I am late to this strange party.
There is a kerfuffle going around about empathy being a sin. Some theodudes think it is and most people know it isn’t. I am not going to get into it too much, but here are a couple of links to the empathy is sin crowd.
When you start with man as image-bearing creature of God, you can understand why sympathy is good, but empathy is sinful.
Do not surrender our mind to the sinful emotional responses of others.
Minnesota pastor Joe Rigney sat down with Doug Wilson to declare empathy a sin in this odd exchange.
Rigney: That’s right. And the, and I think that actually is the most relevant difference between them because, so empathy is the sort of thing that you’ve got someone drowning, or they’re in quicksand, and they’re sinking. And what empathy wants to do it jump into the quicksand with them, both feet, and-and it feels like that’s going to be more loving, because they’re going to feel like, I’m glad that you’re here with me in the quicksand. Problem is you’re both now sinking.Wilson: Right.Rigney: Right. Whereas, if you do, I’m going to keep one foot on the shore, and I’m actually gonna grab onto this big branch, and then I’ll step one foot in there with you and try to pull you out. That’s sympathy, and that’s-that’s actually helpful. But to the person who’s in there, it can feel like you’re judging me.Wilson: So sympathy’s clearly hierarchical.Rigney: Right. It implies that one person is the hurting, and one person is the helper.Wilson: Right.Rigney: And, and no, and that’s part of the problem is no one wants to feel like they’re the hurting. We want to equalize everything. And so, and so empathy demands, get in here with me, otherwise you don’t love me.Wilson: But what do you lose— when you get in there with them, and you’re all in, they’re drowning, they’re in the quicksand, they’re in the trouble, and you identify with them completely.
Rigney went around a little with Karen Prior here.
What the theodudes seem upset about is that they seem to believe empathy puts the person who understands another’s feelings and experience on the same level as the person who is being understood. They want to be in authority.
Equality. What a concept.
Furthermore, they seem to think empathy means accepting everything anyone else does without moral evaluation. Or at least James White seems to think that. White goes out on the porch of his blog and yells at all of the empaths on his lawn, screaming:
We are not to weep with the bank robber who botches the job and ends up in the slammer. We are, plainly, to exercise control even in our sympathy. We are not to sympathize with sin, nor are we to sympathize with rebellion, or evil.
But the new cultural (and it has flown into the church as well) orthodoxy is: you shall empathize. You shall enter into the emotions of others AND YOU SHALL NOT MAKE JUDGMENTS ABOUT SAID EMOTIONS. By so doing YOU SHALL VALIDATE ALL HUMAN EXPERIENCES AS SUPREME. The greatest sin of all today is to say, “The emotions that person is experiencing are the result of sinful rebellion against God, and hence do not require my validation, support, or celebration.” HOW DARE YOU! That is the great rule I stepped upon, and must now pay the price.
I’d like to say I know how you feel, James, but I don’t.
Empathy is Not Sin
Empathy isn’t acceptance of things you don’t agree with. Empathy doesn’t require you to give up any position you might otherwise have. For instance, parents can empathize with their wayward children (“when I was your age…”) and still adminster correction and direction. When parents communicate their understanding with care, it helps build relationship even when restrictions need to be imposed.
Empathy is simply understanding the inner world of other people. It is all about being able to relate to them and understand what they are going through. It quite important in human functioning and when absent is associated with cruelty and antisocial behavior.
When Joe Rigney and Doug Wilson talk about someone jumping into quicksand with both feet, they are not describing empathy; they instead describe impulsivity. Sympathy or empathy might move a person to prosocial behavior, but strategy to conduct the behavior is another matter. A thoughtful person would perform the rescue safely; an impulsive person might just jump in. Both would be empathic, but only one would live to tell about it.
Understand this; empathy is good.
Here are some articles on empathy and related topics.
As students approach graduation, they often consider the next phase of their work. Joining a professional association is one aspect of professionalization. I hope psychology students at grad and undergrad levels consider what Central Baptist College Prof. Aaron New has to say below.
The AACC has been promoting its upcoming World Conference this October. One of the special events of the conference is the “Connect U & Young Professionals Panel” targeting college students and recent graduates.
1. As I noticed these promotions last week, it occurred to me that I wish I would have known about the AACC as a recent graduate what I know now. I invested in the AACC for many years, and did so rather blindly for three reasons. One, the organization seemed to be the only (or main) show in town. Two, AACC conferences had all the big names in Christian counseling. Three, my professors encouraged me to be involved. I didn’t ask any questions or pursue any other options. But I regularly gave the AACC my money in membership dues and conference expenses to be part of the club.
If I had it to do over again, I would want answers to some questions before making the same commitment. What follows are some questions I encourage students and new professionals to ask AACC leaders and supporters. I will begin with those for which I already have some answers, then I will suggest others. The AACC may not like addressing these questions, but it is not unreasonable to ask them to do so.
Is the AACC a member-driven organization? How do members participate in the group?
