BiographySince 19 years I work with subjects who experience psychiatric symptoms. The desolation associated with severe mental illness struck me often. It was hopeful to notice that treating help-seeking subjects in an early phase with psychotherapy instead of medication, led to a good recovery in many patients. Since 2001, I have been involved in studies that investigate the prediction of severe mental illness in subjects with emerging symptoms and new treatment methods to reduce the chance of progression to severe mental illness. Furthermore, I do research that transcends the traditional diagnostic boundaries in psychiatry as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM). My second book entitled 'Prevention in Mental Health Care: Time for a new approach' was published in July 2016 by Routledge. This book addresses fundamental questions in psychiatric research and practice by combining philosophy, neuroscience and clinical experience. The stories of the patients I work with form the basis of this book.
Areas of Research / Professional Expertise
Early intervention in psychiatry
Cognitive behavioural therapy
Travelling, philosophy, literature
Published: Aug 23, 2015 by The Lancet Psychiatry
Authors: Dorien Nieman and Patrick McGorry
Review about early intervention in psychiatry
Published: Mar 04, 2015 by The Lancet Psychiatry
Authors: DH Nieman
Comment on the Freedman et al (2015) paper in The Lancet Psychiatry about the Worry Intervention Trial
Published: Jan 08, 2014 by Schizophrenia Bulletin
Authors: Nieman DH, Ruhrmann S, Dragt S, Soen F, van Tricht MJ, Koelman JH, Bour LJ, Velthorst E, Becker HE, Weiser M, Linszen
This paper describes an optimized prediction model of a first psychosis, considering different sources of information.
By: Dorien Nieman
Fowler, P. J. (2017). Prevention in mental health care: Balancing neuroscience with social justice. [Review of the book Prevention in Mental Health Care: Time for a New Approach. D. Nieman]. PsycCRITIQUES, 62(26).
Reviews the book, Prevention in Mental Health Care: Time for a New Approach by Dorien Nieman (see record 2016-52467-000 (record/2016-52467-000)). The book provides a novel integration of emerging advances in cognitive neuroscience with a phenomenological approach to mental health assessment and treatment. The synthesis reveals new opportunities for earlier identification and better response to psychological distress. Implications are immense for the future of mental health care; however, the focus on subjective experiences of human suffering must be balanced with collective action to eliminate the root causes of disparities in mental illness.
The future of prevention must include new and better clinical tools, but also continue to promote social justice. The balance better ensures population-level improvements in mental health. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
© 2017 American Psychological Association.
Prevention in Mental Health Care: Time for a New Approach by Dorien Nieman calls for a paradigm shift in defining and promoting mental health. It represents the most recent contribution to a long tradition of advocacy for mental health prevention training and practice (Albee, 1986; Albee & Dickey, 1957; O’Neil & Britner, 2009). The text expands prior work by highlighting the implications of recent advances in cognitive neuroscience on prevention and connects these advances with insights from Western philosophy on the human psyche. The synthesis of science in the context of the subjective experience of psychological distress represents a strength, yet the book pays little attention to the social justice issues that underlie disparities in human suffering around the world—a theme of prior calls for prevention and promotion of mental health.
Regardless, Prevention in Mental Health Care provides an interesting resource for practitioners in psychiatry, psychology, social work, and public health, as well as philosophers and artists describing the human experience.
The need for prevention and promotion has been a battle cry for a relatively small but persistent group of mental health professionals and researchers for at least 60 years. In 1957, George Albee and colleagues completed an analysis of the mental health workforce for the Joint Commission on Mental Illness and Health (Albee & Dickey, 1957). The commission aimed to identify strategies that would achieve provision of the National Mental Health Act of 1946, which included prevention of mental illness. Albee illustrated the structural deficiencies in training and practice that would make reducing the burden of mental illness impossible. He showed that the supply of clinicians could not keep up with the demand for treatment based on current practice and workforce projections. Albee expanded the argument throughout his distinguished career to advocate for different approaches to assessment and treatment, emphasizing primary prevention to reduce exposure to oppression and inequality that drove population rates of psychological distress (Albee, 1965, 1986, 2006). His legacy continues to motivate efforts outside of the mainstream of mental health professionals to develop policies and practices that promote mental well-being, such as in the Society for Community Research and Action, the Society for Prevention Research, and the Prevention Section of the Society of Counseling Psychology.
Prevention in Mental Health Care continues the tradition of advocating for prevention. The text focuses on the need for enhancements in the assessment of mental health that more directly connects with treatment. The first two chapters provide a wonderful synopsis of the problems with the current classification systems. Nieman clearly articulates the limitations of the Diagnostic Statistical Manual of Mental Disorders (DSM), as well as provides a clear explanation for its continued use. I especially appreciated recognition of the undue influence of the medical model in psychiatry and the various lobbies that actively maintain power. These dynamics were replicated in computer simulations that explored the lack of the mental health prevention workforce (Fowler, Brown, Fleming, & Hovmand, in press).
