Reception Is a Window into Your Organization
Housing and homelessness organizations tend to have one, if not two, primary windows into the organization as a whole. The first is reception. The second is outreach. This blog focuses on reception.
Managerially and operationally, I like organizations to think of reception as air traffic control, not as an administration or greeting function. While administration and greeting may occur within reception, it doesn’t matter what type of program you operate, the orientation has to be towards air traffic control.
Air traffic control knows all the air traffic in their general area. If it is on radar, it is asked to identify itself if it hasn’t already done so. Reception, at some level, needs to know who all is in their area. Anonymity doesn’t cut it.
Air traffic control knows which aircraft are seeking to land. In the context of homeless and housing service delivery, reception needs to know which people are accessing resources to “make a landing” versus those that have enough fuel to travel through and have alternate plans.
If there is a landing – even a temporary one to refuel – air traffic control knows about it. Airplanes don’t sneak into airports and just arrive at the gate. People should not be able to just slip into a drop-in or day program without connectivity to reception in housing and homelessness service delivery. And yes, that applies to “low barrier” programs too.
Upon arrival at the airport, ground operations – which may be organized and/or communicated through air traffic control – tells aircraft which airstrip to land on, where to vector, and which gate to park at. Reception has a duty to get inbound individuals/families to the people that can best assess their needs for the right programs at the right time to end their homelessness.
Air traffic control deals with competing interests of inbound aircraft, as well as dealing with issues of those that weren’t planning on landing, but need to. Reception, too, plays a vital role of managing competing interests. But this can’t be based upon emotion or intuition. It has to be based upon facts and needs. It is through reception that high performing organizations are able to facilitate the right type of assessment.
Air traffic control is the first point of contact with a specific airport. Reception is the first point of contact with a housing or homelessness serving agency. When the right information is provided, regardless of the conditions, there is a smooth landing and taxi to the gate at the airport. When the right information is provided by reception, regardless of conditions, there is smooth alignment of needs to programs that can meet needs.
Upon landing at an airport, airplanes and its passengers are further assisted by signage. There are clear directions of where you are and where to go. “Wayfinding” helps ensure that aircraft aren’t bumping into each other; that pilots know where the end of the runway is; that passengers know what terminal they are in; that people find their luggage (assuming it made it on the plane); etc. Any reception area worth its salt has to have clear signage and communication so that people know exactly where to go within reception to get the services that they need.
Here are some general suggestions, then, for your reception:
It is not a junior or entry-level position within your organization. Staff it with someone knowledgeable of all of your organization’s programs, and has likely spent time shadowing or working in each of them.
Offer signage in multiple languages that is easily understood. Avoid jargon that a newly homeless person or family would find difficult to follow.
Filling out forms and the like should happen when people are connected to the right program, not in reception.
Keep things moving in the reception. Do not create an environment where people can just “hang out” without connecting to service.
Experiment with the right staffing number to address the volume of people that are steered through reception. Keep in mind that the staffing volume will be greater during a transition program if your current reception does not perform these functions.
Manners go a long way. Respectfully determine why each person is at your organization. Even low-barrier services should be focusing on ending homelessness and reception should reflect that.
Case managers, case advocates, immediate support workers, etc. should take their cue through reception of which individuals to engage with that day and why when services can be provided without an appointment.
Making the Most of System Expert Conversations
A week ago I was interviewing people experiencing homelessness in Virginia Beach. On the beach. In the woods. Outside tents. In a shed. At a drop-in center. Outside a 7-11. At 2am at an IHOP. Beside a dumpster. In a meal line.
Not long before this time in Virginia Beach I was doing the same thing in Barrie and Orillia. In a gazebo. By a marina. Outside a shelter. In an alleyway. By a coffee shop. Along the shoreline. In the alcove of a business.
In the last year I have been fortunate enough to have a half dozen experiences where I was the lead researcher with people with lived experience at being homeless. I am moved each and every time. Of all the research I get to do, interviewing people with lived experience is by far the most rewarding to me. I get the best information, unfiltered by others. People that are homeless or recently experienced homelessness don’t feel that they have to say nice things about any particular service provider – though they may very well have loads of positive things to say. I take that power dynamic out of the equation, which would be ever so present if the sessions were being conducted inside a service environment or were orchestrated by staff within a service organization.
