We are forging a new vision from the apocalyptic landscape we now see for many too many people with severe mental illness (SMI). That vision is not simply about more treatment, although first-rate treatment is very important. It is a vision of what can — and MUST BE — AFTER treatment— to instill real hope for a decent and meaningful life. It is a vision that lives in the more permeable zone we call ‘community.’
We must recognize that a disproportion of those on the streets who are ill are Black and other minorities. While living without stabile housing confers a level of stress and illness, we are not here addressing the entirety of the unhoused population, but rather those with SMI. Why are so many on our streets? Missing a vision of what a life outside of asylums might look like, we have over 70 years backed into a crisis-driven system of dismembered parts. That vision MUST include 4 pillars that are interdependent and have an embedded social contract
I. Affordable, decent permanent housing, II. ‘Connectivity,’ III. Meaningful work and activity, and IV. Treatment for behavioral and physical health (including for instance, the use of evidence-based medication/where clozapine becomes readily used as well as injectables),
These work best intertwined with creative endeavor.
This requires new approaches, reaching across the silos that now narrow, duplicate and confuse our energies.
We need to make our workforce more diverse and reflective of those served, but also to open up opportunities for those who have been shunted to the very periphery of our communities. It is indeed a tall order. How that gets done will vary by state and locality. Giant steps HAVE been taken in some states — yet they become isolated steps without a coherent vision.
Our goals?
To lay out a vision – a visual road map, showing the spectrum of need and how we move from ‘either/or’ to ‘win-win.’ Community mental health and those most intimately afflicted has been characterized by deeply polarized and divided camps. While this is an oversimplification, we think it fair to say that one ‘camp’ has been focused on civil rights and the slippery slope that can occur in inappropriate reinstitutionalization (absolutely imperative), the other, by the essential nature of severe mental illness as a neuropsychiatric condition, for which medication, health care, housing and rehab are essential interventions (also absolutely imperative). Falling into the cracks of this? Hundreds of thousands of very ill people, criminalized and incarcerated, or foraging food and material goods out on the streets — especially those unable to follow a therapeutic and medication regimen due to anosognosia (lack of insight).
To move from polarized entrenchment to powerful advocacy for the most vulnerable — those with SMI and substance abuse. This is NOT an ‘either/or — requiring exclusion of the elderly, children and families. There ARE enough resources for vulnerable groups IF we allocate and make use of these resources thoughtfully.
Our means? Through addressing the hard questions that divide us, our aim is to bridge between critical though currently adversarial voices — using deep interviews, podcasts and vlogs together with writing and linking with beacons of excellence.
