How To Start And Grow An SA Group


By Margery Wakefield

In Denver, Colorado


I honestly don’t remember how I first heard of SA.  My memory is not 100% because of all the meds I have taken over the years for my schizophrenia.  But somehow, about ten years ago, I came to know about SA.

The next thing I remember is going to an SA conference in Michigan, where I learned how to run a group, and I met Joanne Verbanic for the first time on an elevator.  The conference was great, but what I remember most about it was that they shut down the Big Boy restaurant near our hotel one night so that the SA attendees could have a dinner.  Now, if you’ve never been in a room with 100 or so schizophrenics all having a good time, then you’ve missed a very interesting experience!  It was fun.

When I came back to Denver, I was determined to start an SA group.  At about this time, Larry A, called me and told me about another woman in Denver who also wanted to start SA in Denver.  Her name was G. and we soon joined up together.

The first step was to find a place to meet.  I think G. solved that problem.  Anyway, we found out that the Mental Health Center on Dickinson Place was centrally located.  Even better, they offered us the use of a room at night free of charge.  We jumped at the opportunity.  So, SA Denver was formed.

Next, we printed up flyers.  I went to Walmart and found some bright, neon colored paper and bought three packages of it, then drew up a flyer and headed to Kinko’s to have it typeset and printed off on the colored paper.  So far, G. and I paid for everything ourselves, but since I was working, I didn’t mind.

We hung the flyers everywhere we could think of: the mental health center where we were to meet, other mental health centers around the city, clinics, grocery stores, coffee houses, etc.  I went around Denver with the flyers, some thumbtacks and some scotch tape and just hung the flyers wherever I could.

At first, the meetings consisted of just G. and myself.  Instead of meeting in the big empty room at the mental health center, we frequently went to the nearby Village Inn, where we would have coffee or tea and wonder if our group was EVER going to grow.

Then, one night, a gentleman named B. joined us.  His ready sense of humor immediately changed the dynamic of our little group.  Soon after H. (female)and L. (male) increased our number to five.  We were growing, and that was exciting!

We placed some ads for SA in local, free newspapers, announcing our meeting time and place.  As a result P. (male) joined the group.  In those days we ran the meetings by the book – the Blue Book.  We didn’t vary things much.  But then, D. (female) joined up, but complained that the format was always the same.  So I said, OK, and we began to take some liberties with the pre-printed format, using the hour more for sharing and less for just reading the same things in the Blue Book over and over at each meeting.  We started reading some of the other things in the Blue Book, and also some of the personal stories.  It’s amazing what is contained in that book!

As the first year or so passed, other members came and went, but about three quarters of the people who came, stayed.  A camaraderie began to develop among the members of the group.  New members were made to feel welcome, and we freely shared advice and humor about the various challenges of our illness.  It was beginning to feel like a family.

Another successful action for us was to visit the local hospital social workers, especially the psychiatric social workers.  We went on these visits by appointment and in pairs, and brought a stack of flyers with us to give to the social workers.  This did bring in an occasional new member.

I decided that it was time to let the professionals in the community, the Denver metro area, know about our group.  One of our members, L. (male), was a computer genius.  I am sure there is one of these in every group.  So I went through the Yellow Pages and collected the names and phone numbers of the 110 or so psychiatrists in Denver and suburbs.  H. called each one of these psychiatrists and got their addresses.  We then had L. enter the addresses on his computer and print out a set of labels.  I drafted a letter and enclosed two SA flyers, and we bought the stamps and did our first mailing.

It worked.  A few more members showed up.  So we decided to do the same thing for all the psychotherapists (92) and psychologists (220) in Denver.  It was expensive because of the postage needed, so I realized we were going to have to have some source of income.

So we had the first SA bake sale at the mental health center, in the foyer.  I got donations of baked goods from a local bakery, Entenmann’s, from our nearby grocery store called King Soopers, from Perkins Restaurant and Bakery, and from Einstein Brother’s bagel store.  We found out that if we took signed letters with brochures and flyers and SARDAA’s tax-ID#, we could get gift cards from both the grocery store and from the nearby COSTCO.

