On the core beliefs of a humane mental health system

October 24, 2014 by


From the archives

Originally posted on Hopeworks Community:

from the archives

Is it possible for the mental health system to be humane????  Many would answer no.  Some might say it already is.  What core beliefs would characterize such a system if it could exist.  Below is my attempt at an answer.  When I look at the posts on this blog I am astonished at how many posts speak directly to one or more of these “core beliefs.”

  • A mental health diagnosis is not a real thing.  It is not the fundamental reality of the person diagnosed.  It is a name for a group of behaviors, experiences, and beliefs that compares that person to other people with similar experiences, behaviors and beliefs.  It is either a useful comparison in which case it helps to create a plan to help that person or a misleading and useless comparison that fundamentally leads to actions that are either useless or even harmful.  No matter…

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What if recovery is more than mental health

October 24, 2014 by


From the archives

Originally posted on Hopeworks Community:

Treatment as I understand the term is really about some notion of mental health.  Recently I have become convinced that recovery is about much more than mental health.

Recovery as I have said in recent posts is, I believe, about moving towards a better life.  The issues associated with mental health are certainly a core part of finding a better life.  But they are not the same thing.  Neither are the problems that get in the way of a better life simply a derivative of mental health concerns.  We make a mistake I think when we give the mental health system carte blanche ownership of the notion of recovery.

I met a lady this past week who is severely depressed.  There would be something wrong if she wasnt. 

She has lived in a car for the past year.  She was thrown out of a horribly abusive home by parents who…

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An everyday definition of recovery

October 24, 2014 by


From thq archives

Originally posted on Hopeworks Community:

This is a repost of an earlier post on the definition of recovery. It relates very directly to points made in more recent posts. It tries to talk about recovery in real life terms and not psychological jargon. I very much believe that recovery is a everyday thing that struggling people already know about and the key is what we do with each other and not what an “expert” does to us.

An everyday definition of recovery

There are a million definitions of recovery.  Some of them I even understand.  Here is my attempt at a simple minded definition:

Recovery is moving towards a better life.

It is not a destination.  It is not a thing you have.  It is not something you achieve.  It is a journey, “a moving towards.”

It does not mean that everything must be good.  It means that overall things are part of the process…

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What do you advocate for: the importance of shared concerns

October 21, 2014 by

Advocacy starts with concerns and effective advocacy starts with shared concerns.  Many groups that I have been part of talk about the importance of action but too often they spend more time sniping at each other than they do actually doing anything.  To some degree this seems to be changing but there is a long way to go.

Part of the problem I wonder is that maybe we get the cart before the horse.  Effective advocacy is not so much a function of the brilliance of the solutions we propose as it is our commitment to the concerns we share.  If we have no common concerns that grab us at the gut level the likelihood is that we will have little common cause.  If our shared concerns do not move us to action the likelihood is that we will not act.

I think there are many important concerns.  Murphy’s concerns are inadequate.  There is far more going on than his 4% he is always talking about.  Coercion is not the most important issue.  If you have something that works you normally dont have to force people to buy it.

The post below talks about my concerns.  It was written some time ago but as we struggle to move forward in action seems relevant.  You may share some of these concerns.  Others you may not.  You may have some not on this list.

What we are for depends on what we care about.  I applaud the many people who seem committed to finding shared concerns and common action and getting past the chronic squabbling that has left us immobilized.

In a preceding post I talked about an essential, suprisingly often forgotten, step in advocacy. Before anyone can respond to what you ask you must be clear about what you are asking.  If people are not sure what you are selling they probably arent buying.

I also talked about the importance of being for something.  It is a lot easier to convince someone not to buy something if you give them a better alternative.

I have listened to a lot of ideas about change.  Some seem very important and very doable. Some dont seem relevant to current reality.  They just arent going to happen.  No one other than a small group is for them and it is unclear if hopes for legislative support are even realistic.  Some dont seem like they are very true. They are not what they are advertised to be. Some seem important. Some seem not so important.

