MENTAL HEALTH CRISIS

✌️✌️I’m fired up about the “mental health crisis”.

I know I’m a C.E.O. of a substance use disorder recovery organization and I’m supposed to stay in my lane.

But… I think we all know that is a silly proposition. REGARDING MENTAL HEALTH AND SUD.

Probably the most accurate thing I ever said.

ALL IS NOT EQUAL

There is great help available. But it’s not always easy to find. It’s not available equally.

And our understanding of mental health syndromes / disorders is not complete.

We know that certain medication is essential in certain situations. Especially for acute stabilization to mitigate potentially dangerous behaviors etc …

We know that certain medications are necessary from a “maintenance” perspective.

It’s especially important to stay on medication to avoid “kindling” (ie…stacking episodes one on top of the other with no period of stability).

The longer you go between episodes the better the prognosis.

INCOMPLETE SOLUTIONS

We know that medicine is an incomplete solution. Lifestyle and self-management is just as important as “medicine”.

However, there is a catch 22… when we go off medication we may experience symptoms that make self-management difficult.

That’s another reason why prescribing “maintenance” medication is such a common practice.

We know that MOST PEOPLE struggle mightily with taking maintenance medication.

It’s too simplistic to say “take your medication daily” and then admonish people when they don’t.

When I broke into the behavioral health field, I did so as a mental health Casemanager at the University of Pittsburgh Medical Center-Western Psychiatric Institute and Clinic.

ASSERTIVE COMMUNITY TREATMENT

This was 2001. I quickly progressed to program director of an Assertive Community Treatment (ACT) Team.

ACT is one of the most intense and challenging models across the entire behavioral health continuum.

We were responsible for individuals with “serious and persistent mental illness”.

People coming out of state hospitals. The era of de-institutionalization manifest in western Pennsylvania.

I learned motivational interviewing in 2001. And we were saturated with continuing education.

The main job was not “getting people clean and sober” OR making people “comply” with treatment plans.

CONNECTION & SUPPORT

Our job was connection. It was support.

Our job was the provision of unconditional positive regard regardless of the “patient’s behavior”.

UPMC was a teaching hospital. So we received fantastic training. DBT intensive and certifications. CISM Intervention’s and certifications. On and on.

We were rotated through on-call weeks. The team provided crisis support 24 hour/365 days per year.

We were not allowed to say the patient “just did not show up for his appointment”. We had to go find them.

On a regular basis I had a psychiatrist in the car with me as we searched the streets of Pittsburgh looking for one of my participants.

INTENSE MENTAL HEALTH FOR 5 YEARS

5 years. The most important 5 years of my career. The most fulfilling 5 years of my career. And the most stressful and difficult 5 years.

We just wanted to help. No other agenda.

I burned out. But it was still wonderful experience.

At the end of the day …. we marked progress in terms of incremental steps.

MODEL MENTALITY

I know this model can’t be replicated everywhere. It’s very expensive. We could only serve 150 people at any one time.

It’s not necessarily the model that I want to promote. It’s the mentality.

Even so, I don’t anticipate this type of thinking becoming commonplace. Where does that leave us?

Families are going to have to fill in the gap? Become case managers?

Become subject matter experts? Train families and participants so they can serve as their own case manager?

Is that ludicrous?

Is it any more ludicrous than the current model?

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