NIMH vs DSM-5: No One Wins, Patients Lose

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The flat out rejection of DSM-5 by National Institute of Mental Health is a sad moment for mental health and an unsafe one for our patients. The APA and NIMH are both letting us down, failing to be safe custodians for the mental health needs of our country.

DSM-5 certainly deserves rejecting. It offers a reckless hodgepodge of new diagnoses that will misidentify normals and subject them to unnecessary treatment and stigma.
The NIMH director may have hammered the nail in the DSM-5 coffin when he so harshly criticized its lack of validity.

But the NIMH statement went very far overboard with its implied promise that it would soon find a better way of sorting, understanding, and treating mental disorders. The media and internet are now alive with celebrations of this NiMH ‘kill shot’. There are chortlings that DSM-5 is dead on arrival and will perhaps take psychiatry down along with it.

This is misleading and dangerous stuff that is bad for the patients both institutions are meant to serve.

NIMH has gone wrong now in the very same way that DSM-5 has gone wrong in the past — making impossible to keep promises. The new NIMH research agenda is necessary and highly desirable — it makes sense to target simpler symptoms rather than complex DSM syndromes, especially since so far we have come up empty. And the new plan will further, and be furthered, by the big, new Obama investment in brain research. But the likely payoff is being wildly oversold. There is no easy solution to what is in fact an almost impossibly complex research problem.

New NAMI Fact Sheet

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Boise police officers say they shouldn’t be counselors

The Idaho Statesman
Boise police officers say they shouldn’t be counselors
Read more here: police chief wants a better network for people in mental health crises, so they don’t become criminal cases or suicide statistics.


On Tuesday night, a woman called police to a house near State Street because her husband was holding a gun to his head. The woman fled with her 2-year-old. Officers caught the man on the roof of his shed and took him into custody on a mental hold.

On Wednesday night, officers talked a suicidal woman down from the Emerald Street overpass. She was distraught over a recent DUI arrest and child custody issues. Officers took her into custody after closing the Connector for 30 minutes.

By noon Thursday, Boise Bench Patrol Officer Gary Wiggins had fielded four mental health-related calls.

“It’s a daily occurrence for us,” said Wiggins, a 20-year veteran.

Boise Police Chief Mike Masterson said these cases and the May 31 death of Troy Epperly are among reminders that services are lacking for Idahoans who need mental health care and that police are shouldering a growing burden.

Epperly confronted police outside a Boise residence after telling his estranged wife he intended “suicide by cop.”

He refused to drop his gun. Police shot him. He died in the hospital.

Investigators last week concluded that the shooting was justified. But Masterson and Wiggins hope for a day when mental health issues are resolved long before they become crises requiring police intervention.


Officers get paid to be first responders. But they’re not mental health professionals, said Wiggins.

“We get calls on everything from people whose power has been turned off, threatening to kill themselves if someone doesn’t turn it back on, to people who used to be in mental health outpatient programs but aren’t now because those programs don’t exist anymore,” said Wiggins.

“The worst thing for me is going into situations by myself,” he said. “Not because I’m worried for my safety, but because I don’t know what to do for these people.”

Twenty years ago, Wiggins spent lots of time making arrests. Now he jokes that each officer should get a Prius and work in street clothes because they spend so much time helping people find services. “We do more social interventions than crime-fighting,” Wiggins said.

Wiggins said he’s felt the effects of cuts at Health and Welfare. Mental health staffers once available 24 hours a day are still available all weekend — but not from midnight to 7 a.m. weekdays.

Masterson said police take people for mental hold assessment in only about 10 percent of mental health calls. What happens to other men and women in distress?

“What do we do to help those people?” said Masterson.

And officers often end up on additional calls involving the 10 percent who have been hospitalized.

In one case, Wiggins responded to five mental health calls for the same man. On the fifth, the man had hanged himself.

Over the past two years, Boise police have responded to 13,000 mental health-related calls — everything from welfare checks to attempted suicides and overdoses.

Decades ago, domestic violence had a stigma similar to mental health issues and suicide. Society responded with tougher laws and coordinated services. That hasn’t happened for mental health.

“I can show you statistics that over the last five years, drunk-driving arrests have decreased by more than 50 percent and there’s a correlation of fewer accidents. Roads are safer,” said Masterson.

“What I can’t do is show you the same decreases in suicides and people in crisis.”


Boise police have taken steps to prepare officers for expanding demands. After the 2004 fatal shooting of Matthew Jones, a 16-year-old who approached an officer with an unloaded antique gun, city Ombudsman Pierce Murphy recommended the department provide officers with training to defuse mental health crises.

The department, working with Health and Welfare, created a Crisis Intervention Team. Officers from across the department have received 40 hours of training.

The problem, Masterson said after the Epperly shooting, is that such efforts are “downstream” — responding to people in crisis after the fact.

“As a state and society, we need to focus on ‘upstream’ efforts to minimize using police from Boise, Chubbuck, Post Falls or any sheriff’s department in our state as primary intervention services,” he said.


One place to start would be a state suicide hotline.

Kathie Garrett, former state legislator and chairwoman of the Idaho Council on Suicide Prevention, said the goal is to get the hotline running by mid-November.

Hotline advocates have raised close to $369,000, about $50,000 short of what they’ll need to operate for the first two years, said John Reusser, who’s been hired to head the hotline. The group is still raising money.

Both Masterson and Garrett say a hotline is just one step in what needs to be a network of services to help people — whether they have insurance or not — and to follow up after the crisis has passed.


Idaho ranks 47th in spending on mental health care, according to the Speedy Foundation, named for Olympian Jeret “Speedy” Peterson, who had a history of depression and took his life in 2011.

After the Epperly report, Masterson called on residents to ask lawmakers for more funding for mental health services. Masterson testified before the Legislature a couple of years ago supporting a tax increase on beer and wine to help pay for programs.

The chief also wants people to take responsibility and recognize when someone close to them is in crisis.

His officers see the results when that doesn’t happen.

“I’ve had officers who have pleaded with people until their voices were hoarse, only to have people shoot themselves in the officer’s presence,” said Masterson. “We like to think there’s a tough veneer. But it takes a toll. Officers question themselves, ask themselves what they might have done.”

Anna Webb: 377-6431

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