Putting Care into Mental Healthcare
It was a powerful Expert Night on Mental Health. As we all grappled with the challenges of how we can prioritize mental health in our country, we also reflected on the very personal nature of this theme for all of us. As member Leti Light said, “this is real for us.”
For a recap of the evening’s discussion, read on.
Epidemiological Crisis of Despair
“Our culture is in trouble and it needs to heal,” said Alex Briscoe, Principal of California Children’s Trust. Suicide claimed over 47,000 lives in the U.S. in 2017, an increase of 33% since 1999, while many other developed nations saw a decrease in that time frame. More armed service members die from suicide each year than the number of lives lost during the operations in Afghanistan and Iraq.
And it’s not just suicide. You need look no further than our own streets to see the toll that unaddressed mental health is having on individuals and communities.
Many are calling it a mental health crisis. But it’s important to note that, as Tom Insel, Special Advisor to Governor Newsom on Mental Health, pointed out, “when we talk about the mental health crisis, we are talking about a failure of care” not a dramatic increase in the prevalence of mental health conditions.
Photo Credit: Marla Aufmuth
The Kids Are Not Alright
“What will the most prosperous nation in the history of the world do when it wakes up and finds that twice as many of its children are trying to kill themselves?” Alex asked. Because that is what has happened: hospital admissions for self injury by youth increased by 104% from 2006-2016. As Alex pointed out, it’s our kids telling us it’s really hard to be a kid right now.
Photo Credit: Marla Aufmuth
A key problem in how we deliver “care” to young people is that we wait for them to fail into care. Behavioral issues go unsupported until they lead to interventions delivered through institutions: special education, child welfare, juvenile justice. But yet part of growing up is failing and falling down. Young people need protective factors as they grow -- like a trusted adult in their lives beyond a parent, and the ability to reframe their experiences -- and many communities currently lack these.
Jails Are Not Mental Health Facilities
Far too many people end up incarcerated for exhibiting the symptoms of their mental illness. And we often hear that jails are our largest mental health facilities in the country. Keris Myrick, Chief of Peer Services for L.A. County Department of Mental Health, took issue with that: “Jails are not a mental health facility, they are jails.” Calling a jail a mental health facility creates an inaccurate picture of mentally ill individuals as criminals and overstates the mental health “care” that is available in jails.
There are solutions that are working in some parts of the country that could be imported to California. For example, Maricopa County in Arizona has a coordinated system that starts with a 988 (rather than 911) number to call when someone is experiencing a mental health crisis. The police do not respond to these calls; instead, a van shows up with a nurse, social worker and peer. They support the individual and get them into care at a crisis stabilization center or psychiatric ER, seperate from the regular hospital system. And, importantly, as Keris pointed out, restraints and seclusion are not deployed.
Alex also offered solutions for youth that include a heavy investment in school-based mental health systems, care offered in communities and homes, and a diversion program at the door of the jail that keeps kids out of jail, because “it’s a really bad place for kids.”
Redefining Care
Keris was diagnosed with schizophrenia and noted the care she received “wasn’t caring at all”. One early interaction she had with the “care” system was with the police. And while she acknowledged that police do helpfully step in when someone’s having a baby or a heart attack, that intervention does not involve being handcuffed and put in the back of a car, like it often does for someone having a mental health crisis.
Photo Credit: Marla Aufmuth
Once in the “care system”, the focus tends to be exclusively on a person’s illness and symptoms. Oftentimes goals are framed around taking your medication. But as Keris noted “have you ever heard of an asthmatic’s life goals being to use their inhaler?” Someone with a mental illness is much more than their illness and has life dreams and goals.
Alex noted that currently there are very few services that exist where people live, work and play, in non-stigmatizing contexts. And the workforce does not look like the population they are serving. Convenience is something we have come to expect and demand in our lives, but mental health support is built around the payers and providers, not around the patient’s needs, convenience, and culture.
The Solutions are Hiding in Plain Sight
The panel agreed that our current medical model is not sufficient - or as Tom put it, “I don’t think most people want to buy what we are selling,” So what’s to be done?
- Social solutions are critical. Moderator Yana Jacobs, an MFT and 40-year veteran in the field, emphasized that whatever the model, “you have to see the human connection”. Social connection is vital to heal people and improve mental health in our communities.
- People with lived experience must be part of designing the solutions.
- Our care system should focus on a person’s strengths and build out care plans that draw on those strengths. In other words, care that looks at the whole person and treats the whole person, not just their illness.
- A coordinated system is needed. In Tom’s travels to most California counties to learn about their mental health care system he found many bright stars, but the various pieces weren’t linked up to deliver optimal, coordinated care. A Governor’s Task Force on Mental is working on that now.
- Investing in peer support is a win-win. It helps solve the shortage of mental health professionals while strengthening cultural competency and increasing the number of professionals who look like the people they are caring for.
- Public-private partnerships are the future. Medi-Cal alone cannot fix the system. Private and public payers and providers must come together to reimagine the care system.
Hungry for more? Check out our Issue Brief on Mental Health.
Our theme on Mental Health continues on February 24th with Organization Night. Our 12 finalists for a grant will be presenting about their work. You can RSVP here.
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