I like your comments, Kate! And I will add another thought using my personal experience and perspective. Not only do people within the mental health system need to listen, they also need to share their own stories of being traumatized by the very same system. But they are caught in their extreme interpretation of their ethic about no personal disclosure and the system’s conflict of interest restrictions, and many don’t yet even perceive the trauma in their environment.
Like I myself have done mostly during the earlier part of my own recovery from trauma experiences and extreme states (and I am still vulnerable to doing again if I get lax or am caught off guard), mental health system personnel can become defensively aggressive when they intend well but simultaneously feel guilty for their part in a system perpetuating pain much of the time. In my case as a “mental health professional,” it was a double dose. I had my own personal life trauma, and then I eventually worked in a mental health hospital while loathing much of what I saw and had to rub up against.
First, in my personal life into adulthood, I totally did not connect my own trauma experiences with some of the extreme states I experienced and the mistakes I couldn’t explain I was making. I was diagnosed with schizophrenia, and that for me needed to be as hidden as I could keep it, and it was how I internally accounted for my troubles. Although I understood and “empathized” with those publicly sharing their trauma stories, I was blind and numb to my own. And no rational discussion, education, or therapy helped. What ultimately helped was folks more personally sharing their stories with me and showing me compassion when I was confused, ashamed, and defeated. They didn’t have to tell me that they empathized; they showed me, and showed me how to do it. I now am thankfully open with my story and have come to understand myself and others with trauma experiences much more meaningfully.
Second, I eventually worked in a mental health hospital, but could buffer myself pretty well from its trauma potential by staying on a course guided by the ethics and humane principles I was taught in non-traditional training programs. And, I was truly fortunate to have worked most of my professional career elsewhere with others similarly dedicated,. But the hospital experience at the end evolved into some travesties the system can produce. In that situation, my adherence to principles made me a target of the well-intended “experts” who saw my insistent assertions of humane principles as being obstacles to their medical approach and the fulfillment of what they had learned. As responsible administrators left during this decline, I began to lose my own centering while becoming re-traumatized, and became a vocal opponent unwilling to resign, and up for the fight. I didn’t recognize that I was fighting others similarly system-traumatized. I might have done better at bringing my points to bear had I been aware and could have shown compassion as I firmly maintained my principles. But I was still learning and in the thick of it. I left just before they were to fire me. They learned nothing from my sharpening claims of their incompetence, and I had to learn about what happened inside me via more recovery and the kind sharing of others.
So, today I am better prepared to show the kind of compassion your comment (and some others) above shows, and I admire your patient explanation to Bob. I think your tone of compassion will bring greater understanding than even your good explanation. No matter, you are living Recovery Principles, and that is a great model for us all and most likely to be effective. Retaliating in kind never works. IMHO. Thank you.
I am only reflecting what I see and is happening periodically. Joan Keenan, before she moved from CA to OR, was part of developing a good training series for traditional organizations about integrating Peer Specialists into mental health services in a meaningful way. Also, there are two great examples of Integrated Health Care programs within the AZ system which are centered on Recovery and Peer values, while maintaining a traditional shell to conform to requirements for third party billing.
I am concerned that Peer orgs have not yet found a way to coalesce and collaborate for a more powerful voice. Each Peer org represents only a segment of the whole, and we see what that has achieved. There are some states in which the Peer orgs have actually achieved pretty good collaboration and mutuality, and within their state structure, stand a better chance of having their values and roles respected and incorporated; yet is way too rare. We need to be strength-based and join together around values and principles to be effective in a diverse set of roles, IMHO.
I so much respect your knowledge and compassion. Several individuals have been trying to put together some form a training for traditional professionals to help them learn what you know and practice. But reductionism in science, a pathology orientation, and the lack of training about how to go within for knowledge, is not easily overcome. The art and spirituality involved in healing through mutuality/collaboration has been sifted out by science in a reductionistic and misguided attempt to understand with empirical pureness. After the sifting is finished, sterility has been achieved.
