Better Services, Not Forced Outpatient Treatment the Answer

“In this environment, court mandates alone are unlikely to be embraced and acted upon by resource-strapped mental health providers. Meaningful changes in community mental health outcomes will require attention to the intensity and quality of care as well as to its patient centeredness and recovery orientation.”
Dr. Joseph P. Morrissey at the Sheps Center in Chapel Hill
Published in Psychiatric Services, a national online journal

On the President’s Executive Order

Commentary worth reading . . . 

“I hasten to point out, however, and we must emphasize repeatedly, these two actions—gun background checks and mental health funding–are quite separate from each other, and they are not causally related. It would be a very definite mistake to link them too closely. To do so runs the risk of further stigmatizing the population of persons who suffer from mental health and substance use conditions. As has been stated very frequently, persons with these conditions are far, far more likely to be the victims of crime than the perpetrators.”

– Ron Manderscheid HERE

Ron Manderscheid Says It Best . . .

From an article written last August titled, “THE ISSUE IS GUN CONTROL”

“Last Thursday, Representative Tim Murphy (R-Pa.) asserted that we have a “failed mental health system.” He should have said we have a “failed Congress for not addressing gun control.” He was using last Wednesday’s Virginia shootings to promote passage of his own mental health bill, which has serious, if not fatal, deficiencies.

“We need to question Murphy’s logic and motivation very closely. Persons with mental health conditions, just like all individuals, deserve dignity and respect; they should not become the whipping boys for the unwillingness or inability of the Congress to pass national gun control legislation. Neither should the mental health system.

“As many of us have stated repeatedly in broadly diverse venues, the vast, vast majority of people who shoot others are not mentally ill. They may have malicious agendas, and they may be violent and angry, but they are not mentally ill. To assert otherwise simply is incorrect: Violence must not be confused with mental illness. This mislabeling inappropriately assaults the dignity and promotes the stigmatization of those who actually do have mental illness.”


Dr. Ron Manderscheid is one of the most brilliant thinkers on mental health systems I have met.  I have read his work for years, learning about his when he was working with SAMHSA.  He writes about the need to develop recovery-focused services and systems, about the role peers can plan in mental health and in integrated health care systems, about how we should be thinking about all the changes coming so fast to our system, about the civil rights of citizens who deserve better treatment access and approaches instead of forced outpatient care . . . I could go on.

He is brainy.  He is the Director of the National Association of County Behavioral Health and Developmental Disabilities Directors.  He is a leader of the College of Behavioral Health Leadership whose annual summit is a think tank where people from across the country who work in many capacities as well as people who have recovered from severe mental health challenges work hard to collaborate for solutions.  This group recently fostered research on peer support compensation but publishes other very timely reports in our field.  He loves research and quotes it easily when making his points in presentation.   Besides all this, he teaches at Johns Hopkins University!

Dr. Manderscheid is a scholar of the things that matter so much to us who wish to see our fellow citizens offered services that help them heal from their mental health challenges.  Yet he is not all brains.  He uses his knowledge with heart.  He seems to lay out paths with his knowledge to consumer leaders across states, to hospital administrators, to policy makers, to so many in this extremely diverse network of advocate-workers.  He is trusted and respected as a comrade whose values are what weave us all together.

To read the rest of this well-reasoned article on the issue of gun violence and mental health politics, check THIS out.

“Don’t give up on our citizens in adult care homes!” we say.

Read the original article and the comment at

Mr. Gerry Akland begins his article with a statement that the Department of Justice/North Carolina agreement “requires” that people living in adult care homes be moved into independent housing in the community. This is simply not true. In fact, the entire “in-reach” process is generally done by specifically trained Peer Specialists who themselves have once struggled with serious mental health challenges but who have since recovered meaningful lives by living actively to manage their health. Their efforts are aimed at engaging people in these facilities in order to offer them the information, the support, and as necessary, the advocacy they may need to help them find a different home in a community—IF they wish to relocate.

In fact, many people are so disabled by the very passive lifestyle North Carolina has allowed to develop in these places that they are afraid of the world beyond the parking lots. They have less resilience and may lose initiative toward growth and change. Many years before this settlement between the federal and our state government, community members tried to give input to rules developed by the Department of Health and Human Services so these places could offer more support health and growth, yet our attempts were neglected.

Perhaps readers do not realize that we are not talking about assisted living in the usual sense of the word where there are Activity Directors, van drivers for non-medical outings, and medical oversight. No holistic approach here, and insufficient medical care! Under-qualified staff are given just a few hours training before they are tasked with dosing medications to patients. And very few of these settings have ensured that staff have training in responding to mental health related needs.

I once visited an adult care home in Yadkinville (and have been in many since). This “home” had 190 beds and, while our policies had once assumed these settings would be for the “frail elderly” I saw very few of these. There were, in fact, young people in their 20s, 30s, and 40’s as the majority of the population. They were very eager to talk and have company, and I could not imagine why they were in such a setting that snuffs hope, does not cultivate engagement, does not offer exposure to new interests, etc. I could only think of two things: 1) these individuals are seen as without hope for a more meaningful life and therefore exhausted families and under-resourced systems have resigned themselves (and these residents) to this lifestyle in the name of safety and 2) this unregulated industry must have continued to grow because somebody else’s (or several somebodies’) interests are involved.

