For most consumers under its auspices, we mental patients just call it the system. The truth is there are many ‘systems of care’ around the US. Social security, Department of Social Services are examples of other systems. No system is more archaic, coercive, and outmoded than the public mental health system. The public mental health system is complex, repressive, and misunderstood.
I hope to make sense of the public mental health system through a dual perspective. I am a clinician and peer advocate. The biggest delinquency is rooted in failure to provide adequate person-centered care. As a mental health provider and peer, I have witnessed various attitudes towards consumers, most not person-centered. I define person-centered here as holding a stance towards consumers that allies with their recovery and creates a culture and environment of healing.
I have worked at various levels of the mental health system. Working in the community mental health clinic (for example, freestanding clinics NY-Article 31), community centers, schools, and conducting home visits providing in-home therapy, my experiences are fairly diverse.
All of my experiences have provided an opportunity to work with other systems. Systems which intersect the mental health system stunned me. Remarkably, the most person-centered attitudes I have observed while working in mental health were in other systems (such as DSS and social security, as well as schools and other community organisations ).
I have been told this is because mental health patients have a high rate of recidivism to renter he system after “graduating” or from not qualifying for services. Strangely, as if patients are set up to fail when the support is pulled from underneath them. Too often, when left to their own devices to succeed without support, symptoms activate without wanting and success is never realized.
Processing the lack of compassion in the system was even more sobering. The Mental health system’s so-called person-centered care is as rife with inequity as it is with racism, bias, and stigma. As s community practitioner and peer, I would have thought mental health has the most advanced person-centered perspective. I would hazard to say we have not yet reached the limits of applying a single theory to our practices. How wrong I was…
As an example just think about this dynamic. After years of support, suddenly, people carrying a mental health diagnosis improve in their condition. Then, the folks working hard to heal are dropped from services to survive without help. Many of whom were subject to conditioning, in some cases, hand-holding, and in others, learned helplessness. This happens all the time in the public mental health system.
The struggle I am describing sets the stage for the bigger dilemma in mental health. How to be transparent, authentic, and accurate for the best interest of the consumer’s care, treatment, dignity, and right to the best practice) Despite the challenges, there are options for health professionals handle this complex aspect of proving stigma and bias free treatment.
Being a social worker and peer means building empathic connections with clients and colleagues. Peers know what it’s like to be sick. Peers also know what it’s like to be treated for a illness. Bridging this gap is fundamental in providing the best possible care available in mental health. Let’s face it; human biographies are deep and complex and require authentic peers comfortable with life’s journey. ‘
The most intimate and supportive relationship in a system centred around suffering and deep pain has got to be even more powerful and healing. In the face of such suffering, restoring the human aspect of care in human services is critical.
The system needs supervisors, clinicians, and administrators who understand how to support and hold space, while challenging the fear of the unknown. Call it ‘treatment’, ‘case management’ or ‘peer support’, we are all looking to resolve the mental health issues of our clients and patients.
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.