If I had to
pick the single most pressing problem in the mental health system
today, it would be the great confusion about mission and goals within
What is the system’s purpose? Perhaps the purpose
is to produce treatment hours? Or, maybe it’s increased tenure
in the community (fewer hospitalizations or longer time in between
stays). Maybe it’s
quality of life. Recovery? Normalization? Compliance? We can’t
have a system that “works” unless we know what it is that
we want that system to do.
We also can’t effectively measure outcomes unless we’re
clear about the system’s mission and goals. Absence of clarity
about what our mission is precludes evaluation and effective management.
Quality Improvement Committees evaluate how long it takes staff to
answer the phone or to see a person for the first intake appointment.
Is that really what we want to measure—how well staff members
answer the phone? Or, do we want to measure the outcomes of recovery
for the clients we serve?
Why this confusion? Well, first of all, it’s not a mental health
system at all—it’s a mental illness system. The system
seldom teaches people how to be healthy. Instead, the system labels
people as ill.
It informs the public, family, friends and others that it exists to
help the “mentally ill.” As people enter the system, they
can actually lose their identity as a person as the“ill” persona
For example, we all have many roles in life—husband,
father,worker, student, teacher, grandpa, friend, etc. One of the
illness” occurs when someone’s primary identity or role
becomes that of “mental patient.” Sadly, I’ve known
too many people who introduce themselves by their psychiatric diagnosis.
Too often, the focus of conversation is on the current label or what
drugs someone is taking. I often wonder where the rest of the person
is hiding and how to connect with that person. We are all so much
more than“mental patients,” but clients are actually trained
to be“mentally ill” and not mentally healthy.
This occurs because most of the efforts by the
system refocused on disability instead of strengths and abilities.
In this way, dependency
is maintained under the guise of good care. People in the system tend
to believe that “mental illness” is all-pervasive. Staff
members believe that severe and persistent disabilities associated
with mental illness are grounds for assuming clients are incapable
of choice. They believe that impairment in one life area affects all
The system’s biological approach reduces
human distress to a brain disease, and recovery to taking a pill.
The focus on drugs
obscures issues such as housing and income support, vocational training,rehabilitation
and empowerment, all of which playa role in recovery.
What about those staff who are doing a good job?
Too often,major advances are accomplished by those considered rebels
in the mental
yet the system rewards conformity and punishes non-conformity. Life
as a mental patient revolves around the “Cs” of Control,Confinement,
Containment, Conformity and Compliance.
Symptoms must be controlled in order to make people
conform to some undefined social standard. Otherwise, they must
be confined in a hospital
where those symptoms will be contained by assuring compliance with
a regimen of drugs and treatment.The “C” that is missing
is Connection. What’s needed is the human connection to help
people to recover and heal. Instead,many mental health clinicians
tend to equate subduing the person with treatment; a quiet client
who causes no community disturbance is deemed “improved” no
matter how miserable or incapacitated that person may feel as a result
of the treatment.
As a father, I taught my kids to ride a bicycle
in the usual fashion. I held onto the back of the seat and ran alongside,holding
bicycle until sufficient momentum had been achieved. And then, I let
go. I let go knowing that my kids would almost certainly fall and
skin their knees. I let go because I loved my kids and I knew that
didn’t let go, they would never know the joy and independence
of accomplishing it on their own.
I feel that too often, the system (and family,
friends and others)holds on too long and too tightly. The system’s
safety net can become part of the problem. People can get stuck
in the system for too many
years, and never get to know freedom and independence.
Yes, there are risks, but life is full of risks,
and it is through taking chances that we learn and grow. If I try
something one way
and it doesn’t
work, I try something else. If that doesn’t
work, I try something else. That’s part of being human, but
too often “mental patients” aren’t allowed the right
to explore and make mistakes without it being labeled negatively as
a failure. One mental patient can help another mental patient with
this because we’ve “been there, done that.” We understand
In the drug and alcohol system, it’s almost
a prerequisite that you be a recovering alcoholic or addict to help
others with their
issues. Alcoholics Anonymous has been successfully helping people
for over 70 years. Yet our mental health system seldom recognizes
that recovery is possible and even more seldom realizes that one of
best ways to achieve recovery is through self-help peer support.The
system tends to be deaf, dumb and blind to research and ignores its
implications in practice.
The system needs to be clear about its mission
and goals. It needs to become a system of mental health and not
a system of mental illness.
It needs to hire people who are well on their road to recovery to
help guide others down a similar path. It needs to focus on recovery
stop promoting a negative self-fulfilling prophecy by labeling people
as “ill.” The system can change, but it must do so with
purpose and focus, and with the help of current and former service
recipients. Nothing about me, without me!
Pat Risser received NMHA’s 2005 Clifford Beers Award, the
highest honor, for his invaluable contributions to the areas of case
management, recovery and empowerment. He’s served as president
of the MHA of Contra Costa County (Calif.) and the National Association
for Rights Protection and Advocacy, and has worked with many other organizations,
advisory groups, boards and commissions. For more information, visit
his Web site at http://home.att.net/~LetFreedomRing