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Mark Furlong on Thresholds and Communities of Care

On the future of mental health

Eric Maisel
Source: Eric Maisel

The following interview is part of a “future of mental health” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress. I’ve aimed to be ecumenical and included many points of view different from my own. I hope you enjoy it. As with every service and resource in the mental health field, please do your due diligence. If you’d like to learn more about these philosophies, services, and organizations mentioned, follow the links provided.


Interview with Mark Furlong

EM: Can you tell us a little bit about Thresholds?

MF: Thresholds is Illinois’s largest provider of community based rehabilitation and recovery services for people diagnosed with serious mental health conditions. Thresholds specializes in services that happen in the community, that is, beyond the four walls of an office or clinic. Thresholds was Illinois’s first provider of Assertive Community Treatment (ACT) and currently has over 100 teams providing various levels of supportive services for people diagnosed with mental health conditions. Thresholds serves about 10,000 people per year in Chicago and northeastern Illinois.

EM: Would you say that you have an underlying philosophy with regard to what helps people in distress?

MF: Thresholds held a roundtable discussion in 2012 where we asked a group of people who have recovered from serious mental health conditions what helped them.

The themes that emerged in that roundtable reflect our philosophy about what helps.

1. Consider life as distinct from diagnosis

2. Help meet basic needs.

3. Encourage empowerment

4. Educate about how to manage conditions

5. Support community

6. Provide hope and encourage faith

7. Teach healthy thinking

8. Focus on wellness

Mental health conditions have a lot in common with other health conditions. When a person experiences a serious and ongoing mental health condition, their life is changed. However people can learn to manage these conditions to be able to live full and meaningful lives. There are a number of social determinants that affect a person's health and mental health. For example without decent, safe housing, a strong social support network and meaningful activities such as work or school, recovery from a mental health condition becomes more challenging.

When a person has a job, a good place to live, and relationships with people who believe that they can and will recover, the likelihood of them successfully managing a mental health condition increases greatly. At Thresholds we place a great emphasis on housing, work, and belonging to a community that offers supportive relationships.

Another important factor is that people in distress will do much better when they drive their own recovery. At Thresholds we spend a lot of time talking to people about their strengths, goals, dreams and aspirations. The motivation to do the work necessary to manage a mental health condition has to come from a person's own desires. Nobody wants to do "mental health treatment." People just want to feel better and get on with living.

EM: What are your thoughts about so-called psychiatric medication as it relates to the folks you serve?

MF: Medication can be helpful in managing some mental health conditions but it is rarely sufficient by itself. The decision to take psychiatric medication should only be made after carefully weighing the risks and benefits. I know sometimes individuals and families can be desperate for relief from distressing symptoms and they are very happy for the symptom reduction that medication can provide. The problem is that many psychiatric medications are associated with long-term health risks and serious side effects.

Many people who have been diagnosed with schizophrenia or bipolar disorder decide to take medication for years. This is because they believe and have experienced that their lives are better when they take medication. It's a very personal decision and at Thresholds we support people in making this decision.

EM: How can people support “communities of care” like yours, either yours specifically or, more broadly, the concept of “communities of care”?

In the United States today few, if any of the insurance-based funding sources for mental health services support anything like a community of care. The funding models for mental health services are based on an acute illness, fee-for-service model where providers are paid for each unit of service they deliver. This payment model incentivizes unnecessary services, stifles innovation and leads to all kinds of inefficiency.

Communities of care are incredibly helpful for people with mental health conditions but they are hard to create, especially without funding and resources to support them. Insurance reimbursement structures are not a particularly sexy topic, but at a policy level people could be really helpful by supporting reform in healthcare payment so that incentives are aligned around better health outcomes for people with mental health conditions. When better health and life outcomes become the focus of care, communities of care will not only become possible, they will make good human and business sense.

EM: If you had a loved one in emotional or mental distress, what would you suggest that he or she do or try?

That's also a great question. Unfortunately there is no simple or good answer to that question. The resources available in the U.S. for people experiencing emotional or mental distress vary greatly at the state and community levels. Insurance coverage varies greatly as well.

That said, I would recommend:

1. See your doctor for a good medical work up. There are a number of medical conditions that cause serious problems with mood or thinking.

2. See a counselor for an evaluation. If appropriate there are a number of evidence based interventions that can be very helpful. You can search for "community mental health center" in your community or ask your physician or insurance company for a referral.

3. Find other people in your community who have gone through similar experiences. The support of a community can make a tremendous difference in a person's life. A counselor or community mental health center may be able to help you find these supports.

4. Learn about how diet, physical activity, sleep, stress and other lifestyle factors affect your mental health. A lot of people experience relief by making changes in some of these factors. Consider learning about WRAP (Wellness Recovery Action Plan).

5. If suicide or self-harm are a concern call 9-1-1, a suicide hotline or go to the closest emergency room.


Mark Furlong is the Chief Operating Officer at Thresholds in Chicago (, Illinois’ largest provider of community based, recovery focused services and supports for people experiencing mental health distress. He is a licensed clinical social worker in the state of Illinois. Over the last 30 years Mark has provided employment supports, homeless outreach, housing support services. In 2004 he helped develop and launch the Thresholds Peer Success Center which is staffed entirely by people with a lived experience of recovery. Recently he has been involved in developing pilots to demonstrate that better insurance reimbursement structures can drive improved experience of care, better outcomes and better use of limited resources.


Eric Maisel, Ph.D., is the author of 40+ books, among them The Future of Mental Health, Rethinking Depression, Mastering Creative Anxiety, Life Purpose Boot Camp and The Van Gogh Blues. Write Dr. Maisel at, visit him at, and learn more about the future of mental health movement at

To learn more about and/or to purchase The Future of Mental Health visit here

To see the complete roster of 100 interview guests, please visit here:

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