More often than not, I am able to reveal information in an aggregate sense that the community did not have before. I am not interested in examining any particular anecdote of a person that I interview. Instead, I am interested in what happens when I undertake analysis across the interviews. This is when trends emerge and I can start to draw conclusions about what is going on in a community. I try to get a good number of interviews conducted each time. In Virginia I did 81. In Simcoe I did 67. In London I did 87. I’ll stop there.
The context for why I am seeking the voice of persons with lived experience changes, but the general questions that I ask are the same.
I start with simple things – age and gender. I can do the first cut of analysis on these two pieces of information first. It isn’t uncommon for the experience of service access and outcomes to be different for younger persons versus older persons, for the experience of men to be different from the experience of women – and the experience of men and women to be quite different from the experience of persons that identify as transgendered.
Next I look at whether they identify as being single, being in a childless couple, or whether they are a family unit taking care of kids. If they have kids I find out how many and the ages of the kids. Generally, the experience of childless couples is very different than the other groups, as service systems in most cities go out of their way to treat them as single adults rather than a couple. And in too many communities, same-sex childless couples struggle with the stigma of trying to maintain their relationship inside a shelter environment where acts of affection or intimacy are not allowed.
I then move onto the person’s experience of homelessness. This gets a little trickier so the way in which I explore the questions is a bit more involved. In essence what I want to know is: what is the cumulative duration of homelessness throughout their entire lifetime; how long they have been homeless in their most recent experience of homelessness; how long they have been homeless in the city where I am actually speaking to them. Related to the homeless question, I want to find out the last time they had housing and the city where that housing was located. I’m sure the day will come when this turns out differently, but in all my years of doing this type of research I find out, lo and behold, that most people have had secure housing at some point in the city where I am interviewing them, debunking the myth that homeless people are travelling from one city to another in search of the greatest, most generous services of all time.
At that point I remind folks that I am not a cop nor am I service provider and that if they provide me open and honest information I can help more homeless folks overall, but they are welcome to skip my next set of questions if they want. I remind them that their response is anonymous. I also tell folks it is better to skip the questions that to give me a load of BS. First I ask them if they are having any issues with their mental health, usually framing the question first as “Have you ever had a conversation with a psychiatrist or psychologist? When was that? What was that for?”. I follow that with physical health. I usually frame this question first with, “Have you seen a doctor or nurse for anything in the last year? When was that? What was it for? Is it still going on? Anything else you feel you should see a doctor about now?” Then I ask them how much alcohol or other drugs they consume on a daily or weekly basis. I usually frame this with, “Be straight up with me – how much have you had to drink this week and what did you drink? What other drugs did you use and how many times?”
A statement of affirmation goes a long way after these three questions. I find it helps to look them straight in the eye when I thank them for their honesty on those questions. In almost all instances people I interview answer all three questions.
From there I move onto how much they interact with other services. In the last year (or perhaps I’ll say something like “Since last winter” to help them put the time frame in context), how many times, approximately, have the police had an intentional conversation with you…more than a ‘Hey, how ya doin’?’ sort of conversation?” I then ask how many times they have been to the emergency room of the hospital in the last year for their own health issues and how many of those trips were in an ambulance. I follow that up with inquiring whether they have spent any time admitted as a patient in the hospital in the last year. And finally in this section I ask them how many days they have spent behind bars in the last year.
“In your opinion, what is the number one reason you aren’t housed right now?” is the next question that I ask. Sometimes people will tell me they don’t know. I ask them to close their eyes and dig a little deeper in those instances. I remind them that they are the expert on why they aren’t housed and I want to learn from the expert.
The questions in the next section of my interview change depending on context. At this point I may be asking their opinion on permanent supportive housing or affordable housing. I may be asking about the type of housing they would want. Sometimes I find myself asking what they would do to improve the homelessness and housing system. In other instances I have found myself asking folks how they spend their days from the moment they wake up until they go to sleep.
The last question I ask is always the same, “What haven’t I asked you about that you feel we need to talk about?” I never know where the response to this question will go. At times, the most rich information from the entire interview comes from this very question.
