May is Mental Health Month — 31 days dedicated to raising awareness for, and breaking down stigma against, the tens of millions of Americans who will experience a mental health or substance use disorder each year.
We’re halfway through the month and so far we’ve shared information about how policymakers can improve America’s mental health and addiction care systems by investing in prevention and prioritizing access to affordable treatments and services — but the mental health journey doesn’t end with prevention or early intervention. Often, that’s just the beginning of a longer journey.
While nearly one in five Americans — tens of millions of people — will experience a mental health or substance use condition in any given year, less than half will receive any treatment. Even for those who do receive services, though, treatment does not guarantee long-term recovery. That’s why bolstering recovery services and supports is a crucial component of addressing the nation’s mental health and addiction crises.
Recovery based on evidence, not stigma
Due to years of stigma and inaction, many of the recovery treatment and services in the current mental health and addiction care system relies on misconceptions and antiquated beliefs. If policymakers are serious about addressing the mental health and addiction crises, it is crucial that behavioral health and primary care treatment providers follow science rather than stigma.
Like those living with diabetes or cancer, patients living with mental illnesses such as depression and anxiety require personalized treatment and support services. Measurement-based care models for mental illness and addiction allow providers to get people the help they need earlier, and if the prescribed treatments aren’t working, the provider can adjust the care plan to address the patient’s specific needs. This video from The Kennedy Forum has more on the benefits of measurement-based care models:
Policymakers must also work to expand the use of evidence-based practices that support long-term recovery and care for the whole person.
In the case of opioid use disorder (OUD), for example, we know that abstinence-only therapies alone do not address the physiological needs of those living with addiction. Medication-assisted treatment (MAT) — an option that combines the use of recovery medications, counseling, behavioral therapies, and social supports — is considered the gold standard of care for those living with OUD because it helps stabilize a person’s brain while addressing the psychological components of addiction. However, only about 5% of American physicians can prescribe recovery medications. It would be inexcusable in America to deny those living with diseases like diabetes or heart disease medication that’s been scientifically proven to successfully treat their illness, so why would we tolerate a system that does that for those living with addiction?
The mental health and addiction communities understand the importance of prioritizing evidence-based services, now we just need the resources and investments necessary to get it done. If you’re interested in learning more, Shatterproof, a Mental Health for US coalition member, has more information on the importance of implementing MAT programs in addiction recovery settings.
Additionally, SAMHSA offers a comprehensive resource center for communities, clinicians, policymakers, and others in the field tools and resources that can help incorporate evidence-based practices into their communities or clinical settings.
Wraparound recovery supports
People living with mental illness, especially serious mental illness (SMI) and substance use disorders (SUD), rely on stability to recover, but so much about the current mental health care system is unstable. The lack of accessible, affordable, and timely treatment and recovery services has left many without the support they need and diverted people away from care and towards hospitalization, homelessness, or the criminal justice system. This, of course, makes long-term recovery hard to achieve. People living with SMI/SUD deserve community-based social supports that recognize their inherent dignity and provide the support they need to maintain their recovery.
The lack of affordable housing across the country affects a number of populations, but especially those living with SMI/SUD. For our readers who are not living with SMI/SUD, let’s try a little experiment: Imagine you’re an individual living with SMI or SUD and you’re unable to work while also maintaining your recovery. You rely on your monthly Social Security disability check to survive–with an average of $752 per month, you’re expected to put a roof over your head, put food on your table, cover the costs of for your medications, and pay for transportation to and from your treatment. Now consider the fact that the average national rent for a studio apartment in 2016 was $752 and the cost has only gone up since then. How can anyone possibly be expected to maintain stable housing and pay for their SMI/SUD treatments when rent alone is 99% of their income? This impossibility is just part of the reason that adults living with serious mental illness and/or substance use disorders make up 46% of homeless adults within the US.
