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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.
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Interview with Laysha Ostrow
EM: Can you tell us a little about Live & Learn, about its philosophy and intentions?
LO: I started Live & Learn because there is an absence of collaborative research by and for people with lived experience of the behavioral health system. Live & Learn is a woman-owned microenterprise for social change, incorporated in California but serving the country. Live & Learn provides research, evaluation, consultation, and technical assistance services to behavioral health-focused community-based organizations and governmental agencies.
Our approach synthesizes the capacity of those with lived experience of the mental health system (such as clients, patients, and survivors) and those with learned expertise through professional training. We form partnerships with governmental and non-governmental non-profit and for-profit entities in the public, private, and academic sectors to maximize opportunities for cross-learning and growth. One example includes a recently launched initiative, www.PeerRespite.net, which provides a resource page for peer respite hospital diversion programs along with a survey to further document emerging practices in these programs. I am available to help stakeholders design and evaluate their services and approaches.
EM: You’ve had personal experience with the psychiatric system, the special education system, the disability system, and the family court system. Can you share how these experiences inform your work?
LO: I believe that including people with lived experience of the behavioral health and social service systems in research, implementation, and evaluation is essential to progress. Other disenfranchised groups – women, people of color, and people with physical disabilities (to name a few) – have made enormous strides in influencing the systems that have oppressed them, yet people with first-hand experience of psychological distress and associated services are still marginalized in professional practices.
There is an emerging voice in my generation for being “out of the closet” while conducting rigorous research, but we all could do more to support meaningful professional involvement of people who are current and former so-called “clients” and constituents of our services and policies. Given my personal experience as a young adult in special education and disability-related systems, I believe this process starts with how we enact social justice on campuses. Other countries have dedicated funding streams and requirements for this kind of involvement – the U.S. still has far to go.
EM: What do you see as some possible useful connections between the practices of “public health” and individuals suffering with emotional and mental distress?
LO: Public health research is the study of causes and consequences of health problems in large populations or groups. These groups are typically defined by shared characteristics such as common risk factors (e.g. zip code) or disease. Public health practice includes policies and other interventions to address health problems and promote wellness on a large scale.
Public mental health is what most people featured in these interviews do in their work: focus on populations, groups, communities, and environments rather than individuals as the source of 'ill health.' It’s important in public health research and practice, as we work on alternative mental health strategies, to address the larger environment and its collective impact on individuals’ mental health if we want to start having better outcomes. This includes big policy changes, thinking carefully about how we finance mental health services, and concretely demonstrating the value of the perspective of affected groups that are affected by the problems we want to solve.
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?
LO: My first job in mental health research was at a lab that was pioneering the study of antipsychotics in children and teens. I suppose what I drew from the data I could see “on the ground” was that my experience with psychiatric drugs as a teen was not unusual: There was no identified pathology (as there is with other medical specialties) to ascertain diagnoses and make decisions about courses of treatment; and the participants were not offered other non-medical services, nor did they necessarily have access to non-medical services.
Above all, when you’re talking about children, you’re really talking about families, schools, and peer groups – and absolutely nothing was done in these realms other than provide un-tested and un-approved medications for the “identified patient.” That was in the mid-2000s; I was a child mental patient in the 1990s. Now it’s 2016 and little has changed.
I believe it is useful for us as a society to seek biological evidence for the causes and consequences of suffering, but I also think we could do a lot more to provide access to psychosocial interventions at the individual, family, and community levels. This lack of access has a lot to do with our graduate training of clinicians and how we finance healthcare because both of these systems emphasize biomedical perspectives and do very little for the humanity we all possess beyond our bodies.
EM: What do you see as strengths and limitations of our current systems for people in emotional distress?
LO: My parents are both doctoral-level practitioners in the healing arts. My mother is herself someone who has struggled with mental health problems. We lived in a town that had the best public education system in one of the most progressive states in one of the wealthiest countries in the world. This also happens to be where the best hospitals in this country are located. In other words, my family didn’t exactly suffer from a lack of tangible and intangible resources when I was really struggling. Despite all that, I was subjected to some of the most awful things that anyone could do to a loved one, and especially a young person.
My family has had to work hard to heal from that, and one thing my personal and professional experience has taught me is that our systems are so broken – and good services so hard to find – that you just have to be very, very lucky if you are experiencing psychological distress. Love is not enough; money is not enough; access to “the best” is not enough. I think that there have been substantial improvements in our mental health service systems in the past 50 years, including that long-term institutionalization is much more rare, and opportunities to participate in society are more available.
My work focuses on system and societal level changes, rather than clinical or individuals ones, because those can have the biggest impact and often do the most harm when not structured in helpful ways from the perspective of people who use services. That is the type of change I hope to support through Live & Learn and our partners.
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Laysha Ostrow, PhD is the CEO of Live & Learn, Inc. She holds a PhD from the Johns Hopkins School of Public Health and a Master of Public Policy from the Heller School for Social Policy and Management at Brandeis University. She is particularly interested in collaborating with community-based programs, state & local governments, and academic institutions on designing and implementing projects that are inclusive of people with lived experience of behavioral health and social services.
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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 ericmaisel@hotmail.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
To see the complete roster of 100 interview guests, please visit here:
