Nothing About Us Without Us: System Changes Not Informed by System Users and Allies Will Fail

This week, the Strategic Plan for Improvement of Behavioral Health Services was released to the General Assembly.  It offers some clear data defining areas of system need and it focuses on bringing more accountability to system management.  But it does not go far enough to ensure that public dollars are purchasing value in the lives of those served through citizen tax dollars.  The following explains what is missing in this plan.

 

In order to effectively serve an identified group of citizens (“intended beneficiaries”) using public dollars, the use of these dollars and the assurance of quality results from their expenditure MUST be guided substantially by the beneficiaries and those who are their closest personal allies.  Simply put, if the development of a citizen-serving system of supports and services is not adequately informed by its users—its customers—then it will neither be efficient or effective.  Indeed, such a system  can actually worsen of the health status of those who were actually intended to benefit by the system.

This has happened in North Carolina.  We have in the past fifteen years worked hard at seeming without being, turning our state motto on its head!  In spite of multiple system reforms and constant instability, we are still hurting.  Readers can see excellent data in the recent Strategic Plan and in the report, The State of Mental Health in America , a state-by-state analysis of mental health and substance use care and access which shows North Carolina being in the bottom quarter across most reporting fields.  But data aside, our communities live this systemic ineffectiveness and inefficiency daily.   Citizens know this.  Leaders probably know this.  But it takes a bit of courage to reframe an overall objective and to share the mission and the effort with others—including those whom leaders may feel don’t really matter.

Political structures and the sequestering of decision making power to few top officials, elected and unelected, has created a very inefficient and ineffective superstructure for serving people with intellectual and developmental disabilities, with mental health challenges, and with substance use problems.  In fact, I know that many fine people who work for our Division of Mental Heatlh, Developmental Disabilities, and Substance Abuse Services wish for more community informed change but are not themselves empowered enough to help lead.  And I know many direct service providers who also are frustrated by the culture of service provision in our state—yet they feel they cannot act or speak to foster change or they risk losing their jobs.  We suffer from an outdated state-funded operational culture and we need to bring it to currency!

Consider that if the changes we make in our system are not motivated by the desire for good outcomes, then the things that motivate—profits, preservation of status quo, mere compliance, etc.–are actually toxic to having an efficient publicly funded system!  This is why the changes put forth in the State Strategic Plan for Improving Behavioral Health Services may indeed manifest as structural changes and may call for more fiscal accountability, but we may still miss the mark as far as human service results  are concerned.

Effective people-serving is best accomplished when the systemic driver is optimal outcomes and these outcomes are defined by the folks intended to benefit by these services.  In order to insure such outcomes, we would need for service system development, service delivery, and service quality improvement to be done with significant and continuous involvement of the people who use them, their families, and those who have first-hand experience with life improvement because they truly have learned what works!  (We pay for a lot of things that do not work!  And we are not paying for some that we know are working out in our communities.  Yet there are dollars existing through federal grants that could be used this way if our state administration would only allocate them to do so.  So will such innovations be sustainable?)  What we need is true, transformational change where we do not just “put new wine in old wineskins,” so to speak.  And we cannot have such change without the Voices of service users, ex-users, family members, well-motivated providers, and others at the local community level who would focus on real solutions!

The world is changing.  Internationally a strong and informed community of individuals–many having lived with mental ill-being, substance use history, or other disabilities–has shifted the paradigm on improving health and mental health of their fellows.  These changes started in other countries and have taken hold in several states in our country.  They are based in the belief that individuals with challenges have important understanding to offer that will enhance the systems created to help them.  Their agency is respected and their families are valued as important system informers, as well.  The deliberate, valued engagement of system users and allies to inform those systems has reduced hospital and other facility utilization, has greatly increased numbers of individual recovery and integration into community life, and has reduced the misunderstanding about the value of citizens with mental health and substance use challenges and developmental disabilities.  We should aim for no less than this, and we should insist upon a plan for real engagement of system users, families, and local community voices as an adjunct to the Strategic Plan for Improving Behavioral Health Services.

What Counts? And is Anybody Counting?

(Posted on FB, NC CANSO EMPOWERS page)

While the public mental health system isn’t the only source of help and support for people with mental health challenges, they are to ensure that citizens with no private means–and that is so many of us!–are given the help they need when they may need it. Are the outputs of your MCO reflected by people living higher quality lives and personal growth or is your area still having growing numbers of citizens appearing in EDs when in personal crises or because they simply do not know where to go?

If you are on a CFAC (consumer and family advisory committee), please ask about the numbers of individuals utilizing Emergency Departments and psychiatric emergency centers, where they exist. Because these numbers are the best indicators of 2) how well people are accessing services before they reach the point of crisis, 2) the service culture and quality with which they are met, and 3) the coordination of the local mental health system, including relationships with community assets that may be best able to help and individual, depending on need.

If you are an advocate serving on a CFAC or not, this is such important information for us to have! We can hardly ask for specific changes to ensure progress in our communities with out such data.

Is no one keeping this data? Then we as caring citizens must ask the legislature and the Department of Health and Human Services to put a focus on these aspects of service.   Because we may be spending way too much money on too few good or lasting results if such things are not regularly considered!

URGENT! NEW SUBCOMMITTEE ON MH/DD/SAS NEVER MET!

🔔
We won’t have a citizen-worthy system unless citizen stakeholders–including those who have histories with these mental health, substance use, and developmental challenges, are engaged and included 
in ensuring that dollars are buying quality for the people served!
 
🔔

 

NC CANSO 
Legislative Alert!
Call on the NC Legislative Oversight Committee on Health and Human Services’ newly established 
 
SUBCOMMITTEE ON BEHAVIORAL HEALTH/DEVELOPMENTAL DISABILITIES  was to have convened in the weeks ahead of the opening of this spring session (March 2).
  1. One of the VERY important aims of this subcommittee is to address the development of a comprehensive plan that would include outcome based measures, clear definitions of the roles and responsibilities of DMA, DMH, and the LME/MCOs.
  2. It would also address how to ensure that our public service systems become TRULY informed by community stakeholders, including CONSUMERS and FAMILY MEMBERS!  
  3. Further, this committee could be the legislative forum that introduces lasting recovery-promoting policies in North Carolina’s public mental health and substance use services system!
 
Without our voices, North Carolina will have industrialized mental health care that reflects productivity, but NOT VALUE!  Help ensure that our dollars are purchasing life-improving outcomes through better informed systems at every level!
___________
Please help now!  Time is essential!
Email or call these Committee Members and interested others.  Tell them that you are concerned about the future of mental health services and the futures of their recipients, and ask them to CONSIDER OUR ADVOCACY EVEN NOW AND BEGIN SUBCOMMITTEE MEETINGS AS SOON AS THE SESSION IS OVER!  
BOTTOM  LINE:  We NEED their efforts!  CALL OR EMAIL Committee members and chairs:
 
From the Senate:
Tamara.Barringer@ncleg.net                       919-733-5653
 
Louis.Pate@ncleg.net                                     919-733-5621
 
Tommy.Tucker@ncleg.net                            919-733-7659
 
From the House:
Josh.Dobson@ncleg.net                                 919-733-5862
Nelson.Dollar@ncleg.net                               919-715-0795
Donnie.Lambeth@ncleg.net                          919-733-5862
Chris.Malone@ncleg.net                                 919-715-3010
___________________________________
Thank you for your
very important advocacy!

DOJ Frustrated About Slow Progress Supporting Transitions out of Assisted Living Facilities

The article below linked was published in Raleigh yesterday, January 19.  This is at least the second time the federal government has expressed concern about our insufficient effort re: the initiative.  For mental health consumers, this is a social justice and civil rights issue.  People in area homes have been placed here from all over the state while the legislature let us develop one of the largest “assisted living” industries in the country.    It takes guts to live in these and more guts to leave after one has become accustomed to custodial care.  

