What world are we living in?!  Hundreds of thousands of people live on the street. Our safety net is threadbare. There are real and imagined fears of a slippery slope in ‘reinstitutionalizing’ people who can and should live in community — while at the same time, families and neighbors have experienced up close a level of danger when a loved one refuses medication and becomes violent that is intolerable (these are a minority but a very palpable risk that must be addressed — preferably NOT through the criminal justice system). Affordable housing has become an endangered species!

It is time to re-examine our social contract, including our most vulnerable.  This includes children and their families, those with disabling conditions, the elderly, and the homeless with serious mental illness and addiction. It is time to incorporate all we have learned, including the impact of anosognosia (lack of insight into one’s own illness) on how we approach breaking the cycle of untreated disability and homelessness.

Since deinstitutionalization some seventy years ago, we have neglected to adequately envision a healing community that welcomes most people with serious mental illness. Too often we applaud islands of excellence that are isolated trees in an apocalyptic landscape.

It’s time to reassess how we approach and act on the many problems at hand.

How do we understand the range of illness and disability? Recognizing that MANY people with serious mental illness can and do live in mainstream community. They recognize their need to manage their condition/s, much as those with diabetes or heart disease. They take medication routinely or have worked out indicators of when they must re-initiate their meds. They have jobs. They have housing, either as a result of their work, or with help from family. Families become a repository of support AND housing for many in this group. For many others — the lack of insight into their illness creates a potentially lethal slope into lack of self-care, managing the illness (vs the illness managing the person) and the inability to effectively cope with job, rent, transport and engagement. While still, treatment alone cannot and does not provide hope for an engaged and connected life in community.

How might we create a matrix — between the various treatment settings and such an engaged life?

How can we reach across currently polarized divides – the ‘pro’ and ‘con’ for involuntary care? What guardrails do we put in place to prevent inappropriate mandates?  At the same time, how do we assure that people are not ‘dying with their rights on?’ How do we keep families and communities safe from the relatively few, potentially dangerous and endangered people with serious mental illness? 

How do we understand that there is a spectrum of ability and need when considering compulsory treatment or care?

How do we develop an effective advocacy arm to foster legislation and care that brings people from the edge of a cliff to more robust lives in community? We cannot be successful with warring factions that split our energies.

How can we better measure accountability, efficiency, and successful outcomes? And what is the necessary and appropriate role of government?

Integrus Health Group proposes a series of key topics that inform the development of a vision for the future. By entering into conversations that include divergent voices we hope to put forth important questions, and answers, that move mental health planning and policy forward.

How are we going to do this?

Through literally envisioning and mapping several alternate realities can look like — to be adapted to local conditions, recognizing the energy and genius that is to be found ‘at the ground level.’ Through podcasts, interviews, and face-to-face meetings with divergent voices, we’ll investigate hard issues and the people tackling them. Many individuals and organizations will be invited to participate as we forge a path towards a sustainable mental health landscape that heals.

Along the way, we welcome your contributions and feedback.