Thank you for your inspiring words, and keep the faith.
This article explains well the way in which, if not careful, Peer Support will become in the public sector a creation unrecognizable to those who fought for the right to self-determination, and to those who continue to support each other daily outside the definitions of state control. Creating a manual for Peer Support, as what often is one reference point for “competencies” in medical model professions, is antithetical to the essence of Peer Support. As a musician friend once reflected, “the music is what happens in between the notes.”
I like this website. It continues to forge down the more difficult path bounded by extremes and absolutes. I am routinely suspect of points of view bolstered by absolute certainties and inevitabilities; unless of course the views conform to my biases!!! 🙂
Your article is right on the mark, Bob. And beyond my agreement with all of the markers you propose for an integrated system of health care, I particularly like your sensitivity to those who might find the use of accurate terms like “mutilation” and “poisoning” not to their liking. We all need to show this kind of sensitivity and compassion, while also maintaining an unyielding focus on the real effects of the deficits involved in mental health system failures. Psychiatry, and my own profession of psychology, have in the main become inured to perspectives other than that held by the dominant and controlling role of “expert.” This limited “expert” perspective is reinforced by the political and economic pressures to successfully meet the minimal standards for treatments covered by payers, and to not extend “treatment” beyond the reduction of “acute” symptoms. As we have seen in the past, successfully achieving these short term goals can foster an expert’s self-importance, defensiveness, and being closed to alternative viewpoints. That type of expert perspective and system orientation might even lead an “expert” professional association leader to declare a person who is voicing evidence-based contentions to accepted standards, to be “a menace to society.” So, compassion and understanding for those so caught in their self-fulfilling web of rigidity is very important. And by doing so in your article, you are living the Recovery values you preach. Your past work as an administrator was filled with many examples of compassionate visions of effective system transformation.
I would, however, want to promote some awareness of fledgling organizations which are displaying your integrated health care organization markers. I do not know of many, but I was fortunate in November to have been provided tours of two such organizations in Tucson AZ. Assurance Health and Wellness Center (http://assurancephoenix.com/assurancewellness/index.html), particularly their original integrated health care clinic in Tucson, not only orients itself around Recovery values, but has embedded in all areas of treatment, administration, and governing authority the roles of Peer Specialists to guide and ensure reality-based program planning and evaluation. This organization was purchased by a larger integrated healthcare enterprise, but the Tucson site is still serving as the model for organizational health at the 16 additional clinics they are operating across Arizona. A smaller organization, Camp Wellness (http://medicine.arizona.edu/news/2016/ua-camp-wellness-receives-2016-recognition-excellence-award-us-substance-abuse-and-mental), is also the type of effective smaller scale organization which never loses site of self-determination and strength-based factors necessary for sustainable client hope, inspiration, and motivation. Such organizations can serve as models of the values and markers your article portrays so well.
Thank you for your ongoing attention to the administrative realities of true system transformation toward a Recovery future.
Great blog, Bob! The strength of people’s feelings about this confirm that you are speaking about a key issue. For me, when I am dealing with the effects of abuse (similar to what I am understanding many here to be saying they have experienced in the mental “health” system), one strong initial response of mine is to fight back, and to not particularly care too much if the one who has hurt me feels some of the same pain. At that point, I don’t really care; and in fact, there is a part of me which wishes I could make it so. It just hurts, and just talking doesn’t make it disappear. Yet, good friends who have made it down the path of recovery a bit further fortunately don’t leave me when I want to do to others what has been done to me, and I gradually can begin to focus on what principles I truly want to live by; one being that I want to hold people responsible for their actions, and I truly don’t want to become a vengeful abuser myself. But finding the path to that balance, where I am staunchly unrelenting in my boundary setting, yet open to finding common values even with my “enemies,” is very challenging for me. I try to distinguish the abuse from the abusive person caught themselves in such tragedies. I hope to make even further gains in that as I continue in my life.
Thank you for stimulating such important discussion.