I know some social researchers feel it necessary to give homeless folks an honorarium for participation either in cash, cigarettes, food, grocery card, coffee, or whatever. I don’t. I think the currency of our exchange should be a shared commitment to improve homeless programs and services. The way I see it, the folks I am interviewing are already the most invested people in needing to see improvements. They give me their time and I give them mine. I am passionate about making improvements. They invest in fuelling my passion. The system as a whole benefits.
Every single time you consider improving your program or your community’s response to homelessness, it is incomplete, in my opinion, if you do not get the input from people with lived experience – currently or past homeless people. Don’t do it as tokenism. And don’t do it with staff that have a direct bearing on whether they get a shelter bed tonight or get access to housing. Neutralize the power dynamic. And when you get the information, listen to it. This isn’t just a “nice to do” part of the process…it is potentially the most important part of information gathering and analysis that you can do.
Youth: Tomorrow’s Adult Homeless Population If We Don’t Understand What We Are Dealing With and How to Deal With It
Even if you predominately serve homeless adults, I want you to read this blog. I want you to do so because if we don’t do the right things for homeless youth now they become the adult homeless population that you work with. And I want you to read this because we think of people becoming adults at age 18 and that is dead wrong from a developmental perspective. Some of the adults you are serving are really youth.
If you already serve youth, I want you to read this blog. I want you to read this blog so that I can better help you understand why certain things are happening in your service delivery. I am going to get all nerdy with some brain development stuff, but in a way that I hope will be helpful to you.
If you are a person who peripherally pays attention to homelessness issues I want you to read this blog so you can realize the staggering costs associated with youth homelessness. You will be shocked. You will want to do something about it. Whether you are conservative or liberal in your perceptions about tax policy, you are going to want to see something different happen in serving youth.
I see mind-boggling different definitions of what it means to be “youth” in my travels. To set the record straight, I think it should go until at least 24. Yup – six years past where many (most?) communities set the bar of service delivery for youth and make a delineation between the youth system and the adult system. Yup – six years after when most youth that have been in care will age out of the foster care system. Yup – some 8 years after we legally are allowed to drive. Yup – years after people can legally be their own decision-maker, buy alcohol, purchase a weapon, serve in the military, or even get married.
Here’s why…
The Corpus Callosum is the part of the brain that takes care of things like intelligence, consciousness and self-awareness. It does not reach maturity until the mid to late 20s. Up until it hits maturity a sense of self is externally defined. A person is defined by what their friends or family think they are.
The Temporal Lobes in the brain help us figure out the appropriate emotion response and regulates emotional maturity. It is still developing up until age 24. Know what this means? It means taking another person’s perspective into account does not come naturally until it does mature.
The Parietal Lobes also develop into the early 20s. This is the part of the brain that is responsible for integration of auditory, visual and tactile signals. Show a mature adult pictures of a range of facial expressions while doing a brain scan and the Parietal Lobes light up. Show a youth the exact same pictures and it is the amygdala that lights up rather than the frontal cortex. The youth brain interprets the pictures to have one of three responses – fight, flight or friendly. The adult brain can decipher the complexity of emotions.
The Frontal Lobe usually doesn’t even begin to start developing until 16. This is the part of the brain that helps us regulate self-control, judgment and deferred gratification. We can have loads of opinions about what youth should be able to do, but the fact is they can’t do what their brains are not ready to do.
Ever ask a young person why they did something and they say, “I don’t know.” Frustrating as it may seem, that can be an honest response. Synaptic wiring is still developing. Growth is still happening in the brain. If we think youth are fully prepared for adulthood just because they are 18 it will lead to bad social policy and hampers our ability to help youth in crisis.
The good news is that we are understanding more about the malleability and reprogramming of the brain. The right experiences and supports can help rewire the brain. Youth that have had a crappy upbringing and become homeless – or had a great upbringing and still become homeless as a youth – need not be plagued with a lifetime of homelessness. But these youth need supports in housing.
Consider some of these facts that we have from the child welfare system that reinforce the need for supports:
Only 75% of youth in foster care graduate high school.
