Mental health in the US: New ideas on care emerge
Mass shootings by mentally unstable people have focused attention on the inadequacies of the US mental health care system, in which less than half of the seriously ill can get treatment.
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Lisa began teaching swimming to children, something she had done in the past and loved. She lives on her own, and she manages her relapses herself, with some awareness of when she's starting to become sick again.Skip to next paragraph
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Sacher is grateful for the shift, though she also regrets the many lost years, and wishes there had been the possibility both for mandated treatment and programs that targeted young people when Lisa first became ill.
"She went through 17 years of instability," says Sacher. "If we had had AOT when she first got sick, she would be functioning on a much higher level now…. Those were ... years that took away from her true potential."
But that isn't always the case. For Ann, who has also struggled for years with mental illness, hospitalization made things worse.
When Ann (whose respite care director asked the Monitor not to use her last name because of the social stigma of mental illness) went to New York's Bellevue Hospital Center to see her therapist in June, she was in the middle of a crisis episode, and her therapist immediately took her to the emergency room. The whole experience there – being shuttled back and forth between the psychiatric ward to a medical room, and feeling as if no one was listening to her – was confusing and terrifying, and she checked herself out, says Ann, a longtime New Yorker who works as a playwright. If she hadn't heard about a new option, entirely voluntary, with no forced treatment, she says she would have just gone home, even though she knew she shouldn't have been on her own.
"My whole thing is fight or flight," says Ann. "If I were faced with a situation where I had to stay, I would have left."
The place Ann went is a nondescript townhouse near Union Square in New York. One of two respite centers run by a new pilot program called Parachute NYC (a third is in the works), the eight-bed home welcomes any guests – the term "patient" is never used – who feel that they may be hitting a crisis point and need some support.
Staying in the warm, welcoming rooms is voluntary. No one is forced to take medication. Staff are peers – people who have their own experiences with mental illness, have extensive training, and often relate to someone experiencing a mental-health crisis.
Along with the respite centers, the program runs mobile teams that work with individuals experiencing a crisis in their own environments and mobilizes their social community of family and friends to support their treatment and foster long-term change in how they approach their mental illness.
The basic idea: Catch people early in the trajectory of mental illness and provide a "soft landing," whence the name "parachute."
The program's respite centers, one of which caters specifically to young adults, are an alternative to hospitalization for people approaching a crisis. "As the challenges become greater, [it gives them] some place to go that's not about an institution," says Trish Marsik, assistant commissioner for mental health at the New York City Department of Health and Mental Hygiene. "It will provide an alternative to hospitalizations here in New York City that we haven't had before."
The department pays for the program with a federal innovation grant from the Centers for Medicare and Medicaid Services, and by partnering with eight providers to offer services. The Manhattan respite center is run by Community Access, a nonprofit that has long been meeting the needs of New York's mentally ill, and most of the mobile teams are run by the Visiting Nurse Service of New York.