The AACC is *not* a member-driven organization. It is a for-profit business owned and operated by Tim Clinton. Members don’t vote on anything or participate in governance of the organization. Principally, they form a pool of consumers for AACC marketing efforts. There are no requirements or pre-requisites for membership other than a willingness to pay membership dues. https://www.aacc.net/memberships/
In most professional associations, members serve on committees which serve the profession. Policies are suggested to the governing board made up of representatives elected by members. Those representative deliberate and vote on items suggested by members. Members have input into the rules, ethics and policies that govern the profession. Not so in the AACC. All decisions are made by Tim Clinton. He may use input from others but there is no requirement that he do so.
2. Does the AACC have officers? Who are they? How are they determined?
The AACC does *not* have elected officers. Though Clinton promotes himself as the “President” of the AACC, this is a self-appointed title and the position is not voted on. Any other officers are staff hired by AACC and are not elected. The president and staff are not accountable to members.
3. Does the AACC have a board of directors? Who are they? How are they determined?
The AACC does *not* have a typical elected board of directors – one that oversees the operation and direction of an organization. Dr. Clinton is not accountable to a board and may run his business in any way he sees fit.
4. If there is any other kind of board?
The AACC has advertised several different boards over the years. For many years up to 2018, the AACC claimed to have 1) an Executive Board, 2) an Editorial Board, 3) a Business Advisory Board, and 4) a Clinical and Pastoral Advisory Board (see: http://old.aacc.net/about-us/leadership/). In 2018, the AACC began to promote a different set of boards. 1) an Executive Advisory Board, and 2) a National Board of Reference (see: https://www.aacc.net/wp-content/uploads/2018/01/AACC_Board.pdf).
I will make two observations here. First, I have been told by multiple sources that the AACC boards only serve in an “advisory” role. They give input when asked, which seems to be a rare occurrence. Second, the boards do not appear to be updated very often. In 2017, I brought it to the attention of the AACC that William Backus was still listed among the members of the Clinical and Pastoral Advisory Board even though he passed away in 2005. After repeated requests for a more current list of board members, I was told by a customer support representative, “I have asked 2 different people for lists of the board members, and all the lists I have received do include the gentleman you listed below. That is the most up-to-date list that we have.”
5. How are ethical complaints against AACC members submitted and how are they handled?
The AACC does have a code of ethics. But I am suspicious of how well they enforce this code. Consider this correspondence from September 2018. Readers will notice that it takes some time for the AACC to respond. In the end, the AACC refuses to indicate who serves on the Law and Ethics Committee or how to submit a complaint to them directly (as I think is instructed by the code of ethics). Instead, the AACC states that ethical complaints are to be funneled to the person in charge of public relations for the AACC.
6. How does the AACC decide when/where to be active in political debates and races?
The politicization of the AACC has been a concern of mine for some time now. I began asking Dr. Clinton to avoid politicizing the AACC back in 2016. I felt strongly enough about this issue, that I attempted to write AACC board members. This letter became incorporated into an online petition that gathered 190 signatures, though I’m not sure it was very effective.
7. The AACC Foundation is the nonprofit arm of the AACC. What does it do? Where is the data/evidence of this work? Does the AACC profit from the AACC Foundation?
The publisher of this blog has looked into the relationship of AACC to the AACC Foundation in two articles (here and here). In summary, the AACC Foundation is a nonprofit means of getting income to the AACC. A miniscule amount goes to charitable purposes.
8. The AACC lists several colleges and universities as “partners” (https://www.aacc.net/schools/). What does this mean, exactly? How does a college/university become a partner? What advantages or benefits do these partners have for AACC members?
9. Since the AACC isn’t a nonprofit like other professional associations, where do the profits from the AACC go? Why doesn’t the AACC disclose financial statements like other organizations do?
10. Who serves on the Law and Ethics Committee of the AACC? How are members determined/appointed?
11. How many AACC members have had their memberships revoked (or been otherwise sanctioned) for ethics violations? For what reasons?
12. What is AACC’s “Christian Care Network” and how does it differ from the new “Christian Care Connect” (that charges clinics/organizations $749/year and individuals $249/year)?
13. To become a member of the CCC, is anything required beyond paying the annual fee? How is the integrity of this referral source maintained? What assurance does the public have regarding the legitimacy of these referrals?
14. What is the relationship between the AACC and all of these organizations? Is there one or more parent companies involved? What loyalties (formal or informal) do these organizations have to each other?
- Light University – https://www.lightuniversity.com/
- International Board of Christian Care – http://www.ibccglobal.com/
- Board of Christian Professional & Pastoral Counselors – http://www.thebcppc.com/
- Board of Christian Crisis & Trauma Response – http://www.thebcctr.com/
- Board of Christian Life Coaching – http://www.thebclc.com/
- International Christian Coaching Association – http://www.iccaonline.net/
- Ignite Men’s Ministry – https://www.ignitemen.net/
- Extraordinary Women – https://www.ewomen.net/
- Life, Love, and Family – http://www.lifeloveandfamily.org/
- James Dobson Family Talk – https://drjamesdobson.org/
15. About these organizations: Do AACC membership dues (or any other AACC revenues) support any of the other organizations? What staff are responsible for working at multiple organizations? What resources do any of them share? Are there any financial conflicts of interest for any of those parties? Where these organizations are not entirely independent, is that information made available to members/users?
