Yana Jacobs Foundation for Excellence in Mental Health Care
On the future of mental health
Posted February 24, 2016
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 Yana Jacobs
EM: Can you tell us a little bit about the Foundation for Excellence in Mental Health Care?
YJ: The Foundation was developed by a group of researchers, psychiatrists, clinicians, people with lived experience and family members. We all had years of first-hand experience working in the mental health field and knew the model of care was deeply flawed and people were not recovering, moving on with their lives. We witnessed a growing population of “chronic” disability and people dying 25 years younger than the general population.
Our group knows that people for the most part can and will get through their emotional crisis and move forward with their lives. The mission of The Foundation for Excellence in Mental Health Care is to change the current paradigm by connecting the passion of private philanthropy with the world’s top researchers and programs to bring recovery–based care and supports to every community. The change we seek begins with standing by those who need us, seeing hope where others see despair. It takes courage to speak up when systems fail us. We can thrive only when research is unbiased, dialogue is open, and healing is an often-achieved goal.
It takes respect, compassion, and the sure knowledge that recovery is more than a possibility - it is what we expect. We are structured as a Community Foundation yet we function like a Community Mental Health Development Bank. Our geographical location is the world and what we help donors fund is focused solely on mental health research, education, and programs. Through the various research projects and pilot projects along with educational symposiums we will change the current practice so as to assure that services are being provided that assist people in their recovery and that the facts are being disseminated to allow people to make informed choices on their treatment. EXCELLENCE expects recovery!
EM: What are peer-staffed respite programs? How do they work and how easy or hard is it to find one?
YJ: Peer respites are homes in communities that are staffed by people with “lived experience” who have been in the mental health system. I personally value the Intentional Peer Support (IPS) Training model for all peer staff to have prior to working in a respite. You can learn more about IPS here.
Peer Respites provide a place for people to choose to go when they are wanting some support, someone to talk with, a respite from their current living situation. Often a respite is pre-crisis and therefore may be seen as preventative care rather than “acute” care. Currently the “system says” you’re not acute enough to be admitted to a residential setting or hospital, and the message is that you need to wait to be in a full crisis that often would lead to a locked hospitalization, at this point an individual may be at risk of losing their housing and are typically faced with forced treatment. The Respite offers a compassionate and safe place to go when one feels the need and knows that if they could have a change of scene, get away from a stressful housing situation, family member, etc., that they will be okay.
Peer Respites are voluntary, often with a self-referral process, short-term, a couple of nights up to two weeks, overnight programs. They provide trauma-informed and person-centered crisis support and prevention 24 hours per day in a homelike environment. This is a link to where to find a Respite House.
EM: Can you tell us a little bit about your Soteria House experience?
YJ: Soteria was my introduction into the world of “mental health” in the mid 1970’s. It was a NIMH funded research project designed by Dr. Loren Mosher. It was an unlocked home in the community for people having their first psychotic “break”/”episode”; individuals were randomly selected after admission to a locked psych hospital and given the choice to come to Soteria or stay and receive conventional treatment in the inpatient hospital.
The house staff was selected based on personality rather than “professional” experience. It should be noted that “professionals” were actually not desired as staff members. We basically shared personality traits that engendered “tender loving care” and the ability to “be with” someone who was in an extreme state. In my mind I equated my roll to being a “guide” with someone on hallucinogens. I loved working there as it wasn’t like “a job” but rather an opportunity to have deeply intense conversations and be with people in the most raw and human states. I loved it!
Most people moved through their emotional distress and went on to live their lives, be it back to college, or home and pursuit of work. I loved picking people up from the hospital as it felt like we were offering them a safety raft and a “get out of jail” card. You’re free! They came to Soteria, had their own room and were free to cook their own meals, hang out in the living room or sleep all day in their room. After about 6 weeks typically the extreme state would begin to subside and people would start to do the work around understanding what had happened to them and would begin to move forward.
EM: What are your thoughts on the current, dominant paradigm of “diagnosing and treating mental disorders” and the use of so-called “psychiatric medication” to “treat mental disorders” in children, teens and adults?
YJ: After my Soteria experience followed by 30 plus years working in the traditional mental health system it was clear to me that the diagnoses were not based on any scientific tests or evidence, but seemed to be a cluster of descriptions used to discuss an individual in “short hand”/summary.
