What's Inside:
Study Shows Mental Illness Often Begins in Youth, Treatment Delays Worsen Issues

Advocacy Improves Grim Earlier Federal Outlook

NMHA Hosts Meetings on New Medicare Part D Benefit

First Person Perspective: What’s the Mission of the Mental Health System?

Journalists Attend NMHA Teleconference on Children’s Mental Health

Cruise’s “War of the Words” Fuels Stigma, Misinformation

NMHA’s 2005 Meeting Promotes Justice, System Changes

Research Notes

NMHA Tools You Can Use

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 the system.

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 becomes primary.

For example, we all have many roles in life—husband, father,worker, student, teacher, grandpa, friend, etc. One of the real tragedies of “mental 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 abilities.

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 health community, 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 up the 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 if I 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 each other.

In the drug and alcohol system, it’s almost a prerequisite that you be a recovering alcoholic or addict to help others with their dependency 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 the 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 and 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!