Mark Ragins on MHA Village
On the future of mental health
Posted March 20, 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 Mark Ragins
EM: Can you tell us a little bit about MHA Village?
MR: MHALA is a large local chapter of National Mental Health America. We operate a variety of programs centered around advocacy, public education, service delivery, innovation, workforce training, and community development. Our services are in two main clusters – one in Lancaster and one in Long Beach.
The Village was established in 1990 initially as a demonstration project funded by the California state legislature. Some of the same legislators who had brought deinstitutionalization to California in the 1970s had serious misgivings about how community mental health had turned out. Too many people seemed to be falling between the cracks and ending up not getting the help they needed. They wanted us to demonstrate the best that community mental health could be. They wanted us to “do whatever it took” including ACT teams, the clubhouse model, psychiatric rehabilitation, supported housing, education, and employment, integrated substance abuse services, family support, crisis services, and facilitate health care – all in one integrated, “one-stop shop” program.
Administratively, we were integrated with capitated funding and quality of life outcome accountability. We soon found that the emerging recovery movement gave us the vision to integrate all those services into one welcoming, hopeful, vibrant program. The project’s outside evaluator reported after three years that we had the best results across a range of quality of life outcomes of any program in the literature for people with a range of disabling mental illnesses.
Visitors began coming to the Village to be inspired and instructed from all over the world. We received a number of awards for our work. We became recognized leaders and proponents of the Recovery Model for people with mental illnesses. You can see my writings on recovery here.
Over time we’ve adapted our methods to other specialized populations including homeless people, high utilizers, repeatedly hospitalized people, jail diversion, poorly engaged people, transitional-aged youth, veterans, and medically fragile homeless people. We helped spread the model all around California where similar programs are called Full Service Partnerships. California’s voter’s passed proposition 63, the Mental Health Services Act, which taxes millionaires to spread recovery based programs throughout the state, especially FSPs.
Back at the Village, MHALA has moved from a “static” “services of indefinite duration” model to a “flow” model where people move along a continuum of recovery based programs as they grow and recover. We now have a comprehensive recovery-based system of care in Long Beach. We designed the Milestones of Recovery (MORS) tool to track people’s recovery and promote flow. We continue to innovate to improve our practice and push the boundaries of the recovery model while adapting to the ever-changing environment around us.
EM: Would you say that you have an underlying philosophy with regard to what helps people in distress?
MR: We believe in the recovery model of care. We believe that recovery isn’t something that can be done to someone. It is a process where people overcome the losses and destruction in their lives to rebuild themselves, their relationships and their roles in the community. Recovery is a path best travelled alongside a helpful guide or mentor.
In the same way that hospice programs use Kubler-Ross’ stages of death and dying (denial, anger, bargaining, depression, and acceptance) to help people die with dignity, we use four common stages of recovery (hope, empowerment, self-responsibility, and attaining meaningful roles) to help people live with dignity.
The three major transformations in the recovery movement are:
1) Person-Centered: Moving from centering our efforts on the treatment of illnesses and the reduction of symptoms to a holistic service of people and the rebuilding of lives. This is needed to engage people
2) Client Driven/Collaboration: Moving from professional directed relationships emphasizing informed compliance with prescribed treatments to individualized relationships emphasizing empowerment and building people’s self-responsibility. This is needed to motivate and build skills
3) Strengths Based/Resilience: Building hope for recovery upon each person’s strengths, motivations, and learning from suffering rather than upon the competence of professionals and medications to reduce or eliminate the burden of their illnesses. This is needed to build self-reliance and move on from depending on professionals
From the recovery model we’ve created a set of practical principles we use to guide our work:
WE BELIEVE …
1. Hope makes recovery possible; it facilitates healing of the mind, body and spirit.
2. Welcoming people includes creating a culture of acceptance with easily accessible integrated supports and services.
3. Focusing on the whole person includes their strengths and weakness, abilities and barriers, wounds and gifts.
4. Each person creates their path and determines the pace of their recovery.
5. The recovery process is a collaborative journey in support of individuals pursuing their life goals.
6. Relationships are developed through mutual respect and reciprocity, including openness to genuine emotional connections.
7. A solid foundation for recovery is built by helping people to honestly and responsibly deal with their mental illness, substance abuse and emotional difficulties.
8. People thrive, grow and gain the courage to seek change in respectful environments that promote self-responsibility.
9. The practical work of recovery takes place in the community.
10. Each person has the right to fair and just treatment in their community ensured through advocacy and social responsibility.
11. Everyone deserves the opportunity to have a place to call home.
12. Promoting natural supports, having fun and a sense of belonging enhances quality of life.
13. Employment and education are powerful means to help people build lives beyond their illness.
14. Program success is based on achieving quality of life and recovery outcomes.
EM: What are your thoughts about so-called psychiatric medication as it relates to the folks you serve?