The questions below are adapted from a previous post. They are one way, certainly not the only and probably not the best way to look at proposed mental health reform. How much would a proposal actually change things? Does it address important problems? Does it address what you want addressed? Does it leave important questions unaddressed?

What does the proposal have to do with:

The issue of access to services. There is no help if you cant get it. Lack of access is a major issue for many many people. Health care reform and adequate funding for mental health services are both essential.

The issue of effective services. Many things we do dont work very well. Some things may even do more harm than good. We do too much because that is what we are used to doing or because someone has a vested interest in continuing to see it done.

The issue of making sure those who seek help are treated with dignity and respect. For too many the most difficult thing is not the issues they deal with but the system they turn to for help. Those who help you should not be a source of trauma in your life.

The issue of making sure that people have access to correct information to enable them to make decisions about their own lives. The mental health system should be accurate and honest.

The issue of supporting people in making those decisions. Empowering people to be in charge of their lives.

The issue of enabling people to acquire the skills and tools that really make a difference in their lives. Learning makes a difference and the mental health system should make possible learning that makes a differerence.

Addressing issues of homelessness, joblessness, and poverty that are so often part of what it means to  be labeled with a mental illness in this country.

Addressing the dismal state of health care that so many people with mental health diagnosis receive. It is a crime and disgrace that people with psychiatric diagnosis die much earlier than those without. Everyone with a diagnosis knows what it is like to be treated like real medical issues are “in their head.”

Addressing the very real issues of discrimination and prejudice that is a core element in the life of everyone who has a mental health diagnosis.

Addressing the benefits, risks and side effects of medication. Making sure that choices about medication are informed choices.

Addressing the national disgrace of the treatment of those with mental health issues in the jails and prisons of this country.

Addressing the national calamity of suicide.

Addressing the growing issue of trauma.  Moving mental health from a whats wrong system to a what happened system.

Addressing the issue of peer support. It is clear and overwhelming that the voice of lived experience matters. What role should it play in an optimal system?

There are many more issues to be considered, Some issues translate easily into proposed legislation. Some may not translate at all and other advocacy may be called for. The important thing is to know what you are asking, ask something worth asking and have a plan how to effectively get the answer you want.

What I learned from the fight for peer support centers

October 20, 2014 by


Peer support Centers may well be on the chopping block again with the new budget. This post was written last year when we found out peer support funding had been restored.

Originally posted on Hopeworks Community:

It really sounds kind of strange to say we won, because in a very real way we all won.  Vulnerable people who depended on a service, a service that for most of them, had given them their best chance for a better life can still depend on that service.  And for once the system made the decision to not hurt people.  They refused to believe this was the only way, the only choice they had.  They listened and they changed.  The governor of Tennessee is a businessman who talks a lot about “good customer service.”  They decided to give “good customer service.”  The essence of good customer service is to know you are there for the customer and not vice versa.  Today customer service won in Tennessee.

I learned a lot about small voices.  This was not a campaign of big voices or big organizations.  This was one of ordinary…

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The 4% that isn’t 4%. Jaffe on what he is really for….

October 19, 2014 by

A mental health advocate reported an interesting conversation to me he had with DJ Jaffe. 

According to the advocate he was trying to talk to Jaffe about the value of peer support and the recovery model.  Jaffe reportedly cut the conversation short.

(And this is paraphrasing from what I was told) “I am not interested in any of that.  I am only interested in the 4% that don’t know they are sick….”

He said more than that, but that short statement leads to a bunch of different reactions:

What about the 96%?  The problem with the mental health system is way past 4% of anything.  Too many people lack access to services (again Murphy is against health care reform), too many of the services offered are not very effective,  and the system as a whole stigmatizes the people who use it and that is barely scratching the surface.

