Progress in Public Mental Health

“Through all the sorrow of the Sorrow Songs there breathes a hope — a faith in the ultimate justice of things.”
–W.E.B. Du Bois

Good mental health and the experiences of those living with mental illness are rarely part of society’s larger dialogue. I want to share some of the exciting work under way in the public sector of mental health.

Some of the work includes providing more culturally and linguistically appropriate care, improving access to care and prevention, and using those with trauma histories to serve as peers, mentors, and coaches in overall wellness strategies.

Several states have developed networks to hire and train persons with “lived experience” to work in the mental health system. They work alongside clinical staff to model recovery and show that these debilitating illnesses need not become so life-disrupting that dreams cannot be pursued. Through peer support, which is rooted in mutuality, trust, and reciprocity, peers are providing voices where they were once silenced and consigned strictly to institutions.

Newer approaches to care are building on the ever-increasing use of technology and telemedicine to deliver counseling and other therapies to isolated communities where there may be a dearth of professionals trained to help people with emotional distress and serious mental health conditions. The use of tele-behavior health and videoconferencing is rapidly becoming the norm as states attempt to improve quality of access and outcomes.

And speaking of outcomes, those who receive mental health services are fast becoming agents in their own care and contributing to the design and evaluation of systems to include satisfaction survey instruments. Those with lived experience are serving on boards and committees and leading national organizations, much in the same way I have for the past 20 or so years.

People are no longer routinely placed into institutional settings where treatment merely consisted of medication ingestions. Rather, today, under enlightened leadership and better science, people like myself are being successfully integrated into the whole fabric of community life.

It has been a tremendous opportunity for me to be involved in what is known now as the recovery movement. This has been a significant paradigm shift. Persons with mental health conditions are receiving treatment in partnership with their providers that puts the individual at the center of treatment and where the person seeking care is no longer an object of care but is directing his or her well-being.

This shift in mental health care and treatment has occurred because of a change in attitudes about mental illness, as well as court decisions. Most significant is the Olmstead case, where the Supreme Court concluded that it was a Constitutional imperative that persons be integrated in the least restrictive settings possible, especially when doing so would pose no undue financial burden on the states.

States are devising new and exciting alternatives to jails and detention centers as places for mental health care. In Massachusetts, we’re expanding our use of jail diversion programs, homeless outreach, and employment services.

We’re also doing much to address discrimination and stigma through creative messaging across different platforms. We’re involving stakeholders in the clergy, business, and academic communities by presenting lectures and tool kits on countering offensive language.

Prejudice can disappear but it requires constant agitation, and most of all discourse, which Grinnell powerfully prepared us all to do.

Research and experience tell us that through social contact, we reduce the distance between the stigmatized and those who are not so identified. We must engage with those whom we have stereotyped and “otherized.” This requires effort and must be intentional. It has taken hold in several communities. People deliberately have lunch or go on an outing via drop-in center or mental health facility and purposely engage mental health patients not as the “other” but as fellow citizens. While stigma and discrimination continue in many communities, I believe that such attitudes will ultimately dissipate from our landscape.

A best friend at the College told me at one point, “You are wondrously created.” For me, that continues to mean that I can and have done wonderful things. What a powerful message he was projecting to me at a time of deep personal loss and distress.

A diagnosis need not become a destination point, and with care and attention, all of those affected by it can enjoy independent and productive lives in the community. In my view, a person has value not merely because he or she contributes to the integrity of the public treasury, but because they contribute to community life. For me personally, that will continue to mean my participation on boards that advance the understanding of the “other.”

“If there is no struggle, there is no progress.”
–Frederick Douglass