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Full access and integration is the freedom once realised by the first reformers in the mental health movement of the 1970s and 1980s.
I have had the task several times of filling out an SPOA application. SPOA applications mostly collect compiled EHR records with a few short blurbs filled out by the referring clinician. Well, to get right down it, these applications are a shining example of clumsy ‘clinician-crat’ work that is mucking up access to patients that need it the most. I have not only had applications rejected for purely political reasons, I have also sat at SPOA meetings and listened to the politics of mental play out in all its fury in a small room with clinicians with large, ego-inflated heads. All of them talking about patients and clinical work in less than humane and very subclinical language, if you catch my meaning. At these meetings, I acutely observed clinical input passed over for political reaching from different agencies involved, over-involved in some instances, and in the end totally failing their patients.
I am talking specifically about referral packets that go to one agency instead of others. Patients that qualify for multiple programmes and their fate bound up in the political leanings, and even apparent stigma of certain disorders over others, to decide which service they would be eligible for in the end, if any. At some of these SPOA meetings, sub-meetings were even called to correct, add ‘oversight,’ and make forgotten cases that were failing more visible. I have sat at these meetings too, termed ‘support circles’ in my local county. At these support circles, patients would complain about their workers, and everyone would point fingers at the service provider failing them the most. This person was usually left in the precarious position of explaining himself, even if he has done no wrong, but was the scapegoat of terrible treatment and care coordination.
Most importantly, I want all this politics and regulation to end. I want to make referrals for needed services and have my patient’s fate be a product of the necessary treatment, not what looks best on paper to justify a county service.
Programmes need to stay open and operate under the highest level of professional scrutiny, which means no longer deferring recovery and long-term independence goals for politics – the end of top-down forms of treatment in which patients access care based on their treatment success. Years ago, the level of care philosophy made sense, but does it still make sense today when installing choice and nuanced person-centred care into the framework?
We must pave the way to end long-term in-patient treatment and funnel consumers back into the community for the long-term on their roads to recovery. Treatment and services must genuinely be centred on the patient’s needs and not exist to engrain the guise of neo-institutionalisation, passing it off as a reform and a functioning mental health system.
Max Guttman is the owner of Recovery Now, a private mental health practice in New York City. Through his work as a Licensed Clinical Social Worker, therapist, and disability rights advocate, Max fights for those without a voice in various New York City care systems. He received a ‘2020 Bearcats of the Last Decade 10 Under 10’ award from the Binghamton University Alumni Association.
Guttman treats clients with anxiety and depression but specializes in issues related to psychosis or schizoaffective spectrum disorders. He frequently writes about his lived experiences with schizophrenia.
‘I knew my illness was so complex that I’d need a professional understanding of its treatment to gain any real momentum in recovery,’ Guttman says. ‘After undergraduate school and the onset of my illness, I evaluated different graduate programs that could serve as a career and mechanism to guide and direct my self-care. After experiencing the helping hand of my social worker and therapist right after my ‘break,’ I chose social work education because of its robust skill set and foundation of knowledge I needed to heal and help others.’
‘In a world of increasing tragedy, we should help people learn from our lived experiences. My experience brings humility, authenticity, and candidness to my practice. People genuinely appreciate candidness when it comes to their health and Recovery. Humility provides space for mistakes and appraisal of progress. I thank my lived experience for contributing a more egalitarian therapeutic experience for my clients.’
Posted in Change, DISABILITIES, Future, Pathway, racism, Reform, Systems Issues, TermsTagged future, language, mental health, recovery, reform, SINGLE POINT OF ACCESS, SPOA