Laurie Ahern, Peter Stastny and Chris Stevenson
INTAR The International
Network Toward Alternatives and Recovery (1)
The International Network Toward Alternatives and Recovery was
founded in 2003 by a group of U.S. practitioners and advocates in
mental health recovery, including world renowned psychiatrists,
people who have recovered from mental distress, psychologists, family
members and other mental health professionals. (see www.intar.org)
The international organization grew out of the shared experience
and expert body of research that demonstrates a strong need to promote
non-medical humane, non-coercive ways of helping people in emotional
crisis. INTAR is a key international organization dedicated to advancing
the knowledge and availability of alternative approaches for individuals
experiencing severe mental distress.
In an era of so-called evidence-based treatments and
best practices, people who experience extreme states
of mind, traditionally labeled mental illness, are still being subjected
to predominantly bio-medical and involuntary treatments, often including
repeated or prolonged hospitalizations, high dosages and multiple
combinations of powerful psychiatric drugs, along with a lack of
recovery-oriented services and opportunities in the community. People
treated with traditional mental health services, and their families,
have become increasingly more disillusioned with the results of
conventional psychiatry and seek alternative practitioners and forms
of assistance. The research literature supports their skepticism.
A recent review of the literature demonstrates that a considerable
percentage (40-60%, depending on the study) of individuals who experience
a psychotic episode would recover without neuroleptics if they participate
in active psychosocial treatment, while short- and long-term damage
from these drugs is very common (Aderhold & Stastny, 2007).
This greatly increases the need to amplify and search for alternative
approaches that enable individuals to recover without undue harm
to their bodies and minds.
Individually, INTAR members have experienced substantial success
in advancing self-help programs and alternate clinical approaches
that help put the person's distress into context, thereby respecting
and acknowledging the entirety of the person and the experience.
As a result, the work of INTAR members has assisted people to regain
control over their lives without debilitating treatments meant to
cure them. One INTAR member, a recovery researcher, described the
drastic difference in outcomes when a non-medical, person-centered
approach is used to help a person through distress:
Take two wonderful, happy, smart young men. Both
were in college, living on their own testing the waters
testing themselves. New friends, new freedoms, new loves, new ideas,
new temptations new everything. Both had the world at their
feet and were limited only by their own imaginations of what their
lives might be about, might become.
Jack is a child I have known for his entire lifetime. I watched
him take his first steps and say his first words. I watched and
I'm still watching.
Karl I met just months ago. The parallels between these two
young men are eerie yet the outcomes so different
so frighteningly different.
Crash, crash, crash. It seems to happen at that age. Eighteen
to mid-twenties. And it happened to Jack and Karl.
Jack was at a college in New England and Karl was in school
out on the West Coast. When Jack was 15 years old, he and a friend
were car-jacked at knife-point. Even though they caught the man
and he was sentenced to seven years in prison Jack
never seemed to quite get over it. He would not stay alone in
his house at night, always locked his car doors no matter where
he was going, and would not travel without a cell phone.
Karl told me about a time when he was an exchange student in
high school, how he had been held up mugged alone
in a foreign country and had never been so terrified in
Jack has always wanted to be a journalist and Karl, he told
me that music has been his passion since as long as he could remember.
Both had such high hopes, such big dreams. Only one dreamer remains.
The other dreamer died with his dreams when he was labeled 'mentally
Each experimented with drugs for the first time in college
Jack went to a concert and tried LSD. Karl started smoking marijuana
with the band he formed in college. Pandora's box was now open.
Paranoia and fear trickled in, replacing logic. Men were after
them, people were talking about them. They could not sleep, they
could not eat. Fear was the dominating factor in their lives.
The drugs were gone, the high was over, the trip had ceased
but the demons remained.
Jack called home and Karl's friends called his parents. This
is where the road divides. This is where the similarities end.
This is where one has a breakdown and the other has a breakthrough.
Jack's mother knew he was frightened. She told him to leave
college and come home. She felt she needed to help him feel safe
again the only way to bring him out of this fearful place.
Karl's parents told him to come home. They too knew he was frightened,
needed help. They brought him to the best psychiatrist. He was
hospitalized. He was medicated. He was told he had a chemical
imbalance of the brain. He was labeled. He was told that college
was too stressful for him. He could never return. He tried to
commit suicide. He lived, but his dreams, his dreams died.
