I spent the first 22 years of my life in a multiethnic, inner-city neighborhood on a tree-lined street with row houses. I lived not only with my parents but also with all of the families on the block whose household heads were the sons and daughters of first- or second-generation immigrants from Italy, Ireland, Poland, and Eastern Europe. The moms on the block looked out for the children who played on the sidewalks and street. I knew nearly every "mom" on the block, many of whom were my mother's friends. And then there was Angie, my Mom's close friend.* Angie lived 2 doors away. She visited my mother often, sometimes 3 times a day, and she called on my mother for "help." I never quite understood what kind of help Angie needed. I recall accompanying my mother once when she visited Angie who had retreated to bed for several days, and there was the day that Angie appeared in a formal gown and garish makeup to purchase produce from the neighborhood huckster. No one said a word about Angie's appearance, and my mother walked her home and helped her change her clothes. That evening at the dinner table I told my mom that some of my friends said that Angie was "crazy" and needed "to be put away." My mom replied dispassionately, "Angie is just a little odd but most of the time she is okay. She is a good friend and neighbor-don't listen to those kids. Eat your dinner!"
It is 6 decades since my mothers' debut as a psychiatric diagnostician. A lot has changed including (1) the publication of the first Diagnostic and Statistical Manual in 1952, giving professionals a nomenclature for mental illnesses; (2) the closures of state mental hospitals and the transfer of its long-term patients to the "community"; (3) the development of psychotropic drugs for many forms of mental illness; and (4) the discoveries related to the neuroscience of mental illness. All of this "medical model" focus on more accurate diagnosis and symptom control has not resulted in approaches to mental health and illness that help patients and families explore and better understand their unique experiences of mental disorder and of the system that provides treatment. In a qualitative study conducted by The Philadelphia Coalition of Community Mental Health Centers, 137 diverse consumers were asked about their experiences with both primary care and mental health services, with the aim of exploring models of integrated care.1 Among the findings was a telling list of what consumers believed might improve their care. Consumers in the Philadelphia articulated that they:
* Need more time for providers to listen so that they can establish personal connections. They especially appreciated peer specialists, but not every center had them.
* Need to be seen as equal partners in their care, particularly when information is shared about illness and care, both primary and behavioral health.
* Need to have their total health information shared with both primary care and mental health providers so that coordination of both physical and mental health care improves.
* Need empathy and understanding of both the trauma and stigma of mental disorder.
This list reminds me of how my old neighborhood approached Angie. My mother's characterization of Angie as "a little odd" highlighted the acceptance of Angie as a member of the community, a tolerance for her behavior with no stigma attached, an anticipation of her behavior and the trauma she might experience, and caring interventions in her times of need. This is a prescription for a holistic approach to mental health care.
-Gloria F. Donnelly, PhD, RN, FAAN, FCPP
Editor-in-Chief
* Angie is a fictitious name. [Context Link]
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