What about the 334,000 mentally ill people in jail?  Are they part of the 4%?  How do they know?  Is there some type of proof past their assertions?  Does anyone really believe that for 334,000 people that criminal behavior was the result of a deficiency of AOT time or psychiatric hospitalization?  Is anyone really that simple minded?

What about truth in advertising?  The “4% and only the 4%” doesn’t really sound much like the deliverance of the mental health system the Murphy Bill promises.  They are building a 7-11 and calling it a shopping mall. And it isn’t even much of a convenience store.

How do they know the 4% is 4%?  There are 6.5 million people in Tennessee. About 350,000 receive mental health services. A little over 21000 are in prison. 4% of 6.5 million is 260,000 people. Where are they????? By definition they are not in the mental health system. They don’t know they have a problem. They are not filling the jails. They are not filling the psychiatric hospitals (Tennessee has about 12000 committals a year and some of those are repeats). Where are they? How can 260,000 thousand people with severe mental illness go undetected?? Severe mental illness should have severe life impacting symptoms that can not be hidden. Losing 260,000 thousand people would be like the 5th or 6th largest city in Tennessee disappearing. Where did they go?

The answer is that the 4% was never there to begin with. That number is one of the most unchallenged pieces of mythology in all of Torrey land. Do the math for your state. You will find a lot of people missing that Torrey and Jaffe assure you are there.

AOT is strongest in New York. They serve 2000 people..
1/3 is 1%. And it is one heck of a large assumption to even believe all of those 2000 are anosognosic.

If you look at closely what is Jaffe really for… not much for very many.

Let your legislator know today what you are for.

Truth and honesty

October 12, 2014 by

There are those who believe that mental illness is a pernicious, life killing force that has destroyed innumerable lives and affects our society in horrible ways.  They think it is utterly essential for people to get help and if in the process some rights are treated as less that important that is an acceptable trade off. Many believe that the “mentally ill” are very poor at realizing or accepting they need help and that coercion is an inevitable part of an effective mental health system.

There are those believe that the mental health system is a pernicious, life killing system that has destroyed innumerable lives and affects our society in horrible ways. They think it is best that people not get involved in it and the long term cost negates any short term gain. They believe that professionals are very poor at helping people and either don’t realize or don’t care that they often harm the people they are trying to help.

One side says the most important thing is the “mental illness”. The other side says the most important thing is what it means to have a “mental illness”, how it affects the way others treat them and how,in the end, they treat and define themselves.

One side says it is about medical issues and getting people to be good patients. The other side says it is about human issues, and how well we care for those that need help.

And there is another larger side that says it is not either/or. They think some measure of both sides make the most sense. They are suspicious of anyone’s claim to the truth. They believe helping people in serious distress and treating them with dignity and respect are not contradictory things. They believe it is more important to have an honest passionate stake in what works, in what helps, than anything else. They believe it is too easy to get wound up in defending your position and lose focus on what helps particularly when it doesn’t jive with your position.

Most of the people I know are somewhere in the middle. They know first hand the impact that mental health issues have had in their lives. They know about trauma and hurt. They also know about discrimination and prejudice. They have had varying experiences in the mental health system. Some feel it has saved their lives. Some feel like it hurt and some feel like it hurt badly.

They think a mental health system that helps people that need and want help with services that help is important. They think we just haven’t kept our promises. Mental health budgets have been cut past the bone and that to talk about mental health reform without even mentioning that is a peculiar blindness. Even those who advocate great changes recognize that penny poor systems seldom make any changes.

They think that labels do not explain people. Calling many different things one thing does not make it one thing. And they believe a system that claims to know so much about “mental illness” seems at times to know very little about people. They think the claims that people like Rep Murphy makes that the experience of coercion has no lasting effect on people is simply nonsense. They have been there. They know.

One lady said it best, “Every time I hear someone tell me they know the truth about mental health…Mental illness…Mental anything….I think they are either simple minded or just heavily invested in their own ego. I wish we could find a way to stop worrying so much about truth and pursue honesty a little more passionately. The most helpful thing my psychiatrist ever did was to tell me that he didn’t know when he didn’t know. People who are always arguing about the truth want to win more than they want anything. We need more people who want to help more than anything.”

