Are mental health professionals also gatekeepers?

• Sadly, I think they are also gatekeepers.

• I only say 'sadly' because I have experienced not having "a trusted mental health professional" and that was definitely a gaping hole trying to access services (or more specifically the right services for both my late son or myself)

• The sytem(s) have to be navigable without having the 'sherpa' there... or we get lost even trying to find a "trusted mental health and/or addiction professional" who then might be able to help us navigate.

Betty-Lou Kristy

PROVIDING EVIDENCE from community to systems level policy, planning & governance

  There are so many problems with mental health treatment touched upon or merely hinted at here.  Sherpas aren’t useful on oceans and the reality of mental health and addiction treatment is that every wave and person is different; there is no mountain to climb, only a destination to find, a sea to negotiate.

Unlock and navigate?

My “illness” is my own. 

It is the job of a good mental health professional to understand my relationship with my self qua ‘illness’ and ‘health,’ not unlock some thing for me.  Why do I not have the keys to my own health? When did I give them up?  Attempting to navigate a system designed upon the premise that I am unable to navigate it is not evidence that I cannot navigate it, it is evidence that my charts and watch have been taken away and longitude is difficult to calculate without either.  The absence of trust is the normal state in MHA conditions and this is a healthy defensive posture, not evidence of abnormality or delusion; that is, when one’s own mind is already betraying one, it makes sense to be wary of someone patronising or condescending to the state of one’s health.  Especially when they have the keys, compass, clock and sextant.  How’d they end up with all the power? is an intelligent question.

Systemically, the notion of any door leads to all doors must be made real.  The agencies must talk to one another.  Why trust a mental health professional?  I can’t think of any reason.  I can think of trusting a mental health advocate.  Any professional who is not an advocate first should quit; they are the obstacle to recovery.  I am not saying blindly agree with every plan, just argue out the constructive details then throw your professional weight against the system to see things are done. I am not always well – but I usually am myself.  Do not be misled.

Practise Trust

Say so.  Say, “I do not trust that answer.”  “I do trust that, but need to be sure.”  “I completely agree.”

Then acknowledge the system is still broken when only a professional can navigate it.

Then do it.

Navigate the waiting lists and be there throughout the wait.  Connect regularly.  Phone, meet, text or email.  Stay in contact.  Because I have no reason to trust you since you are the system: so follow up however long it takes and I will trust you.

Be professional.

D

err, I ranted. No gatekeepers are wanted, but a broken system relies upon the position.

Wow Dylan,that was so passionate, powerful and real.

I don't think you ranted at all and there are so many things you said that resonate with me (and will resonate with many others)

Thank you.....

Betty-Lou Kristy

PROVIDING EVIDENCE from community to systems level policy, planning & governance

Hi Betty-Lou. Your note about "Trusted Professionals", reminds me of a published document from Maine. "In Their Own Words: ("ITOW" [acronym]) : 200 Maine persons with Lived Experience, and Professionals They Trust, Tell What Helps and What Hurts". I believe it can be accessed in pdf format from the Anna Institute website via the "Documents" section. It contributed to the "Trauma-Informed" programming of Maine's Mental Health and Substance Abuse agency..

Very nice description Dylan, thanks. Like the "healthy defensive posture" in particular

Hello Robert:

I just explored that site you mentioned and it has a wealth of information. Thanks for bringing that to my attention.

Betty-Lou Kristy

PROVIDING EVIDENCE from community to systems level policy, planning & governance

Excellent post Dylan. Well said.

Here is the link to the document Robert referred to --  

IN THEIR OWN WORDS

Trauma Survivors and Professionals They Trust Tell What Hurts, What Helps and What Is Needed for Trauma Services 

Thanks Julia

I found the article "In Their Own Words" very powerful and distressing.  I am part of the review of the Prevention and Maintenance of Aggressive Behavior - old name and we are trying to find a new name.  I have sent the document to our lead so that it might be incorporated into the new training that will take into account trauma, re traumatizing actions, staff beliefs, idiosyncrasies and trauma, safe and healing environments and more.  It takes time to change but what better time than now.