Only 6% of youth that have been in foster care will graduate from a post-secondary institution.
Only 16% of youth that have been in foster care will achieve sustainable employment.
What do we need? Well, not just one approach, but several. Being a youth does not take away the power of choice. Some youth will do great in congregate living arrangements with on-site supports. Others will do great in scattered site housing with mobile supports. Some will benefit from alternative schools, while some will benefit from mainstream school with supports, while others will benefit from a short break from school with re-entry. Some will benefit from structured life skills classes, while others will benefit from integrated, one-on-one instruction in a youth’s own apartment. Some will benefit from job skills training and resume development classes, while others will benefit from job attainment with supports. And I could go on.
And some critics will think – don’t these types of supports cost a lot of money?
Well, the cost of doing nothing is a lot more.
In 2012 the Kellogg Foundation Report “The Economic Value of Opportunity Youth” presents some interesting facts. Each disconnected youth (defined as young adults between the ages of 16 and 24 who are neither in school nor working—usually without a network of family, community, or institutional support) presents an immediate taxpayer burden of $13,900 per year (taxpayer burden is everything service related that taxpayers foot the bill for) and an immediate social burden of $37,450 per year (social burden is all other relevant costs like higher health care costs, marginal excess tax burden, lost wages, etc.). That’s more than $51,000 per year. A disconnected youth that gets to age 25 without there being an effective intervention will impose a future lifetime taxpayer burden of $170,740 and social burden of $529,030.
That’s EACH DISCONNECTED YOUTH!!!
Across the US there are 6.7 million youth that are disconnected or at risk of being disconnected. That’s 1 in 8 youth. The money adds up pretty quick.
Every youth disconnected for three or more years has very serious consequences. Some of those include: higher likelihood of chronic homelessness as an adult; lower earning potential, more joblessness and erratic employment history; increased likelihood of being a single parent; more reliance on government assistance; greater interaction with the mental health system; more involvement with the criminal justice system; more problematic substance use; and, taxing use of the health care system.
SO…what to do –
Serve youth in youth-specific programs throughout their brain development, up until at least age 24.
Offer an array of housing options with supports – do not keep youth homeless in programming and do not think a one size fits all approach answers all problems.
Improve transitional planning from the foster care system through specialized programming (some great programs totally eclipse the national average for aging out of foster care).
Conduct joint advocacy and awareness on youth homelessness in your community, not just youth organizations advocating for youth.
Ensure that staff working with youth understand brain development so as to not set up unrealistic program expectations or frustration.
Use the costs of disconnected youth to help create the business case for helping more youth through specific, dedicated supports and housing.
2013: The Year to Stop Doing Certain Things in Order to Strengthen the Resolve to Ending Homelessness
In 2012 I have been fortunate enough to spend time in 37 different communities that are trying to end homelessness. When you include attendees at conferences and webinars, that number expands into hundreds of communities. Then there are all of the cities that other OrgCode team members have been too that I never had the privilege to get to. I like to say we get around, but in a good way.
More than other years, I am struck by certain things I wish many communities would STOP doing come 2013 and wanted to take this opportunity to share some of these with you. There is loads of potential for positives here. Here is the list to reflect upon:
Stop resisting change. Trust the long-term potential of great ideas. Change, itself, is inevitable. That doesn’t mean it isn’t hard. Sure we like to romanticize caterpillars becoming butterflies, but the whole process sucks for the caterpillar…it goes blind, the legs fall off, and the back rips open for the beautiful wings to emerge. Our “openness to experience” makes the process of change more invigorating, educational, inspiring, beautiful, etc. Imagine a world where all caterpillars just want to remain caterpillars. We’d never have beautiful butterflies. I at least want the pain of change to be worthwhile. And change does not come from passivity.
Stop being afraid to commit to ending homelessness. The difference between wanting to end homelessness and being committed to ending homelessness is the difference between bacon and eggs…a days work for the chicken; a lifetime commitment for the pig. If we share a steadfast fixity of purpose…if every decision we make in the present is about supporting where we want to be in 5 or 10 years, we will be further ahead than hoping, guessing, praying that maybe, just maybe, somebody else will do something at some time in the future.
