All the money in the world won’t fix the problems of the state-funded mental health systems. No state can afford to give everyone with a problem a psychiatrist, case manager, expensive medication, Medicaid or Medicare, and poverty, unemployment, or disability benefits.
Many states are trying to limit the number of people eligible for services, limit the amount of service individuals can get in a year (managed care). Each answer causes people in need to suffer.
The third approach, which nobody in government is taking seriously, is making people well. Many people can learn to thrive with less government-funded service, or none at all.
What public mental health systems really need is a revolutionary new idea that has already been thoroughly tested and proved. Peer support fits that description perfectly.
The often self-fulfilling premise of public mental health systems is that everyone who seeks their help has a permanent, chemical brain disease, needs lots of invasive medication for life, and will be dependent on the system forever.
Often, what the system diagnoses as a permanent brain disease is really caused by social and economic pressure, previous trauma, isolation and loneliness, lack of community connections, and hopelessness. Wellness Wordworks founder Corinna West calls this “the distress model” of emotional disability. With the right kind of help, people can go through distress and come out whole, or stronger, on the other side.
(I became Wellness Wordworks’ board chair when it started in 2009, and am a frequent writer, and edit guest blogs, on their website.)
The 2002 report from the National Association of State Mental Health Program Directors said that “peer support from trained people, who have overcome and are successfully managing post-traumatic feelings and distress, is the most effective intervention.”
New Hampshire — once recognized as the best state mental health system in the country – is now being sued for by the U.S. Justice Department and others for violating their clients’ civil rights. The state mental health authority blames the state Legislature for underfunding community treatment, forcing them to confine people in nursing homes who are capable of living in the community with supports.
In its good days, NH was the first mental health system in the country to fund a network of independent “recovery-based, non-medical, trauma-informed” peer support agencies (PSA’s), a major reason for its outstanding national reputation. Today, these PSA’s are even more underfunded than community mental health centers (CMHC’s.)
The state has never really used its PSAs fully, as an evidence-based part of overall community treatment. It already has a workforce of trained peers, who help people deal with distressing, disabling feelings and behavior.
Peer support is not a medical service, and PSAs cannot prescribe medication. But scientific discoveries in the last 15 years question the wisdom of the CMHCs’ practice of “diagnosis and medication first, for everyone, for life.”
No reasonable person questions that psych meds help many people, especially in the short term, but studies of people who stay on meds 10 or 20 years show some disturbing long-term outcomes, like increased cognitive damage, and increased chance of progression from depression to bipolar disorder to rapid cycling bipolar disorder, catastrophic weight gain, and all the chronic diseases connected to obesity.
People who stay on psych meds long-term have life expectancies 20 years shorter than other people. Countries and systems that medicate less than we do have less permanent disability and unemployment, and higher rates of recovery, long term.
These findings and much more are summarized in laymen’s terms in the award-winning book Anatomy of an Epidemic, 2010, by medical journalist Robert Whitaker.
Quality peer support can save states money by triaging people, and presenting ways of getting through distress, before they get a hopeless diagnosis of a permanent brain disease, and start medication for life.
We’ve documented that people who use peer support to supplement medically-based treatment use fewer expensive state-funded services, like hospital beds, emergency rooms, individual psychotherapy, one-on-one visits with case managers in the community, disability, and poverty benefits.
Wellness Wordworks already has eight economically self-sustaining, distress model alternatives running in Kansas and Missouri. They are based on the arts, physical exercise, peer support, and community building. None use any state funds, and can all be duplicated elsewhere.
We hope to launch Internet-based “peer support without walls,” that will be cheap enough for people to pay for with user fees, memberships, or bartered volunteer hours at non-profit agencies. There will also be free peer support and recovery groups for people who can’t go to a peer support agency.
We think this will allow underfunded PSA’s and underpaid peer specialists to supplement their income, and extend their reach far beyond their buildings.
Ken Braiterman, 63, of Concord, NH, is board chair of Wellness Wordworks, and former chair of the NH Mental Health Consumer Advocacy Council.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.