Saturday, December 21, 2013

Visions for the Future of Mental Health Care




Updated and partially re-written, July 2015

In the nineteen or so months since I first wrote this I have seen nothing to show me that the need for a facility of my vision has declined at all, in fact I just see more and more people slipping through the cracks of the mental health care system. 


I say mental health care but I don't really mean that. What I mean wouldn't fit neatly into a headline, though. What I mean by mental health care is advanced care for those specifically with schizophrenia, advanced bipolar disorder and major depressive disorder. You know, the hard cases. These are the people that the current system is failing so badly. The numbers speak for themselves. I won't get into them but research the numbers of suicides related to these three, research the numbers of people on the streets related to these three and research the numbers of people on permanent disability related to these three. Spend some time doing that - with a little old fashioned gumshoe street work thrown in to put faces to the numbers - and tell me how the current system is not failing these people. You can add my face to the numbers as well if you like - I am a textbook example of how the inept mental health "care" system - one based on drug therapy that's been proven in long term studies to not only be ineffective but also cause long term brain damage - has been utterly failing a very large number of people. 

There are other reasons people slip through the cracks that social scientists and those in the mental health care system simply do not understand.

Many of them will fit into two categories:

One, they will reject traditional diagnostic methods and drug treatment for their disorders. There are long reasons for this which I'll have to dedicate a separate post to but going on my own experience, the many people I have met in psychiatric hospitals and got to know as human beings (rather than "psych patients") and in talking to street people, these people become very hurt by and deeply mistrustful of the mental health care system, psychiatrists and drug therapy (which for them will be forced drug therapy). So they avoid the system even if at some level they know they need help.

Two, is that they tend to be very proud, independent people who want to be self-reliant and feel deep uncomfortable living on hand outs. They want mostly to take care of themselves in their own ways. This does NOT mean, as many mistakenly assume, that they "choose" the streets, it's just that all the alternatives are too difficult for them to bear and to negotiate. 

I have spoken to many of these people (and met them and got to know them) and they are at their core good, good people. But between mental health issues, the stigma and rejection of society and the cycle they become trapped in, they end up in untenable situations. 


My vision is for specialized long term treatment facilities for those disabled by one of these three disorders or those as I described above. The facility of my vision offers the best hope for people in this category of mental health problems. 

I can't even begin to tell you the mountains of research and reading I put into this, not to mention my not inconsiderable experience of being "on the inside" of the current mental health "care" system. 

This is what I want my true legacy to be - to see this vision realized. It would take massive efforts and real courage but it's doable. As government agencies are too closely tied to pharmacological and mainstream psychiatric models, it'd have to be privately run and funded. 

In the grand tradition of visions for the future, I bootstrap off of past or present successful models. They are as follows:

Soteria House:

Founded by Dr. Loren Mosher in the early 70s, Soteria House was a long term treatment facility for those diagnosed with schizophrenia. No medications, no doctors. NONE. And this was one of the most successful schizophrenia treatment programs in history. Patients lived there and interacted with each other and grad students (I believe ... not professionals at any rate) who received a bit of training. The patients could live in a low stress and embracing environment where they were free to talk out the workings of their inner minds in a non-judgmental environment. And patients by and large got better (which is defined by being able to return to work, raise a family and other basic societal norms). This is not the case with most people diagnosed with schizophrenia today. 


Hearing Voices Network:

I have personal experience working with a local chapter of the Hearing Voices Network. HVN provides a network of chapters that provide peer to peer counselling for those who, as their subheading reads, "hear voices, see visions or have other unusual perceptions" in a non-medical, non-judgmental setting. There is nothing, I can tell you, like peer to peer discussions about the mental phenomenon we experience for working through these issues and not be made to feel "wrong" or "broken" or "diseased" or otherwise judged. Unlike in talking with various "doctors" from the mental health care industry (psychiatrists, psychologists, medical doctors, and others), you talk with people who actually know what it feels like and who take a non-diseased approach to unusual mind phenomenon. My facility would provide a similar atmosphere and approach.  