Typically I would see varying diagnoses in each person’s chart, no two doctors would agree on the diagnosis. The medications didn’t seem to “cure” anyone and were most often met with resistance by “the patient” so I personally never felt comfortable with the medical treatment model.
I saw people on “cocktails” of multiple medications, rather than on a trial of one, low-dose medication and if that medication didn’t help, then stop it and try a different one. Instead the prescribers would just keep adding on more and more medications. I worked as a crisis worker at the front door and simply didn’t see people get well in the hospital, instead I saw people were becoming “chronic longer term patients of the system.”
I witnessed the long-term negative side effects of weight gain, dulled thinking and speech. I especially abhor the mental health treatment for children and teens, their brains are still growing and developing and given the complexities of the human brain, it seems dangerous and actually abusive to administer any psychoactive medication to young people. All that said, I can see a place for medications with adults only if one requests medication after they have been fully informed of the risks, pros and cons. Many people often report some symptom relief, and I’m all for giving people something that relieves their suffering if they ask for it.
I believe that we are wrongly “diagnosing” about 75%-85% of the population currently being served in the public mental health system. This is based on my experience that most people who present to a psych emergency center in an extreme state have had some sort of stressors, trauma and/or reasons for their extreme state. The challenge is to be curious, explore, and find out together what happened that precipitated this event?
I think of psychosis as a healthy human reaction or defense system to a bad situation. It’s part of how we survive. Psychosis develops often for good reason, not to be squelched, but rather understood. This takes time and true interest and compassion. The problem is that clinicians don’t either have the time or simply aren’t willing or able to take the time to explore “what happened”, what might have precipitated this event? Often the professionals are scared of the extreme behavior.
I believe each person has an individual story and that no two people are the same, meaning one person diagnosed with “schizophrenia” will not be the same as the next person given the same diagnosis. I believe the system has developed around myths that have now become “facts” and it requires some real unwinding of the history of the mental health field to really understand what we know and what we don’t know.
I trust that most people, if given time, space, and compassionate support, will move through their crisis and gain insight and understanding. I also believe there is a small group of people who may in fact have a biological component that is triggering a thought “disorder,” we simply don’t have the science yet to give out this sort of diagnosis and be certain. I think we are doing more harm by not giving people all the information and allowing them to choose what they’d like to try in terms of treatment.
There clearly is not a “one size fits all” … having a model like Open Dialogue, with a safe place for sharing, exploring and finding out together what’s happening to me seems like the treatment of choice. The Open Dialogue approach from Finland makes good sense to me as a model of care. It’s the only model that I’ve seen that embraces an openness to finding out together with the individual involved what’s going on. Medications are available but used moderately and for short periods of time, mostly to aid with sleep.
EM: If you had a loved one in emotional or mental distress, what would you suggest that he or she do or try?
YJ: Given that we currently don’t have Soteria-like residential settings in every city, I’d set up a similar situation, a “safety net “composed of family/friends, people with “lived experience” who could be with my loved one 24/7 to assure that they are safe. I’d only want to do this in a home setting, preferably near open space and nature. I’d be sure that all the people volunteering to provide this safety net were there to simply hold the space rather than “fix” someone or tell them what is right or wrong, what they must do or not do. I have faith that given a loving and safe space, individuals will work through their emotional distress. It just takes time.
Yana Jacobs, LMFT is currently chief development officer at the Foundation for Excellence in Mental Health Care, www.mentalhealthexcellence.org a private community foundation with a mission to bring alternatives into the mainstream public and private sectors. She began her work at Soteria House in the mid 70s, mentored by Loren Mosher, MD. Soteria House became her foundation as she moved into other areas of employment within the mental health field. Yana spent over 30 years working both in private practice as a therapist and in the public sector at Santa Cruz County Mental Health in California. She first worked with their crisis team and later became the Chief of Adult Outpatient/Recovery services. As an ally to people with lived experience she implemented a Peer-Run Respite House, funded by a SAMHSA Transformation Grant. Yana believes we must work both as an activist on the outside and with our allies on the inside if we are going to bring about real change.
For more information: www.mentalhealthexcellence.org
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 email@example.com, visit him at http://www.ericmaisel.com, and learn more about the future of mental health movement at http://www.thefutureofmentalhealth.com
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