From the Raleigh News And Observer:

Federal government says NC is shirking its agreement to help mentally ill people with housing and jobs

“The state agreed in August 2012 to provide housing for 3,000 mentally ill people by 2020, and supported employment for 2,500 by 2019. The state entered into the legal agreement with the U.S. Department of Justice to avoid getting sued for violations of federal laws that require states to provide services to disabled people in the least restrictive settings. A federal investigation found that the state was segregating people with serious mental illnesses in adult care homes when they were capable of living independently with mental health services and help finding and keeping jobs.

“The federal Justice Department filed the motion on Jan. 9 in U.S. District Court, asking the court to enforce the agreement.”

NC CANSO’s Letter to the Secretary Brajer: Time to Invest in Recovery Through Peer Activity

Dear Secretary Brajer, Interim Director Vogler, Consumer Policy Advisor Ken Schuesselin, Susan Robinson and other leaders:

NC CANSO (North Carolina Consumer Advocacy, Networking, and Support Organization) is a consumer-operated non-profit organization that has been active in our state since August of 2009.  With its limited resources, we have continued to advocate, educate, and developed a vocal network of persons who have lived with consequence of mental ill-being and/or with co-occurring substance use problems.   We move forward on the principle of hopefulness because we know that so many of our fellow North Carolinians—even with severe life struggles or symptoms—can have better lives because of mutual support through peers and other factors, some of which are strengths of our mental health system.

Needs Not Captured by the State                                                                                                     The Board of Directors of NC CANSO is concerned that so few resources are dedicated to developing easily accessible, multi-functioning peer led efforts.  This includes an active, engaged state-wide peer organization that empowers others to recover and contribute to their communities.   This state-wide organization should be engaged with and supportive of the development of peer operated support centers across our state that are “safety nets” to our safety nets, offering supports not reimbursable by Medicaid but essential to the community while helping people to reclaim a social life, gaining self-help guidance and support through easily accessed centers.

Other states have funded such state wide organizations as well as such peer operated supports for many years and find them as a real complement to the formal system of services.  Peer support centers impact individual participants, the local community, and the larger mental health system.  This is evident in the noted reduction of hospitalizations among peer center participants when assessed annually.

For years, consumer advocates have met with officials to urge them to support more consumer engagement in system change and more consumer input into vital issues that may be larger than system developments (such as recovery and rights).  State staff are generally friendly, but there are years of little or usually no follow up to our concerns.  The lack of responsiveness by staff when well-meaning individuals share concerns must make us wonder if we share the same values.  Does the State honestly share the same hope for recovery that so many recovery advocates do?  Why, then, has it taken literally years of discussions and seeming dismissals of ideas with no communication with us?

Our state must address the disparity between the planning and implementation culture of our public human services system and the recovery culture which has continued to grow out in our communities—often outside of the public system.  Certainly, this requires allocation of funding toward new activity, and the one source especially made available to our state for funding such efforts is the Community Mental Health Block Grant.  In fact, in other states, (Georgia, Tennessee, Ohio, e.g.) much of what we discuss here are funded with the MHGB.

The Mental Health Block Grant in North Carolina                                                                  About five years ago, a group of consumer advocates who met regularly with the Division of Mental Health about system issues—a routine that should now be resurrected—inquired about how the Block Grant was used because we felt that new solutions could be funded with some of those dollars.  To our dismay, we learned that 88 per cent of the block grant was giving to the MCOs and 12 percent was used for other specific initiatives.  We were not satisfied with this fact then, and would be far less so now, if those numbers have not changed.  This is because while the system is still very focused on the medical model as the driving approach to services, we need Block Grant dollars to support the less clinical, more psycho-socially oriented supports to recovery, such as peer-operated services.

But additionally, we know that the MCOs under waiver management have put aside enough funds to draw on to serve the underserved through the provider system.  We trust that someone in the state will ensure that they do use these funds accordingly for client care rather than investing them to grow more money.  Anyway, we must challenge the state to put more funding toward progress-yielding solutions instead of putting more dollars toward less effective yields.

