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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Ms. Marsik is particularly excited about the pairing of the respite centers with the mobile teams, all of which include a social worker, a psychiatrist, and a peer trained in "needs-adapted treatment" – a model that is centered on the individual and his or her family and friends, goals, and needs. The program is relatively new in the United States but has had great success in Finland, where one long-term study of a model, used with first-episode psychotic patients, found that two years later more than 80 percent of patients had no residual psychotic symptoms, 84 percent had returned to full-time work or study, and only one-third had used antipsychotic drugs.Skip to next paragraph
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In other words: Patients were functioning well in the real world and didn't seem to be relapsing.
Staff at Parachute NYC, which began in January, hope to find similar results, firmly believing that a more welcoming, person-centered approach at the onset of illness can prevent more serious episodes and involuntary hospitalization.
Ann says that for her, it was exactly what she needed: "Just knowing I had a room to myself, with a private closet and private bathroom, and knowing I could leave my suitcase by the door and if I decide to run out I can, no one is holding me down, no one is going to shoot me up with medication or tell me I'm crazy – I could relax on my terms."
She stayed for two weeks, and was there with six guests, all of whom bonded, she says. They cooked dinners and ate together, and attended many group classes. Ann attended art classes, creative writing groups, and sessions in which she and others worked on developing a "tool box" for themselves to help deal with their illness, sometimes writing about strategies that seemed to work, how they felt in different situations, and how to apply these insights to their lives.
"You don't have to go to groups, but over time, everyone was in the group," she says.
Having peers on staff who have dealt with their own mental illness and hospitalizations was also a huge support. "Everyone here has a diagnosis, and they're working professionals now," Ann says. "I met with a friend of mine a couple days ago, and she said 'you've found your swans.' I feel like I belong here. I'm with people I understand and they understand me, and there's no judgment."
The staff who work there say that the voluntary nature of Parachute is key.
"Self-determination is huge – to have one's dignity and be master of one's domain," says David, a peer counselor at the respite center near Union Square who says his experiences with hospitalization and the mental health care system allow him to connect with guests in a very immediate way. "Everyone tells you what you should be doing. When you come to those decisions on your own, it's lasting."
What Parachute is doing "is uncharted territory," says Jamie Neckles, the project manager from the city's Department of Health and Mental Hygiene.
A federal grant is funding the pilot program, but Ms. Neckles hopes that if evaluations are positive, it will become a reimbursable service through Medicaid, since it will probably be far more cost-effective to help people in a preventive way. The daily operating cost of respite care, for instance, is $272 per person. Costs vary across hospitals, but that's about one-third the cost of a night at a New York psychiatric hospital for someone with a diagnosis of schizophrenia.