I heard Robert Whitaker talk once about the possibility of an honest mental health system. I have others talk about not protecting turf or status. I have heard others talk about ideology masquerading as ideas.

I confess I like the idea of a system that goes past competing claims of truth and towards a common commitment to honesty and real care. Makes real sense to me.

Peer support and hope

October 12, 2014 by

This post was written last year.  There is more than a little possibility that funding for peer support centers will be  proposed to be cut.  That decision will be made in the next few weeks.  Sometimes we dont know what we have until we lose it.

Peer support has helped them to find a real, impactful and central place for hope in their lives.  Too often peer support is dismissed as “treatment only less.”  And not too often is it seen as something different that is just as essential as any treatment in the recovery of people who seek help for mental health issues.  It gives people who will not do better without a sense of hope, a hope they never found in their experience of the “ordinary mental health system.”  In seeing other people who have been there and made it, other people who are making it, and other people who are struggling as hard as they are but not giving up the lesson is clear– IT DOESNT HAVE TO ALWAYS BE THIS BAD.  IT CAN GET BETTER.  I CAN DO IT AND IT IS WORTH DOING.  Without this faith treatment, even the best and most skilled treatment is stillborn.  And it is peer support centers, peer driven services, and support networks of all kinds that people find it.

Peer support is for many  people the missing piece of a puzzle that sometimes seems to be more of a problem than a solution.  I know of so many people who tell me that mental health services were so insufficient, so disappointing, so discouraging for them.  The message that they got, sometimes in ways spoken, sometimes in ways unspoken was that it was not going to get better.  Everywhere they looked the only message was failure.  One guy told me, “My therapist was a smart man.  He told me a lot of stuff that he thought would help.  But I always felt like he didnt really think it would help me.  He was as discouraged in his way as I was in mine.  Day after day he was talking to people with little real sense of hope and he never could figure out to sell people on hope.  He really meant well, but I was just one of the crowd.  It wasnt until I walked into a peer support center that I really realized it wasnt just talk.  Things could get better and they could get better for me.”

I have come to believe that peer driven services dont compete with treatment.  They complete it.  And person after person is telling me the same thing.  The mental health system has a problem.  So many people in it just dont buy in.  It is not because they dont believe they have a problem.  Misery has a way of letting you know it is there.  It is not because they dont think they need help.  Talk to anyone who has lived with the desperation of life coming apart at the seams.  It is because they dont see any solution, just one more source of deprivation and disappointment.

Peer support centers in Tennessee dont begin to serve everyone in need and they are not likely to do that.  In the short run they save lives and restore hope.  In the long run perhaps they can be new yeast in a system that badly needs hope and a way to look at things that reaches out to everyone.

Mental Health Season will soon be amongst us

October 12, 2014 by

Mental health season in Tennessee will soon be here. The early word is that the Governor is asking for a budget with a 7% cut. If this becomes a reality (and no one really knows yet for sure) then the peer support centers are on the chopping block once again plus Lord knows what else. My hope is that decisions have not been made yet. And it is with that hope that I post the following articles. Last year the peer support centers were on the block and with the voice of some lot of people they were saved. These articles were all written last year but they reflect a truth still true.

There is a fundamental absurdity in the plan to cut out all funding for peer support centers in Tennessee.  It makes my head hurt just thinking about it.

The newspapers, magazines, tv, and every politician who wants to get noticed has had something about the need to force people with mental health issues to accept treatment whether they want it or not.  Warnings of more mass shootings and other catastrophes grow more and more strident.  The Murphy Bill, currently just introduced in Congress, favors involuntary treatment on a national basis as one of its core provisions.

