One of the great challenges of working as a legislator is finding time… time to get to know what things look like from the inside time to get to know whats really helping people verses what just sounds good time to recognize that what sounds good has often been made glossy and shiny more by money and marketing and less by substance and whats real. Time can be a curse when you’re always running short of it. It can be hard to place blame or point fingers given the heavy demands on the average politician, yet the consequences of that lack of time have the potential to be fairly dire.
Not surprisingly, the Massachusetts Mental Health System is currently experiencing a budget crisis. Why? I’m not entirely clear, but it has something to do with “Chapter 257.” What the heck is Chapter 257? I’m still trying to figure that out, too, but here’s a one-sentence explanation offered by the ‘Campaign to Strengthen Human Services.’
“Chapter 257 of the Acts of 2008 is the historic act that reformed how the Commonwealth pays for essential social services for our most vulnerable residents. It was passed unanimously on roll call votes by the Legislature to address more than 20 years of chronic underfunding of the human services system.”
Notice the year: 2008. As these legislative mandates are prone to do, the implementation has dragged on. Then comes Judge Mitchell Kaplan who, on January 15, issued a final order that Chapter 257 must be fully implemented by July 1. Now, ordinarily, improved rates following “years of chronic underfunding” would sound great. But, here’s the catch: When you raise rates, but don’t increase the overall budget… Well, something’s got to go.
Yes, we knew something would be ‘going.’ However, even with that knowledge, we thought we were safe because peer-to-peer supports in the state represent such a comparatively miniscule piece (well under 1%) of the proverbial pie that any cuts would decimate our ability to function while not really making much of a dent in the overall debt. Unfortunately, new Governor, Charlie Baker, holds a different perspective.
Up until March 4th, we though we were safe. We had no idea where budget cuts were going to land, but we knew they weren’t going to land on us. Unfortunately, on March 5th, we learned that the Governor’s budget proposal included a 50% cut to all Recovery Learning Communities across the state. 50%. That’s 1.7 million dollars. Half of our state-funded budget. We had somehow awoken in Oz and Dorothy’s house was hurtling out of the storm and – instead of at a more appropriate target (one that might have some hope of withstanding such a blow) – it was headed straight toward us.
Let me back up for a minute. For those of you not in the know, there are six Recovery Learning Communities (RLCs) in Massachusetts. They are based in the Central, Boston, Metro Suburban, Northeast, Southeast and Western areas of the state. Each RLC is then asked to cover that entire region within which they are based. You’ll usually see me writing about the Western Mass RLC because that’s where I find my ‘day job,’ and our area (for example) covers four different counties.
The RLCs were first funded beginning back in 2007 and following many years of advocacy from individuals who’ve been through the system, been diagnosed, experienced trauma, and – one way or another – come to understand the value of peer-to-peer support. They were funded with the goal of building peer-to-peer communities that can facilitate healing, connection, learning and systems change as led by those who have ‘been there.’ We’ve gained steam rapidly ever since we were ‘born.’
Now, don’t get me wrong. I have lots (and lots) of criticisms of peer-to-peer support as it exists in this country, and it would be silly of me to pretend otherwise. For example, see my blog, ‘In Peer We Trust.’ In that blog I focus, in part, on states where the nature of peer support has suffered for having been made Medicaid reimbursable, as well as on one study where peer support has somehow been warped into ‘case manager aides.’ It’s true that peer support often lacks integrity and vision. It gets twisted and confused about as often (or more) than not.
But all peer-to-peer support need not be that way, and I believe in what we’re doing. Although, as a rule, we do not employ invasive outcome measures, when we do take time to review our efficacy, we are getting great results (see fact sheet here). More importantly, every day, I see or hear the difference we’re making not just with individuals who are struggling in some way, but also with the broader community. And, in the words of Daniel Mackler in Beyond the Medical Model, “I trust people way more than I trust studies.”
We’re making waves on the national front, too. See the mention of the ‘Hearing Voices Network’ in this vitriolic post by one of my <sarcasm>fave Huffpo authors</sarcasm>, Susan Inman? That’s the Western Mass RLC she’s talking about nine paragraphs down when critiquing the Hearing Voices Network workshop at Alternatives 2014. (I consider a little hate mail or critiquing by the likes of Inman to be a sure sign we’re squarely on target!) People from states as far as Arkansas and Oregon have also contacted us to learn about our approach, and people have traveled from Texas, California, Florida, Idaho and more to take our trainings. We’re not perfect. We’re forever learning and growing. But we’ve got something going on here that’s worth preserving.