I know many individuals like yourself who have been helped within the traditional medical model system. That is certainly a good thing, and each person needs to be free to voice their experience and satisfaction or dissatisfaction. I personally enjoy traditional practitioners who say to me what you are saying above. “We are operating in the dark.” That builds my confidence that I am experiencing a person open to working with me to find solutions for my needs, and not someone assuming a posture of medical certainty while minimizing my ability to make informed decisions. I have a hard time finding the folks who can do that. I am both a retired practitioner and a person with lived experience, and from both directions I know that there is truth in different perspectives.
Great questions that will need good discussion and decisions for interpretation.
Just about the general “where do you go from there,” the findings will help guide the answer to that. Reduced costs with no improvement will not be fully acceptable. But seeing outcome rates currently showing poor long-term “success” on average using traditional expert medical model schema and the costs to consumers and the public alike, should prompt deserving attention to the good outcomes generated by evolving engagement interventions. Those produced by Recovery and Peer services which have increased: client motivation (measured by improved involvement with supports, both short and long-term, via Intentional Peer Support and eCPR); employment through supported employment services, leading to long-term unemployed individuals gaining and maintaining employment (particularly via the evidence-based Individual Placement and Support model); self-management of psychotic symptoms via Open Dialogue and Hearing Voices support groups facilitating personal relationship development, improved housing retention rates, employment, and community involvement. If these data remain steady, and costs are compared with the exorbitant current pharmaceutical and hospitalizaton costs being paid, this venture would be historic with helping the system make “informed choices!” When the system gets healthy, it will help create a positive momentum.
I really like folks who look at an unmet need, gather info, consult colleagues, and envision options for change while proposing action steps. Your work here is that in exemplary fashion.
Count me in! And thank you for inspiring some pragmatically-based hope.
Taking a difference of opinion, polarizing it within an extreme conceptual framework, and then assigning it a pathological label is one common response.
Wonderful! Collect data. Anticipate criticism of small “n”‘s; we will need to expand these services to provide a stronger data base. Just as Jeffrey Lieberman called Robert Whitaker a “menace to society,” expect the pharmaceutical and psychiatric industries to fire smoke bombs to continue the deceit. An expanded exposure is now beginning.
The states where private peer organizations sponsor and pay for their own conferences, like Peerpocalypse in Oregon, continue to provide a forum where voices and opinions across a spectrum are heard loud and clear. These conferences are wonderful, and spawn new actions and a strong feeling of support and affiliation.
I agree with you, Steve. It has been fun to accomplish so much in the past ten years that has produced tangible and meaningful changes along with good evidence based outcomes. I am afraid that the landscape of NIMH and SAMHSA will be “contoured” to reflect the massive and destructive Trumpian changes everywhere.
Great article. SAMHSA has been a foundation of Recovery Principles and the growth of some humanity in our mental health system. As Murphy, the National Council, and NAMI try to take us back and “make psychiatry great again,” we are seeing the seepage of ill-founded psychiatric biological and involuntary band-aid approaches into an evidence-based set of non-medication and Peer strategies. The intent is clear: place a medical professional over SAMHSA and gradually make Recovery-based healing devolve into oblivion.
I like your perspective, your questions, and your thoughts about alternative ways of responding to the information gained. In my training/work as a Psychologist, the emphasis for testing was the identification and delineation of factors related to “problems.” Tests/assessment tools were geared mostly for pathology identification, and too rarely attended to strengths. Even treatment “progress” in some models would focus on the frequency, intensity, and duration of the “problems,” and would be measured by decreases of these factors accordingly. Refocusing on strengths, past successes, and incremental improvements toward adaptive activities seems much better informed, and a source of hope and inspiration.
May her spirit fill us all.
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I like your comments, Kate! And I will add another thought using my personal experience and perspective. Not only do people within the mental health system need to listen, they also need to share their own stories of being traumatized by the very same system. But they are caught in their extreme interpretation of their ethic about no personal disclosure and the system’s conflict of interest restrictions, and many don’t yet even perceive the trauma in their environment.