3500 people a day come voluntarily to peer support centers for a fraction of the cost of other programs and it works better to keep people out of jails and psychiatric hospitals than any other type of program.  It is Tennessee’s biggest single success in voluntary treatment.  BY FAR.

Help me out.  Why again do we want to get rid of peer support centers??  How, exactly how, does this make sense???  If it was a person rather than a system we would say they have a problem with self – harm behaviors.  How can we propose anything like this and call it our best and most well thought out option??? Does this make sense to anyone???

Charitably speaking this is cutting off our nose to spite our face.  What will we choose to cut off next?

finding life in hard times

October 10, 2014 by

Much of our time is spent comparing how we are doing with how others are doing and one of the things we always compare are the obstacles in front of us and how they reflect on us.  We want our obstacles to be big enough to testify to our heroism and integrity, but not so big that they reflect poorly on us.  We like it best when our obstacles are out of our control although that doesnt mean we wont try to control them.  It simply means “it aint our fault.”  Obstacles are best when they provide justification and not accusation.  If we must have hard times the least we can hope for is that they provide some personal righteousness.

We tend to look at them as things that are in the way of what we need to be concerned with or what we want.  They are the “buts” in our life.  They prevent life from being what it could be if everything made sense and was as it should be.  But maybe they are not in the way.  Maybe they are the way.

Life is hard.  Do we ever stop and think about what that means?  Even when you try hard, when you do the right things, think the right thoughts, want the right things– even when your ducks are in a row– life is hard.  Being hard is being life.  No matter how we try to “medicate” life we will never feel good enough, think good enough, act good enough, care good enough for it to stop being hard.  Life has a measure of disappointment and tragedy for all of us.  It also because of this has a measure of triumph and victory.  How many times do you look back at your life and say, “I wish I knew then what I know now….”  It wouldnt matter.  Getting rid of one bump is a drop of water in a sea of bumps.

But if you accept hard and you dont have to always know why, or always have to defend your dignity because of the bumps you can find the opportunity in difficult times that enables you to step forward in life.  Hard can make you stronger.  It does for people all the time.

I have a friend who was a refugee from the Sudan.  He spent years in prison because of his religious convictions.  He is a  quiet and humble man.  What he described to be was hard to believe.  I dont see myself making a day of what he lived every day with.  But he was not angry, mean, hostile or resentful.  He was grateful.   And he treasured everything about life.

I asked him what he got out of the experience.  He told me it taught him to love Jesus more.  In his eyes what was important became more important when nothing else was important.  You had to listen to his explanation to really get the impact.

He never in my hearing used or implied the word the word “but.”  He was in prison “and” Jesus loved him.  Something was wrong and this is what he could do.

This is not meant to be an advertisement for Christianity.  Many people who read this blog have told me in no uncertain times they dont share those beliefs and many have told me about the damage done to them in some way by “Christians.”  It is meant to be an advertisement for a way of approaching life.  Do not look for the life behind the obstacles, past the hard times, lost in the pain.  Look for the life in the obstacles, in the hard times and yes, even in the pain.

The people I know who do the best in recovery all believe the same thing although they describe it in a million ways.  Life is a gift….even the rotten, stinky, unfair things that seem to follow us everywhere…. and it is a gift worth treasuring and in the treasuring we find the next step to a better life.

The most helpful people in the world….

October 9, 2014 by

The most helpful people in the world are not those who know a lot but those that know they don’t.

I have a friend whom I believe is a very good psychiatrist (I know some people think that is a logical contradiction).  I asked him the secret of being a good psychiatrist:

“Learn, study and get to know as much as you can, but even more importantly know what you don’t know and know that how well you care is as important as anything you know.”

The 125 letter: outrage

October 9, 2014 by


It should not be dangerous to be “mentally ill”: the battle for the soul of the mental health system

October 9, 2014 by


From the archives

Originally posted on Hopeworks Community:

It should not be dangerous to carry the label of “mental illness.”

It is.