16. There have been concerns about Tim Clinton and ghost-writing and plagiarism. Has this been addressed by the AACC via their ethics committee?
17. The AACC has made Christian Heathcare Ministry a ‘premium elite partner’ but CHM is an insurance alternative that does not cover psychological treatments or counseling. Can you explain the nature of this partnership? How does it promote Christian counseling? How does it benefit AACC members (especially those who are licensed and accept insurance reimbursements)?
For myself, I have concluded that the AACC is not a professional organization worth my affiliation. Elsewhere, I challenged my colleagues,
So here is my call to Christian Counselors. Leave the AACC behind. You don’t need their expensive conferences or memberships. You can do better than their borrowed and recycled materials. There are better, more authentic ways of navigating your professional affiliations.
I would likewise encourage college students and recent graduates. As the AACC comes courting you, be wise. Ask some hard questions before you settle on your professional affiliations.
I thought immediately of the Milgram experiment when I saw this interview with Tom Homan the Acting Director of Immigration and Customs Enforcement.
— The Situation Room (@CNNSitRoom) June 19, 2018
In 1961 and 1962, social psychologist Stanley Milgram wanted to know if average Americans would follow the orders of an authority even if those orders led them to harm fellow research subjects. Milgram created an elaborate ruse to fool volunteers into thinking they were giving electric shocks to an accomplice of Milgram. Milgram created an experimenter role, an actor who had to learn word pairs, and the actual subject who had to teach the actor the word pairs. When the teacher thought the learner (the actor) got an answer wrong, the experiment called for the teacher to shock the learner for the wrong answer (who the teacher thought was strapped into a chair). The teacher-subject thought the shocks increased with each wrong answer until the learner finally indicated that his heart was hurting and wanted out of the experiment.
No shocks were actually being delivered. However, the teachers thought they were actually giving shocks. The experimenter was in the same room and exhorted the teacher to continue with the experiment over the loud protests of the actor-learner. Milgram’s question was: Would these average citizens continue giving what they thought was painful shocks to a helpless fellow citizen based on the direction of an authority figure?
There were various trials but about two-thirds of the subjects shocked subjects to 450 fake volts because they thought the experiment required it.
Now, ICE officials and workers at the border are refusing to take responsibility for their actions and saying that they do what they do because of the law. One of the factors that social psychologists typically point to is the defusing of responsibility. In the replication of the Milgram experiment, follow up interviews of subjects really highlighted this factor (Watch this clip to see subjects placing responsibility on the experimenters).
I realize that a person cannot just stop doing a job that is needed to support a family. However, over time, there are whistleblowing mechanisms in government and the ability to go to the press. Mr. Homan paused several times before he answered and fell back on the a frighteningly familiar rationale for doing something that has people on the right, left, and center ready to march.
How long will GOP politicians, ICE officials, and workers do what they believe their authorities tell them to do?
The Milgram experiment is an enduring caution that Americans are not immune to cruelty and defusing responsibility in ways that can lead to further tragedy. I think we are already there on the border and need to end the Administration’s zero tolerance policy now. It is inhumane.
See below for original footage of the Milgram study:
Social psychologist Jerry Burger and ABC News reported on this replication in 2007.
Because I posted a link to an article from Rachel Denhollander and Sovereign Grace Churches’ response to her, I am posting a link to Denhollander’s extensive reply to SGC. I encourage readers interested in the ongoing saga of Sovereign Grace Churches to read the entire reply from Denhollander. She begins:
I have prayed and considered for nearly three weeks whether to respond to the statement by Sovereign Grace Churches posted on February 13th. This blog post is the most extensive statement by the organization with respect to serious questions that have been outstanding for nearly a decade. However, the response is misleading on several vital points, and leaves many disturbing questions unanswered. Because of this, I have chosen to respond in greater detail and renew my call for Sovereign Grace Churches (SGC, formerly Sovereign Grace Ministries (SGM)) to submit to an independent third-party review of how they have handled reports of abuse.
This call does not rise from a sort of Javert-like obsession with SGC, but from the knowledge that evangelical churches are plagued with serious problems related to how we respond to and counsel victims of sexual assault. In fact, experts have stated that both the amount
of abuse, and the failure to report it, is likely worse than in the Roman Catholic Church – a religious organization often used by evangelicals as a byword for sexual assault scandals. Research bears out the claim these experts make. Because many churches are ideologically committed to the theories that lead them to handle abuse so poorly, many church leaders are very sincere, yet sincerely wrong. Sadly, these leaders and institutions also remain resistant to outside accountability or input. This is a serious problem that damages the gospel and pushes the most vulnerable away from hope and refuge. Addressing this issue is not damaging the Gospel, it is instead seeking to restore the Gospel and Christ to their rightful authority and priority over institutions and mishandled theology.
