TOWARDS A FIRST RATE MENTAL HEALTH SYSTEM

by Bob Bennett, Chair PAIMI COUNCIL,

NEVADA DISABILITY ADVOCACY LAW CENTER

EXECUTIVE SUMMARY

Due to the tragedies in Carson City, Tucson, and others around the world, it is past time to consider what a first rate mental health system would look like- and then begin to implement it.  Currently no first rate mental health system exists anywhere, but developing one needs to be a priority. Much has been learned about the brain during the past twenty years, but little of it has so far found its way into our mental health system.

 “Training in behavioral health now occurs in disciplinary or sector silos. Furthermore, there is little collaboration among the disciplines on workforce development efforts, such as competency development, despite the presence of many shared competencies across professions. Three other tensions impede cooperation on a strengthened national workforce development agenda or dissemination of workforce innovations across sectors and disciplines: the divide between the mental health and addiction portions of the field; the split between treatment and prevention that exists within mental health and within addictions; and, in all sectors, the separation between the traditional treatment system and the recovery community.” [i]

“Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential… Mental health recovery not only benefits individuals with mental health disabilities by focusing on their abilities to live, work, learn, and fully participate in our society, but also enriches the texture of American community life. America reaps the benefits of the contributions individuals with mental disabilities can make, ultimately becoming a stronger and healthier Nation.”[ii]

A first rate system would be recovery oriented, cross disciplinary and open to all who feel they need it.  Denying treatment to everyone who hasn’t been put into one of the boxes of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV] is counter- productive, as is turning away those who aren’t considered ‘a danger to self or others’.

 TRAUMA

A first rate system would be non-stigmatizing, non-blaming, and respectful of clients.  Questions about trauma would be standard, as well as availability of trauma treatments.  Recently the Substance Abuse Mental Health Services Administration (SAMHSA) has focused on implementing greater trauma awareness in mental health settings.  The research on trauma has considerable implications, not just in the field of mental health, but public policy, criminal justice, as well as sociology, and several other fields of study; particularly due to the COMPULSION TO REPEAT, that is to say a compulsion can develop to repeat the circumstances of the original trauma. 

“Trauma can occur from a variety of causes, including maltreatment, separation, abuse, criminal victimization, physical and sexual abuse, natural and manmade disasters, war, and sickness. Although some individuals who experience trauma move on with few symptoms, many, especially those who experience repeated or multiple traumas, suffer a variety of negative physical and psychological effects. Trauma exposure has been linked to later substance abuse, mental illness, increased risk of suicide, obesity, heart disease, and early death.”[iii]

Treatment for Trauma needs to begin as soon as mental health problems are suspected. 

COGNITIVE THERAPIES

Many, if not most individuals, with a mental health diagnosis have learned poor reactions to stress (schemas).   Typically inadequate reactions to stress begin when an individual is quite young, and eventually become habits; reactions which involve little or no thought.  A goal of the various cognitive / cognitive behavioral therapies is to help individuals (whether or not they have a mental health diagnosis) relearn stress responses. 

Schemas begin as coping strategies; a way of dealing with a difficult emotional situation. But they can become self- defeating, guiding lives within a framework of distorted reactions.   Schemas influence our perceptions of events without our being conscious of them. They hinder us in responding to things as they actually are, and keep us in the rut of a habit. The task of changing a schema is two-fold: we have to unlearn the self-defeating old habit and replace it with a new, healthier one. As we become more aware of how schemas are pushing us back, we’re more able to push forward, intentionally resisting the habitual impulse dictated by the schema and going in a more productive direction.

The excerpts presented are from EMOTIONAL ALCHEMY: HOW THE MIND CAN HEAL THE HEART by Tara Bennett-Goleman, © 2001. An expanded version was used in my book, MENTAL ILLNESS A GUIDE TO RECOVERY [with permission of Harmony Books, a division of Random House, Inc.].  While this is not the only, nor the latest version of cognitive therapy, it has the advantage of being easily understood by those without formal education in the field.

