Neo-Institutionalization is covert, insidious, and must be stopped at all costs. In the The New Gold Standard in Mental Health Treatment: De-Mystifying Neo-Institutionalization©, I suggested that state of mental health treatment has fallen under the shadow of something more dangerous to the consumer of services than ever before in community mental health systems across the United States. The term community mental health evolved from the vacuum wake left from de-institutionalization.
People were genuinely excited for this new turn in seemingly more person-centered care in modern mental health treatment. Decades later, however, the movement, or trend, stalled, and today, in its place is an aging system in decay set up for needs of consumers from a distant past. In New York State, each county answers to the Office of Mental Health. Other states follow similar regulatory structures for providing treatment. The county mental health office, the most local unit in the community mental health system has become nothing more than an office to lodge complaints and keep records of its failing services.
I am suggesting that we turn the system on its head. We need first re-establish the consumers voice in treatment. The system is still very much run by so-called experts and autocratic practitioners who left behind the noble helping profession for commercial benefit. These clinician-crats now dominate the system and make up the ruling or decision-making elite in community mental health and local government. The only exception to the this dominating stakeholder is the peer professional.
Unfortunately, in order to do business with these clinician-crats, the peer profession has been commodified and reduced to dollars & cents on the state budget plan. With this said, in order to truly reform the system, we need to re-structure the system to match the needs of consumers with programs & services truly reflective of the values community mental health espouses and once meant to people leaving the hospital system for full access & integration into the community.
Full Access & Integration is the freedom once realized by the psychiatric survivors of the 1970’s & 1980’s. Access & integration means not only ramping up points of entry into local community health networks it means connecting mental health treatment to all goods & services targeting healing and health related issues. The rise of the Modern Health Home and fall of the silos gestures to the system’s attempt at integrating care, but, like most new turns treatment, the outcomes reflected the clumsy practices of the care management philosophy and regulations.
Now, instead of one service at a shop or agency, we have several services intersecting with health & wellness. However, like most products assembled hastily, the quality in care reflects a degradation of skills & care overall across the states. The concept worked, but the fine tuning in hiring practices & billing overshadowed the assembly of worthwhile and beneficial programs.
Ultimately, the hospitals are still open. Long term out-patient programs still exist and are even more abundant than ever before. I am suggesting we remove the “levels” from our systems of care and end top-down forms of treatment in which patients are granted access to freedoms based on their success in treatment. The level of care philosophy made sense years ago, but does it still make sense today?
We are supposed to be paving the way to end long-term in-patient treatment & funnel consumers back into the community for the long-span in their roads to recovery. Instead, we are feeding a system that privileges restriction, seclusion, & isolation from the community. If treatment & services were all considered at the same level of care, there would be no disputes from consumers that treatment isn’t truly centered on the needs of the patient & not there to simply maintain & re-justify its own upkeep as a once-functioning system.
Author Info:
Max E. Guttman
Max E. Guttman is the owner of Mindful Living LCSW, PLLC, a private mental health practice in Yonkers, New York.
