By Jennifer Brizzi
Iron shackles and chains bound the wrists and ankles of the mentally ill in America until the middle of the 20th century. Eventually, after the practice was finally deemed inhumane, they were melted down to be recast into a 300-lb bell to signify how far we’ve come, with the connotation that the shackles and chains still exist in the misunderstanding people tend to have with any and all mental illnesses.
Especially in light of the current opioid crisis, that sense of understanding, and our more general misunderstanding, has been long in coming, both on a national level and in the changing strategies of individual treatment centers. Those needing to recover from addiction face a maze of public policy blanket statements, some more helpful than others. The New York State Office of Alcoholism and Substance Abuse Services (OASAS) states that more than 1.9 million New Yorkers (1.77 million adults and 156,000 youth ages 12-17) have a substance abuse problem, which is about twelve percent of state residents age 12 and older. The OASAS acknowledges that its impact is even greater than that, with the problems addiction causes extended to the millions of other individuals whose lives are also affected, from immediate and extended family members to society at large.
Of those 1.9 million New Yorkers, OASAS claims to help 260,000 of that number, by certifying and funding addiction prevention and treatment measures. Some of their strategies include “enhanced enforcement” of laws like prohibiting alcohol sales to minors, raising alcohol taxes to discourage use and abuse, as well as regulating “beverage outlet density” in communities and regulating opening hours for the vendors of alcohol. For drug addiction control, their goals include implementation of “Substance Abuse Prevention Model Programs’ in schools and workplaces and other places where people gather, and the establishment of a registry/searchable database of organizations that prevent and treat mental and substance use disorders.
Often these two entities, mental and substance use disorders, go hand in hand because the mentally ill try to self-medicate their anxiety, depression or other illnesses. The psychological afflictions with the highest rates of substance abuse are antisocial personality disorder and bipolar disorder. About 8.9 million of Americans suffer both a substance abuse problem and a mental health diagnosis. More than half, or 55.8 percent per the Substance Abuse and Mental Health Administration (SAMHSA), don’t get treatment for either issue; only 7.4 percent receive help with both.
Many are noting these days that much of the reason for self-medication’s abuses has to do with the continuing hangover from our long misunderstanding of mental health issues, and the continuing stigmas that has kept alive.
On a broader scale in the realm of public policy on mental health and addictions, the federal government remains regulatory in nature, creating public policy that’s focused on their main purpose as a funding source for services. But they also serve a protective role that is aimed at preventing discrimination against the afflicted. One of the federal government’s most significant acts was the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 that insures that insurance plans don’t give mental health care the short shrift compared to physical health care.
NAMI, the National Alliance on Mental Illness (nami.org), funds research and takes responsibility for protecting access to treatments and services for mental health issues. The National Council (www.thenationalcouncil.org) boasts a “strong addiction and mental health safety net,” their emphasis on public education regarding all elements of mental illness and addiction, helping state and local governments, as well as behavioral health programs from small to large scale, deal with the ways in which all of us are affected, just as all must be concerned with health care on a purely physical level.
Finally, the stance of Mental Health America (mentalhealthamerica.net) is an interactive approach that seems to take the form of practical interventions. “[We] believe policy should ask people what they need to live the lives they want and support them getting there,” is their key statement of mission. It was this organization that was responsible for the construction of the Mental Health Bell I mentioned at the start of this story.
Their fight, they claim, prioritizes early intervention, treating the mentally ill and the addicted with dignity, and implementing ways to reduce homelessness and incarceration. Their policy recommendations appear to stress integrated care/treatment and a goal of complete recovery, an arena where many “recovery” aimed treatment centers fall short.
An April 2018 Boston Globe piece tells the story of one Colin Beatty, who created Column Health, a group of Eastern Massachusetts drug treatment clinics (columnhealth.com). He was inspired by the drug overdose of his sister, whom he feels was failed by a system that emphasizes treatment but not relapse prevention.
Beatty felt that many treatment facilities are unwelcoming, frightening and disrespectful to the addict, and so he strives to maintain a dignified yet homey atmosphere in his. Therapy takes place on site rather than being farmed out elsewhere.
While many clinics may be successful at keeping people off drugs while they are in the programs, once they return to their regular lives, relapse is likely. Many experience several stints in rehab with no success because the underlying reasons they became addicted—such as childhood trauma or mental illness—are not addressed and so they remain after detox and treatment.
Beatty holds his clinics accountable and measures their relapse rates, as well as detailed data on all his patients, including how often they take their medications and so forth, in order to decrease that relapse rate. He sees official creators of public policy as funders of treatment, but also as entities that inadvertently reward failure and the need for additional pricey treatments.
At Column Health, the tagline is “Addiction treatment that doesn’t suck.”
In other words, it’s all about getting beneath what drives us to self-diagnosis and medication, the reasons why we become addicts. Which means continuing to look beyond all those stigmas about all our mental health issues, as a people, that we’ve been misunderstanding for centuries now, and may only be starting to fully understand now.