She continues to call for an independent investigation of the charges against SGC. It is hard to see any problems with this request. If SGC doesn’t trust GRACE then another person or group could surely be secured to do the job.
Desiring God, the ministry of John Piper, continues to receive negative reaction to a Twitter message about mental health posted on Tuesday (2/6/18).
We will find mental health when we stop staring in the mirror, and fix our eyes on the strength and beauty of God.
— Desiring God (@desiringGod) February 6, 2018
Many readers, including me, felt the tweet implied that the cause of mental illness is a lack of faith. However, many believers experience emotional distress and many non-believers don’t. The tweet and later effort to put it in the context of a 2007 article fell flat. Adding insult to injury, Desiring God had nothing else to say, leaving the tweet in place and offering no apology. As Phoenix Preacher Michael Newnham wrote, “Being a Christian Celebrity Means Never Having to Say You’re Sorry…”
Being a Christian Celebrity Doesn’t Mean You Are an Expert at Everything
Some of them think they are. And their fans often put them in that role. I rather like what Newnham has to say about his approach as a pastor to mental health concerns.
As a pastor my “expertise” is limited and I’m as broken and fallible as you are.
In some ways, maybe more so.
I don’t know how to fix your sex life, raise your kids, manage your finances, or treat your ills.
I’m not even that good at what I’m trained to do.
My job is to help you grow in the grace and knowledge of Jesus, just as I am growing as well.
My job is to be present when you need me, to the best of my ability.
My job is to pray with and for you, that God will give you wisdom about the problems that are beyond my scope of expertise…which are most of them.
Sometimes, my job is to give you a referral to someone I trust can help you.
This is really good. Keep all of the Desiring God ministries and give me men and women like this in community churches everywhere.
The Desiring God tweeter should meet some Christians who found help from psychotherapy. I am the first to acknowledge (and call out) the shoddy and quack therapists, but I also know that therapy can be a lifeline to people when everything else (including the church) has failed them. Read the response of this Christian blogger with who responded to a challenge about therapy.
Last night I read a disturbing sentiment on someone’s blog. In effect, she said she doesn’t support therapy because there is nothing therapy can provide that can’t be provided through a relationship with God. This disturbs me because so many Christians feel this way or similar, and it is essentially a way of saying that all mental illness or emotional issues are a result of a broken relationship with God or a failure of faith. I can’t tell you how hard it is to hear this; I lost many friends who made this conclusion out of ignorance or arrogance.
In response, she wrote:
The first thing to be said here is that yes, God can and does have the ability to heal anything. Read this blog if you doubt that. Yes, my hard work and new variations of meds and finding the right (and strange) combination of meds matters, along with many other things like vitamins and diet and sunshine, but that I’m in remission (partial or otherwise) is nothing less than a miracle.
However, I firmly believe that God uses tools to heal. For those with mental illness, one of those tools can be therapy. I don’t know a single therapist (even the really bad ones I’ve had and there were several of those) who have claimed to be a cure for anything just by themselves. Instead, therapy provides support while you do what needs done, just like a cast supports a fractured arm.
Bipolar illness damages my relationship with God. I am not good at connecting with anyone and I need help to do so. That’s one place therapy comes into play. I also need help with things that should be basic. Reading the Bible and understanding it is one of them. I can’t follow a “real” Bible. I use a children’s version when I can, but truthfully that’s not a lot. I just have a lot of emotions surrounding the inability to handle the real Bible that make it hard to stomach my watered down one. Maybe a better person wouldn’t struggle with the anger that I can’t be an adult in all things, but I do. It’s a side effect of an illness that took away so much of what I wanted in life.
This person didn’t get sick by staring in a mirror, nor was the remission due to looking away from it. The Desiring God-style advice yielded frustration and as she said, condemnation from Christians. I urge pastors to put aside fear and reach out to local experts in mental health for referrals when someone in your congregation needs help. Not all encounters will go well but begin seeking referral sources now as you would sources for other medical and health specialties.
A Christian organization which may provide assistance is Christian Association for Psychological Studies.
Yesterday afternoon, The State (SC) newspaper ran a story with this headline:
PTSD patients with weak faith should visit doctor, televangelist tells Fort Jackson
The televangelist in the title is Kenneth Copeland who, at the last minute before his controversial scheduled speech to troops at Fort Jackson, Columbia, SC, issued a new confusing statement about post-traumatic stress disorder. The full statement is provided at that article; I think the title of the news article is accurate.
You’ll recall that Kenneth Copeland, along with self-styled historian David Barton, told soldiers suffering with PTSD to get rid of PTSD by reading Bible verses and rebuking Satan. That advice brought condemnations from a variety of Christian and other groups, including those who advocate for veterans.
In his new statement, Copeland denigrates the faith of people who seek medical help while appearing to give his blessing to treatment. He says:
From our perspective, a Christian should ask the Lord what steps of recovery should be taken to receive natural help for the disorder. Many Christian organizations exist to give Bible-based help to those that suffer from PTSD.