A week before the bake sale, we used the group time to make two giant posters, with crayons and markers and posterboard donated by King Soopers.  We hung one poster in the foyer of the mental health center, and one in the break room upstairs.

Our first bake sale was a success, and we were about $300 richer.

What to do with the money?  One thing was to pay for more stamps to complete the mailings.  And with the rest, we started having pizza nights.  The pizza nights were successful in bringing out the troups.  We also tried movie nights with popcorn.  But these were not so successful.  For many of the members, including myself, they simply demanded too much concentration, so movie nights were soon abandoned.

About five years ago, we had our First Annual SA Picnic in July.  This has become an annual tradition.  We decided that we would invite family and friends to the picnic, and this has become one of our two open events each year, the other being our Annual Christmas or Holiday party. Parents, brothers, sisters, husbands, wives, boyfriends, girlfriends, friends – all were welcome.  COSTCO again donated $25 worth of picnic food, and the grocery store did the same.  Again, with signed letters and the correct paperwork.  The rest of the money came from our small reserve fund.  The picnics and the holiday party are great fun for everyone.  At the picnics, my cousin and her husband have volunteered each year to be the grillmaster and the hostess, and like everyone else who gets to know the group, they have kind of adopted us.

I believe that in addition to the serious business involved in a successful SA group, there should also be some fun – and laughter.  I can honestly say that we have both in our group.  Sometimes I think we have too much fun!  People walking by our door on group night must wonder:  What’s going on in there???

Sometimes, when our funds are low, we have a potluck, where everyone brings something to eat or drink.  These always result in too much food, and are quite popular and successful.

About two years ago, I was cleaning out the closets in my apartment, and I thought, “Why not have a swap meet? “  I announced it to the group, and we did it!  Everyone brought their “junk” from home and we put all the stuff on the conference table in our meeting room.  Then after a few seconds, everyone went to the table to pick out their “treasure” from someone else’s “trash.”  By the end of the night, the table was clear, except for the few things which no one wanted, which were donated to Goodwill.  But everyone went home with something.

We are still evolving as a group.  Sometimes, I think the group takes on a life of its own.  Now we have a coffee group on Saturdays, which was initiated by G., and we also have a walking group on Saturdays as well, weather permitting.  Many of the members find walking extremely therapeutic, and doing it as a group is even more fun.

So, these are some thoughts on starting and growing a successful SA group.  This is not the only way to get a group going; this is just the way we did it.

I hope that these ideas are helpful to someone just starting up a group.  It’s been a LOT of work, but, in the end, well worth it.  If you persevere, I think you will find that you have built a community of friends.

We call ourselves family….


Margery Wakefield

February 24th, 2013

Cognitive Behavioral Therapy for Subjects at Ultrahigh Risk for Developing Psychosis

Background Evidence for the effectiveness of treatments for subjects at ultrahigh risk (UHR) for developing psychosis remains inconclusive.

Objective A new cognitive behavioral intervention specifically targeted at cognitive biases (ie, Cognitive Behavioral Therapy [CBT] for UHR patients plus treatment as usual [TAU] called CBTuhr) is compared with TAU in a group of young help seeking UHR subjects.

Methods A total of 201 patients were recruited at 4 sites and randomized. In most cases, CBTuhr was an add-on therapy because most people were seeking help for a comorbid disorder. The CBT was provided for 6 months, and the follow-up period was 18 months.

Results In the CBTuhr condition, 10 patients transitioned to psychosis compared with 22 in the TAU condition (χ 2 (1) = 5.575, P = .03). The number needed to treat (NNT) was 9 (95% confidence interval [CI]: 4.7–89.9). At 18-month follow-up the CBTuhr group was significantly more often remitted from an at-risk mental state, with a NNT of 7 (95% CI: 3.7–71.2). Intention-to-treat analysis, including 5 violations against exclusion criteria, showed a statistical tendency (χ 2 (1) = 3.338, = .06).