MR: First a comment about the label of “so-called psychiatric medication” that clearly reflects doubts and mistrust of these medications. We are in a very reductionistic era where a large array of psychological and emotional distress and disability is being defined as brain illnesses. The further assertion that all of these conditions are best viewed as chemical imbalances that need medications to restore a healthy balance is even more questionable. It’s far more likely that medications are creating a new change in chemical balance that is often useful – for example reducing anxiety, depression, psychosis, or mood swings – regardless of the underlying cause. That’s why we don’t actually have to figure out why someone has any given symptom to help them with medications.
To be fair, however, that’s how the vast majority of medications work throughout medicine. Hypertension medications don’t correct the underlying reason you have high blood pressure, they just artificially, usefully, lower blood pressure regardless of the cause. The same thing is true of anti-inflammatory meds, antacids, cholesterol meds, diabetes meds, glaucoma drops – the list goes on and on. But when we’re dealing with the brain – the most complex thing in the universe – that is intimately connected to our mind, thoughts, emotions, consciousness, our personhood, our social identity, even our spirit – this approach seems much more crude and profane than when it’s applied to a blood vessel or a fat cell or even a kidney.
The problem isn’t that psychiatric medications are worse than other kinds of medications. The problem is that brains are so much more amazing than the rest of our bodies (at least in my view as a psychiatrist, although I know an endocrinologist who thinks pancreases and fat cells are more amazing than brains).
Therefore, in my view the first thing we should do when we’re using psychiatric medications is be careful, thoughtful, compassionate, highly individualized, and collaborative. Too often instead medications are prescribed in an amazingly cursory, inconsiderate way. The growing demand for medications and limited supply of prescribers is leading to ever more rapid, “efficient” prescription services – a very concerning trend.
Many people feel quite traumatized by the medication services they have received – including cursory, conflicting, inaccurate diagnoses, forced medications, overmedication, powerlessness, severe side effects, long term changes, having their personal feelings and stories and spiritual strivings reduced to symptoms to be eliminated and assaulted, having to rely on meds forever, stigma and prejudice and labeling, etc. – most services are rarely sensitive to or helpful with these traumatic aspects of psychiatric medications.
We’ve developed a medication collaboration approach within the recovery model that helps mitigate much of the most destructive aspects of medical model prescribing. Our key tools are:
1. Person-Centered Formulations instead of Illness-Centered Diagnoses
2. Relationship based services
3. Trauma informed care
4. Goal driven medications and treatment
5. Shared decision-making
6. Activated patients promoting their own recoveries
7. Building resilience
Even with these strategies, however, we still need to listen carefully to the person we’re trying to help and to be humble about our understandings and our medications.
EM: If you had a loved one in emotional or mental distress, what would you suggest that he or she do or try?
MR: We’ve too often come to a place where either people embrace the medical model entirely – searching endlessly for the perfect treatment, the right doctor or therapist, the right medication, the right hospital or program and then turn themselves over to professionals to fix them, like it works on TV – or they reject medical treatment or even psychotherapy and try to recover on their own, or entirely within a counterculture.
I don’t think either extreme is the best option, but too often that’s all that’s available. Most of the people I’ve seen recover have integrated both professional treatment, often, but not necessarily including medications, with their own efforts to improve their lives. They’ve take self-responsibility for both their lives and their treatments.
Here’s a list of things I’ve seen people do that helps them recover. No one has to do all of them, and they don’t have to be done in any order, but if someone doesn’t do any of them, they’re unlikely to recover:
1. Talk to other people instead of isolating
2. Actively build security in your life – money to survive on, safe housing, and connections with family, friends, and spirituality
3. Actually feel feelings and emotions instead of deadening them, medicating them, avoiding them, or getting high
4. Learn some emotional coping skills
5. Learn to “use” medications instead of just “taking” medications
6. Engage (or re-engage) in activities that make you more fun and interesting
7. Take responsibility for your own life and make some changes in yourself
8. Go to work even when you’re not feeling well
9. Do things outside of being a mental patient and outside the mental health system
10. Improve physical health and wellness
11. Love other people – family, partners, kids
12. Work on acceptance and forgiveness instead of blaming and vengeance
13. Give back by helping others
14. Find meaning and blessings in suffering and reconnect with God and spirituality.
They should start wherever they want and set their own goals, because everyone I love is stubborn and will likely worker harder on what they want to do instead of what I want them to do.
Also, if you want to change your life, it’s important to think not just about what you’re going to start doing differently, but oftentimes more importantly about what you’re going to stop doing that’s holding you back or keeping you suffering – like using drugs, hating God, staying with abusive partners, cutting yourself, pushing everyone away to avoid being hurt again, prostituting, blaming everyone, etc. There are a lot of ways we hurt ourselves. As we say at the Village, “If you want to play the saxophone, you have to put down the ducky.”
I’m Mark Ragins, MD. I’m a psychiatrist. I’ve been at the MHALA Village since it opened in 1990. I’ve worked on our Full Service Partnership teams, our Homeless Assistance Program, our Transitional Age Youth Academy, and now on our Welcoming team and as our Medical Director. I’ve also been heavily involved in the Recovery Movement for 25 years writing, speaking, training, consulting, and developing clinical and administrative tools to support our work. Check out our websites at http://mhala.org and mhavillage.squarespace.com
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
To learn more about and/or to purchase The Future of Mental Health visit here
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