Like I myself have done mostly during the earlier part of my own recovery from trauma experiences and extreme states (and I am still vulnerable to doing again if I get lax or am caught off guard), mental health system personnel can become defensively aggressive when they intend well but simultaneously feel guilty for their part in a system perpetuating pain much of the time. In my case as a “mental health professional,” it was a double dose. I had my own personal life trauma, and then I eventually worked in a mental health hospital while loathing much of what I saw and had to rub up against.
First, in my personal life into adulthood, I totally did not connect my own trauma experiences with some of the extreme states I experienced and the mistakes I couldn’t explain I was making. I was diagnosed with schizophrenia, and that for me needed to be as hidden as I could keep it, and it was how I internally accounted for my troubles. Although I understood and “empathized” with those publicly sharing their trauma stories, I was blind and numb to my own. And no rational discussion, education, or therapy helped. What ultimately helped was folks more personally sharing their stories with me and showing me compassion when I was confused, ashamed, and defeated. They didn’t have to tell me that they empathized; they showed me, and showed me how to do it. I now am thankfully open with my story and have come to understand myself and others with trauma experiences much more meaningfully.
Second, I eventually worked in a mental health hospital, but could buffer myself pretty well from its trauma potential by staying on a course guided by the ethics and humane principles I was taught in non-traditional training programs. And, I was truly fortunate to have worked most of my professional career elsewhere with others similarly dedicated,. But the hospital experience at the end evolved into some travesties the system can produce. In that situation, my adherence to principles made me a target of the well-intended “experts” who saw my insistent assertions of humane principles as being obstacles to their medical approach and the fulfillment of what they had learned. As responsible administrators left during this decline, I began to lose my own centering while becoming re-traumatized, and became a vocal opponent unwilling to resign, and up for the fight. I didn’t recognize that I was fighting others similarly system-traumatized. I might have done better at bringing my points to bear had I been aware and could have shown compassion as I firmly maintained my principles. But I was still learning and in the thick of it. I left just before they were to fire me. They learned nothing from my sharpening claims of their incompetence, and I had to learn about what happened inside me via more recovery and the kind sharing of others.
So, today I am better prepared to show the kind of compassion your comment (and some others) above shows, and I admire your patient explanation to Bob. I think your tone of compassion will bring greater understanding than even your good explanation. No matter, you are living Recovery Principles, and that is a great model for us all and most likely to be effective. Retaliating in kind never works. IMHO. Thank you.
Report comment
Good morning,
I am only reflecting what I see and is happening periodically. Joan Keenan, before she moved from CA to OR, was part of developing a good training series for traditional organizations about integrating Peer Specialists into mental health services in a meaningful way. Also, there are two great examples of Integrated Health Care programs within the AZ system which are centered on Recovery and Peer values, while maintaining a traditional shell to conform to requirements for third party billing.
I am concerned that Peer orgs have not yet found a way to coalesce and collaborate for a more powerful voice. Each Peer org represents only a segment of the whole, and we see what that has achieved. There are some states in which the Peer orgs have actually achieved pretty good collaboration and mutuality, and within their state structure, stand a better chance of having their values and roles respected and incorporated; yet is way too rare. We need to be strength-based and join together around values and principles to be effective in a diverse set of roles, IMHO.
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I understand. I can still come upon some rare exceptions. I am hesitant to talk in absolutes.
Wonderful blog. Thank you very much. I sent on to Beth Filson to help distribute to iNAPS members an awareness of your excellent message.
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I so much respect your knowledge and compassion. Several individuals have been trying to put together some form a training for traditional professionals to help them learn what you know and practice. But reductionism in science, a pathology orientation, and the lack of training about how to go within for knowledge, is not easily overcome. The art and spirituality involved in healing through mutuality/collaboration has been sifted out by science in a reductionistic and misguided attempt to understand with empirical pureness. After the sifting is finished, sterility has been achieved.
Thank you for your inspiring words, and keep the faith.