Our first priority as Christians should always be to find scriptures that offer hope for healing and deliverance from the maladies that we are confronted with. Prayer, application of God’s Word, and ministry from professionals will bring the lasting help that those suffering need.
Brother Copeland would be the first to tell you the doctor is your best friend if you are sick and your healing has not yet fully shown up. It takes time for your faith to develop. For that reason, it is perfectly all right to pursue medical attention as well. In fact, to refuse to consult a doctor or perhaps stop taking medication (prescription or over-the-counter) before faith is fully developed for healing is potentially dangerous. That would be considered ‘presumptuous’ faith.
This is double talk. On his broadcast in 2013, he told PTSD sufferers
Any of you suffering from PTSD right now, you listen to me. You get rid of that right now. You don’t take drugs to get rid of it. It doesn’t take psychology. That promise right there will get rid of it.
In this command, Copeland addressed anyone suffering from PTSD. Now he wants people to think he qualifies his advice. He didn’t apologize or say he was wrong before. He simply pretended he didn’t say it. The answer is still the same. Develop your faith, get rid of that. You don’t need drugs or psychology when you have faith. Copeland’s new statement continues:
God is not competing with doctors or medicine. Like any loving father, He will use any avenue available that you allow Him to work through to help you get well. Getting you well is His desire. Any good doctor will tell you he does not do the healing. He only assists your body to work the way it was created and designed to function by God.
This new moderate sounding Copeland emerged the day before his scheduled visit to Fort Jackson. However, he doesn’t explain what changed in his beliefs, if anything. He doesn’t say he was wrong before nor does he express any regret for his previous bad advice.
As far as I can determine, Copeland’s appearance went as scheduled today.
A military religious freedom watchdog group is asking Commanding General Major General Pete Johnson to uninvite Kenneth Copeland from the February 1 prayer breakfast at Fort Jackson, South Carolina. Kenneth Copeland has a rather checkered history but the main reason for the outrage is Kenneth Copeland’s past teaching on how to address post-traumatic stress disorder. On that topic, the head of the Military Religious Freedom Foundation Mikey Weinstein told the General:
But there’s something else that makes Copeland an even more outrageous choice to speak to any military audience. He has claimed that PTSD isn’t real because it isn’t biblical, saying on a 2013 Veterans Day episode of his TV show:
“Any of you suffering from PTSD right now, you listen to me. You get rid of that right now. You don’t take drugs to get rid of it, and it doesn’t take psychology. That promise right there [referring to a Bible verse he had just read] will get rid of it.”
Copeland’s guest that day, Christian nationalist pseudo-historian David Barton, wholeheartedly agreed, adding that warriors in the Bible fighting in the name of God were “esteemed” and in the “faith hall of fame” because they “took so many people out in battle.”
At the time, Barton and Copeland took a lot of heat over that “advice.” Before I go on, here is the segment:
Gospel Destroying and Demonic Advice
The Gospel Coalition’s Joe Carter called this advice “gospel destroying” and “demonic.” Copeland still has aspects of this advice on his website (source and source). I did a short series on PTSD which highlighted damaging aspects of Copeland’s and Barton’s advice. In short, their advice was insulting to PTSD sufferers. The military should warn their people about Copeland, not invite him to lecture them.
Copeland Disqualified Himself
I hope the General decides to find another speaker. In my opinion, Copeland disqualified himself to speak to our service men and women. In addition to his bogus advice about PTSD, he teaches that people who recite certain Bible verses will survive war. In essence, his teaching is that Christians will survive if they do the right things and recite the right magic Bible verses (Psalm 91 is one he suggests). In his PTSD video, he claims that the Bible gives a promise of survival to soldiers who fight for God. I don’t know what happens to people who don’t believe these things according to Copeland.
I can’t imagine what he will say that will be of general benefit or encouragement to people of all faiths. His teaching in his Veteran’s Day video and on his website requires a rather close adherence to his specific interpretation of the Bible. There are many Christians who reject this approach, not to mention those of other faiths and no faith. Surely, General Johnson can find someone who can bring people together and respect troops of all faith traditions.
Here is the announcement in the Fort Jackson newsletter:
National Prayer Breakfast to take place Feb. 1 at NCO Club sponsoring the National Prayer Breakfast for the Fort Jackson Community 7:30-9 a.m. Feb. 1 at the NCO Club. Nationally recognized televangelist Kenneth Copeland will be the speaker. Tickets are available from your unit. The event is free, but offerings will be accepted at the event. Attire will be duty uniform or civilian equivalent. The purpose of the NPB is to emphasize the importance of prayer for the Nation, Fort Jackson, our armed forces, and our Families. The themes for the breakfast are: prayers for the nation, community relationship and spiritual fitness.
UPDATE (1/12/18) – Last night, SAMHSA Asst. Secretary Elinore McCance-Katz released a statement about the termination of NREPP. The full statement is at the link and the end of this post. She also held a brief conference call with reporters. Although I wasn’t on it, I communicated with two people on the call. On the call and in her written statement, Dr. McCance-Katz criticized the NREPP. On the call, she was quoted by a reporter on the call as saying, “We in the Trump administration are not going to sit back and let people die,” she said, which will happen “if we leave things up on the website that don’t help people.”
