VOCAL’s Advocacy Team educates peers, communities, policy makers, legislators and government officials about peer values, recovery-oriented systems and the needs of consumers as communicated to us by our members.
full human rights and self-determination of every individual, regardless of mental state or diagnosis
the right of each member and member center to self direction
all peer-run centers regardless of agency size, services, or programs
individual input, and we operate by an inclusive process with open and honest communication;
each person’s individual process of recovery; and
the worth and dignity of all people.
ON STIGMA: Behind the discrimination, inadequate services, and crippled lives of people with mental illness lies a pervasive, historic misconception of what serious mental illness is and means. VOCAL witnesses the wholeness of people with mental illness, and their potential for full, meaningful, self-directed lives. We believe people can overcome learned dependency and self-stigmatizing and connect with their own drive to recover and reclaim their lives. We believe that as peers speak their truths and work with administrators, politicians, providers and the public to transform the system, stigma will be dispelled. We believe that recovery from mental illness can be a transformative process, which gives meaning, resiliance
THE SYSTEM IN CRISIS: We believe that the vast majority of problems society associates with people with mental illness could be avoided if appropriate and timely mental health services were readily available. Virginia’s mental health system has been in crisis since the budget cuts of the 80s. Consumers in many locations do not receive services when in need, and in many locations they do not receive services at all. The Inspector General’s Report from June 07 found an average wait for an outpatient appointment is to be 35 days. The average wait for outpatient appointment following emergency is 23 days.
Current services tend to focus on symptom management with medications, and often are not provided in the spirit of recovery and self-direction. Peer support, individual wellness planning, information about innovative modalities, and consumer-run programs must be readily available to all peers.
Since people were moved from state hospitals into the community, beginning in the 70s, without adequate community services, the number of incarcerated people with mental illness has increased markedly. Incarceration and criminalization constitute inhumane treatment for people with mental illness. People become more ill, lose benefits and needed community connection. All mental health planning must be driven by visions of the consumer as director of his/her own treatment and recovery, and of wellness and crisis prevention. Consumers must be involved in all aspects of planning on state and local levels.
ACCESS: The goal of the mental health system needs to be improvement of service coordination and access. This position is supported by the President’s New Freedom Mental Health Commission of 1993 which called for a system transformation focusing services on consumer and family driven, coordinated services and the Institute of Medicine (2006) which contends that mental health services must be patient-centered, respectful of, and responsive to individuals’ preferences and needs.
Advances in treatment have allowed the treatment of mental illnesses to dramatically change during the last half of the 20th century. Virginia’s budget continues to focus its dollars on residential and crisis care, yet outpatient, person-centered treatment has proven to lead to recovery for many people, thus allowing them to use fewer services and fewer budget dollars. Research on the economic productivity of treatment is new, but it raises challenges to the traditional spending structure focusing on mental health crisis management. It is becoming increasingly evident that budgeting for preventive care is ultimately more cost effective over time in addition to its value on human life and dignity, allowing individuals with an illness to be involved in their own treatment and recovery.
People with a mental illness diagnosis are generally non-violent and do not need to be separated from the community while receiving services. In fact, most of the issues associated with mental illness and society could be alleviated if appropriate, timely and reflect effective treatment approaches fostering individual choice services were accessible. The United States Psychiatric Rehabilitation Association states that all people have the capacity to learn and grow and this potential is not nullified by a diagnosis of mental illness. Individuals in early stages of an acute psychiatric episode can avoid hospitalization through early intervention of services tailored to the needs, wants and experiences of each person in recovery.
We believe the following services represent a minimum community standard and should be offered to all mental health consumers in Virginia:
In an emergency situation:
1. A trained individual who answers the crisis line 24 hours a day, 7 days a week. Not an answering service or machine message.
2. A face-to-face meeting with a licensed clinical professional who can make a diagnosis, within 24 hours,
3. Direct access to a physician and an immediate medical examination by a physician to rule out underlying medical conditions or to identify co-occurring conditions,
4. Immediate care coordination with your current mental health and medical care provider,
5. Immediate attention to meeting basic needs for food, shelter and clothing,
6. Interventions that promote the least coercive, non-traumatizing contact or connection to services. Do not involve police in transportation or use handcuffs to detain non-combative consumers,
7. Preserve prior living arrangements during times of crisis, especially if the result is hospitalization, and If the individual is calm and not combative, restraints should not be used.
8. Where a Temporary Detention Order (TDO) hearing results, access to legal representation at least 24 hours prior to any court appearance and representation by an attorney trained in mental healthcare issues and mental health law.
In routine care:
1. A range of treatment options that serve to pre-empt the development of problems and that support a consumer’s ongoing recovery; and
2. Timely access (within 7 days) to individual counseling, to peer supports, to a physician, to crisis stabilization programs outside of a hospital setting and to housing supports and supported employment.
INVOLUNTARY COMMITMENT: The application of involuntary treatment fundamentally violates the constitutional rights to privacy and due process among individuals in recovery from psychiatric illness. Involuntary treatment represents an abject failure of the public mental health system, coercing and forcing treatment as a substitute for inadequate funding and access to services.
Virginia is responding to an ongoing need for continued systems transformation as well as the immediate emotionally charged tragedy at Virginia Tech. There seems to be a community-wide fear of violence perpetrated by the mentally ill population. However, a 1998 MacArthur Foundation study showed that people with a mental illness are no more violent than the general public. In reality, people with a mental illness are 2½ times more likely to be the victims of violence then a person without an illness.
Involuntary commitment is often viewed as a way to help people who are so sick they cannot understand their need for care. All too often, however, people with a mental illness seek out help on their own and are not able to access adequate services in a timely manner, if at all, and this delay can lead to a crisis situation in which a person becomes unnecessarily much more sick.
A three year study at Bellevue Hospital in New York, comparing the impact of providing an enhanced, better-coordinated package of services, both with and without the used of mandated care came to the conclusions that people do better when they are offered better services and that mandated services do not improve the outcome. Rather, mandated treatment unduly violates peoples’ rights and erodes their faith in the system
Studies1 indicate that more mandated treatment orders are levied at people of color, namely African-Americans and Hispanics. This implies that adequate mental health services are not currently being offered equally and the system is more likely to mandate treatment based on a person’s social/economic status, instead of the most effective services available for that person. What does this tell us about the adequacy of our community mental health service system in properly serving the population of Virginia?
We must reject legislation and public policies that authorize the use of such force. The Virginia state legislature has the responsibility, in the face of unconvincing research and discriminatory implementation, to increase access and availability to adequate voluntary treatment resources where individuals’ well-being, liberty and interests are valued.
Reference: 1. Loring M, Powell B. Gender, race, and DSM-III: a study of the objectivity of psychiatric diagnostic behavior, J Health Soc Behavior 1988 Mar;29(1):1-22. PMID 3367027