What We Talk About When We Talk About Mental Health
Past and present members of the Hogg Foundation National Advisory Council peer around the corner toward the future of mental health in America.
We asked current and former members of our National Advisory Council for their thoughts on what they saw as the future of mental health in America. Their responses were edited and arranged by theme.
Defining the Future
I suspect that the future will discard the label “mental health” in favor of “brain health.” The word “mental” has so many incredibly negative connotations to it. It perpetuates the stigma around particular diseases. If we are able to find the things that afflict the brain and cause disease, without being so attached to the strange behaviors that we associate with people suffering from brain disease, I think we’ll make far greater strides.
Mental health is like an adolescent, struggling with issues of its identity, voice and relationships. In many ways, it is not much different from when Ima Hogg endowed the Hogg Foundation for Mental Health. There have been great advances in all aspects of mental health, yet tension persists between those who believe mental illnesses are biologically predetermined and those who believe life experience plays an equal role. There’s also a lack of clarity about whether mental health treatment is a part of the medical “home” or even a member of the family? Are those who receive treatment and support patients, clients, consumers or just “Joe”? As I listen to the chatter, it is sometimes difficult to determine whether mental health services are a part of the healthcare, social welfare or criminal justice systems. Therein is the rub; it isn’t clear at all. That lack of clarity leads to a divided voice for advocacy, and has enabled mental health care, and persons with mental illnesses, to be marginalized. How we meet these challenges will define our future. Will we find the elusive common ground? Without that shared voice, that common ground, the future will be pretty much a reflection of the past.
I hope for a day when every person who experiences extreme emotional states is given the respect, hope, emotional connection, and involvement in the decisions affecting their lives that they can heal and recover full, meaningful lives in the community.
I hope for the day when rather than being seen as threats to society, we will be seen as a source of wisdom that we obtain through our recovery which will be valued and incorporated into the fabric of the system and society.
I hope for the day when all suffering will be seen as understandable human responses to trauma rather than a chemical imbalance or malfunctioning fear circuit.
I hope for the day when it will no longer be necessary to isolate persons in distress in traumatic psychiatric hospitals because voluntary community-based, recovery-based, trauma-informed services and supports will be universally available.
I hope for the day when the mental health system will be run by persons with lived experience of recovery from extreme emotional states, because we are the ones who truly understand the type of compassion and emotional connection needed to facilitate healing.
Mental health services will increasingly need to be integrated into physical health services. This will be especially important for communities of color and socio-economically disadvantaged populations who are much less likely to seek mental health services. In many instances, individuals from these communities are going to be more responsive to the primary care physician regarding mental health issues than they would be with a mental health professional. On the one hand, this is an unfortunate by-product of the continuing stigma of seeking mental health services. At the same time, however, I think it will ultimately benefit the mental health profession, because it’s more aligned with the understanding that health consists of an inextricable link between the physical and mental.
Mental health is at a crossroads in this country. With the passage of the Affordable Care act, there are renewed opportunities to focus on integrated care that includes mental health as a key component of improving the overall health outcomes for individuals living in this country. The Hogg Foundation has played an important role in defining the issues and can continue to help communities negotiate the future landscape.
The potential for integrating behavioral health with primary health care is very exciting. The diagnoses and treatments from both sides support each other. There is a long ways to go on that, but certainly I think that with all the federal legislation and changes in the health care directives, that that is really where our world in the U.S. is turning toward: the complete integration of primary with behavioral health.
For too long, behavioral health has been treated as a stand-alone form of care delivery. The future is going to be around integration with chronic care management and overall population health improvement. Those two angles, or whoever can figure that out, are going to be where all of the action is.
Efforts at integrating behavioral health care for low income and ethnic minority populations has taken a huge step forward through the expansion of coverage for behavioral health conditions under the Affordable Care Act These efforts need to remain a focus and prior- ity for the health philanthropy field in order to insure systemic change and uptake of best practices going forward.