There still is no time table for the implementation of the Policy Lab or any new approach. The statement is light on specifics. When I ask about when and how this is going to happen, I have gotten no responses. I hope to have another post later today with reactions to the Asst. Secretary’s remarks and am holding out hope that SAMHSA might address the issues of timing and implementation.
(Original post begins here)
One thing is clear. The National Registry of Evidence-Based Programs & Practices contract has been terminated. SAMHSA’s statement about the registry first posted here on this blog is now on the NREPP website (see the statement in red below):
In one form or another, the question on the minds of many mental health researchers and advocates is “what now?” After I received the statement above on 1/8, I asked a SAMHSA spokesman when researchers would be able to submit programs or update new programs. There has been no answer. It appears that SAMHSA discontinued NREPP even though the agency is not prepared to “reconfigure its approach” to evidence-based practice. Thus far, something is being replaced by nothing.
Media accounts of NREPP’s demise reflect the reaction of the mental health community. The Week‘s headline this morning reads, “Trump officials froze a federal database of addiction and mental health treatments. Nobody’s sure why.”
On Tuesday, Think Progress led with “Without warning, the government just ended a registry of mental illness and drug abuse programs.” The subtitle? “And didn’t bother to warn program participants ahead of time.”
Yesterday, the Boston Globe‘s health news service Stat began:
The Trump administration has abruptly halted work on a highly regarded program to help physicians, families, state and local government agencies, and others separate effective “evidence-based” treatments for substance abuse and behavioral health problems from worthless interventions.
Also out this morning, the Washington Post covers much of the same ground but provides no details from SAMHSA about when the new process will begin.
I say again, SAMHSA replaced something with nothing and did so in the middle of an addiction epidemic.
Rep. Grace Meng Wants to Know What’s Going On with NREPP
Rep. Grace Meng represents the Sixth District of New York and is a member of the House Appropriations Committee. On January 5, unaware of the impending controversy over NREPP, she wrote SAMHSA to praise NREPP and ask how she could help support the registry. She closed her letter by saying,
Again, thank you for the NREPP. I feel that the registry and its website are crucial public health tools. Respectfully, I wish to know how you will grow the NREPP and its website, how you intend to review more opioid abuse-specific programs, and how I may be of help to you in these endeavors.
When Rep. Meng learned about the NREPP’s termination, she followed up with another letter on January 8 requesting the answers to several questions. The first question was “Why, with specificity, was this contract terminated?” That was followed by nine additional questions:
These are good questions. I would add, why did SAMHSA terminate NREPP when it appears that SAMHSA doesn’t have another evidence-based process ready to go?
For background, see my first post on the termination of NREPP.
Statement of Elinore F. McCance-Katz, MD, PhD, Assistant Secretary for Mental Health and Substance Use regarding the National Registry of Evidence Programs and Practices and SAMHSA’s new approach to implementation of evidence-based practices (EBPs)
Thursday, January 11, 2018
SAMHSA and HHS are committed to advancing the use of science, in the form of data and evidence-based policies, programs and practices, to improve the lives of Americans living with substance use disorders and mental illness and of their families.
People throughout the United States are dying every day from substance use disorders and from serious mental illnesses. The situation regarding opioid addiction and serious mental illness is urgent, and we must attend to the needs of the American people. SAMHSA remains committed to promoting effective treatment options for the people we serve, because we know people can recover when they receive appropriate services.
SAMHSA has used the National Registry of Evidence Programs and Practices (NREPP) since 1997. For the majority of its existence, NREPP vetted practices and programs submitted by outside developers – resulting in a skewed presentation of evidence-based interventions, which did not address the spectrum of needs of those living with serious mental illness and substance use disorders. These needs include screening, evaluation, diagnosis, treatment, psychotherapies, psychosocial supports and recovery services in the community.
The program as currently configured often produces few to no results, when such common search terms as “medication-assisted treatment” or illnesses such as ”schizophrenia” are entered. There is a complete lack of a linkage between all of the EBPs that are necessary to provide effective care and treatment to those living with mental and substance use disorders, as well. If someone with limited knowledge about various mental and substance use disorders were to go to the NREPP website, they could come away thinking that there are virtually no EBPs for opioid use disorder and other major mental disorders – which is completely untrue.
They would have to try to discern which of the listed practices might be useful, but could not rely on the grading for the listed interventions; neither would there be any way for them to know which interventions were more effective than others.
We at SAMHSA should not be encouraging providers to use NREPP to obtain EBPs, given the flawed nature of this system. From my limited review – I have not looked at every listed program or practice – I see EBPs that are entirely irrelevant to some disorders, “evidence” based on review of as few as a single publication that might be quite old and, too often, evidence review from someone’s dissertation.
