I have written and spoken at length, over many years, about a historical development in the mental health system that I call “the professionalization of care” (see, for example, this issue of the Shalem Digest or this video introduction to WrapAround). No doubt some would say that I carry on about this theme ad nauseam. But when, yet again this weekend, I learn of experiences of harm created by “the professionalization of care” in the mental health system, I can’t let it go. It makes my blood boil.
First of all, let me be clear: I work in the mental health system, and I am a professional myself. I have many friends and colleagues doing outstanding work in mental health, sometimes in difficult circumstances, and none of the work is easy. I am not out to “shame and blame” the mental health system or the people who work in it. On the contrary, I have great hope and affection for that system and many of the people in it.
This weekend I heard a story that, sadly, I hear over and over again. A young man went into a serious suicidal crisis. He has a strong, attentive and supportive family. He was admitted to the psychiatric wing of a local hospital, where they worked well with him and with the immediate crisis that he was going through. But his parents were ignored, overlooked, not valued and (absurdly) subtly blamed for the circumstances that led to the crisis.
Some of the advice given to them from young social workers was boilerplate, social work textbook advice which, because it was abstract and not connected to their actual realities, was far off the mark, even bizarre. Yet it was delivered in a way that the parents experienced as patronizing. It made them feel small, unimportant, less than competent, frustrated and confused.
In these kinds of scenarios, which, regrettably, I hear over and over again, what the “system” fails to realize, and simply refuses to acknowledge, is that this young man’s parents and supportive community are the key members of his treatment team.
To its detriment, and to the detriment of both their client and the people engaged in the client’s life, the mental health system displays a persistent bias against people involved who are not trained professionals, people who do not have the same level of mental health “expertise” that professionals have. All too often, they even see them as obstacles to mental health. Even from a strictly “professional” or analytical standpoint, this stance is problematic, because the mental health research is clear that relationship is the strongest protective factor in both recovery from and prevention of mental health crises.
Until this “professionalization” bias changes, the crisis in the mental health system—which manifests itself in increasingly overloaded caseloads, demands that cannot be met, funding shortfalls, and sometimes poor outcomes for clients—will continue to worsen. That’s because professionals can’t do it on their own.
Family and community members can’t do it on their own either—they need the support of professionals. The professional sector needs to find new, innovative ways of partnering with informal supports. But let us not underestimate the dramatic paradigm shift and the serious self-reflection that this requires of mental health systems. Regrettably—I hope I am wrong—I am not seeing progress.
I am grateful for programs like WrapAround and Attachment Therapy with traumatized children and youth—both of which Shalem is heavily involved in—that deliberately support and position parents, family members and community members as the central, critical members of the professional treatment team. Sadly, precisely because of the gaps created by the “professionalization of care,” the need for and the demands on these programs grow more and more intense.
If you are a community member, how can you help your community (whether a workplace, faith community, school or neighbourhood) to step up and assume its rightful responsibility to look after its most vulnerable members? And if you are a mental health professional, how can you learn to embed yourself in communities, even when that action might conflict with some of the training you have received? What process can you undergo in your practice to become aware of the bias and privilege you display as a professional?
These queries may sound hard-hitting. Certainly they are challenging. But for families like the one I encountered this weekend, we owe real, genuine answers to these questions.
Mark Vander Vennen, MA, M.Ed, R.S.W., is the Executive Director of the Shalem Mental Health Network