I have been in Mental Health for over 30 years and although that time has been on the sideline I have seen great change but the safe and healing environment is still not here yet.  Thank you for all your comments they help us all.  J    

Thank You Julia, for posting that link. A number of similar publications like it, can be found and/or accessed in our National Center for PTSD Library in White River Junction, Vermont. I read part of the report of the Canadian Solicitor General on the Aboriginal Schools, there, and found the noted efforts to create a Healing Society commendable.

Thank You Dylan for a most eloquent plea, for not only what you need, but for sharing the hope of trusting egalitarian relationships with others who share our goal of Recovery, and for letting me know that-so that I might concur (in whole or in part). I do concur!

Also,Thank You 5Jackie. I will hope that since it was published, in 1997, some improvents have occured in Maine, and elsewhere. I testified before the Vermont Legislative Trauma Commission in 2000. Since that time I have had my hopes raised by much, and despaired on more than a few occasions, although I found Susan Lawrence, M.D.'s book "Creating A Healing Society: How unhealed Trauma..." and her personal narrative of her childhood, and how it helped her discover her mission[s] in life, after enduring substantial tragedies, and how her mission progressed and where she asked: "What happened to You?" rather than "What's Wrong with You?", and how the U.S. Center for Disease Control partnered with Kaiser-Permanente Health to study almost 18,000 of their patients and what their childhoods were like....and how we can avail our presence to one another to make the Hope of Recovery a reality, and ensure that resilience is available to future generations. Four Canadian Protestant denominations which ran the Aboriginal Schools have officially taken responsibility for their part, and an effort is underway to embark on a healing process, similar to what Nelson Mandela embarked on in South Africa. Regretably, my nation has yet to incorporate Children's Rights into our National Constitution like most of the other industrial democracies have done. A 13 year old boy, at the time, from Canada, undertook a mission to improve the conditions under which many Children around the world labor, in unhealthy and outrageous conditions, and the book "Child Labor" is a fitting tribute both to himself and the honor of Canada. That is only my expressing my humble opinion based upon my world view. It is no more valid than your post is for you.

Thank All of you again for participating in this forum, and for letting me also.

I just posted on a different EENet Connect forum, the web address for a document: "Mental Health Workforce" by (U.S.) Congressional Research Service; I'll try to avail the web address here too, later.

"Mental Health Workforce" by Congressional Research Service, might address some of the Gatekeeper and other questions. A pdf version can be viewed at:

     http://www.fas.org/sgp/crs/misc/R43255.pdf

Thanks for the links, Robert.  And a very stimulating discussion, everyone!

I found ITOW a disturbing and informative read.  None of this is new – the report itself is 15 years old and every report from the past fifty years sounds similar, so long as there is a persons with lived experience component.  That is, where PWLE have input, the problems with stigma, discharge handoffs, unsupported wait times, in/appropriate medications and side-effects, and so on, have been raised.  I have been a part of two major discussions in the past month alone that both asked, “What can be better done?” and the solutions are practically identical today as then and previously.  Better integration of services and a great deal more empathy among some workers (not all); education; flexibility. So little has in fact changed despite efforts to do so.  This is why I found the report distressful, as much as for the format’s content – “in their own words.”  Difficult but necessary reading.

I have yet to read “The Mental Health Workforce,” but hope it is more encouraging.  The summary’s focus on wages is not, but then the paper may provide a better understanding of the system.

Regardless, a system so complex and varied requires navigators: people who know and understand the system.  Without these people (paid peers in many cases) people will continue to receive inadequate care and return to emergency departments or even the streets.  Navigators are different from gatekeepers inasmuch as a pilot has a destination and a keeper may simply refuse admittance.

Ciao,

D

As usual, I agree with Dylan.

Thank you Dylan...

Also, thanks to Robert for his contributions and links to documents

Betty-Lou Kristy