From the Editor:
Mental illness is one part of my tapestry. That’s what Misha Kessler said last week at the second global urgent and emergency mental health care Crisis Now summit and IIMHL conference. He made a crucial distinction: mental illness is not the entirety of who he is, turning on its head the assumption that people are defined by their illness. This word shift humanizes and destigmatizes, reminding people that those who experience mental illness aren’t other. They are one of us, and a mental health crisis can happen to anyone at any time. It’s not a reality meant to scare people but to erase the fictional line drawn between them and us. Those categories do not exist as mental health crisis affects nearly all of us—either because we experience it or because a loved one does, and we, as a society, need to care about what happens to people in crisis. At one point, during the first day of the summit, Dr. Caroline Dollery, Clinical Director for East of England strategic clinical network for mental health, neurology and learning disability, leaned over to me and said, “It really comes down to caring.” Her words stuck with me. Caring alone doesn’t do much without money, but then again that too comes from those in power caring enough to value and fund mental health crisis care. When boiled down, she’s right. Caring—and education that makes people aware enough to care—must be the underpinning for any crisis system to be successful.
Two quotes came to mind as I sat amongst 60 leaders from nine countries at the Education Development Center (EDC), nestled at the edge of Georgetown, Washington D.C., mere steps away from the Potomac River. Liz Fosslien and Mollie West Duffy define diversity as having a seat at the table, inclusion as having a voice, and belonging as having that voice be heard. Epictetus, the Greek Stoic philosopher, said, “…it is impossible for anyone to begin to learn that which he thinks he already knows.” Experts in all fields are at risk of building an insular, impenetrable fortress of thought where external concepts are not allowed because, well, they are the experts. It’s a mindset that prevents convergence of fields and expanding perspectives. That is not this group.
Over the two day summit, which culminated with developing a framework for an international declaration, we heard from people with Lived Experience, law enforcement, leaders of health technology automation, pathophysiology technology, and the law, as well as innovative mental health professionals. The room seemed to expand at its seams with experts on mental health crisis from around the world who came together and said, “You know who should be part of building the mental health crisis system in any nation? The very people it’s meant to serve.” It so simple, as breakthroughs usually are, that those whose voices should part of creating a system be of the people who’ve had to navigate the existing crisis system (often systems): patchworked silos that Dr. Phil Moore, Deputy Chair at NHS Kingston Clinical Commissioning Group in the United Kingdom, says are more often single points of rejection instead of access. While nations are nuanced, leaders from nine countries said fragmentation was part of the problem in each of them. “It’s pointless to have a crisis system that doesn’t work,” said Dr. Moore.
When we came back from breaking into five delegation workgroups, each team presented their blue-sky pitch, an idea that would launch crisis upward in a tangible, attainable, and translatable way. The teams discussed sustainable funding mechanisms, standardized definitions, and data-driven quality improvement. The commonalities between them were striking: the groups stated mental health is a cornerstone of overall health and crisis care must be centered around the people who need it, and available to anyone, anywhere, and at any time. Meaning, crisis care must meet people where they are, and not the other way around. It’s what’s practiced in the Netherlands with their crisis resolution and intensive home treatment (IHT) program, where multidisciplinary teams go to the homes of people experiencing urgent psychiatric issues. Treatment can be scaled up or down to match patients’ needs. The reason for going directly to patients, says Elnathan Prinsen, Ph.D., is that it makes treatment more accessible, and it prevents further disrupting the day-to-day lives and social roles of people in crisis. “The person may be a father, a spouse. We must focus on treating people in their environment, allowing them to maintain all social roles.”
The caring Dr. Dollery mentioned is not only about compassion toward those who have experienced crisis and face mental or behavioral health challenges, but also includes self-compassion for those of us who struggle with it on a day-to-day basis. Kessler shared with me previously that being caring toward himself has been instrumental in his recovery, allowing him to accept that he will face lows, and while, yes, he does all he can to address them, they will sometimes happen. Shelby Rowe, a mental health professional who I interviewed for #CrisisTalk in June, shared a similar sentiment of self-caring and revealed that permitting herself to acknowledge her feelings and release anger at herself gave her a sense of freedom from fearing failure. What people with Lived Experience share is that recovery is a journey, not a finish line. It’s also not about curating a fictional recovery perfection that appears unattainable to those in crisis.
Perhaps this all seems obvious. Truths can appear cliché. Too flat and straightforward, so sometimes we don’t say them, and we miss opportunities for people outside of mental health to get it, preventing laypeople like myself, a journalist, to gain entry into these discussions. Yet it’s these threads and stories that draw people in, bringing them to a place of understanding and compassion. Mental and behavioral health crisis is everyone’s concern, and we all need to be part of the crisis conversation and solution.
You can see a recap of the 2019 IIMHL Crisis Now 2 Global Summit here: http://bit.ly/youtube-crisis2019.
-Stephanie Hepburn, editor in chief of #CrisisTalk