team’s list of accomplishments in suicide prevention before leaving office?

There is still time for you to try to change what this picture looks like in order to bend the rising U.S. suicide rate curve.

research-chart

You are an elocutionary potentate and a transformational leader of humanity.  I imagine that you have inspired millions of Earthlings to serve the public’s interest in ways that they might not have without your influence.  I am grateful to include myself in this group.  Your vision for the future of this country inspired me to do the hard work to try to make a difference for others by being the change that I wish to see in this world.

With the election behind us, I’m happy to report that I am in the process of rescheduling the meeting between the AFSP executive leadership and Vice President Biden.  I will be sure to share the time of that appointment with you and your staff once it’s scheduled just in case you might be available to join us.

Thank you for all that you have done to prevent suicide and to improve mental health care in this country.  Thank you for being a constant reminder of the positive difference that someone can make in the lives of others.

Sincerely,

Francesco Bellafante
American Foundation for Suicide Prevention, Greater Philadelphia Chapter Board of Directors
Zero Suicide Champion
frank talk about mental health ~ leveraging the genius of Einstein to stop suicide and to maximize well-being
iameinstein.com

Suicide attempt reason reveal 18 1/2 years later | frank talk about suicide | episode 7 preview

I was named after my paternal grandfather who died in a mysterious explosion at the fireworks factory where he worked two days after Christmas in 1951. My father to be was 13 years old. Within a year, he was earning $15 a week to help support his mother and two younger sisters delivering newspapers and working in a drugstore as a stock boy and soda jerk.

He was bringing home $400 a month, in today’s dollars, to help support his family.

He was 14 years old.

Music:

Father
by Estes Shane Whalen