The most important question is always why. So, why do we do what we do in behavioral healthcare? Put simply, we seek to equip individuals with serious mental illness to live happy, healthy, productive, and connected lives.
Peer 2.0 aims to value recovery by measuring these real life outcomes. We intend to bring a research-based rigor to the project, not simply anecdotal support. We believe the lived expertise and experience of peer supports are central to this work, and must be integrated within the clinical and medical teams of community behavioral health.
In 2013, the Regional Behavioral Health Authority in Phoenix, Arizona operated by Magellan Health implemented a breakthrough plan for investing $27 million, focused strongly on peer and family roles.
Download the Toward a Peer-Driven System document here.
Several years ago, I was working as a counselor with a young man who was hard-charging through an advanced degree; seemingly destined for great success in life. He initially came to me because of grief around a broken relationship. Over the course of a six-month period, our team concluded that he was experiencing his first onset of serious mental illness.
Today, he would be in his 40s. As a person with a serious mental illness, there is only a one in five chance he will be employed. He would be twice as likely to be employed if he had instead been in a tragic accident that resulted in a visual, hearing or mobility disability. If unemployed, he would likely be missing the sense of contribution to community and the connection to others that many of us feel as a result of our work.
Additionally, he would be two to three times more likely to have developed diabetes, heart disease, or obesity than the general population. The average American has a life expectancy of 79 years. In 2006, the National Association of State Mental Health Program Directors (NASMHPD) found that a person with serious mental illness in the US dies on average 25 years younger than the general population (that’s 54 years). In comparison, the average life span in war-torn Afghanistan is 61 or seven years longer than someone with a serious mental illness in the United States.
These outcomes are relatively well-known but in recent years more attention has been paid to the impact of non-medical determinants of health that warrant consideration. Holt-Lunstadt and colleagues conducted a meta-analysis of health outcomes that revealed friends and social supports are the single most powerful indicator of health life and longevity. Simply put, loneliness increases the likelihood of early death by 30%. For context, increasing one’s community connections correlates more closely to longevity than quitting smoking according to the study.
When Americans are asked if they have “someone to rely on in times of trouble,” 90% answer yes. In Iceland, the answer is nearly 100%. Not a lot of research has been done in this area for people with serious mental illness. However, Magellan Health contracted providers surveyed over 20,000 people with a serious mental illness in Arizona between 2010 and 2013 with similar questions about whether the person has “someone to talk to about problems” and “someone who invites me out occasionally for dinner/activity.” The findings would suggest that only 55-65% of respondents with serious mental illness have “someone to rely on in times of trouble;” which is again on par with Afghanistan where 57% answer in the affirmative.
Lastly, the young man I saw all those years ago was accustomed to making decisions about his life. Tragically, many individuals with serious mental illness realize less autonomy and self-direction, and may even be incarcerated. Elyn Saks is a non-federal member of the ISMICC, an expert in mental health law, and a person who lives with schizophrenia. Her recent article in Politico, The Consent Dilemma, thoughtfully examines the negative impact of increasing coercion and force in behavioral healthcare treatment.
These real outcomes can be measured and tracked for improvements. I’ve summarized them in the balanced scorecard graphic (above), Valuing Recovery: Real Outcomes for People with Serious Mental Illness.
WHY do we do what we do in behavioral healthcare? We seek to equip individuals with serious mental illness to live happy, healthy, productive, and connected lives. It’s not only their illnesses that conspire with barriers to achieving these objectives, but our society also limits their potential success through low expectations and discrimination. We can and must move beyond a focus on symptom reduction and stabilization to support people beyond their behavioral health needs to succeed in the community where they live, work, and play.
Thomas Joiner’s groundbreaking 2005 work “Why People Die by Suicide” suggested that the two most painful experiences in life are loneliness and feeling like a burden to others. By contrast, he suggested that people who are connected and perceive they are making a contribution to others are protected. We tend to think of suicide as simply a symptom of serious mental illness, but the outcomes generally experienced by SMI individuals (lonely, unemployed, etc.) would suggest tremendous risk for any population. In fact, the hazard ratio for suicide for people with SMI dramatically exceeds other “at-risk” groups like LGBT, older white males, active duty military and veterans, and Native Americans/Alaskan Natives.