For most consumers under its auspices, we mental patients just call it the system. In reality, there are a number of ‘systems of care’ in the United States, including Social Security and the Department of Social Services. The public mental health system is a complex, repressive, and misunderstood system. No system is more archaic, coercive, and outmoded than the public mental health system.
My goal is to make sense of the public mental health system through a dual perspective. As a clinician and peer advocate, I know that one of the biggest causes of delinquency is the inability to provide adequate person-centered care. As a mental health provider and peer, I have seen a variety of attitudes towards consumers, most of which are not person-centered. As I define person-centered here, it means creating a culture and environment that is supportive of consumers’ recovery.
Working in community mental health clinics (e.g., freestanding clinics NY-Article 31), community centers, schools, and providing in-home therapy, my experience is fairly diverse.
My experiences have provided me with the opportunity to interact with other systems. Systems that intersect with the mental health system amazed me. In my experience working in mental health, the most person-centered attitudes were found in OTHER systems (such as D.S.S. and Social Security, schools and other community organizations).
The reason for this, I have been told, is that mental health patients have a high recidivism rate, which leads them to return to the system after “graduating” or not qualifying. Strangely, the support is pulled out from beneath patients. Too often, when left to their own devices to succeed without support, symptoms activate without their will, and success is never realized.
The lack of compassion in the system was even more sobering. So-called person-centered care in the mental health system is as rife with inequity as it is with racism, bias, and stigma. It would have seemed to me as a community practitioner and peer that mental health has the most advanced person-centered perspective. However, I would hazard that we have not yet reached the limit of applying one theory to our practice. How wrong I was!
Think about this dynamic as an example. After years of support, people with mental health diagnoses suddenly improve in their condition. As soon as they begin to heal, they are dropped from services so they can survive without assistance. There are a lot of patients in the public mental health system who have been subject to conditioning, sometimes hand-holding and sometimes learning helplessness.
Mental health is a complex dilemma, and the struggle I describe sets the stage. Despite the challenges associated with proving stigma-free treatment, there are options for health professionals to handle this complex aspect in the best interest of the consumer’s care, treatment, dignity, and right to the best practice.
A social worker or peer must build empathic connections with clients and colleagues. In addition to knowing what it’s like to be sick, peers also know what it’s like to be treated for an illness. To provide the best possible mental health care, we must bridge this gap. There is no doubt that human biographies are profoundly complex and require peers who are comfortable with the journey.
It must be even more powerful and healing in a system centered around suffering and deep pain to restore the human dimension of care.
Supervisors, clinicians, and administrators need to hold space and support patients while challenging their fears. We are all trying to resolve our patients’ and clients’ mental health issues, whether it is through treatment, case management, or peer support.
Author Info:
mentalhealth
Max E. Guttman is the owner of Mindful Living LCSW, PLLC, a private mental health practice in Yonkers, New York.
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