Why We Need a Paradigm Shift in Mental Health Care: The Case for Recovery Now!
Another "May is Mental Health Month" has come and gone, and it is time to build on years of awareness campaigns and move into action to promote whole health and recovery. People with serious mental health conditions are dying on average 25 years earlier than the general population, largely due to preventable physical health conditions, so why do we still focus on mental health separately from physical health? And when we know that people with serious mental health conditions face an 80 percent unemployment rate, why do we largely ignore the role of poverty, economic and social inequality, and other environmental factors in mainstream discussions about mental health?
Decades of public health research have clearly shown that access to the social determinants of health -- affordable housing, educational and vocational opportunities, and community inclusion -- are far more important to mental and physical health than access to health care alone. As one recent article explained: "For many patients, a prescription for housing or food is the most powerful one that a physician could write, with health effects far exceeding those of most medications." Yet this wisdom does not generally guide policymaking in the U.S. Among nations in the Organization for Economic Co-operation and Development (OECD), the U.S. ranks first in health care spending, but 25th in spending on social services. Is there something wrong with our very concept of "care"?
This question is not just theoretical for me. As an adolescent, I attempted suicide several times. I found myself in the back of a police car more than once and was frequently hospitalized. At age 16, I was diagnosed with bipolar disorder. Two years later, I found myself sitting in a squalid group home, where I was told I needed to remain for life. I had no high school diploma and no job. My hopelessness and despair were all-encompassing.
I managed to get on a different path when I obtained access to safe and stable housing, education, and social support. Today, I am living life as a mother and a mental health advocate. I train human service providers in suicide prevention, recovery, trauma-informed approaches, and person-centered health care. Every day, I'm grateful that I was able to regain my life, and I want everyone to have this opportunity.
To help promote a paradigm shift in mental health care, I've been part of starting a new, nonpartisan public awareness campaign called Recovery Now! This campaign seeks to educate all Americans about the kinds of services and policies that promote real recovery and whole health for people affected by mental health conditions. Here are a few key messages of the Recovery Now! campaign.
Recovery is possible for all.
The vast majority of people living with mental health conditions, even people diagnosed with serious mental illness, can enjoy a high quality of life in the community with access to the right kinds of services and supports. Dr. Richard Warner, clinical professor of psychiatry at the University of Colorado, noted: "It emerges that one of the most robust findings about schizophrenia is that a substantial proportion of those who present with the illness will recover completely or with good functional capacity." A slew of other studies have found similar results.
An argument used against recovery is that there are some who can't or won't voluntarily seek treatment or services. Yet there are plenty of evidence-based ways to reach people, such as motivational interviewing, or employing peer-to-peer support or community health workers to do homeless outreach or to engage with persons with complex mental and physical health needs. But these kinds of strategies are vastly underutilized.
We must advocate for recovery-oriented policies.
Hope is essential for recovery. But hope is not enough. Too many people are still unable to access the kinds of services and supports that would help them to recover. In particular, people of color are overrepresented in our jails and prisons, and are underrepresented in community-based mental health and social services.
A prime example is in Chicago, where newly re-elected Mayor Rahm Emanuel closed six community mental health clinics in the most economically disadvantaged parts of the city, which has resulted in an increase in persons with mental health conditions being incarcerated in the Cook County Jail for low-level, nonviolent offenses related to their disabilities. While the recent appointment of a psychologist to head the jail is a step in a better direction, how will this appointment impact upon the lack of availability of community-based services in Chicago for people who desperately need them?
Yet Mayor Emanuel is not unique in his choices. Community-based services have been slashed in many state and local budgets. Any short-term "savings" accomplished by such cuts will always be offset by the devastating long-term human and economic costs that result when we deny quality services and supports to the people who are most vulnerable.
Mental health legislation has been introduced in the House and is expected in the Senate. All legislation should be evaluated through a recovery lens and should clearly address the social determinants of health. Policy should seek to end deadly cycles of poverty, homelessness and incarceration in ways that are culturally appropriate, rehabilitative rather than punitive, and community-based. We can't talk about more hospital beds without talking about supportive housing and other programs that will actually help people to stay out of the hospital and out of prison. We need legislation that tackles disparities in access to education and employment, and funds proven programs that prevent crisis and recidivism.
We need sound policies that promote recovery for all Americans affected by mental health conditions. We don't have the luxury of continuing to get this wrong. Too many individuals, families, and systems are in crisis, and it doesn't have to be this way. We need recovery, and we need it now.