Report comment
This article explains well the way in which, if not careful, Peer Support will become in the public sector a creation unrecognizable to those who fought for the right to self-determination, and to those who continue to support each other daily outside the definitions of state control. Creating a manual for Peer Support, as what often is one reference point for “competencies” in medical model professions, is antithetical to the essence of Peer Support. As a musician friend once reflected, “the music is what happens in between the notes.”
Report comment
I like this website. It continues to forge down the more difficult path bounded by extremes and absolutes. I am routinely suspect of points of view bolstered by absolute certainties and inevitabilities; unless of course the views conform to my biases!!! 🙂
Report comment
Your article is right on the mark, Bob. And beyond my agreement with all of the markers you propose for an integrated system of health care, I particularly like your sensitivity to those who might find the use of accurate terms like “mutilation” and “poisoning” not to their liking. We all need to show this kind of sensitivity and compassion, while also maintaining an unyielding focus on the real effects of the deficits involved in mental health system failures. Psychiatry, and my own profession of psychology, have in the main become inured to perspectives other than that held by the dominant and controlling role of “expert.” This limited “expert” perspective is reinforced by the political and economic pressures to successfully meet the minimal standards for treatments covered by payers, and to not extend “treatment” beyond the reduction of “acute” symptoms. As we have seen in the past, successfully achieving these short term goals can foster an expert’s self-importance, defensiveness, and being closed to alternative viewpoints. That type of expert perspective and system orientation might even lead an “expert” professional association leader to declare a person who is voicing evidence-based contentions to accepted standards, to be “a menace to society.” So, compassion and understanding for those so caught in their self-fulfilling web of rigidity is very important. And by doing so in your article, you are living the Recovery values you preach. Your past work as an administrator was filled with many examples of compassionate visions of effective system transformation.
I would, however, want to promote some awareness of fledgling organizations which are displaying your integrated health care organization markers. I do not know of many, but I was fortunate in November to have been provided tours of two such organizations in Tucson AZ. Assurance Health and Wellness Center (http://assurancephoenix.com/assurancewellness/index.html), particularly their original integrated health care clinic in Tucson, not only orients itself around Recovery values, but has embedded in all areas of treatment, administration, and governing authority the roles of Peer Specialists to guide and ensure reality-based program planning and evaluation. This organization was purchased by a larger integrated healthcare enterprise, but the Tucson site is still serving as the model for organizational health at the 16 additional clinics they are operating across Arizona. A smaller organization, Camp Wellness (http://medicine.arizona.edu/news/2016/ua-camp-wellness-receives-2016-recognition-excellence-award-us-substance-abuse-and-mental), is also the type of effective smaller scale organization which never loses site of self-determination and strength-based factors necessary for sustainable client hope, inspiration, and motivation. Such organizations can serve as models of the values and markers your article portrays so well.
Thank you for your ongoing attention to the administrative realities of true system transformation toward a Recovery future.
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Beautiful.
Thank you.
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Great blog, Bob! The strength of people’s feelings about this confirm that you are speaking about a key issue. For me, when I am dealing with the effects of abuse (similar to what I am understanding many here to be saying they have experienced in the mental “health” system), one strong initial response of mine is to fight back, and to not particularly care too much if the one who has hurt me feels some of the same pain. At that point, I don’t really care; and in fact, there is a part of me which wishes I could make it so. It just hurts, and just talking doesn’t make it disappear. Yet, good friends who have made it down the path of recovery a bit further fortunately don’t leave me when I want to do to others what has been done to me, and I gradually can begin to focus on what principles I truly want to live by; one being that I want to hold people responsible for their actions, and I truly don’t want to become a vengeful abuser myself. But finding the path to that balance, where I am staunchly unrelenting in my boundary setting, yet open to finding common values even with my “enemies,” is very challenging for me. I try to distinguish the abuse from the abusive person caught themselves in such tragedies. I hope to make even further gains in that as I continue in my life.
Thank you for stimulating such important discussion.
