Money Alone Won’t Fix Public Mental Health Systems

Ken Braiterman

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.


  1. The author of this article states, “No reasonable person questions that psych meds help many people, especially in the short term…”

    I consider myself a reasonable person and I disagree that these toxic poisons help anyone short term or long term!! And a life destroying bogus stigma from the junk science DSM always precipitates that useless, deadly drugs.

  2. I wonder, if you get rid of diagnoses, what makes someone a peer? How does an undiagnosed person know who their peers are? Or how does anyone? What are the common bonds or experiences or knowledge that would make a “peer counselor” of use? I was on disability for several years, but I always identified more with the graduate students I had left behind- those were my peers. Those were the people who had lives I wanted.

    • Could not agree more. Peer are people who the mental health system approves of. They are people who they believe have gotten better and recovered. The question I have is this. If these people are such experts, and have recovered so well, then why are they not out there working in the real world, with the average person. No instead they stay in the mental health system and are paid like shit, to tell us that we simply need to do what they do, and we will all get better just like them. Problem is they are not me. They do not know me and they do not know my life or my experiences. I don’t need a person who recovered from a psychotic break telling me how to get better from a profound dissociation. I am me. I am perfectly OK as I am.

      The ONLY reason peer led services exist is because they are full of people who support the current system. They do not question what goes on, they do not feel the need to enable us to go out into the real world. The blind don’t need peer workers, they just go out into the world. The deaf don’t need peer workers, the paralysed do not need peer workers, the intellectually disabled do not need peer workers. No they are all allowed to be who they are, as full and productive members of society warts and all. I and others like me on the other hand need to RECOVER and that means not only do I need to listen to doctors and therapists, but now also supposed peer workers who are approved by these people. They are approved as they do not rock the boat.

      I also question the role of these medications for anyone at all at any time. I wonder how these people can say that if they have read any of Whitakers books.

      • Some of us may believe in the system, but I think they are far and few between. I stay in the system to try and fight it and change it from within. I am retired; I was a hospital and nursing home chaplain. I ran into emotional anguish and spent two and a half months in the state hospital where I now work. While locked behind the doors I vowed that I would come back and make a difference for the better. I beat my head every day against the brick wall, not for the money, which is quite good by the way, but because I feel that I can use my skills as a chaplain, along with my training as a peer, to make a difference in individual lives and to let people know that there is someone here who really does know something of what they feel and who truly cares about what happens to them. Only one of the peer workers I know supports the system; all the rest of us are rabid revolutionaries who work quietly in the trenches and behind the enemy lines. And we are not approved of by the system. It took over a year for me to even be hired into here. The powers that be kept coming up with all kinds of wierd “rules” that they were pulling out of their behinds, to keep me from being hired. However, another peer who is knowledgable about rights and discrimination guided me through the battle and the hospital had to hire me. A year later I am preparing to actually move into the units and touch base with the people I meet in Admissions where I work. Only two psychiatrists in the entire hospital support my presence here but they are also the ones who actually do therapy with their people, rather than poking them full of toxic meds. I am not liked by the upper levels in the hospital and am often snubbed in the hallways when they pass me. I think you make a lot of assumptions about who and what we are without knowing much of anything about us and what we do. Most of us are not supporters of the system but work within it because it’s very difficult to come up with the money to run centers on our own. Oregon has many peer run centers and those centers are supportive of people getting off those toxic drugs and getting their lives back. My state is way behind in these things but that’s not surprising since it’s in the wonderful South and is the buckle of the Bible Belt. I think that if you investigated what we really do you might be very surprised about what we do and what we believe and what we support. Most of us are not lackeys of the system.

        • By the way, yes I’ve read Whitaker’s books and have talked with him back and forth. He is a great man, as are so many others working against the system, who happen to be peers. Will Hall, Oryx Cohen, the list of names is quite long. They’re peers and they work to give people alternatives to the system. So, please do some investigating.

  3. “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.”

    Often?!!! I’d say every time. I’d also like you to table evidence for the ‘real’ brain disease exceptions you allude to, because I don’t believe you can table such evidence.