Even More Integrated Care
There has to be a way to strengthen the role of community in wellness and recovery. The behavioral health field is trying to transition from a “treatment episodes” model to an overall wellness model, but we have quite a ways to go in the transition. All of the words are there, but the training and all of the things necessary for a practical transition are not yet in place. With the shift to an overall wellness model, we can still provide effective treatment while also helping the person find a positive place in their community. Without that community context, treatment is short-lived. Another good thing about the overall wellness model is that culture comes into play, and this can be another way of strengthening gains from treatment.
Mental Health 2.0
We have to figure out how to use smartphones as mini-treatment providers in some ways. When you look at younger people now, and how their smartphones have become an appendage and a comfort zone for them, you just know that there has to be a way to use that technology. –Holly Echo-Hawk
The trick with mental health has always been two challenges, it seems to me: One is the financing of community mental health services, which has never been great, combined with the deinstitutionalization of mental health services decades ago. The other issue is finding innovative ways of delivering mental health services that can leverage advances in technology — mobile apps, telemedicine, videoconferencing and things like that. The reason those two issues are of particular importance is that I think if there are ways to creatively come up with, for example, telemedicine behavioral health services, one, it would reduce costs, two, it opens the door for creative financing mechanisms, and three, it leverages the available technology we have currently. I don’t think we’ve done a good job leveraging our advanced technology in common with providing care and services and supporting individuals in real-time.
When I try to see way out into the future, and I think about all of the new and exciting medical technologies that are being created, I think that we’ll get close to bringing about a lot of healing, because I think that we will find a great number of remedies for many these of conditions that affect the brain.
The increased visibility of violent public shooting incidents has the potential to provoke a backlash against the mentally ill, if thoughtful and well-informed advocacy and education about the reality of the link between mental health and violence is not disseminated along with the horrific stories.
We need to continue trying to inform reasoned policy on “assisted outpatient treatment” and other involuntary treatment models, as well as address the issue of our jails being used as acute care providers of last resort. The Hogg Foundation has been extremely helpful thus far. However, I fear that Rep. Tim Murphy’s bill, which considerably relaxes standards for involuntary treatment, will have unwelcome consequences. Capacity, capacity, capacity is the issue here — and by that, I don’t just mean “beds.” We focus too much on furniture and buildings and not enough on the workforce and training.
One challenge facing those interested in mental health is the disproportionate level of resources that are going towards the primary care setting. This should not be an either-or situation, but the reality is that primary care settings are often not properly equipped to handle complex mental health issues.
Domingo Barrios is Chief Development Officer with The Rose, a breast healthcare organization in Houston, Texas. He has served as Chief Executive Officer with Heifer International Foundation and Vice President of Greater Houston Community Foundation, among other positions.
Dennis Mohatt is the Vice President for Behavioral Health for the Western Interstate Commission for Higher Education (WICHE). He serves as the Director of the Mental Health Program and the WICHE Center for Rural Behavioral Health Research.
Kevin Cokley is an Associate Professor of Counseling Psychology and African and African Diaspora Studies at The University of Texas at Austin. He is the Editor-in-Chief of the Journal of Black Psychology.
Daniel Fisher is a Co-Director of the National Empowerment Center in Lawrence, Massachusetts, a consumer-run research, training, and information center, which he helped found in 1992.
DJ Ida has over thirty-five years experience working with Asian American, Native Hawaiian and Pacific Islander communities and currently serves as the Executive Director of NAAPIMHA.
Holly Echo-Hawk is the founder of Echo-Hawk & Associates, a consulting company specializing in children’s mental health. A Native American with both rural and urban experiences, Holly brings unique insight into the disparities of mental health access for ethnic minority families.
Roderick King is CEO of the Florida Institute for Health Innovation, and an associate professor in medicine and public health at the University of Miami. He holds faculty appointments at the Harvard Medical School and Harvard School of Public Health. His academic work, teaching and key consulting roles focus on minority health policy.
Mary Rainwater consults with nonprofit and government health, mental health and philanthropy organizations and academic institutions. She has extensive expertise in the areas of mental health, the delivery of integrated health services to underserved communities and designing and developing programs for special populations.
Sue E. Estroff is a professor of social medicine and adjunct professor in the departments of anthropology and psychiatry at the University of North Carolina at Chapel Hill. She studies sociocultural forces that influence the biographical experiences of persons with disabling chronic illnesses.