State Mental Health Hospitals – Lost in the Past

The padded room. The straight jacket. The nurses tightening the leather confines on a writhing patient. That is the image that comes to my mind when I hear “state mental health hospital.” Unfortunate as it may be, this is not an entirely outdated image. While community- and university-based treatment facilities for mental illnesses have slowly begun progressing into recovery-based approaches, state hospitals on the eastern reaches of the country seem to be lost in the past; focusing on stabilization rather than treatment.

In the 1950s, those with mental illnesses were seen as societal misfits and were, consequently, jailed. The prison system became stressed and, as a result, the government issued funding for the creation of mental health asylums and hospitals. It is more then mere coincidence that such facilities were constructed directly next to state penitentiaries.

As mental health hospitals cropped up along the eastern coast, the mental health population was transferred from jails to asylums. Yet something was still wrong; the focus was still on simply removing the individuals from society. In the opinion of many practitioners, the purpose of hospitals was, to a large extent, to warehouse humans rather than to treat mental illnesses. Even for the most well-intentioned facilities treatment was largely an impossibility; the staff to patient ratio was incredibly imbalanced, meaning stabilization, rather than treatment and progression, became the priority.

But mental health workers did the best they could do with what they were given, and such workers should be commended and applauded for their bravery and devotion. As the years have progressed, treatment facilities have become far less stressed, making quality treatment within a state hospital a possibility in regards to patient-staff ratios. Unfortunately, as the mental health community has progressed into the concept of mental health recovery rather than mere treatment, the state institutions have not yet followed.

State practitioners still largely focus upon stabilization rather than systematic recovery. The difference is in the end result. Recovery focuses upon creating an improved living condition wherein those suffering from mental illnesses can continue to live rich, fulfilling lives while living on their own and being self-sufficient. Recovery is also largely driven by the consumer rather than the practitioner. Treatment and stabilization plans, on the contrary, do not focus upon self-empowerment and enrichment, but rather upon finding the right combination of medication to insure minimal down-spirals while the mental healthcare consumer remains in their current condition. Stabilization tactics are also largely driven by the mental healthcare practitioner, thus lack motivation goals innate to inwardly driven recovery methods.

The problem arises in the fact that stabilization might truncate symptoms with medication at a certain level, but such a treatment plan does not encourage a reduction of symptom interference levels or self sustainability. Stabilization of mental illnesses assumes the current condition of the mental healthcare consumer is as good as their life is going to get; the assumption that one can recover from a severe mental illness to live a fulfilling, successful life is not even made evident.

Mental illnesses and mental recovery demand a systemic, systematic treatment plan that addresses several factors of an individual’s life. The social network needs to be addressed. Housing needs to be addressed. Employment needs to be addressed. And yes, medication and symptom stabilization does need to be approached as well, but it is one factor of the overall treatment plan, not the entire purpose of mental healthcare systems.

To find out more about recovery-based facilities, check out the Mental Health Center of Denver’s homepage at MHCD’s homepage, or access their research and evaluation team’s homepage at Research and Evaluations.

The mental health recovery movement is continuously growing. State institutions are a great improvement over mental hospitals of the past, but the road to recovery lies in mental health recovery based approaches; those that treat multiple levels of a consumer’s life simultaneously. Recovery needs to be the focus, not stabilization. Fulfillment rather than existence. Happiness rather than mundaneness.

– Lex Douvasa

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Peer Mentoring and Mental Health Recovery

A peer mentor is typically seen as someone to look up to in a professional sense; someone who knows the ropes, someone to guide you, someone to protect you from making the mistakes they made, and someone to go to when you are unsure or need advice. Peer mentors exist at the school level with upper classmen mentoring underclassmen, and are a well established institution in numerous professions. Recently, however, the use of peer mentors in the mental healthcare field has found its way into American practices. Interestingly enough, peer mentors for mental health recovery treatment plans differ quite remarkably in reference to their duties between the American model of support and that developed by practitioners in the United Kingdom.

In cutting-edge American mental health facilities, one is beginning to notice the development of peer support groups and peer mentors. These peer mentors are mental healthcare consumers well on their way to successful recovery who have been employed by the facility they are receiving care from to help those at lower functional levels with similar diagnosis.

The benefits implicit therein are that the peer mentor has first-hand knowledge of what the mentee is experiencing. They understand the withdrawal pains. They can empathize with the frustrations of self-forgiveness. And they can guide mentees to more productive paths. Furthermore, peer mentors humanize the face of mental healthcare for each individual consumer; the treatment becomes relatable and believable because it is coming from the mouth of someone with the mentee’s very same diagnosis who has picked themselves up, dusted themselves off, and made a success of themselves with the prescribed treatment plan.

In the U.S. context, peer mentors are typically a supplementary service; they are not primary care, they merely act as another factor of treatment. They exist to teach mental healthcare consumers how to function properly in the world again; mentors teach mentees how to get to the bus, how to get a transit card, where to get their groceries, where the bank is, etc. Professional providers still maintain their position as primary care giver and occupy the main psychotherapy role. Mental healthcare consumers argue this is very beneficial for mental health recovery, but would like to see more out of their peer mentors.

In the United Kingdom, however, peer mentors almost take the place of primary care givers in regard to psychoanalytical duties. When an individual with a mental illness experiences a downswing, it is their peer mentor who receives a call, not their doctor. This comes at a loss, however, for in taking on such a high-level role, peer mentors in the United Kingdom tend to ignore lower-level functions such as re-educating their mentees on the necessities, such as how to catch the bus, where to get their transit pass, etc with the expectation that the mentee’s support network will take on such duties.

The inconsistency in how the concept of peer mentors and peer support groups is approached is symptomatic of the differences between American and U.K. mental healthcare beliefs. In the United Kingdom, mental illnesses are seen as a communal responsibility; they are not shameful, it is merely the job of an individual’s support network to emotionally and physically encourage the individual throughout his/her treatment plan. In the United States, however, a mental illness is seen as an impurity in the family, and is followed far too frequently with alienation from social support groups.

Thus the U.K. peer mentors, as in following with their culture, take the lead in guiding mentee’s through troubled water they have already traversed. In America, mentors must take on the lonely role of the mental healthcare consumer’s only support group, thus teach them the necessities of life while leaving psychological treatment to the doctor.

Both approaches have their benefits for mental health recovery. Consumers seem to indicate preference towards approaching their peer mentors with day-to-day problems rather than a psychologist or psychiatrist who may sympathize, but not empathize, with their diagnosis, thus profess favoritism towards the U.K. model. Contrarily, however, one cannot change an entire culture, and American consumers enjoy the basic knowledge bestowed upon them by peer support groups; thus express a need for the American style as well.

Peer mentors can prove immensely influential in mental health recovery with regard to providing motivation and hope. Hope is a critical factor in recovery from mental illnesses, as can be read in my article Spirituality and Hope in Mental Health. Peer support, and its role in mental health recovery, is yet to be firmly established in the American context however; thus we must wait with abated breath as the movement grows to see what role peer mentors will take on next.

-Lex Douvasa

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