So, why us? Community Based Flexible Supports (the latest title for what are essentially residential mental health services) in the state have a budget of about 260,000,000 million. A cut of 1,700,000 million would represent only 0.65% of their total budget. Clubhouses across the state have a budget of (as best as I can surmise) around 22,500,000 million. A cut of 1,700,000 million would represent a somewhat larger but still comparatively small 7.50% of their total budget. In other words, they’d survive. I’m not sure the residential services would even feel much of a pinch over a less than 1% cut. But the RLCs? 50% isn’t a cut. It’s an incapacitating blow.
Am I arguing that Community Based Flexible Supports and/or Clubhouses be cut in our stead? That’s not really my point. Moreso, I’m wondering the motivation behind expressly issuing orders of protection over services that would be much more minimally impacted, while essentially cutting the legs out from under a support that already makes up less than one half of a percent of the state’s total mental health budget. The man behind the decision is so new to his position as Governor that he can’t possibly fully comprehend the very real people he’s hurting or how much. But, while I’m attempting to have some compassion for the difficult position he’s in with a situation he has more inherited than created, I can’t help but assume that this must somehow boil down to how he (and so many others) see and value (or don’t) ‘peer supports.’
It doesn’t matter that peer supports in general continue to come out on top in every research study I’ve found, or that the RLC where I find my home is doing cutting edge work that has attracted even international attention. Peer supports don’t typically matter to the general public (at least not this kind). They’re forever seen as ‘less than,’ even by most people who smile and nod away while we’re testifying to their powerful impact.
Here’s the crux of the problem as I see it: The way many people understand the ‘power of peer supports’ is akin to how they understand ‘recovery.’ That is to say, they see it on a categorically different scale. What do I mean by that? Well, the average person seems to define ‘recovery’ on a scale especially made for people who have been given diagnoses, and that scale tops out way before it reaches what they would see as ‘normal’ success for the average citizen. (This is a prime example of why I don’t particularly tolerate the term ‘recovery’ well myself. See my blog on that subject called, ‘The Recovery Trap.’) Ditto peer support.
The invisible scale they’re using to measure what it means for peer supports to have ‘positive impact’ is simply set at a much lower bar than any conventional mental health service. And, it doesn’t matter one bit that a growing number of people are saying it’s often the reverse; that it’s the alternative supports that saved them while the conventional supports played only a supporting (if any positive) role. Those are just the ‘crazy’ people talking, after all. If they lack insight into themselves, why should we trust them to tell us about what works as far as the system is concerned?
And this is why our plight should matter to you. All of you. To an objective person, it’s pretty undeniable that peer-to-peer supports – at least when offered with integrity and clarity of vision – have real impact, and not just on their own patronizing and watered down scale.
But what’s ‘real’ doesn’t always matter when you’re the one in power. There’s no requirement that those in power even take the time to ask around or do any sort of reality checking of their own belief system whatsoever. And, we need all of our voices to come together to challenge that sort of power in order to have any sort of hope at all.
To the best of my knowledge, the majority of people who hang around these ‘Mad in America’ parts are particularly interested in prioritizing, promoting, and creating access to (true) alternatives, including those built upon peer-to-peer supports. But, whenever one of us falls, it becomes that much easier to knock the next one down. We need more examples to point to, not less; more places to reference and say, “If they can do it, why can’t we?”; more places to call upon and say, “If you don’t believe us, how about them… or them… or them?”
If we fall, I hope you will all see it as a little bit of you falling, too. And, along those same lines, if we come out of this threat whole, we hope you will all share in the success.
Right now though, more than anything, we hope you’ll stand with us in the fight.
To help advocate for the RLC budget to be fully restored, you can:
- Call or e-mail Massachusetts Representatives to express your concern (particularly those on the Ways and Means Committee!) and ask them to make restoring the full RLC budget one of their priorities. If you’re a Massachusetts resident, all the better, but support from any source counts!
- Share this blog and/or the resource information below with your various networks and websites!
- Leave messages of support or any strategies you might suggest below (This will not only support us directly, but also serve to keep this blog active and more visible!)
- Check back frequently to the RLCs Website for updates on our progress and additional ideas of how to support our efforts
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.