STRESS & GRIEF

Helping People with Mental Illness[iv] claims some people have a higher chance of becoming mentally ill than others:  Normally, people become mentally ill when they have been under high levels of stress.  Stress can be considered two ways:   1. Acute stress - bereavement, losing a job etc… this is sometimes referred to as stress resulting from life events 2. Chronic stress - results from things such as unhappy relationships, not having enough money etc….

While this may be an over-simplification, stress has been proven to be a factor in both the onset of mental illness and relapses[v] with many factors being able to contribute to the stresses which can overwhelm individuals, contributing to their becoming part of the mental health client population.

Grief[vi] has been identified as a stress factor.  Recognizing grief, such as the grief over the perceived loss of a meaningful future due to having been diagnosed with a serious mental illness, and the stages of grief – shock, denial, bargaining, anger, guilt and finally acceptance - can help prevent a serious downward spiral.  Grief also affects family and other loved ones of individuals diagnosed with a mental illness.[vii]

PEER GROUPS

At this time, many of the practices and treatments from the Consumer/ Survivor/ Peer movement are considered as evidence supported, evidence informed or evidence suggested practices.[viii]  Additionally, since an understanding of facts differ between competing sector silos, at least portions of what is considered factual information held by one silo is considered nonsense by the other.  This contributes to the environments in which behavioral health care is both given and received being toxic for persons in recovery, family members, and the workforce.[ix] 

Peer groups have been proven effective for individuals with mental health problems.  Some of these groups, such as NAMI’S PEER TO PEER TRAINING, help individuals learn how to recognize when symptoms are about to overtake them, and are very valuable in preventing relapse.  The W.R.A.P. (Wellness Recovery Action Program) primarily helps individuals over-come the effects of trauma.  Other groups are less formal, but give hope to individuals that they are able to over-come the stigma and other hardships associated with given a diagnosis which is often misunderstood.

“Since empowerment, hope, and self-determination are repeatedly cited as the keys to people’s recovery (Ahern and Fischer (2001), Anthony et al. (2002), Zinman (2002), Chamberlain (2003), it appears that the underlying institutional medical culture of the present system, with its over emphasis on the narrowly defined version of the medical approach, is actually interfering with recovery.  Recently consumer/ survivors, administrators, and families have united in the conviction that the mental health system needs a fundamental transformation at the level of its mission and values to one based on recovery.”[x]

MEDICATIONS

We are not going to deny the usefulness of various medications in the treatment of the various Mental Illnesses, however we take the position that the least amount of medication needed to keep severe symptoms in check is in the best interest not only of the individual being treated, but for civil society as well. However, while the DSM-IV, pg.6, states “It is often difficult to determine whether presenting symptomatology is substance induced…, or toxin exposure.” the mental health community has generally failed to consider anything outside of illicit drugs as capable of inducing symptomatology.  We believe this is one of the serious shortcomings of the mental health community.

SPIRITUALITY

Many with Mental Health problems believe spirituality comprises at least one avenue for recovery.  Some see their recovery journey as essentially spiritual in nature.   This should not be discouraged.  Various spiritual traditions, plus some scientific literature, seem to support this.  

HARMONY CENTERS

Harmony Centers are not meant to replace facilities which house individuals when they are exhibiting psychotic behaviors to such an extent that they are at imminent risk of harming self or others, but rather facilities, run by the private sector or non-profits, which teach recovery skills and are places an individual can go to when they feel they are slipping towards a psychotic episode or are interested in building resiliency.

ALTERNATIVE THERAPIES

Numerous alternative therapies exist.  Not all have gone from ‘evidence suggested’ to ‘evidence based’, but information about these should be made available to the wider audience of all who are interested in Recovery from Mental Illness.  For only in this way will these various modalities undergo the scientific rigor needed to prove or disprove any benefits they may have for individuals in need of treatment.