Nieman offers a phenomenological approach to assessment and treatment of mental illness as a needed antidote for the field. Instead of focusing on symptoms, she argues for paying greater attention to the lived experience of those seeking help in guiding directions for providing support. By listening, we may better differentiate normative pain experienced in life versus indication of mental illness, which she connects later in the book with existential and humanistic philosophers. The approach destigmatizes psychological distress, as well as provides greater opportunities for early and less intense intervention. This contrasts with the DSM that focuses on discovery of problems and fails to consider etiology or treatment in assessment.
The book provides insights from cognitive neuroscience as a potential method for phenomenological assessment. Referencing research on biological markers and clinical staging, the text emphasizes cognitive impairment as a useful framework for understanding and promoting mental health. Nieman reviews common cognitive impairments that underlie a host of mental health disorders, and she argues these are more reliably detectable through behavioral and biological assessments. Clinical examples also illustrate how impairments emerge in therapeutic situations and how they inform diagnosis and direct intervention. Prevention efforts would benefit in a couple of fundamental ways. Reliable assessments would quickly distinguish pervasive impairments that indicate need for more intensive rehabilitation, while more local impairments could inform humanistic interventions that help people endure difficult transitions, making mental health services more efficient. At the same time, assessments could also identify impairments prior to the manifestation of associated symptoms. This would revolutionize the application of preventive interventions tailored to individual capacities.
The promise of more efficient and individually tailored mental health prevention must be balanced with a greater recognition of the systematic injustices that drive rates of psychological distress. Prevention in Mental Health Care argues for a redesign of mental health services that explicitly recognizes pain and suffering as a valuable part of life. This is important and complements a long history of philosophical and religious traditions, such as the Buddhist distinction between pain and suffering. However, people in marginalized groups suffer more than others. Mental health care will struggle to keep up with demand for services until these systemic inequities are addressed.
The emphasis on subjective experience of suffering should not be focused on conceptualizations of Western philosophers (the only ones reviewed in the book). Instead, new approaches must consider the collective experience of suffering. George Albee referred to the “-isms” that are the true causes of population rates of mental distress—racism, sexism, classism, and the many other dimensions (Albee, 2006). Nieman mentions environmental factors that contribute to mental well- being on four pages, and primary prevention is mentioned on two pages. Moreover, most examples of interventions address individuals already exhibiting symptoms or prodromal behaviors. To promote population-level mental health, mental health care needs at least as much attention on universal approaches that address the root causes of distress, as personalized approaches to alleviate stress and impairment. Thus, psychological interventions for the future must focus farther upstream and be applicable to groups. As Albee warns, individual focused interventions cannot scale (Albee & Dickey, 1957).
Prevention in Mental Health Care provides key insights into redesigning mental health services. It describes current limitations and shows the promise and potential impact of emerging neurocognitive enhancements to mental health assessment and treatment. However, these advances must occur along with ongoing efforts to promote social justice. Reductionism must be balanced with collectivism for population well-being.
- Albee, G. W. (1965). Manpower needs for mental health and the role of psychology.
Canadian Psychology, 6, 82–92. http://dx.doi.org/10.1037/h0083061
- Albee, G. W. (1968). Conceptual models and manpower requirements in psychology.
American Psychologist, 23, 317–320. http://dx.doi.org/10.1037/h0026125
- Albee, G. W. (2006). Historical overview of primary prevention of psychopathology: Address to the 3rd World Conference on the Promotion of Mental Health and Prevention of Mental and Behavioral Disorders September 15–17, 2004, Auckland, New Zealand. The Journal of Primary Prevention, 27, 449–456. http://dx.doi.org/10.1007/s10935-006-0047-7
- Albee, G. W., & Dickey, M. (1957). Manpower trends in three mental health professions.American Psychologist, 12, 57–70. http://dx.doi.org/10.1037/h0044859
- Fowler, P. J., Brown, A. W., Fleming, C., & Hovmand, P. S. (in press). Prevention-focused mental health system design: Workforce trends in the US compared to China. Journal of Social Work Review.
- O’Neil, J. M., & Britner, P. A. (2009). Training primary preventionists to make a difference in people’s lives. In M. E. Kenny, A. M. Horne, P. Orpinas, & L. E. Reese (Eds.), Realizing social justice: The challenge of preventive interventions (pp. 141–162). Washington, DC: American Psychological Association. http://dx.doi.org/10.1037/11870-007
© 2017 American Psychological Association.
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By: Dorien Nieman
Review of my book Prevention in Mental health Care: Time for a new approach by Barnaby Nelson in the journal Early Intervention in Psychiatry
By: Dorien Nieman
Book review of Prevention in Mental health Care: Time for a new appraoch in Tijdschrift voor Psychiatrie. For more information see http://www.tijdschriftvoorpsychiatrie.nl/issues/511/articles/11273
By: Dorien Nieman
Prevention in mental health Care: Time for a new appraoch was reviewed by Alex Langford for The lancet Psychiatry. For more information see http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30189-X/fulltext
By: Dorien Nieman
Interview with AMC magazine about my new book
Published: Apr 18, 2015
In the middle of the video, our research about prediction of a first psychosis is highlighted.