Stop settling for business as usual. If what you were doing in your community worked, homelessness would not have increased or continued and this blog would be moot. Or if you are complacent and don’t take the next step to improve service delivery even if you have turned the corner in your practice you will struggle to complete the job.
Stop thinking your community is so unique that the practices used elsewhere will be useless where you live. You are unique just like everyone else. Let’s transfer the knowledge of what works based upon PROOF and replicate it, rather than starting from scratch over and over again. And yes, there are some ways of delivering housing assistance to homeless people that are PROVEN to get better results than other approaches.
Stop thinking that more money is the answer to everything. Money doesn’t have a brain. You do. The design of homeless and housing service systems in an intelligent manner, where there are investments only in practices proven to work and removal of unnecessary duplication, is the way to go. Continuing to invest in programs that don’t work is a travesty. Funding different entities to do the same thing without a rationale as to why is puzzling. Oh, and any community that doesn’t know the total volume of investment towards housing and homelessness programs in their community – from all orders of government and government departments as well as philanthropic groups and the like – should have to PROVE that all of the money is well spent before even thinking of asking for another dime.
Stop refusing to take informed risks. It has been said that eagles may soar but weasels don’t get sucked into jet engines. I’d still rather be an eagle and soar knowing there is only a slight risk of catastrophe. Think it would be risky to transform your traditional transitional housing into permanent housing with supports? Yup – but worth it. Think it would be risky to transform your street outreach programs to focus on housing solutions rather than short-term needs? Yup – but worth it. And I could go on.
Stop thinking that a big heart is equivalent to a big brain. People wait in emergency rooms in hospitals every day, but we wouldn’t in a million years think that well-intentioned people without any medical training should head down and start practicing medicine. Yet in homeless programs and services – where arguably there are a number of people with more profound and complex needs than what is found in some emergency rooms – we allow people with no or very little training to try ending homelessness. I’m not suggesting a medical model as the answer to ending homelessness. But we need to invest in training and professionalizing services. And if programs are going to use peers/people with lived experience that too needs to happen appropriately. Someone having once been homeless doesn’t make them an expert on homelessness…I once had my appendix out, but that doesn’t make me qualified to conduct an appendectomy.
Stop waiting for everyone else in your community to get on board. Hate to break it to you…they won’t. One or more organization will have a terrific reason to avoid buying in…threat of funding loss; feeling that the population they serve is different; don’t believe in evidence; etc. Get going with those ready to keep on (or at least start) truckin’. You can change the way services are delivered to people without needing “permission” from those organizations that will never get on board.
Stop using luck as a substitute for informed, calculated, planned service delivery. The story of success in our work should not be based upon who walks through our doors next and we happen to have what they are looking for. Nay, our work should have a strong sense of who it aims to serve, why and how best to do it. High-performing organizations do not try to be all things for all people.
Stop ignoring data when it tells you what you didn’t want to know. More often than not in communities, I encounter people that love their local data when it tells them everything they wanted to hear. Others ignore the data, suggest it is corrupt or incomplete when the truth in the numbers does not jive with their world view.
Stop wasting time. Some people may think that the people you serve are wasting time. The truth is, time is wasting them. Every day you get 86,400 seconds invested into your Bank of Life. Spend it wisely and you can greatly impact the life of the people you aim to serve. Waste any of it and the loss is yours and felt profoundly by them. There is no going back. There is no holding onto the time not used in the right way. Invest in today and make a difference.
Stop with the drama. Bickering between organizations does not end homelessness. Cranking up the hysteria of how your organization is the only one that serves people with complex needs, as somehow a badge of courage, is pointless in the bigger picture (and besides, several program evaluations I did just this year showed that not to be the case…those organizations that thought only they served the “hardest to serve” ended up serving clients with no higher acuity than other organizations; it just so happened the staff with the organizations tended to be less trained.) Life is too short and our mission of ending homelessness is too critical to get trapped in pettiness rather than the important work.
Stop focusing on the barriers. Some people and organizations seem to spend more time focusing on the things that get in their way rather than focusing their time and energy on finding solutions. The solution – in whatever form it may take – is worth more than endless hours lamenting a problem but doing nothing about it; or making excuses about why something won’t work without trying anything new that may get a different result. Anyone can feel overwhelmed and give up; it takes a wise person to take compassionate, persistent and committed action every day.
