Fifteen years ago, I put a University on Watch. Those words, ‘on Watch’ were misunderstood, foreign, and caught Binghamton University in Upstate NY off guard.
I truly wonder if I threw the same language at a college in Oregon, if I was a student, how that University would respond, and if Cahoots could successfully intervene before it was too late.
I needed help. I needed a peer. I needed someone with knowledge and understanding of my condition. Well, I did not get the help I needed then.
My words began the chain of events that had me arrested, traumatised, stunting, and deferring my recovery until it was too late to intervene successfully.
That was 15 years ago. The mental health system has come a long way, and I’ve seen it come a long way. I’ve been a part of this miraculous and wonderful critical shift in the very history of mental health, systems in need of dire and urgent reform.
When I came back from college and the long recovery after my state-level hospitalisation and began working as a professional social worker new programmes emerged on the mental health landscape. Programmes that could have made a real difference for people like me. And others.
This change is in part because people like myself, and other advocates, are working side by side with local behavioural health, crisis intervention, and other mental health teams and educating them on the issues at the level I described at Binghamton and teaching them how to intervene successfully.
Today, and I’ve said it before, we stand at an impasse – the boiling point of new reform just around the bend. If we are not careful, the hot button issues, these stuck points, will turn into case law that will sink the system beyond repair and hurl progress back decades.
The issue that hinges on the docket is emergency mental health, crisis intervention, crisis calls, 911, and other emergent crises in the community. From Kendra’s Law in NY to Baker in Florida, we are at the crossroads of possible truly glorious reform.
I am so fearful that this process (the legislative process that dictates the provision, execution, and law, how it defined and carried out, etc.) will get hijacked, derailed, and make all the work done to date moot.
Why? Because life, change, and significant turns in history are not only unpredictable, they come without warning. Reform can go one of two ways. Either the path to progress or make the lives of people with mental health issues and the world that lives among them (everyone) worse.
From treatment to day-to-day living, heed my warning. If we are not very careful, all of our hard work will create severe issues for people with serious mental health issues.
Crisis interventions and the use of social workers, police, and peers to improve current outcomes in emergency crisis interventions are in play in the legal system. There is no answer to which is the right pathway forward. The camps are at odds. We are divided. The jury is still out.
Treatment teams need more time to be educated. More research needs to be completed and tested. We need advocates with real knowledge informing lawmakers. Not special interest groups with an agenda.
Until we have a real tested solution for all 50 states that are clearly defined and without an agenda–we should be very vigilant about ‘reform’ and what that really means.
Time and again, the Cahoots (a programme that refuses to open its books and answer the phone) will not even acknowledge my interview request. They will take my calls, or answer a phone.
Given what I hear, what is published, and my interactions (or lack thereof), I have severe reservations about basing the future of mental health on this model that won’t at least employ or collaborate on tested interventions and research other states have to offer.
I want to see what is happening out there in Oregon is really working. It is one of the few cited programs that ‘exist’ to justify peers be involved in crisis interventions. In NYC, we are now greenlighting peers in crisis interventions.
I am a peer. We are not trained in evidence-based interventions.
Peer work is not an evidence-based intervention (and peer interventions are not ‘evidence-based either’); it is a method, not a skill applied to expect a specific deliverable outcome.
Peers, at this time, with their education, similar to social workers, given their skills, practice, training, etc., do not give them licence or evidence they can successfully.
I am a social worker. I also teach social work. I have an evidence-based certificate. I was one of the first people out there to do evidence-based social work through UB Buffalo in their pilot project. I must stress that my ‘generic de-escalation’ skills from social work ‘evidence-based’ interventions are minimal and trite.
They are not miracle interventions that work on a population with very different heterogeneous needs and issues. To even believe ‘generic’ skills should ever be carte blanch applied to people with SMI during crisis interventions is not just academically problematic but negligent.
There will be blood on the hands of everyone putting their misinformed faith in social workers and peers over history, tangible objective evidence, and how emergency interventions are handled and go down in this line of work.
Should we greenlight state laws across the country when there isn’t evidence? It will only result in further loss of freedom to SMI folks it will harm them.
Maxwell Guttman, LCSW, teaches social work at Fordham University. He is also a mental health correspondent for Psychreg.
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