Report comment
I know many individuals like yourself who have been helped within the traditional medical model system. That is certainly a good thing, and each person needs to be free to voice their experience and satisfaction or dissatisfaction. I personally enjoy traditional practitioners who say to me what you are saying above. “We are operating in the dark.” That builds my confidence that I am experiencing a person open to working with me to find solutions for my needs, and not someone assuming a posture of medical certainty while minimizing my ability to make informed decisions. I have a hard time finding the folks who can do that. I am both a retired practitioner and a person with lived experience, and from both directions I know that there is truth in different perspectives.
Report comment
Thank you for your continued leadership.
Jacek
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Great questions that will need good discussion and decisions for interpretation.
Just about the general “where do you go from there,” the findings will help guide the answer to that. Reduced costs with no improvement will not be fully acceptable. But seeing outcome rates currently showing poor long-term “success” on average using traditional expert medical model schema and the costs to consumers and the public alike, should prompt deserving attention to the good outcomes generated by evolving engagement interventions. Those produced by Recovery and Peer services which have increased: client motivation (measured by improved involvement with supports, both short and long-term, via Intentional Peer Support and eCPR); employment through supported employment services, leading to long-term unemployed individuals gaining and maintaining employment (particularly via the evidence-based Individual Placement and Support model); self-management of psychotic symptoms via Open Dialogue and Hearing Voices support groups facilitating personal relationship development, improved housing retention rates, employment, and community involvement. If these data remain steady, and costs are compared with the exorbitant current pharmaceutical and hospitalizaton costs being paid, this venture would be historic with helping the system make “informed choices!” When the system gets healthy, it will help create a positive momentum.
Report comment
Wonderful!
I really like folks who look at an unmet need, gather info, consult colleagues, and envision options for change while proposing action steps. Your work here is that in exemplary fashion.
Count me in! And thank you for inspiring some pragmatically-based hope.
Jacek
Report comment
Taking a difference of opinion, polarizing it within an extreme conceptual framework, and then assigning it a pathological label is one common response.
Jacek H., Psy.D.
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Wonderful! Collect data. Anticipate criticism of small “n”‘s; we will need to expand these services to provide a stronger data base. Just as Jeffrey Lieberman called Robert Whitaker a “menace to society,” expect the pharmaceutical and psychiatric industries to fire smoke bombs to continue the deceit. An expanded exposure is now beginning.
Jacek
Report comment
The states where private peer organizations sponsor and pay for their own conferences, like Peerpocalypse in Oregon, continue to provide a forum where voices and opinions across a spectrum are heard loud and clear. These conferences are wonderful, and spawn new actions and a strong feeling of support and affiliation.
Report comment
I agree with you, Steve. It has been fun to accomplish so much in the past ten years that has produced tangible and meaningful changes along with good evidence based outcomes. I am afraid that the landscape of NIMH and SAMHSA will be “contoured” to reflect the massive and destructive Trumpian changes everywhere.
Report comment
Great article. SAMHSA has been a foundation of Recovery Principles and the growth of some humanity in our mental health system. As Murphy, the National Council, and NAMI try to take us back and “make psychiatry great again,” we are seeing the seepage of ill-founded psychiatric biological and involuntary band-aid approaches into an evidence-based set of non-medication and Peer strategies. The intent is clear: place a medical professional over SAMHSA and gradually make Recovery-based healing devolve into oblivion.
Thank you for this article.
Jacek
Report comment
I like your perspective, your questions, and your thoughts about alternative ways of responding to the information gained. In my training/work as a Psychologist, the emphasis for testing was the identification and delineation of factors related to “problems.” Tests/assessment tools were geared mostly for pathology identification, and too rarely attended to strengths. Even treatment “progress” in some models would focus on the frequency, intensity, and duration of the “problems,” and would be measured by decreases of these factors accordingly. Refocusing on strengths, past successes, and incremental improvements toward adaptive activities seems much better informed, and a source of hope and inspiration.
Thanks for the good article.
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