Conclusions Compared with TAU, this new CBT (focusing on normalization and awareness of cognitive biases) showed a favorable effect on the transition to psychosis and reduction of subclinical psychotic symptoms in subjects at UHR to develop psychosis.

Mark van der Gaag, Dorien H. Nieman, Judith Rietdijk, Sara Dragt, Helga K. Ising, Rianne M.C. Klaassen, Maarten Koeter, Pim Cuijpers, Lex Wunderink, Don H. Linszen

Full Article

Choline Supplementation During Pregnancy Presents a New Approach to Schizophrenia Prevention

AURORA, Colo. (Jan. 15, 2013) — Choline, an essential nutrient similar to the B vitamin and found in foods such as liver, muscle meats, fish, nuts and eggs, when given as a dietary supplement in the last two trimesters of pregnancy and in early infancy, is showing a lower rate of physiological schizophrenic risk factors in infants 33 days old. The study breaks new ground both in its potentially therapeutic findings and in its strategy to target markers of schizophrenia long before the illness itself actually appears. Choline is also being studied for potential benefits in liver disease, including chronic hepatitis and cirrhosis, depression, memory loss, Alzheimer’s disease and dementia, and certain types of seizures.

Robert Freedman, MD, professor and chairman of the Department of Psychiatry, University of Colorado School of Medicine and one of the study’s authors and Editor of The American Journal of Psychiatry, points out, “Genes associated with schizophrenia are common, so prevention has to be applied to the entire population, and it has to be safe. Basic research indicates that choline supplementation during pregnancy facilitates cognitive functioning in offspring. Our finding that it ameliorates some of the pathophysiology associated with risk for schizophrenia now requires longer-term follow-up to assess whether it decreases risk for the later development of illness as well.”


Full Article

Medication Compliance When Receiving Aripiprazole, Quetiapine, or Ziprasidone

Background: Schizophrenia and bipolar disorder are chronic debilitating disorders that are often treated with second generation antipsychotic agents, such as aripiprazole, quetiapine, and ziprasidone. While patients who are hospitalized for schizophrenia and bipolar disorder often receive these agents at discharge, comparatively little information exists on subsequent patterns of pharmacotherapy.

Methods: Using a database linking hospital admission records to health insurance claims, we identified all patients hospitalized for schizophrenia (ICD-9-CM diagnosis code 295.XX) or bipolar disorder (296.0, 296.1, 296.4-296.89) between January 1, 2001 and September 30, 2008 who received aripiprazole, quetiapine, or ziprasidone at discharge. Patients not continuously enrolled for 6 months before and after hospitalization (“pre-admission” and “follow-up”, respectively) were excluded. We examined patterns of use of these agents during follow-up, including adherence with treatment (using medication possession ratios [MPRs] and cumulative medication gaps [CMGs]) and therapy switching. Analyses were undertaken separately for patients with schizophrenia and bipolar disorder, respectively.

Results: We identified a total of 43 patients with schizophrenia, and 84 patients with bipolar disorder. During the 6-month period following hospitalization, patients with schizophrenia received an average of 101 therapy-days with the second generation antipsychotic agent prescribed at discharge; for patients with bipolar disorder, the corresponding value was 68 therapy-days. Mean MPR at 6 months was 55.1% for schizophrenia patients, and 37.3% for those with bipolar disorder; approximately one-quarter of patients switched to another agent over this period.

Conclusions: Medication compliance is poor in patients with schizophrenia or bipolar disorder who initiate treatment with aripiprazole, quetiapine, or ziprasidone at hospital discharge.

by Ariel Berger, John Edelsberg, Kafi N Sanders, Jose Ma J Alvir, Marko A Mychaskiw, Gerry Oster

BMC Psychiatry

Full Article

Smoking, Once Used to Reward, Faces a Ban in Mental Hospitals

Annelle S., 64, who has paranoid schizophrenia, took an urgent drag on a cigarette at a supervised outdoor smoke break at Southeast Louisiana Hospital.