Jack's mother and friends stayed home with him, listened to
the fears. He went off caffeine, ate healthy foods and took long,
warm baths. He had acupuncture, massages, and found a therapist
who did not label him. They took walks together, they talked.
Slowly, very slowly, he felt safe enough to come back. And then
they worked on why he left, why this reality was so frightening
that he needed to leave it in the first place.
Jack well, Jack is back living at college. He started
working out and he now volunteers in a home for mentally retarded
adults. He told me several things since his breakthrough: 'This
is the most painful thing I have ever experienced in my life and
I would not wish it on anyone but I would not change a
thing. Better I deal with these issues now than wait until I'm
40 or 50. I feel stronger than I ever have. I've learned so much
about myself, I still have fears but I control them they
no longer control me.'
Karl who once dreamt of being a musician called
me after he walked home from his last day at the day treatment
program. 'I saw a sign on a restaurant window they were
looking for a dishwasher. Do you think I could handle that?'
The participants in the INTAR meetings expressed a common belief.
In their research, practices or advocacy they try to provide safe,
caring and non-stigmatizing assistance to those in crisis or emotional
distress. Although the work of INTAR participants from around the
world is as diverse as the countries they are from, they espouse
the same values and can frequently demonstrate better outcomes than
traditional psychiatric treatment. During the first international
INTAR summit held in the U.S. in November 2005, practitioners from
Canada, Finland, Germany, Ireland, U.K., Austria and the United
States came together to share information, research findings and
their own personal experiences in non-medical approaches in helping
people in extreme emotional states. As one INTAR member stated:
It is our experience that even people
diagnosed/labeled with the most severe mental illness can lead independent
and self-directed lives without lifelong psychiatric treatment.
When you look at a person's life experiences and history rather
than looking at these problems as a disease people can get better.
Over the course of the three-day summit, INTAR members found affirmation
for what they knew (i.e., for the values and beliefs that guide
their individual work). Specifically, these include, among others:
- to do no harm
- create safe spaces
- no coercion
- accepting people's thoughts and feelings
- appreciation of altered states
- accepting different or unusual ways of being
- attempting to understand context but also accepting the limits
of such understanding
- inspiring hope and possibility
- integrate self-determination
- protection of human rights and dignity and
- bearing witness.
The second international summit in Ireland produced a network of
work groups to explore a variety of practices/processes. The most
important outcome of both summits was the conviction that there
is a critical and pressing need to continue the work of the group
and to continue sharing information on alternative practices and
To that end, the participants in the third international summit
in Canada in May 2007 focused on formulating concrete ways in which
INTAR could disseminate the groups' collective experience and knowledge
to a wider audience. Additionally, INTAR held a public panel discussion
at Malaspina University in Nanaimo, British Columbia, which again
demonstrated the public's hunger for alternatives to traditional
mental health services.
What are the Opportunities and Challenges for Promoting Alternatives
through the Work of INTAR?
First of all, practitioners in alternative methods are very busy
making sure that they can sustain themselves and their organizations.
They have little time to promote their own approaches on the world
psychiatric stage, much less engage in general advocacy to promote
humane alternatives of many kinds. It is quite characteristic of
many alternatives that they remain the sole example of their generally
quite successful approach. For example, after 15 years of operation,
there is still only one substantial Windhorse program in operation
(in Northampton, MA), with three much smaller programs in Vienna,
Austria; Lambsheim near Ludwigshafen, Germany; and Boulder, CO.
The Runaway House in Berlin is still the only example of its kind
in Germany, and probably in the world. Related approaches have been
established in New Hampshire (Stepping Stone). A family-outreach
program that does not espouse the medical model has been established
in Toronto, Canada, but so far has not been replicated elsewhere.
With INTAR, there is the possibility that these efforts will cross-fertilize
and their positive results will become disseminated to a wider audience,
thus encouraging further dissemination.
It is also possible that these often fairly insular approaches
require charismatic leadership for their own successes, and that
such leadership cannot be easily transplanted. Windhorse and the
Runaway House have taken many years and a highly dedicated group
of people to become relatively firmly established. It is possible
that the necessary ingredients (beyond charismatic leadership) of
these approaches can be identified and disseminated more easily.