Stop pointing fingers at everyone else. Point a finger at someone and there are three pointing back at you. Want to be effective at ending homelessness? Accept that if you want to be part of the solution you have to acknowledge that you have been part of the problem. Focusing on making your own work better, not on the deficiencies of everyone around you. I am baffled that even some of the best service providers are non-judgmental with their clients, but completely judgmental with other organizations.
Stop accepting that you can be anything other than awesome. Do not second-guess or belittle your potential. Your awesomeness to end homelessness – one person or family at a time – is a great gift. Do not desensitize yourself to the experience of making a difference. Cherish your role in making the world a better place. Sure, you are 1 out of 7,000,000,000 on the planet; but you are the one best positioned to play your role in ending homelessness today. Do not let the potential of your awesomeness slip away.
Setting the Tone for Successful Home Visits
Once an individual or family has been accepted into a housing support program, the support worker (aka case manager) must work to set the tone for successful home visits. This starts with the very first visit. Practicing the tips below consistently – right from the beginning – and communicating these expectations to the people you are supporting results in more focused interactions and better case management results.
Be on Time & Stay on Time
The home visit is a professional interaction with a client. For the home visit to be taken seriously and to reduce missed visits, from the very start it is critical that the support worker is on time. Time management and not trying to see too many clients in any given day is essential to ensure being on time more often than not.
At the beginning of the home visit it is also important to outline how much time you have for the interaction that day. These will vary in length depending on the amount of material to be covered off during the visit. Once you lay out the time for the visit, do not exceed it.
Outline Your Objectives for the Visit at the Beginning
A home visit is a highly structured conversation in the case management process. It is NOT a matter of showing up, checking in or just seeing how they are doing. It is a purposeful meeting to advance the case plan.
At the beginning of the home visit, remind the client of the three objectives that are going to be covered during the session. These objectives would have been decided upon at the conclusion of the previous home visit. Objective based interactions keep the conversation on track and heighten accountability in the case management process.
Reduce Distractions
Ask that the TV, radio, etc always be off during home visits so that you can hear each other clearly without distractions.
Ask the client to hold all non-urgent phone calls and texts during home visits. Avoid being a hypocrite – leave your own phone alone too!
With the exception, perhaps, of some family members, ask that there be no guests during the home visit. Not only can this be distracting, but it can also present a safety risk. Plus there is the matter of compromised confidentiality if others are within earshot.
Acknowledge When the Interaction May be Difficult or Have Conflict
It is best to express empathy and not sympathy. When we are faced with what may be a hard conversation, we may have a tendency to shy away from it or to sugar coat it. In instances where the topic may be unpleasant for the client, I recommend starting with statements like, “This may be uncomfortable for you but it is important that we talk about (subject matter) so that you don’t lose your housing.”
Know your Role
Your role is to be a case manager, not a therapist, armchair psychiatrist, friend, chaplain, etc. Your job is to keep them housed and get them connected to supports for long-term housing and life stability. Your role is to be a catalyst for positive change. You do the hard support and they do the hard work. If you are confused on your role, home visits are more difficult to get results.
Embrace the Awkward Silence
When moving forward with your objectives for the visit, there will be times when the client does not readily engage in conversation or where his/her answers to questions are short responses without much detail. Do not rush in with the sound of your own voice or a litany of follow-up questions. Sometimes when we embrace the silence it creates a safe place – albeit sometimes an awkward pause – for the client to speak first and reveal more information. Our rush through the conversation may diminish her/his capacity to share. If you do all of the talking during the home visits there is not a tone set for sharing.
Take Care of Your Safety
You are responsible for your safety during a one-on-one home visit. Ensure you have mapped out an escape route from the moment you enter in the event that the unexpected (and highly unlikely) occurs where there is an altercation or other risk to your well being. Do not get cornered into an area of the apartment. Avoid bringing valuables into the home. Do not set backpacks or briefcases on the floor in buildings known to have bed bugs. If there are weapons of any sort, ask that they are always stored before a home visit. Ensure someone always knows when you are going to a home visit, where you will be, and what time you are expected to be completed.