Until recently, Southeast Louisiana Hospital in Mandeville was required to accommodate smokers as a state psychiatric hospital. That law has changed, and it has since been privatized.

Hospitals often used cigarettes as incentives or rewards for taking medicine, following rules or attending therapy. Some programs still do.

“It’s mandatory to smoke,” she explained. “It’s a mental institution, and we have to smoke by law.”

That was 18 months ago, and Annelle’s confusion was understandable. Until recently, Louisiana law required psychiatric hospitals to accommodate smokers — unlike rules banning smoking at most other health facilities. The law was changed last year, and by March 30, smoking is supposed to end at Louisiana’s two remaining state psychiatric hospitals.

After decades in which smoking by people with mental illness was supported and even encouraged — a legacy that experts say is causing patients to die prematurely from smoking-related illnesses — Louisiana’s move reflects a growing effort by federal, state and other health officials to reverse course.

But these efforts are hardly simple given the longstanding obstacles.

Hospitals often used cigarettes as incentives or rewards for taking medicine, following rules or attending therapy. Some programs still do. And smoking was endorsed by advocates for people with mental illness and family members, who sometimes sued to preserve smoking rights, considering cigarettes one of the few pleasures patients were allowed.

By Pam Belluck, New York Times

Full Article


Focus on Mental Health Laws to Curb Violence Is Unfair, Some Say

In their fervor to take action against gun violence after the shooting in Newtown, Conn., a growing number of state and national politicians are promoting a focus on mental illness as a way to help prevent further killings.

Legislation to revise existing mental health laws is under consideration in at least a half dozen states, including Colorado, Oregon and Ohio. A New York bill requiring mental health practitioners to warn the authorities about potentially dangerous patients was signed into law on Jan. 15. In Washington, President Obama has ordered “a national dialogue” on mental health, and a variety of bills addressing mental health issues are percolating on Capitol Hill.

But critics say that this focus unfairly singles out people with serious mental illness, who studies indicate are involved in only about 4 percent of violent crimes and are 11 or more times as likely than the general population to be the victims of violent crime.

And many proposals — they include strengthening mental health services, lowering the threshold for involuntary commitment and increasing requirements for reporting worrisome patients to the authorities — are rushed in execution and unlikely to repair a broken mental health system, some experts say.

By Erica Goode and Jack Healy, New York Times

Full Article

Schizophrenic, Not Stupid

THIRTY years ago, I was given a diagnosis of schizophrenia. My prognosis was “grave”: I would never live independently, hold a job, find a loving partner, get married. My home would be a board-and-care facility, my days spent watching TV in a day room with other people debilitated by mental illness. I would work at menial jobs when my symptoms were quiet. Following my last psychiatric hospitalization at the age of 28, I was encouraged by a doctor to work as a cashier making change. If I could handle that, I was told, we would reassess my ability to hold a more demanding position, perhaps even something full-time.

Then I made a decision. I would write the narrative of my life. Today I am a chaired professor at the University of Southern California Gould School of Law. I have an adjunct appointment in the department of psychiatry at the medical school of the University of California, San Diego, and am on the faculty of the New Center for Psychoanalysis. The MacArthur Foundation gave me a genius grant.

Although I fought my diagnosis for many years, I came to accept that I have schizophrenia and will be in treatment the rest of my life. Indeed, excellent psychoanalytic treatment and medication have been critical to my success. What I refused to accept was my prognosis.

By Elyn R. Saks, New York Times

Full Article

Cannabis Use and Depression

Background: While there is increasing evidence on the association between cannabis use and psychotic outcomes, it is still unclear whether this also applies to depression. We aim to assess whether risk of depression and other affective outcomes is increased among cannabis users.