It affects your life in countless ways.  The preceding post links to an article by Pete Earley.  He talks about a mentally ill person who was beaten to death by police basically because he could be.  It shouldnt be, but was and still is.  The people who did this were legally judged as innocent.  To be “mentally ill” means to be less than a person.  It is told to you in a thousand ways a day, in ways both spoken and unspoken.  We use words like stigma, but I am beginning to wonder if that is not too antiseptic a word.  It is discrimination, prejudice, victimization, and dehumanization.  It is nastiness times nastiness.  It is wrong.  But every person labeled “mentally ill” knows it is real.

Let me be clear in what I am saying.  Mental…

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When life is hard…..

October 9, 2014 by

Life has an annoying habit of being hard especially when you are fed up with it being hard.  I know I am worn out on hard and ready for easy.  I try to remember that the difficulty of my life is not a measurement of its quality.  Sometimes I do and sometimes I don’t.

Here are some ideas about hard times:

Know how things are going. Pay attention. Too often we dont.  We are shocked when things all of a sudden seem to go poorly.  It seems like it comes out of nowhere.  And we miss so many good things.  Sometimes I wonder where I was.

Think about momentum.  Going better…..Going worse.  Bad things are less likely in going better.  Good things are less likely in going worse.  Do things on purpose that impact the momentum of your life.  A thousand things too.  None of them by themselves tip the scale but the accumulated weight of them may tip the scales of your life.  Keep a pulse on the direction of life.  What can you do differently that makes a difference.

The more effectively you deal with getting worse the less often you will have to deal with worse.  Have a plan.  Make sure it is a plan you can do, want to do, that you can tell if it works, and that you can continue to make better as times go on.  One friend told me the secret to not getting run over by a car was to learn not to stand in front of them.  See the cars coming.

Dont do life alone.  Support and be supported.  Talking to yourself is okay but as the only thing on the menu it isnt much.  Life is best shared.  It is not a solo act.  Other people have a way of seeing when you cant see, hearing when you dont listen, caring when you dont care and cheering even when you think you dont deserve it.

Do things that matter.  Live life like it means something, like it about something.  We need something to complete us.  Without purpose we paddle furiously but never get anywhere.

Learn.  From everything.  Define events by what you take a way from them.  Learn things that matter and make a difference  Even the worst of times offers a chance to learn something. 

Wait.  When you cant do anything dont.  Just wait.  Make sure when you can you do.  Some things are just survival. 

Remember feelings are not facts.  They are just hypotheses that you must check out.  They are meant to be listened to but listening need not mean obeying.  Pay attention but know paying attention means listening to more than one thing.

Life is an infinite procession of invitations:  to be angry, to be sad, to be glad, to be scared, to be proud, to care, to not care.  An invitation means you decide.  What invitations do you decide to take???  What invitations do you normally miss?

Noise.  The noise around you does not have to be the song you sing.

Count.  You count.  Nothing takes away from that.  You can ignore it.  You can act like it is not true.  You can hope it is not true.  You can try to make it not true.  But it is true.  There is a difference between the package and those things that wrap it up.  You are more than ribbon.

Life sometimes must be hard.  Sometimes it must seem too much.  Sometimes it must seem pointless.  Otherwise how would we ever know when it is not?

On what you can mean: the battle for an identity that matters

October 8, 2014 by


From the archives. A good thing to think about I think.

Originally posted on Hopeworks Community:

Much of the ordinary experience of the mental health system is about identity.  We are told both who we are and what we can become in a thousand ways, both spoken and unspoken.  Often the news is not so good.

When your identity is based on what is difficult for you then much of what you prize or care about is relegated to little more than an asterisk.  I know one person who got excited when he learned about WRAP and when trying to explain it to his psychiatrist was told that he probably needed to increase his medication as he was obviously becoming more manic.    When your living is an illness everything you do is a symptom.  I know another person who told me her life’s ambition was for anyone, one single person to give her credit for being mad when she was mad instead of symptomatic.  I…

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