The Origins of Community Inclusion
Having previously explored the common tendency to blame mental illness as the underlying cause for unspeakable tragedies of mass violence, it may come as a surprise that nearly all results of research concerning linkage between mental illness and violence reveal that those living with a mental health diagnosis are more likely to be victims of violence not perpetrators. Studies show that instances of gun violence related to mental health diagnoses frequently does not extend beyond self-harm. Although the topic of violence and mental illness often takes precedence in public discourse, it barely scratches the surface when it comes to the reasons and needs for improvement of mental health services.
Regardless of any assumed linkage between violence and mental health diagnoses it should be understood that the need for access to mental health services and community supports is paramount. Mental health services, if effectively implemented, can be highly effective, preventative measures for not only any individual suffering from a psychological or behavioral problem with a propensity for violence but also for all peers living with a mental health diagnosis. Services for mental health should exist to serve the community at large not by only preventing crisis but also by assisting in the management of crisis and the overall improvement of outcomes.
The desire for improved outcomes and a compassionate and effective system of care highly informs the current movement for peer support and community inclusion within the mental health community, understanding why and how this movement arose makes it all the more meaningful.
Reflecting on the history of trends in treatment over time, the significance of the current movement, which focuses heavily on advocating for peer partnership and implementing peer support and community inclusion programs cannot be overstated. Up until the 1950s, the general treatment for individuals suffering from a severe mental health diagnosis included, extensive use of shock therapy, lobotomies, and long-term hospitalization that often resulted in individuals spending the remainder of their lives confined to a hospital. The 1960s experienced not only the widespread introduction of the use of psychiatric medicine but also the beginnings of the anti-psychiatry movement. Referring to themselves as ex-patients and at times ex-inmates, survivors began to establish a network of ex-patient groups who banned together, originally demanding not reform but the complete abolishment of the psychiatric system. Anti-psychiatry was a prevailing theme that heavily influenced the early years of the movement giving rise to such ex-patient advocacy groups as the Insane Liberation Front and the Network Against Psychiatric Assault.
The 1970s saw the rise of several monumental civil rights movements including the women’s rights movement, the gay rights movement, and the disability rights movement. The lesser known survivor movement also gained momentum alongside the more publicly visible calls for equality, acceptance, and tolerance. At this time the concept of peer-support began to form among many ex-patients of the survivor movement. Peer-support, they believed could provide a solution to the broken and at time abusive system of care many living with a mental health diagnosis found themselves victim to at this times.
To this day the guiding principle of peer-support rests on the belief that through shared experience and mutual support individuals living alongside a mental health diagnosis can help themselves and their peers in manifesting better outcomes and rectifying a broken system of care. Advocates for peer-support believe individuals living with a mental health diagnosis are more equipped than most professionals charged with their care to provide support and guidance to peers experiencing a similar crisis or working towards stability. Shedding light on the invaluable nature and potential power of shared experience in achieving recovery or management over one’s diagnosis, the peer movement was a significant step towards recapturing feelings of agency, self-determination, and hope within the community.
Following the radical anti-psychiatry movement of the 60s and 70s, the 1980s saw the once vigilant anti-psychiatry and anti-capitalist sentiment held by many of the ex-patient groups replaced by more moderate calls for reforms. Individuals living with a mental health diagnosis began to identify as consumers rather than ex-patients or ex-inmates. Many we’re willing to moderate their more extreme views in the hopes that with such moderation actual reform would be attainable, yet radial organizations still existed and continue to exist at varying degrees.
At this time the survivor/consumer community was experiencing the full effects of deinstitutionalization. Soon after the number of homeless persons skyrocketed throughout the country and local jails were flooded. Services available in communities were insufficient and fragmented. Little to no alternatives to institutionalization existed in the aftermath of the deinstitutionalization movement increasing the likelihood that individuals experiencing a mental health crisis would to be re-institutionalized in community service programs, imprisoned, homeless, or otherwise untreated.
Since the 1950s peers have been speaking out against psychiatric abuses, the misuse of seclusion, the loss of agency, the loss of dignity, and the lack of self-determination most experience at some point in time during their treatment. Yet only in the past 10 to 15 years have we seen the systemic failures of the mental health care system addressed or rectified. In spite of the delays actual implementation of solutions consumers persisted until their voice was heard.
Qualitative research regarding the present Consumers/Survivors Initiatives, such as community inclusion and peer-support programs, reveal that they are an effective means of implementing community integration and improving overall outcomes.
The origins of the community inclusion movement can be traced back nearly five decades, but a continual lack of funding and support has remained a barrier to implementation. In the recent past there has been a trend towards more support, however, the goals of community integration are still being debated. Nevertheless, the history of community integration and the associated peer movement sheds light on our current state of the affairs, how far we’ve come and how far we still have to go.
Next in the series we will address the way community integration currently exists and how it does and can improve quality of life by reducing recidivism and improving outcomes for those living alongside a mental health diagnosis.
Until then here are some questions to ponder:
- How do you feel community integration could improve outcomes for those affected with a mental health diagnosis?
- In what ways can communities support the integration movement?
- Beyond the known benefits of the current initiative what do you see as potential benefits to inclusion? Do you foresee any potential barriers to or weakness of the integration movement?
- What are additional ways to support individuals with a mental health diagnosis in overcoming barriers to wellness?
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Madeline Jaekle is a Mental Health Advocate and Author, based out of Greensboro, North Carolina. Even though Madeline was diagnosed with Bipolar Disorder early on in her adolescence, it wasn’t until the age of 20 that her mental illness fully manifested, in the form of a severe manic episode, with psychotic features. Largely due to the encouragement of fellow community members, Madeline decided to fully embrace the role of Mental Health Advocate, focusing primarily on topics such as adolescent (pre)diagnoses, the criminalization of mental illness, and trainings meant to better equip and prepare not only mental health professionals, but also first responders and police officers. When Madeline isn’t advocating she enjoys spending time with her four-legged companion, and the family and friends that stood by her despite the traumas that arose in her journey to discover the best way to manage her mental illness. In addition to continuing her Mental Health Advocacy, Madeline is working on a memoir chronicling her journey thus far.