But our biggest motivation for the years of advocacy about block grant utilization is that the Federal Government has intended for these dollars to be utilized in ways that promote rehabilitation and functional recovery to the point that there is less utilization of hospitals and other facility based settings.  (United States Code Title 42, Chapter 6A, Subchapter XVII Part B.  See section on criteria for grant on page 1101 of this link:  https://www.gpo.gov/fdsys/pkg/USCODE-2010-title42/pdf/USCODE-2010-title42-chap6A-subchapXVII-partB.pdf )  Can we really make the case that the current service array and how they are managed and administered is resulting in decreasing inpatient and facility care?  Articles in the past two years suggest we need new assets applied to our problems, and we feel that the Block Grant is on source for funding some of these solutions!

The language of the above section addresses service or support needs where peers can serve and can bring expertise to bear which will have improved outcomes while costing less.  The citizens of our state deserve this!  They can bring the hope-based, strengths-oriented philosophy while also utilizing rehabilitative technique and mutuality to support progress in individual lives.  Peer specialists serve well to link their peers to other resources that may be true assets at lower cost to the system—saving costs in the long run.

A Partnership for Progress:  State Leaders and Consumer/Peer Leaders                Additionally, in the states where state-wide peer organizations and consumer operated services are flourishing, it is because of the partnering relationship between state administrations and the lead consumer organizations.  It is evident, given the demise of the past consumer organization, that there has not been the collaboration around ideas, efforts, and outcomes of the organization’s work.  There has apparently been insufficient mutual accountability between the organization and state staff, which would be required for a strong state organization to help lead peers to improved health and mental health.  The absence of such collaboration calls system culture to question.

We cannot improve our shared system without a culture shift toward consumer inclusion and recovery as defined by outcomes.  An enlivened, supported consumer movement is imperative for this to happen!   We must work together to make recovery happen!  Lip service cheapens what this word really means to individuals and their communities!  The peer community wants to work with the state, not tiptoe around and murmur or just dream.  We must engage each other toward shared goals and there must be financial and shared social support before we can truly move toward being a system that focuses on recovery for the citizens of North Carolina.

The efforts of people with personal understanding of illness and how to get well cannot be underestimated as our state seeks to preserve a person-centered foundation during a time when the system is becoming more commercial and industrial.  The industry voice in our state is louder than ever while the stakeholders to be served or those who are their peers and families and who wish to support them are weaker than before.  People are finding themselves feeling even more powerless against such big bureaucracies and even have a difficult time accessing the help they need from such large and often technology-based systems.

Our Ask                                                                                                                                                      We are aware that North Carolina is to submit its MHBG Application in September, and that it has asked for a reiteration of the previous year’s funding objectives.   We ask you to consider that in light of our changing system, the growth of the peer movement, and the need to empower people not just to have symptoms treated but to find wellness and recovery—the application should be altered.

We request that you:

  • Propose to fund a state-wide peer organization with a budget of $190,000.00 or more (I can supply bare bones numbers) with the plan to issue an RFA to include specific objectives and measurable outcomes to be reported. We have already supplied helpful information on objectives and outcomes to Dr. Vogler and other lead staff.
  • Propose the funding of five peer-operated support centers (peer support centers) at $95,000.00 each (I can supply budget information). We currently have several with no sustaining funding but great outcomes.  We can begin with them, because a shortage of peer support volunteers is threatening sustainability.  Foundations wish to help but will not until someone else is a sustaining funder.  We can have a training network as these five refine their operations and show competency in financial management.  Vogler retained a copy of a budget prepared for operating a peer support center recently.

Please, empower us to empower YOU to help our system better serve our communities!

Sincerely,

Laurie Coker, Director of NC CANSO

Ed Rothstein, Board Chair and the Board of Directors of NC CANSO

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.”

WHO IS RON MANDERSCHEID?

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  http://www.newsobserver.com/opinion/op-ed/article48503225.html

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:  http://www.ncspin.com/the-disgraceful-treatment-of-the-mentally-ill/