By Taylor Sisk
As a former psychiatric nurse, Laurie Coker had seen what an emergency room visit can do to a person in mental health crisis. In most cases, that person has arrived because there is nowhere else to turn. Most likely, it’s against his will.
Regardless, it’s not likely where he needs to be.
As the mother of a young man in psychiatric crisis, Coker knew she didn’t have many good choices to help her son when he was in crisis.
Peter had lost his job, was drinking heavily, had health issues that he couldn’t afford to get treated and had learned he had a second child on the way.
He’d told his mother two days prior to his 26th birthday that he felt overwhelmed at the prospect of going on with his life.
Peter was young and strong. Coker believes if he’d gone to the Wake Forest Baptist Hospital emergency room he may well have been handcuffed to a chair, further traumatized. He would have waited days, most probably, before a psychiatric bed came open, because that’s the norm in North Carolina.
If she had involved the police or a mobile crisis team, they would have taken Peter to that emergency room. Such an experience, she felt, would have been demeaning. It would have caused him to further spiral into crisis.
“And I just thought, how unhealthy,” Coker said, “how damaging to the integrity of this young man, this brilliant young man.”
She thought about the perhaps irreparable damage it would do to the few relationships in which he still held some trust – with his wife, mother and other family members – had they subjected him to this experience.
And so they didn’t. Coker was seeking options that she felt might truly do Peter some good.
But on that night six years ago, there were no such options. Two nights later, on his birthday, Peter took his own life.
New model
Coker is director of the North Carolina Consumer Advocacy, Networking, and Support Organization, a group that advocates for people living with mental illness. She also runs the GreenTree Community Center, a peer-support drop-in center in Winston-Salem for people with severe mental health issues.
She’s a strong advocate for peer-run crisis-diversion services, and among her primary objectives is to bring a peer-run respite center to Winston-Salem. It would be a place where those struggling with mental health or substance abuse issues can be among people who understand what they’re going through and help them gain their footing.
A model for Coker of such a facility is Projects to Empower and Organize the Psychiatrically Labeled, a Poughkeepsie, NY-based peer-run advocacy and crisis-diversion services organization. Its mission is to instill a sense of hope and a vision of wellness.
At a forum at Hope Presbyterian Church in Winston-Salem in late March, Coker discussed this recovery-oriented approach to care with a group of mental health and substance abuse service providers and consumers of those services and their families.
The event was sponsored by North Carolinians for Recovery Oriented Care, or NCROCs, and included testimonials from individuals who benefit from recovery-oriented care in general and peer support in particular.
Coker said that in the predominate system of behavioral health care, people are treated as “passive recipients” of treatment. They’re asked, “What’s wrong with you?” rather than, “What’s happened to you?”
The recovery model of care, she said, is solution focused and involves social inclusion, respect for self-determination, an ownership of personal responsibility and the development of coping skills.
It also involves integration with physical health care. “Somehow along the way,” Coker told her audience, “we separated the head from the body.”
We must invest as communities in recovery, Coker said, by attacking stigma, challenging myths and assumptions about people living with mental health and substance abuse issues and advocating for local efforts that promote recovery.
Too many ‘fetters’
Coker was initially interested in applying for funding for a Winston-Salem peer-run respite facility through a state Department of Health and Human Services request for proposals for two “Peer Operated Hospital Diversion” pilot facilities.
But she’s since had a change of heart. Her concern is that if the project were too closely aligned with the statewide system it would become too regimented, limiting the ability to make onsite decisions that meet particular needs.
“I think what we’re going to see is that peer-led initiatives and peer organizations are going to be operating outside the system before the system figures out how to use them,” Coker said.
She believes such initiatives should be funded locally. She cited as a successful example the Promise Resource Network, a Charlotte-based nonprofit that provides information, training and support for people in recovery, service providers, families and the community. Promise is funded with county dollars and through other local sources.
“Once you start working with the [state],” Coker said, “there are just so many fetters.”
At the March gathering, she quoted inventor and systems theorist Buckminster Fuller: “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”
Recovery-oriented care entails a fundamental shift in how we engage with people in need, she said.
Nowhere else
Coker said there would have been no therapeutic benefit to sending her son Peter to the emergency room, to sit, and wait, feeling that much more separated from the rest of his life and the few people he still trusted.
“I wish there had been some other place where Peter could have gone that night,” she said, “where he could have been surrounded by people who cared for him,” and who understood, at least in some small measure, what he was experiencing.
“It was just not a viable option for my son to go sit handcuffed in one of those places,” Coker said of the ER. “You’re talking about for however many days, your loved one is sitting there – who’s brilliant; all these gifts, all this goodness …
“You can’t put a person in a situation like that.”
“We need options. We need peer-supported settings,” a place, she said, “where somebody can be himself and unwind from what’s going on and then figure out how to put the pieces back together.”
Coker knows a lot of very good clinicians. “But when we’re under stress,” she said, “we’re so much more willing to trust somebody else who’s been through something pretty crazy and come out on the other side.”
Among peers, she said, “you can talk about anything and believe it’s OK – things that if you said to your therapist, you’d be afraid they’d lock you up.”
“Being in a more normalized setting,” Coker said, “even though you may not be feeling normal, where you can have a discussion, is so important.”
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Thank you, Mr. Sisk, for touching on so many important issues in this article. I would like to state that many of the staff at the Division of Mental Health, Developmental Disabilities, and Substance Abuse services are taking interest in strategies and practices that promote recovery and reduce trauma to people. However, when a community simply wishes to offer a solution, we have so many political structures and hoops–and actually, many of the biggest barriers can be at the level of the LOCAL community public mental health system. Further, it has been reported that this support setting will eventually become a billed service like those provided by agencies that offer more clinically focused practices. This diminishes the “community” environment and focuses on financial eligibility as a requirement for participation.
A peer support center can serve as an adjunct to what the system offers and complements what the other practitioners do. It is staffed by peer specialists and in most states is funded by grants directly between the state and the center. I am very concerned that this may not be how North Carolina is pursuing this. If Winston-Salem could be funded in the same manner and with the same linkage to the state level as is done for Georgia’s four peer operated hospital diversion sites, I feel the integrity of this practice would be protected. Perhaps the state will consider this as it moves forward. In any case, we are so appreciative that North Carolina does recognize the value of peer centers.
Thank you again for opening readers’ minds to some of the ever-progressing ways communities can help people with mental health challenges.