Methods: A cohort study of 45 087 Swedish men with data on cannabis use at ages 18–20. Diagnoses of unipolar disorder, bipolar disorder, affective psychosis and schizoaffective disorder were identified from inpatient care records over a 35-year follow-up period. Cox proportional hazard modeling was used to assess the hazard ratio (HR) of developing these disorders in relation to cannabis exposure.

Results: Only subjects with the highest level of cannabis use had an increased crude hazard ratio for depression (HR 1.5, 95% confidence interval (CI), 1.0–2.2), but the association disappeared after adjustment for confounders. There was a strong graded association between cannabis use and schizoaffective disorder, even after control for confounders, although the numbers were small (HR 7.4, 95% CI, 1.0–54.3).

Conclusion: We did not find evidence for an increased risk of depression among those who used cannabis. Our finding of an increased risk of schizoaffective disorder is consistent with previous findings on the relation between cannabis use and psychosis.

by Edison Manrique-Garcia, Stanley Zammit, Christina Dalman, Tomas Hemmingsson, Peter Allebeck

Full Article

Warning Signs of Violent Acts Often Unclear

No one but a deeply disturbed individual marches into an elementary school or a movie theater and guns down random, innocent people.

That hard fact drives the public longing for a mental health system that produces clear warning signals and can somehow stop the violence. And it is now fueling a surge in legislative activity, in Washington and New York.

But these proposed changes and others like them may backfire and only reveal how broken the system is, experts said.

“Anytime you have one of these tragic cases like Newtown, it’s going to expose deficiencies in the mental health system, and provide some opportunity for reform,” said Richard J. Bonnie, a professor of public policy at the University of Virginia’s law school who led a state commission that overhauled policies after the 2007 Virginia Tech shootings that left 33 people dead. “But you have to be very careful not to overreact.”

By Benedict Carey and Anemona Hartocollis, New York Times

Full Article

Lithium: How Good is it?

Many people worry that lithium is one of psychiatry’s “Big Guns”, something we use for patients with really severe mental illnesses.  They think, “Hey, I’m not that sick”, and conclude that lithium is not right for them.

They don’t know that lithium, in lower doses, is used in plain depression (not bipolar, not severe).  In fact, for depression that hasn’t fully responded to an antidepressant, lithium is a standard option for “augmentation”, adding it to the antidepressant.

But one of the strongest arguments for lithium is the way it appears to protect neurons.  So I wanted to show you the world’s expert on how lithium works, talking about this aspect of lithium’s potential benefits.  His full comments, on a range of topics, from his interview with a great bipolar advocacy organization, can be read on this link at the Child and Adolescent Bipolar Foundation (CABF).

Here are Dr. Manji’s comments about lithium (it’s a little technical; look for the few ideas I put in bold if you’re getting bogged down):

CABF: Speaking of lithium, your research has uncovered some of its intriguing beneficial properties. Can you highlight the most important ones?

MANJI: Many of the genes that are considered neuroprotective [keep brain cells from dying when stressed] are being remarkably turned on by lithium. Is lithium actually neuroprotective? We hadn’t thought this way before. A number of studies have taken animal cells and tried to kill them by causing stroke, etc. These studies have consistently shown that lithium, if administered before you try to do the bad things (such as induce a stroke),protects the animal’s neurons. In lithium-treated brains, the size of the resulting stroke is smaller, the number of neurons that die is lower, etc. That was amazing. Since these studies were done in rats, you need to be careful about jumping to conclusions that lithium is neuroprotective in people.

Wayne Drevets’ group published a finding in Nature about five years ago that in a part of the pre-frontal cortex of bipolar patients or patients with familial recurring unipolar depression, there was almost a 40% reduction in the amount of gray matter. That was a remarkable finding that you have such a reduction in a discrete part of brain. We spoke to him about our lithium findings and asked him to reanalyze the data. He had a small group of patients who had been treated with lithium for a long time and they did not show the brain atrophy compared with the bipolar patients. Interestingly all of the patients with unipolar depression, whether or not they had been treated with antidepressants, still showed the atrophy. That was a suggestion that bipolar treatments might have a protective effect.


Full Article