Now imagine a future in which supportive housing is made available to those who need it. Housing that offers individuals a safe, warm place to call home and, if they accept it, would provide the treatment and supportive services they need to achieve long-term recovery. Imagine if people with SMI/SUD had access to peer supports that could connect them to community-based services that care for both the mind and the body. If those in recovery from mental illness or addiction had access to a quality education or could receive job or skills training that would help them earn a steady income and contribute to their communities. Finally, imagine a future where people living with mental illness and addiction can receive the care they need and dignity they deserve without having to fear being diverted to the criminal justice system.
This world can be a reality if our policymakers choose to take action and make community investments that protect and expand programs that provide supported housing, peer and caregiver support, system navigation, medication-assisted treatment, community integration, job and skill training, and education for all people with mental health and substance use disorders.
The mental health and addiction community has shown that recovery support services like those mentioned above work. For example, “housing first” programs have been proven to improve lives, generate savings to public systems, and benefit the communities in which they reside. Additionally, programs like Mental Health America’s “It’s My Life” — which combines peer supports, psychiatric rehabilitation, and the emerging best practices of self-directed care — have successfully allowed individuals with SMI to build supportive and sustainable relationships that increase quality of life while reducing crisis events and hospitalizations.
Treatment alone often does not result in the kind of positive long-term outcomes we’d expect from a comprehensive mental health and addiction recovery program. A wide variety of recovery services, treatments, and supports should be available to those who need them.
Expanding peer support programs
Whether we’ve experienced it in a treatment setting or not, we all know what it feels like to build a connection with someone who has had similar experiences to you — someone you can go to for advice or who is there just to listen. Peer support programs are an intentional way of building these connections in a clinical or community setting.
The concept of peer support programs is neither new nor specific to mental health and addiction care. In the late 1700s, clinics would hire recovered patients to assist with “moral treatment.” Since then, various forms of peer support have been utilized in just about every branch of medicine that deals with chronic conditions,including asthma, cancer, diabetes, and hypertension. However, research in the last several years has shown that peer support programs are especially beneficial in long-term mental health and addiction recovery.
According to Mental Health for US coalition leader the National Coalition for Mental Health Recovery, a peer specialist is any person with mental health conditions who have completed specific training that enables them to enhance a person’s wellness and recovery by providing peer support. Research aggregated by Mental Health America has shown the use of peer support improves overall quality of life, increases and improves engagement with services, and increases whole health and self-management. These programs have also been proven to lower the overall cost of mental health services by reducing re-hospitalization rates and days spent in inpatient services.
Policymakers have the opportunity to improve the patient experience, provide more people with the care and support they need, and save money along the way — we must protect and expand the use of peer support services and peer-led programs like:
Developed in 1997 by a group of people who were searching for ways to overcome their own mental health concerns, WRAP is a self-designed prevention and wellness process that anyone can use to get well, stay well, and make their life they want it to be. For more information, or to find resources in Spanish, please visit mentalhealthrecovery.com.
Emotional CPR (eCPR)
eCPR is a comprehensive educational program designed to teach people to assist others through an emotional crisis by engaging three simple steps: connecting, empowering, and revitalizing.
IPS is a training program for people interested in incorporating peer support methods into both traditional and alternative mental health settings. Participants learn to use relationships to see things from new perspectives, develop greater awareness of personal and relational patterns, and support and challenge each other in trying new things.
Recovery that lasts a lifetime
For many people living with mental illness and/or addiction, recovery is a lifelong journey. Some can manage it with their own networks and free resources. Others, including people living with SMI, may need lifelong services. For these individuals, policymakers need to ensure that insurance coverage for psychiatric care, including inpatient hospitalization, doesn’t cut off after arbitrary dollar or day limits. Fully enforcing the 2008 Mental Health Parity and Addiction Equity Act is one step that policymakers can take to address this issue.
As a matter of human dignity, we must also work together as a society to ensure that people living with SMI have a say in their own care. Using shared decision-making and psychiatric advance directives, among other strategies, can help ensure that people living with SMI can choose how they are cared for when the need arises. What is right for one person may not be right for another, so a variety of services and community-based resources should be available to ensure choice. Learn more about how choice and alternatives can enhance the effectiveness of psychiatric care from the National Coalition for Mental Health Recovery.