I am a person who has a psychiatric diagnosis. I spend much of my week with people who hope for more value in their lives in spite of their diagnoses. Through a locally operated peer center, they are connecting, learning self-help skills, recovering their own lives and may well be on their way to employment and more! (Many of us with psychiatric diagnoses do get well enough to work and contribute!) Yet many of these have also had families that were eventually exhausted by them and others who gave up on them.

I encourage readers not to give up on us. We do have the capacity to grow, to heal enough from the trauma that has often been a triggering event in our lives that we can become courageous and learn how to manage our lives so that we stay healthier! And I encourage communities to support recovery in the lives of as many of their citizens as possible! Don’t hide us away, and don’t take away our hope, our sense of person.

I am one who looks forward to North Carolina continuing to focus the rights and the full humanity of citizens with mental health challneges. Each individual should have the right to be welcomed back into our communities if they should choose to come, and we should welcome them with hope and expectation, because communities can offer far more than pills to help people regain dignity and well-being.

Laurie Coker

NC CANSO Director Responds to Article About the Department of Justice Settlement

This commentary was posted on the NC SPIN website on November 28th following the publication of an article by the Director of the NC SPIN news and opinion site.

Mr. Tom Campbell:

I respectfully wish to point that while you suggest we stop the finger-pointing and the blame game, you begin your article blaming a federal agency for the current state of things related to transfer of people held in assisted living settings. You seem to think these are necessary and that they must be good alternatives because of how poorly people with mental illness are treated in our state. Clearly, you have not visited many publicly funded adult care homes or group homes. There are few exceptions to the rule that they are not motivated to provide quality living and activity that help people to live a meaningful life.

I advocate as the director of NC CANSO, North Carolina Consumer Advocacy, Networking, and Support Organization, a state level consumer advocacy organization and as a mother who has lost a precious son through suicide and who has another who has been quite a success in spite of Asperger’s Disorder. Neither son’s situation result involved our system much because it was simply so hard to access the right kinds of services in a timely way and because the depth of societal stigma has pervaded how systems reach out to and help people–even though it would cost us less if we had more personal engagement and outreach with the right kinds of services.

In the estimation of most families and certainly most consumers, our state has developed a crisis based system. Continual crises are what we expect and crisis care is what we fund. We continue to fund new ways to respond to crises and ensure we have enough hospital beds. There have been years of coverage of crisis needs by our local newspapers. But this is extremely expensive, and this was not a problem caused by the federal government, but by the state of North Carolina.

The most troubling part of all this is that there are those who have crises too frequently because they cannot get their footing after illness (absence of the right services and supports again–like adequate peer services and true case management–both lacking in our state while costing far less than high intensity clinical and crisis services). THESE are the North Carolinians who have been fed to a large developed industry whose infrastructure was developed by a handful of North Carolina legislators in the 90s and in the first decade of this century! A few of these are still seated in our current legislature, but most have moved on. One has done time in prison because of similar behaviors with a different industry than this facility industry.

North Carolina has also had DHHS secretaries who knew we were misusing Medicaid dollars paying for care for these citizens in large homes—some as large as 190 beds or more! (Medicaid is not to be used except in smaller group settings of 16 beds or less.) When advocates asked for them to apply for grants that would help us to transition people from these settings, the Secretary refused. The refusal of our state to deal with this can only be owned by the leaders of this state. So the Department of Justice simply cannot be held at fault—although it should have done something far earlier because surely it saw the signs. It was the fault of North Carolina legislatures and administrations through so many years that our state became institutionalized in how it looked at people who were too troublesome for families or unattractive out in our communities. So simply put, we built an industry—one that many legislators have benefited by financially come election time and which it is assumed many family members of legislatures have invested in.

The saddest irony is that we had many of these individuals been offered peer support and social settings in their communities where they feel safe to grow and share and learn and recover, many of these same people would not have needed the artificial settings we put them in, calling them homes. In fact, many of us with a mental health challenge have worked to recover our wellness and to contribute. But because of misunderstanding and outdated assumptions about mental health problems and the people who have them, our state’s leaders have for too long swept us under a rug and gotten by with it until Disability Rights asked for the federal government to investigate. This happened twenty years too late, but mental health advocates who represent the potential for recovery of a meaningful and productive life have celebrated the federal government stepping in—even if we are as disappointed as you may be that they had to step in to do so. But seems so much is politically motivated in our state.

I have a friend who has just been hired by a large corporation to develop a holistic wellness curriculum for persons with mental health challenges. She has bipolar disorder and has been hospitalized many times in her life. I used to visit her there when she was very effected by her ill state. But later, she was offered the opportunity to learn how to manage her own wellness that includes the doctor’s part but goes well beyond that. This was tremendously empowering! Through the years, she found part time work as a peer specialist, eventually went back to school and got her degree, and helped to develop a curriculum for people in our public system to help them learn to become more assertive about setting goals and managing their health. Now she will be working full time and contributing not only to the lives of her peers but to the North Carolina tax base. She is just an example of what is happening in communities across our state, but could be happening far more often in North Carolina. It is because someone has reached out to us to offer us support and not just to insist we take our pills.

We who have psychiatric labels must be seen as people first and must be valued as citizens fully. If our full humanity is dismissed, our state will continue to force institutional isolation and mental health and health decline. This is not only costly to the lives of those in these stagnant institutions, but it is very costly to taxpayers.

Our negligence of citizens by placing so many in these vacuous settings has been bad history. This is our shared fault as one North Carolina Community. However, this is our opportunity to re-think what has motivated the decisions we have made about mental health care and the people who need it. Let’s welcome this opportunity and the discussion and keep working hard until we get this right!

To read this NC  Spin article: