I want to dispense a new term to conceptualize the poison wreaking so much havoc on community mental health. The word: Neo-Institutionalization must be stopped at all costs! I am going to make the argument why this is so critical and so urgent. After all, the community mental health model is aging already. So, when did this crisis to community mental health evolve? When, how, and why did neo institutionalization come into being? What is neo-institutionalization?
The status 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. But, like most vacuums, impurities, misnomers, and filth crept into the works, mucking up what could have been a new era for mental health. Instead, these impurities and misnomers continue to stifle long term progress and halt progress in its tracks.
Since I’ve been a victim of the mental health system’s broken aspects and began practicing as a social worker, I have been thinking about reform, how, and to what end? When people’s lives and their health are at stake, we need to not only reform but overall the system and create a new Gold Standard in Mental Health Treatment. Turning the old system on its head and supplanting it with a working functioning replacement seems rather slippery, precarious, and possibly dangerous if something goes wrong. That doesn’t even articulate the issues to revolutionize the system to replace it, so I can only imagine the enormity of the task ahead.
To make this shift a reality, demystifying Neo-Institutionalization to the public needs to be the priority of the day. People already had mixed feelings about discharging or being released from long-term settings and the system moving to a community mental health model depending on your belief in recovery. The new turn community mental health signaled seemingly more person-centered care in modern mental health treatment, hidden and covert aspects that persisted without push back.
In New York State, each county answers to the NY Office of Mental Health. Other states follow similar regulatory structures for providing treatment in their districts. The county mental health office (DCMH), 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 services with gross disparities, less than picturesque outcomes, and the ongoing deferral of new research invested into the works. Instead, old acronyms for treatment are jumbled up and switched around, throwing in an exciting new adjective to spice up and senior failing service. It’s pathetic!
I am suggesting that we turn the system on its head without further delay. We first need to re-establish the consumer’s 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 this dominating stakeholder is the peer professional and prosumers.
Unfortunately, to do business with these clinician-crats, the peer profession has been commodified and reduced to dollars and cents on the state budget plan. With this said, to truly reform the system, we need to re-structure the system to match consumers’ needs with programs and services genuinely reflective of the community and the values we want to invest in the new mental health structure. I am suggesting that this can only mean full access & integration of mental health care into the community. No gaps, no service delays, or deferral. No disparities and no new adjectives to describe the same treatment used for decades. Integration includes research and clinical trials at the community level to move the discourse further through on-site access to the latest modalities available.
Full Access and Integration is the freedom once realized by the first reformers in the mental health movement of the 1970s & 1980s. Access and integration translate into ramping up entry points into local community health networks, connecting mental health treatment to all goods and services targeting healing and health-related issues and total wellness. The rise of the Modern Health Home and the fall of the silos gestures to the system’s attempt at integrating care, but, like most new turns in treatment, the outcomes reflect the care management philosophy and regulations’ clumsy practices.
Instead of a one service shop or agency, we have several services intersecting with health and wellness. However, like most products assembled hastily, the quality of care reflects a level of degradation in skills and care. The concept worked, but the fine-tuning in hiring practices and over billing overshadows the assembly of worthwhile and more beneficial programs.
Ultimately, hospitals need to stay open and operate under the highest level of professional scrutiny. Long-term out-patient ‘ongoing’ programs still exist and are even more abundant than ever before. I suggest we remove the “level” from our care systems, which defer recovery and long-term independence goals. The end of top-down forms of treatment in which patients are only granted access to freedoms based on their treatment success. Years ago, the level of care philosophy made sense, but does it still make sense today when trying to install choice and nuanced person-centered care into the framework.
We must pave the way to end long-term in-patient treatment & funnel consumers back into the community for the long-span in their roads to recovery. Treatment and services must genuinely be centered on the patient’s needs and not further engrain the guise of neo-institutionalization and pass it off as a reform and a functioning mental health system.