FROM THE FIELD
Rejecting Coercion, Embracing Community Innovation
By Harvey Rosenthal January 13, 2023 Mental Health Weekly
In 2023, we must join together to reverse appalling trends that are being implemented from New York to California and are taking us backwards to the policies of coercion, criminalization and confinement, most notably by the increased use of inpatient and outpatient forced treatment orders.
While these policies profess to be grounded in compassion, they play too often to politics and public fears around rising rates of violence in this nation that are being falsely attributed to members of our mental health community.
According to the Bazelon Center for Mental Health Law, the research is clear: “people who are involuntarily committed are more likely to attempt suicide than those who voluntarily accept treatment, and involuntary commitment can make young people less likely to disclose suicidal feelings. Further, many of these individuals have already been hospitalized one or more times without any improvement. Far too many prefer staying in the street rather than being subjected to traumatizing stays in hospitals and shelters with dangerous conditions. Finally, people with mental health conditions are 11 times more likely to be victims of violence, not its perpetrators.”
In New York and elsewhere, black and brown people in mental health crises are overrepresented in the population of individuals experiencing homelessness, and so are more likely to be involuntarily hospitalized or subjected to needlessly tragic interactions with the police and prison systems that far too often lead to serious harm and the trauma and torture of solitary confinement.
We must educate and ensure that policy makers and the public understand that true answers will be found via strategies that regard our national and state mental health crises as public health, not public safety, challenges.
We know how to help divert people in acute states of distress from avoidable admissions and incarcerations by funding more community innovations, like peer-led outreach and engagement teams along the model of a Westchester County peer-led program, Immediate and Intensive, Sustained Engagement Team (INSET), that has successfully engaged 80% of the members of a group who otherwise would have received mandated involuntary treatment orders.
We have to stop blaming the patient with demeaning terms like ‘hard to serve.’ It’s us who are struggling with the hard work of finding the right people to offer the right approaches and the expectation of recovery for all.
We need to regard peer supporters as expert recovery and wellness coaches, not case managers, and build systems that will stop passing people on to worker after worker. Let’s stop all of these ‘warm handoffs’ and offer people trustworthy relationships that will last as long as desired.
We can’t move fast enough to fill in a full continuum of crisis services, from mental health and EMT first responder teams, 988 crisis counseling and triage services, peer-run crisis respite houses and living room programs and crisis stabilization centers that should extend beyond the current 24-hour standard and be made widely available, even in the subway stations.
And the answers won’t be found in a frantic rush to build up community hospital psychiatric beds or, even worse, by re-populating the state hospitals of the past, especially when far too many of those admissions lead to another cycle of failed discharge plans.
When people are indeed hospitalized, we know that successful discharge plans must include access to:
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A person who cares: A trusted relationship with a “peer bridger” who will be there from admission to discharge and long thereafter;
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A place to live: Housing first programs that will accept, not exclude, people in the greatest need; and
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A place to go: Culturally responsive social and recovery supports, employment, clubhouses and peer-recovery centers.
We are in an all-hands-on deck moment, fighting for rights, recovery, self-determination and service innovation and against discrimination, racism, scapegoating and coercion.
Inspired government leaders, innovative providers and peer supporters and progressive family and community advocates should forge coalitions with civil and legal rights, criminal justice reform, independent living and homeless advocacy groups to promote and provide truly compassionate and long-lasting solutions that best support our neighbors in need. In doing so, we can create the public and political will to make historic investments in the services of the future, not the failed strategies of the past.
Harvey Rosenthal is CEO of the New York Association of Psychiatric Rehabilitation Services, Inc.