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Email note from DJ Jaffe, Executive Director, Mental Illness Policy Org.

From: DJ Jaffe
To: Art Levine
Sent: Wednesday, December 30, 2015
Subject: Re: finishing a chapter related to solutions that work, in mental health reform, wanted your view on how
AOT would help stop mass shooters, and on supported employment/other psychosocial programs.

Excerpt:
Im sorry I wont have time to talk. Quick answers below

On Dec 30, 2015, Art Levine wrote:

Dear D. J. Jaffe: I'm completing a book on mental health reform this week, and I wanted to better understand how
AOT as run in places like New York could help stop mass shootings or because the people eligible for the program
have to have repeat chronicity of problems and been through hospitals, etc., it might not be useful as a tool to stop
mass shooters ? Some of that material would also end up in the Huffington Post. What's your best phone number?

AOT requires a prior history of homelessness, arrest, hospitalization etc. Some mass shooters have had it
(Hinkley/Weston/Eliot Rodger, etc) and some did not. Whether or not AOT would stop mass shootings or not is
largely irrelevant. Mass shootings are exceedingly rare. There is too small an n. AOT is clearly proven to reduce
homelessness, arrest, violence, incarceration, suicide, hospitalization, etc. To judge whether AOT has merit based
on whether it would or wouldn't reduce mass carnage is not the right barometer.

Also I'd like your views on supported employment, or other psychosocial programs, as described in these USA Today
articles, with some overview data attached based largely on controlled studies. If I remember either a brief email or
talk a while ago, it was your view, it wasn't possible help a majority of the most seriously mentally ill -- people with
long histories of schizophrenia etc -- because they'd be incapable of taking advantage of it? Or that the people
helped must not have really severe mental illness, or words to that effect? I'd like to clarify and get accurately your
views.

Nothing you sent was a study. They are a summary of other studies. I would have to read those underlying studies
and I dont have time to review them for you. Meta studies are notorious for combining underpowered studies of
disparate issues, mining the data to come up with positive results to report. I also could not see conflict of interest
disclosures. IOTW, do Bond/Drake run employment programs? I simply dont know.

When I looked at this issue a long time ago, I found most of the studies were by those who provide employment
training and therefore were lacking independence. They did not segregate by diagnosis. Mentally ill (friends on
Prozac) from seriously mentally ill (schizophrenia/bipolar). Further, I found many of the jobs were peer support,
i.e. were jobs reserved for people with mental illness. Job programs did not lead to competitively based long term
employment for people with schiz outside the mental health or arts fields. Ex. One of the people championed in the
1st USA story as a success, works in the NAMI Office. That is in the mental health industry. Go call the NAMI and see
if he/she is still working there. Not a lot of time has passed, but Id still be curious. Is it a volunteer job?

Obviously, I am not going to evaluate effectiveness based on mass media article in USA Today. Also, there seems to
be a mistake in it that it confuses mental illness in some places, with serious mental illness in others. One of the
reasons we often come to conclusions that others do not, is because we look at the actual research.

I would suggest you try to find people with schizophrenia working in non-supported employment outside the mental
health and arts fields. Ask all those who say it happens to find people for you. I have been largely unsuccessful.
Some schiz remits. Some is episodic. Some is chronic. The treatments are not yet good enough to return people
with it to work, with or without employment training. Good luck with your book/article.

I'd like your views in a brief conversation.

http://www.usatoday.com/story/news/nation/2014/07/10/high-unemployment-mentally-ill/12186049/

http://www.usatoday.com/story/news/nation/2014/12/22/solutions-mental-illness/18816843/

Regarding supported employment, I'm attaching a powerpoint, an overview piece based on about two decades of
peer-reviewed research that appeared in a peer-reviewed psychiatric rehabilitation journal, and an article looking at
"who benefits" that says even the severely mentally ill could be helped by the program (assuming they're not in the
throes of a schizophrenic breakdown). And a five-year controlled long term study from Europe.

For what it's worth, enclosed was an effort by SAMHSA to run "evidence-based practices" for the seriously mentally
ill in community clinic settings that generally incorporated medications back in the early-mid 2000s -- have they
abandoned that interest since then?
http://ccaf.nl/files/2015/06/artikel_mchugo_drake_et_all_fidelity_outcomes_act_psychiatric_services.pdf this one
measures whether they stuck to the model...because it was too expensive to measure outcomes of impact on
clients, so they used methdologies including ACT that have proven effectiveness.
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Here's an overview on psychosocial programs and implementing them for those with schizophrenia, circa 2009:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696376/