The obstacles that alternatives are facing in most communities have
less to do with the lack of buy-in to the principles they are espousing,
but are rather tied to a whole host of economic disincentives that
are exceedingly difficult to overcome. In the USA, for example,
hospitals and psychiatric emergency departments have totally cornered
the market on crisis intervention, especially in urban communities
(with few notable exceptions: San Francisco and San Diego, CA).
This is the primary reason why programs such as SOTERIA that provide
non-hospital, largely drug-free interventions for individuals experiencing
psychosis, have rarely been replicated successfully. It is our hope
that organizations such as INTAR can affect a turning of the tide
by affirming that there are safe and effective alternatives to hospital-based/bio-medical
How Will INTAR Synthesize Charisma and Successful Alternatives
to Traditional Psychiatry for More General Consumption?
INTAR embodies wisdom, creativity and practical experience, but
without being self-congratulatory. The group is not homogeneous;
it represents diversity in hearts and minds and language. The group
has hands across oceans and a shifting population; as new alternative
projects come on board, that adds to the diversity. Through this,
INTAR is a spring of richness. Thus far, INTAR functions in a supportive
and formative way. It breathes life into and feeds the soul of those
who are fighting the good recovery fight, whether experts by experience
or those offering a service, or those who are in both positions.
The people who constitute INTAR make human to human connections
and talk about their different treatment alternatives. As the group
works with a flattened hierarchy we all have expertise but
there is no single expert there is a pattern of operation
tentative, deeply respectful, tolerant and patient. There
is a sense of the group feeling its way in the light.
It remains a challenge to galvanise a loose collective towards
producing outcomes. But much is at stake. If there is no concerted
effort to proffer rational arguments for these and many other successful
alternatives, then they are fated to remain the exceptions that
prove the rule: hospitals and psychiatric drugs will remain the
only available options for individuals experiencing acute psychiatric
problems. Peer support and psychotherapy will be seen as nothing
more than adjunctive interventions that are likely to be priced
out of the market, especially for people considered to have serious
psychiatric conditions. Holistic alternatives and techniques will
remain the purview of rich self-payers and never reach the vast
majority of those who could benefit from them. Therefore, an organization
like INTAR must lead the way in providing the following essential
- Creating and strengthening a world-wide network of like-minded
providers of non-traditional mental health services.
- Developing and disseminating an evidence base that derives from
the collective experiences of non-traditional mental health programs.
- Working in conjunction with other advocacy organizations, such
as MindFreedom International and Mental Disability Rights International,
to promote the widespread availability of effective alternatives.
- Creating an international network of consultants who would be
available for individual and organizational consultations, through
discussion forums, mailing lists, video-links and other means
of real-time communication.
- Engaging with major professional and family organizations that
are traditionally opposed to alternative treatments, but that
are equally committed to finding ways of helping people who eschew
the prevalent methods of mental health systems.
Update (October 2013)
Since the original publication of this book, INTAR has co-sponsored
two large conferences in New York City (2009) and Toronto (2011).
In 2014, an INTAR conference will take place in Liverpool. The first
one was dedicated to the topic of Alternative Responses to First
Breaks and brought together international experts from a number
of countries who addressed this important topic from personal, clinical
and research perspectives. This conference was the springboard for
the a collaboration between the New York City Department of Health
and Mental Hygiene (see www.nyc.gov/html/doh/html/mental/parachute.shtml)
and the Center for the Study of Recovery in Social Contexts (see
which resulted in the funding of a major grant to implement the
Scandinavian Need-Adapted Model in combination with Crisis Respite
Centers and Intentional Peer Support in New York City (Parachute
NYC) (see http://fphny.org/whatsnew/grants).
This chapter represents exclusively the personal views of the authors,
and should not be construed as a statement by the organization or
any other participant in the 2004 and 2005 INTAR meetings. Acknowledgment:
The authors wish to thank Will Hall and Kim Hopper for their helpful
comments regarding this manuscript.
Aderhold, V., & Stastny, P. (2007). Full disclosure: Toward a
participatory and risk-limiting approach to neuroleptic drugs. Ethical
Human Psychology and Psychiatry, 9(1), 35-61.