Advocacy. Towards a more complete vision (thanks to Sita Diehl)

The post below owes a lot to my friend Sita Diehl.  Sita is the national director of state advocacy for Nami.  Linda and I are in Washington D.C for a DBSA conference on advocacy and Sita was a presenter.  What I like best about what she had to say was that is it is based on a clear vision of mental health needs and not identification with some narrow theory or position.

The points below are Sita’s.  The comments are mine.

1.  Protect public mental health funding.

Services in most states, particularly in the public sector, are inadequate.  Most systems are at best skeletal and the pressure in many state legislatures is to remove the bones.  The help that many people need doesnt exist.  The solution to people standing on the cliff is not to destroy the cliff.

2. Expand access to mental health services.

Not only are there not enough services, many people have problems accessing the services that do exist.  Health care reform is an integral part of mental health reform.  24% of the people with mental health issues have no insurance according to Samsha.  We are talking about 11 million people. Telling someone in need they can look but not touch is not policy.  It is simple cruelty.  Telling 11 million is obscenity.

3.  Ensure that effective mental health services are availible.

Too often we ignore what the evidence says works and do what we are used to doing, particularly if someone is making a lot of money doing it.  There is a gap between what we know and what we do.  Their is more and more evidence that recovery based and peer support models work.  Yet in many places there still play a minor role in the services offered.

4.  Promote intergration of mental health, addictions, and primary care.

People with mental health diagnoses get lousy medical care.  They die much quicker than those without diagnoses.  Intergration would finally mean reality to the idea you dont treat the disease- you treat the person.

5.  Improve the mental health care of children, youth and young adults.

No one deserves to suffer and any society that is not committed to alleviating the suffering of its children is not committed to much. 
6.  Meet the mental health needs of service members, veterans and their families.

More service members die from suicide than from war.  The problem is not that we dont have enough war.

7.  Provide homes and jobs for people living with mental health issues.

All the therapy in the world, all the treatment someone receives is not likely to work much if they have no where to live or no job to live on.

8.  Eliminate disparities in mental health care.

Race and ethnicity should not affect the quality of care that someone receives.  The evidence is clear it does.

9.  End the inappropriate jailing of people with mental illness.

Many things should be a crime.  Mental illness is not one of them.  If lack of care is a crime we are punishing the wrong people.

10.  (This one is not on Sita’s list) Eliminate stigma.

The most difficult thing about having mental health issues should not be what other people think about that and how they treat you.  Most of the people I know with mental health issues are ordinary people coping with extraordinary circumstances and not deficient people messing up ordinary circumstances.

I really like the vision of advocacy described here.  It provides a common focus for people to organize around and describes the problems in such a way we will actually know if they are solved.

What do you think??

2 thoughts on “Advocacy. Towards a more complete vision (thanks to Sita Diehl)”

  1. I think that it is one thing to have a list of what clear vision on mental health needs is that they the are just are a list. While it is a good list the problem is that putting it into action is whole other aspect of it. I find within the advocacy through certain agencies that the “story is good but talk is cheap” or it is “talk is cheap but the story is good” which I put in quotes because I believe I heard those words in a song, the point is basically the same – at least to me. I really like the comments that you provided after each of Sita Diehl points.

    I have a question on the presentation that Sita Diehl gave. It is did she give clear visions of mental health needs only? Did she have anything to go behind her clear vision of mental health needs? I’m not sure if you meant that not identification with some narrow theory or position was part of her clear vision of mental health needs or that if she did not go into detail on those visions which you did in the post after each of her points. It would be interesting to know.

    While the list is great, there are many more that are like this and the problem is that we need to stop with the list and start with putting these “visions” into action! That is the problem — being able to putting the ideas into action because of lack of funding. Sometimes I wonder if some within this area like to just to talk about it but don’t really think about actually implementing them and how to do it. It is as long as it is being talked about then all is good. Well, no it is not. We don’t move forward, we stay the same. We still have Olmstead lawsuits and states without a Olmstead plans. We still have people who are not living in the least restrictive setting ad possible nor is there encouragement to do so or at least in my state. We have a huge problem with assisted living facilities that are mainly used for people with mental illness. Many of them break the regulations that the state has yet the state gives them a chance to fix the problem. Some of them it is a regular problem and they need to be closed. They are not. Many live in poor conditions being run very poorly and given very little money each month (around $64/a month). There is no money to help them move to live into community as they give all their money to the place the assisted living facility to pay for living there.

    When it comes to funding for mental health, I find it almost laughable only because we are the first to be cut from the budget if it any government, which includes federal, state, county and more. Substance abuse receives federal money than mental health does! This makes so much harder to do what it takes to help put in action the points that we all have to improve the mental health system. I believe that it will always be like this. We are lowest on in regards to money and we still are consider a thorn in the side of many people (stigma). I don’t thing stigma will ever go away. Ask a person what do they think of when they hear the word stigma and most time you will hear it be about mental illness.

    I don’t know much about Sita Diehl. She wrote an article that upset me a great deal so my thoughts on her aren’t the best. I realize that I’m basing my opinions on one article. I know that it isn’t the best way to make judgment call on a person. I was never able to address the issue with her and was only able to thru National NAMI head of press which was not helpful. Because I know that you friends with her than she most be a good person.

    ***Answer to the question you posed on a vision of advocacy described in your post, it providing a common focus for people to organize around and describes the problems in such a way we will actually know when if the are solved? My answer is I have seen the ideas of this list before just not in the exact words you used. It is things that are said commonly around Nebraska. Is anything being done about? I say no. Do they try? Certain non-profits work hard on it – like our Disability Rights w/ P&A (I happen to be on the PAIMI Advisory Council) The state is doing only what they are required to by law. In 2003, LB 1083 Nebraska Behavioral Health Services Act became a law. In 2004, it was implemented. Within the Nebraska Behavioral Health Services Act it has it: “consumer involvement as a priority in all aspects of service planning and delivery” which sounds really great. It is in actuality project in which consumers tend to have find their way to committees that the state has and to become a part of and would the state members of those committees prefer that I not come to them? Most likely. I ask questions, I bring points that need to be discussed, and once I brought up a solution to a problem that has been one for sometime (which I can’t believe they didn’t think of it themselves!) They do certain things because of the law and you can tell by the way they do it.
    So, back to question and vision of advocacy, it providing a common focus to organize around and describe problems so that it will be know if they are solved? No. It would be nice if it that was that easy. I wish it was. I’m apologize for my negativity. ***

    I do apologize for my length of my comment.

    Larry, if you are interested in LB 1083 Nebraska Behavioral Health Service Act, I would be more than happy to send you a copy.


  2. This was so very true. I love the way it was written. The last statement is what all work so hard to stop but it is a culture change, which is i believe makes it more difficult. Great job.

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