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Money alone won't fix mental health system



Last modified: Thursday, April 19, 2012
The Monitor is absolutely right to scold the state Legislature for under-funding community mental health services ("State mental health system is broken," editorial, March 21). It's gone on more than 10 years and triggered a class-action lawsuit supported by the U.S. Justice Department and others concerned about the civil rights of people with disabilities.

The state does not deny that it institutionalizes people with mental illness who are capable of living in the community or that it's a violation of the federal Americans with Disabilities Act. State officials say their 10-year plan to improve is enough for people who have already been held in the Glencliff Nursing Home against their will, away from family and community, for many years.

But all the money in the world won't fix the problems of the New Hampshire mental health system. 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.

The Legislature in 2011 tried to limit the number of people eligible for state-funded services. The executive branch is trying to limit the amount of service individuals can get in a year (managed care). Each answer causes people in need to suffer.

 Different approach

 

The third approach, which nobody in government is taking seriously, is making people well. Many people can learn to thrive with fewer government-funded services, or none at all.

The often self-fulfilling premise of the public mental health system is that everyone who seeks 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. We call 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.

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 was the first mental health system in the country to fund a network of peer-support agencies, but they are even more under-funded than community mental health centers. The state has never really used them fully, as an evidence-based part of overall community treatment.

We already have a workforce of trained peers who help people deal with distressing, disabling feelings and behavior. The state has done a good job lately improving what was once uneven service quality from one PSA to another.

Peer support is not a medical service, and PSAs cannot prescribe medication. But scientific discoveries in the past 15 years question the wisdom of the community mental health centers' practice of "diagnosis and medication first, for everyone, for life."

 Drawbacks to meds

 

No reasonable person questions that psychiatric meds help many people 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.

Psychiatric meds can cause 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, who documents all his assertions in recognized scientific literature from reputable institutions, medical journals, and the National Institute on Mental Health.

Quality peer support can triage people and present ways of getting through distress, before they start medication, enough to eliminate waiting lists for community mental health center services.

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, a Kansas City-based think tank I joined when it started in 2009, 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.

What the New Hampshire mental health system really needs is a revolutionary new idea that has already been thoroughly tested and proved. Peer support fits that description perfectly.

(Ken Braiterman lives in Concord.)