This is a poor approach to the determination of EBPs. As I mentioned, NREPP has mainly reviewed submissions from “developers” in the field. By definition, these are not EBPs because they are limited to the work of a single person or group. This is a biased, self-selected series of interventions further hampered by a poor search-term system. Americans living with these serious illnesses deserve better, and SAMHSA can now provide that necessary guidance to communities.
We are now moving to EBP implementation efforts through targeted technical assistance and training that makes use of local and national experts and will that assist programs with actually implementing services that will be essential to getting Americans living with these disorders the care and treatment and recovery services that they need.
These services are designed to provide EBPs appropriate to the communities seeking assistance, and the services will cover the spectrum of individual and community needs including prevention interventions, treatment and community recovery services.
We must do this now. We must not waste time continuing a program that has had since 1997 to show its effectiveness.
But yet we know that the majority of behavioral health programs still do not use EBPs: one indicator being the lack of medication-assisted treatment, the accepted, life-saving standard of care for opioid use disorder, in specialty substance use disorder programs nationwide.
SAMHSA will use its technical assistance and training resources, its expert resources, the resources of our sister agencies at the Department of Health and Human Services, and national stakeholders who are consulted for EBPs to inform American communities and to get Americans living with these disorders the resources that they deserve.
UPDATE (1/8/2018) – This morning, I received this statement from a SAMHSA spokesman:
Although the current NREPP contract has been discontinued, SAMHSA is very focused on the development and implementation of evidence-based programs in communities across the nation. SAMHSA’s Policy Lab will lead the effort to reconfigure its approach to identifying and disseminating evidence-based practice and programs.
The Policy Lab is referred to on SAMHSA’s website and is led by Christopher Jones. The Policy Lab was created by the 21st Century Cures Act and is an evolution of SAMHSA’s Office of Policy, Planning and Innovation. Clearly, the issue with the change from NREPP isn’t with the term “evidence-based” since the above statement uses the term and the Cures Act requires evidence-based interventions. For the exact language of the Cures statute, scroll to the end of this post.
(original post starts here)
Yesterday (Jan 4, 2018), a contractor for the Substance Abuse and Mental Health Services Administration alerted program participants that funding for work on the National Registry of Evidence-Based Programs & Practices had been terminated “for the convenience of the government.” According to a source with the contractor, the work was not terminated due to any problems with their work but because the administration did not want to continue it. According to my source, this action follows a freeze in the work which had been in effect since September, 2017.
The NREPP is an effort to alert the public and professional community about evidence-based practices in mental health treatment and prevention. According to SAMHSA’s 2018 budget justification, NREPP helps meet the requirements of the 21st Century Cures Act which requires the government to provide accurate information about what works in the treatment of mental illness and drug/alcohol addiction. SAMHSA is responsible to post this information on an agency website. SAMHSA requested $2.8-million in FY 2018 for NREPP.
According to an email I obtained which was later posted on Twitter by someone else, Development Services Group alerted their constituents that their contract to manage the NREPP’s contents and website had been terminated on December 28, 2017.
The email stated:
It is with great regret that we write to inform you that on December 28, 2017, we received notification from SAMHSA that the NREPP contract is being terminated for the convenience of the government.
This cancellation means that we can no longer make any updates to your program profile. We thank you for the help and cooperation you gave so that we could complete your review.
We are deeply saddened by the government’s sudden decision to end the NREPP contract, under which we have been able to provide and strengthen science-based information about mental health and substance use treatment and prevention programs, both nationally and internationally.
All comments and concerns should be directed to NREPP@SAMHSA.hhs.gov
According to DSG, it isn’t clear what will become of NREPP. The reason the process of evaluating programs was given to a contractor was because SAMHSA did not have a sufficient number of staff to do the job. The website may remain but at present no additional guidance has come from SAMHSA. According to DSG, all materials are being returned to the government and not sent to another contractor.
My calls and emails to SAMHSA have not been returned.
It isn’t clear how SAMHSA will meet the mandates of the Cures Act without a functioning evidence-based program. Another open question is why the program was halted in the middle of the fiscal year without cause (“for the convenience of the government”).
(Updates will be added to this posts through the day)
The entire text of the 21st Century Cures Act is here. For the section relevant to the Policy Laboratory and the work on evidence based practices and programs, see below.
