For most of us served by its auspices, we just call it the system. There are many systems serving consumers with services and its people with “benefits” (e.g. social security, social services). Some of these systems are more distressed and outmoded then others, but no system is as complex, repressive, isolative, feared, and misunderstood as the mental health system. This article explores aspects of the mental health system at the local/community that can benefit from reform. This article is written from the perspective of a clinician who continues to work within the community mental health model and has experienced serious delinquencies in person-centered care, and few opportunities to move forward and escape its revolving door.
The Limits of Person Centered Care
As a provider and peer in the mental health system, I have witnessed various attitudes towards consumers, most of which were not person-centered. By person-centered I mean a stance towards consumers that allies with their recovery and creating a culture and environment in which service recipients feel safe, have a voice in their treatment, feel supported, and made aware of their rights.
I have worked at various levels of the mental health system in my locality; in the clinic, community centers, schools, and people’s homes conducting in-home therapy. These experiences have provided me with an opportunity to work with various systems that intersect the mental health system to connect consumers with other services and benefits.
Remarkably, the most person-centered attitudes held towards consumers I discovered were by other systems, e.g. (D.S.S & Social Security, Schools & other community organizations ) and not the so-called person-centered mental health system and its staff working directly with consumers with a diagnosis. As community practitioners and peers, we like to think that we have the most advanced person-centered perspective, but I would hazard to say we have not yet reached the limits applying it to our practices.
The System’s Revolving Door
The most egregious flaw of today’s mental health system is the utterly difficult struggle it is to leave the system in an “improved” position without relapsing as a result of not connecting to other services given insurance/Medicaid or working disabled issues, and conversely, giving up disability status, and being left to one’s own devices to succeed without any support.
These two stories have been told a million times by consumers that I know and by practitioners and peers that have witnessed and worked with people that encounter the systems forked road: 1) the path of living as “working disabled” with its many restrictions in insurance coverage and assistance and/ or 2) no system support in which it is all too easy to rebound back into the system.
Is anyone really shocked people are rebounding into the system? After years of support suddenly people carrying a mental health diagnosis improve in their condition and are dropped from services to survive without support and years of conditioning, in some cases, hand-holding, and in others, benefits and services.
Does the working disabled path provide any more likely chance of success? As a working disabled consumer I can tell you that the hardest part of this path isn’t feeling well enough to work, it’s navigating the complex system of benefits that comes with the status to stay connected to treatment and the backwards Medicaid system that covers people under this status.
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.
