Chair – Madeline A. Naegle, PhD, PMHCNS-BC, FAAN, is a professor at New York University.

Co-Chair – Mona Shattell, PhD, RN, FAAN is a professor at DePaul University in Chicago and former Public Voices Fellow with The OpEd Project.

Chair Emerita – Linda Beeber, PhD, RN, CS, FAAN is a professor at the University of North Carolina at Chapel Hill.

 

New Models of Mental Health Care, Not “Asylums”

Does the US need institutions to treat or house persons with severe mental illness? A recent paper in the Journal of the American Medical Association (JAMA) authored by three ethicists calls for improved psychiatric care by returning to psychiatric asylums of the past (asylums that are “safe, modern, and humane”).

 

The authors of this op-ed are all psychiatric mental health nurses with many years of experience providing mental health care to persons with mental illness, in inpatient and community settings. We are psychiatric mental health nurse researchers, educators, and practitioners and members of the psychiatric mental health and substance use expert panel of the American Academy of Nursing (Academy). The Academy serves the public and the nursing profession by advancing health policy and practice by generating, synthesizing, and disseminating nursing knowledge. This psychiatric mental health and substance expert panel, numbering more than 100 nurses at the top of the field, recognize the authors of the JAMA commentary for bringing the issue of inadequate comprehensive psychiatric mental health care to the forefront.

 

It is unethical and unconscionable to re-route persons with mental illness to other restrictive settings such as correctional facilities for treatment that may be below standard.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is making strides to incorporate the recovery model into mental health care, and we applaud this agency for leading the charge to integrate behavioral health care, thus creating a very different blueprint for care in SAMHSA’s four major dimensions to support recovery from mental illness: health, home, purpose and community.
  • Health—overcoming or managing one’s disease(s) or symptoms—for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem—and, for everyone in recovery, making informed, healthy choices that support physical and emotional well-being
  • Home—having a stable and safe place to live
  • Purpose—conducting meaningful daily activities, such as a job, school volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society
  • Community—having relationships and social networks that provide support, friendship, love, and hope

We applaud psychiatric mental health nurses for caring for those who are in need now, an the nurse educators who continue to teach the importance of complex relationship skills needed to assist people with serious mental illness.

To be sure, there have been gains in mental health care. But, we need to do much more.

We call for a federally supported national summit convening consumers, mental health professional organizations, and providers to assess progress to date by reviewing existing services such as Assertive Community Treatment (ACT), community mental health services, peer support services, alternatives to emergency departments (such as The Living Room), and looking toward new models of care. The community mental health concepts of 1965 were compromised in a flawed and haphazard array of services. We are not in favor of a return to that cobbled together array of services, often not tailored to population needs. Rather, we are calling for a new conversation about alternative approaches that “institutionalize” all dimensions of recovery.

 

The emergence of new knowledge of complex genetic and neurobiological causes of mental illness tells us that cure is a complex challenge perhaps mastered far into the future.

 

Rather than isolating people with severe mental illness from society, recovery dimensions should embody in vibrant, nurturing communities within the larger society.