SEC. 7001. ENCOURAGING INNOVATION AND EVIDENCE-BASED PROGRAMS. Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.) is amended by inserting after section 501 (42 U.S.C. 290aa) the following: ``SEC. 501A. <<NOTE: 42 USC 290aa-0.>> NATIONAL MENTAL HEALTH AND SUBSTANCE USE POLICY LABORATORY. ``(a) In General.--There shall be established within the Administration a National Mental Health and Substance Use Policy Laboratory (referred to in this section as the `Laboratory'). ``(b) Responsibilities.--The Laboratory shall-- ``(1) continue to carry out the authorities and activities that were in effect for the Office of Policy, Planning, and Innovation as such Office existed prior to the date of enactment of the Helping Families in Mental Health Crisis Reform Act of 2016; ``(2) identify, coordinate, and facilitate the implementation of policy changes likely to have a significant effect on mental health, mental illness, recovery supports, and the prevention and treatment of substance use disorder services; ``(3) work with the Center for Behavioral Health Statistics and Quality to collect, as appropriate, information from grantees under programs operated by the Administration in order to evaluate and disseminate information on evidence-based practices, including culturally and linguistically appropriate services, as appropriate, and service delivery models; ``(4) provide leadership in identifying and coordinating policies and programs, including evidence-based programs, related to mental and substance use disorders; ``(5) periodically review programs and activities operated by the Administration relating to the diagnosis or prevention of, treatment for, and recovery from, mental and substance use disorders to-- ``(A) identify any such programs or activities that are duplicative; ``(B) identify any such programs or activities that are not evidence-based, effective, or efficient; and ``(C) formulate recommendations for coordinating, eliminating, or improving programs or activities identified [[Page 130 STAT. 1221]] under subparagraph (A) or (B) and merging such programs or activities into other successful programs or activities; and ``(6) carry out other activities as deemed necessary to continue to encourage innovation and disseminate evidence-based programs and practices. ``(c) Evidence-Based Practices and Service Delivery Models.-- ``(1) In general.--In carrying out subsection (b)(3), the Laboratory-- ``(A) may give preference to models that improve-- ``(i) the coordination between mental health and physical health providers; ``(ii) the coordination among such providers and the justice and corrections system; and ``(iii) the cost effectiveness, quality, effectiveness, and efficiency of health care services furnished to adults with a serious mental illness, children with a serious emotional disturbance, or individuals in a mental health crisis; and ``(B) may include clinical protocols and practices that address the needs of individuals with early serious mental illness. ``(2) Consultation.--In carrying out this section, the Laboratory shall consult with-- ``(A) the Chief Medical Officer appointed under section 501(g); ``(B) representatives of the National Institute of Mental Health, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism, on an ongoing basis; ``(C) other appropriate Federal agencies; ``(D) clinical and analytical experts with expertise in psychiatric medical care and clinical psychological care, health care management, education, corrections health care, and mental health court systems, as appropriate; and ``(E) other individuals and agencies as determined appropriate by the Assistant Secretary. ``(d) Deadline for Beginning Implementation.--The Laboratory shall begin implementation of this section not later than January 1, 2018. ``(e) Promoting Innovation.-- ``(1) In general.--The Assistant Secretary, in coordination with the Laboratory, may award grants to States, local governments, Indian tribes or tribal organizations (as such terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act), educational institutions, and nonprofit organizations to develop evidence-based interventions, including culturally and linguistically appropriate services, as appropriate, for-- ``(A) evaluating a model that has been scientifically demonstrated to show promise, but would benefit from further applied development, for-- [[Page 130 STAT. 1222]] ``(i) enhancing the prevention, diagnosis, intervention, and treatment of, and recovery from, mental illness, serious emotional disturbances, substance use disorders, and co-occurring illness or disorders; or ``(ii) integrating or coordinating physical health services and mental and substance use disorders services; and ``(B) expanding, replicating, or scaling evidence- based programs across a wider area to enhance effective screening, early diagnosis, intervention, and treatment with respect to mental illness, serious mental illness, serious emotional disturbances, and substance use disorders, primarily by-- ``(i) applying such evidence-based programs to the delivery of care, including by training staff in effective evidence-based treatments; or ``(ii) integrating such evidence-based programs into models of care across specialties and jurisdictions.
In 2017, the following ten posts received the most page views:
10. K-LOVE’s Pledge Drive: Money Behind the Music (2017)
9. Former Newsping Pastor Perry Noble Incorporates Second Change Church (2017)
8. American College of Pediatricians v. American Academy of Pediatrics: Who Leads and Who Follows? (2011)
7. After the Demise of Mars Hill Church Mark Driscoll Landed on His Feet with Over One Million in Donations (2017)
6. IRS and Postal Service Agents on Scene at Benny Hinn’s Office (2017)
5. Mark Driscoll Spins the End of Mars Hill Church (2017)
4. A Major Study of Child Abuse and Homosexuality Revisited (2009)
3. Former CFO at Turning Point Claims David Jeremiah Used Questionable Methods to Secure a Spot on Best Seller Lists (2015)
2. What’s Going on at Harvest Bible Fellowship? James MacDonald Resigns as President of HBF (2017)
and the #1 post is:
Some past posts have aged well. The 2009 post regarding child abuse and non-heterosexuality has been in the top ten nearly every year since 2009. Readers continue to be interested in Mars Hill Church and various players surrounding the demise of that church.
Although the page views don’t show it, the story that continues to be covered here and almost nowhere else is the Gospel for Asia saga. The target of federal scrutiny and two RICO lawsuits in the U.S., GFA has also initiated and been involved in various legal actions in India. Although the scope of the GFA empire dwarfs other organizations I have examined, it continues to fly along under the radar.
For a profile of my work and the role blogging has played in it, see this lengthy article by Jon Ward in Yahoo News earlier this month.