Try practicing these suggestions and I suspect you will find yourself with more focused and more successful home visits.
Mental Illness — Language & Perceptions
I am writing this blog on the day of the tragic shooting deaths of 20 children and eight adults at the Sandy Hook Elementary School in Newtown, Connecticut. Like so many incidents over the past year (and before), this is an atrocious event that leaves us searching for answers. I am experiencing a mixture of both sympathy and utter disgust.
But, I am also feeling anger towards the extensive media coverage that was generated by the event. In the papers, blogs, news coverage, television discussion, etc. – I have repeatedly heard the mental status of the shooter reported in the most derogatory manner.
It may well be that the compromised wellness of the 20 year-old, young adult who perpetrated the shooting contributed to his decision and actions. But, all mental illnesses are not the same. It is like saying that all physical illnesses are the same and clearly they are not. The use of the broadest terms to describe someone’s purported mental state without addressing the type of illness, the impacts of that illness, the treatment options, the access to treatment, potential medications for the mental illness (and the implications of medications), etc. is inflammatory and disrespectful of millions of people around the world who live with mental illness. It doesn’t advance the education about what mental illness is and how best to support individuals and families that are impacted by mental illness. This level of reporting and dialogue takes us backwards in our thinking and perceptions of mental illness. It reinforces and normalizes stigma.
I live with a mental illness. It is depression. My experience with this illness has been a long and storied one. Given the stigma of mental illness, it took me years before I finally received the help that I needed. Since getting the help that I needed, my life has been improving by all measures that are important and my relationship with loved ones and, indeed, myself has improved greatly. For the most part, I feel well on most days.
I am experiencing many of the same feelings that people who do not live with a mental illness have been experiencing. I am shocked. I am distraught. I feel an intense love and renewed sense of protection of my own children. I am in disbelief that someone – anyone – could harm children, teachers and their own mother.
Working in the realm of social policy and planning, mental illness emerges in a range of circumstances, across the entire spectrum from wellness to illness. The stigma that clients of programs experience is, at times, overwhelming. As human service professionals, we promote the need to get mental illness out of the shadows and into the light. We promote dignity and empowerment. We speak a language of wellness. We teach and support practitioners in promoting recovery. We want people who have lived experience with a mental illness to educate others about all aspects of his/her person — they are more than a diagnosis, more than the behavior or feelings of his/her symptoms and definitely more than his/her mental illness.
When mental illness is talked about in a sweeping sense rather than a specific sense, it is a slap in the face to the work and progress over recent years to respect the experience of people with compromised mental wellness. A level of dialogue that uses a broad, stigmatizing position to make a point on the subject casts mental illness as evil.
Let’s consider the facts.
Yes, people with a Severe Mental Illness are in a state where the probability of violence is higher than people who do not have a Severe Mental Illness. This is true most specifically of those individuals that have UNTREATED symptoms of schizophrenia with psychosis, major depression and bi-polar mood disorder. Epidemiological studies and peer-reviewed journals in psychiatry, however, demonstrate some clear facts:
Mental illness is not a major contributor to violence in any community;
Most people with a Severe Mental Illness are NEVER violent;
Most crimes are NOT committed by people with a Severe Mental Illness;
People with a mental illness are more likely to be violent to themselves rather than others, with suicide the most heinous form of violence committed against oneself;
The United States, which has a high rate of homicide compared to other nations, has only 10% of homicides committed by people with a Severe Mental Illness – the remaining 90% are committed by people who do not have mental illness;
People with a mental illness, including those with a Severe Mental Illness are MORE LIKELY to be a victim of violence rather than a perpetrator of violence.
Negative portrayals of mental illness that were reported today by mainstream and social media enhances the stigma and may discourage people from seeking help to treat their mental illness. They have heard, once again, that having a mental illness makes them a deviant person or, based on the horror today at Sandy Hook, a child killer.
And, so I ask that we use the power of our shared grief about this tragic event to better understand mental illness, the differences and variations of mental illness, and the professional supports that are available and necessary. We CAN create an inclusive society where the stigma of mental illness no longer exists.