Delancey Street Foundation:

Founded by Mimi Silbert in the 70s, Delancey Street Foundation has been doing the impossible for thousands of people for four decades. It takes the worst dregs of society - people labeled by "the establishment" as psychopaths, sociopaths and hopeless career criminals - and makes functioning human beings out of them that return to society. We're talking career prostitute drug addicts, pimps, gang members and all manner of "human garbage" that society seeks to lock away for ever then completely rehabilitating them and re-integrating them into society. Her success rate is vastly, vastly superior to the prison system. And get this - she does it alone. No staff, no doctors, no guards, no warden, no bars, no cells - nothing. She stands maybe 5' 1" and she handles about 1,500 of these career "scumbags" at a time by herself. No, I am not making this up. Mz Silbert and the Delancey Street Foundation is easily one of the most inspiring examples of what's possible for human recovery you could possibly find. 


Dr Dean Ornish's program:

Dr. Ornish also does the impossible - he turns around heart disease among those for whom triple or quadruple bypass surgery is the only option for living. Other than himself, there are no doctors, no hospital, no drugs, no surgery - nothing. It's all diet, meditation, yoga and a few other simple lifestyle changes. 

There are a few things that all of these have in common. One is that they are amazing examples of and inspiration for what is possible in human change and recovery. Two is that they are all long term residential facilities or programs. People stay in them for long periods under guided care. Ornish's is the shortest - about six weeks if memory serves - but it has long term follow up. Silbert's is the longest; a minimum of two years. The common theme is that the patients are in a structured environment tailored to their needs. I'll return to this in a moment. First I have to introduce:

Neuroplasticity: 

The brain is not set. It can and will change itself. It will rewire around horrifically damaged areas (like in stroke victims) or in the cases of blindness, it'll "remap" and restructure areas to boost other brain functions to compensate. It'll do this naturally on its own but that does not always lead to the desired results. It works best in structured environments (do you see where I'm going with this?). Neuroplasticity is a sexy popular term that gets thrown around a lot now. But the rub is that it needs structure and repetition - neurons that fire together wire together is how it essentially works. And it needs that "fire together" to happen repeatedly and in close time proximity, two things for which a structured environment and program work best. Hence the above three facilities. Silbert doesn't know this, but her program produces massive plastic change in the brains of her wards - that's how they change from sociopathic criminals into empathetic mainstream citizens. 

Edward Taub of the Edward Taub Clinic pioneered a unique therapy for stroke victims based on the principles of neuroplasticity and this too, I believe, serves as a good model. Again, the patients stay in the facility for extended periods receiving much personal help and encouragement. 

Now, my own thoughts. 

For people with major mental illnesses, the only course of hope is to move forward. But here's the rock and hard place catch-22: A) they cannot do it alone and B) their very brain conditions rob them of the mental faculties to move forward. In order to move forward, they need to be able to work and take care of themselves. Living normally like this is what true recovery is but they can't take care of themselves or work due to their mental conditions and society's view of them (which is not dissimilar to how society views the career criminals that Silbert turns around and enters into society) so they're stuck. 

The only way these people can truly be helped is in a long term facility that A) heals their minds, brains and souls and B) teaches them job and life skills that will help them return to functioning within society. I am not aware of any facility like this. Psychiatric wards certainly don't do this (ask anyone with one of the illnesses I listed who has spent time in one). Public mental health programs try to help with job skills but don't provide long term living and treatment facilities. It's a real crack in the system. When you hear of people "falling through the cracks of the system", this is the massive chasm into which they fall. 

The facility I envision would be the net at the bottom of that chasm. 

In the facility I envision people would get a highly specialized program designed to heal their minds through neuroplasticity, would have a safe, peer supported environment in which to recover from the rigors of life in a society that has rejected them and heal their ravaged souls, and they'd learn job skills that would help them build dignity and esteem and get truly back on their feet again. The program would involve specialized forms of yoga and meditation specifically designed to "build up" the brain regions that are misfunctioning or underfunctioning or, in the case of the ever overactive amygdala in the majority of people with difficult cases of mental illness, calm down brain regions. Jeffery M. Schwartz deals with OCD and other disorders very much in this way, using no medications. There would be much peer to peer group work and individualized therapy. 

The Delancey Street Foundation provides the financial model; aside from doing all this remarkable work by herself, Silbert's program is - get this - completely self funding. She gets no government grants, no private grants or funding - nothing. The program entirely pays for itself (which is why it works). 

The present dominant paradigm of mental health care as run by the alliance between the psychiatric and pharmaceutical industries are not making mental health problems better. Statistics bear out that things are instead getting far worse (and all predictions are for that trend to continue). It is time for widespread alternatives to psychiatric hospitals and forced drug therapy. My vision is an attempt to give an idea of what one alternative might look like. 

Additional notes added June, 2014

A great deal of the daily activities of the program I envision to help heal these people minds and to help their ravaged cells in their brains and bodies recover would revolve around the following:


  • Music therapy. There's just an enormous amount of evidence pouring in from the fields of neuroscience that show the kinds of benefits for the brain that come from regular and carefully directed music therapy
  • Dance therapy. Same benefits as music but with an additional physical component
  • Art therapy. Like music and dance, it opens up and stimulates vast areas of the brain that can help facilitate emotional, spiritual and physical recovery 
  • Yoga, meditation and qi-gong. All of these have been demonstrated for thousands of years (and now through more scientific research involving advanced brain scan techniques) to greatly ease and reverse the damage from chronic stress (which will be a major part of what all mental health patients will be battling) along with building healthy new attitudes and outlooks as well as establishing essential daily physical exercise routines
  • Lifestyle management skills. This would involve specific meal preparation skills in which patients would learn nutritional therapy from shopping to meal preparation
  • Cooking therapy would be part of the above. Learning the joys of preparing oneself nutritional, tasty and inexpensive meals. Proper diet is a huge issue and shortfall in many suffering long term mental health issues
  • Peer to peer counseling and support based on understanding and compassion, rather than the stigmatizing judgment most people are subjected to
All of these daily activities and routines would be built on the foundation of rebuilding the esteem and souls that have been decimated by years of living with one's mind torn apart by inner turmoil, being rejected by society and kicked to the curb of life. 

It is simply not necessary for these lives to be wasted in this way. A great deal of recovery can be achieved and a return to productive society attained.

As of this writing in July 2015, a small groundswell of support has begun to start bringing this vision to fruition. 

Taming the Polar Bears is going to be registered as a charitable foundation able to take in donations for and do fund raising for establishing this much, much needed facility. 

I am hoping an announcement regarding this will be forthcoming in the next few months (though I am in the midst of considerable challenges myself). 

Bradley Esau




7 comments:

  1. Brad: check out http://www.gouldfarm.org/ I know it's in the US but it seems to be what you're talking about.....

    ReplyDelete
  2. I have a nutrition background and taught High School Foods for several years. I would help. The problem is finding a facility where people won't have a fit where it is located. I think a ranch would be the best place. There are treatment centres for drugs and alcohol like that, funded by the government. A place for the hard to treat mentally ill is needed. I like your ideas Brad.

    ReplyDelete
  3. Thanks, Trudy. Yup, that's what I'm thinking, a rural ranch or farm which would be ideal because growing food for the facility on site would be a big part of it.

    The facility of my vision would be self funded, not dependent on government funding (there are important reasons for this).

    ReplyDelete
  4. This is written very well you are a very good writer and you know what we want. I am agree with you. Hope you will Carry own writing in the same way. Thumbs Up!

    Taking Care of Your Vision

    ReplyDelete
  5. Sounds like a great and could be very successful! Looking forward to future posts!

    ReplyDelete
  6. Sounds like a great and could be very successful! Looking forward to future posts!

    ReplyDelete