Sunday, 23 February 2020

Should State Departments of Mental Health Design Policy-Level Jobs Specifically for People with Psychiatric Histories?


On the surface, this seems like a good idea to a lot of people. Many of them theorize that change happens best when you have people both ‘inside’ and ‘outside’ of a system working to make it happen. Others think it’s the best way we can at least ensure that there are voices on the ‘inside’ representing our priorities and values as contracts and other projects are developed, and so on. After all, we have no lobbying group. But is that how it ends up working out?

In September, John Allen, a high ranking official in the New York State Office of Mental Health (OMH) was arrested on 29 counts of child endangerment when he reportedly lured four children ages 12 and 13 into his home and convinced them to take off their pants and wear diapers. Allen, who was making over $130,000 per year, was – as it turns out – the head of the state consumer office. In other words, he was basically in their lead ‘peer’ role. (Read the details of the story on Allen here.)

Now, no state office can be expected to know what hasn’t happened yet. However, in this case, key people at OMH who were responsible for Allen’s hire did know. In the mid-90’s, he had been arrested on similar charges involving children in Maryland. The story was published in the Howard County Times, and we are told that at least some OMH officials were well aware of this history at the point of hire.

Of course, this is an extreme situation, and we do not mean to suggest in any way that State Offices of Mental Health are generally keen to hire folks who operate as sexual predators. In truth, we will probably never know what motivated New York’s OMH to hire this individual, in spite of these concerns, or to keep him employed in the face of other complaints that surfaced while he was in the role. However, it does draw into question OMH’s judgement overall. Would they have excused such a history for a non ‘peer’-designated role? And what are the implications for our community that they made the choice that they did?

Beyond the example named above, State Offices of Mental Health are prone to an array of errors in hiring for all ‘peer’-designated roles, including those at the policy-making level. Although an error more commonly made for peer roles that offer direct support, people are often hired who perhaps have received services in some fashion, and who those in charge think it would be ‘cute’ or ‘nice’ to employ (or will help paint a nice ‘success story’ for the services they offer), whether or not they’re genuinely ready or have the skills necessary to do the actual job. Another common error (at all levels) is hiring someone that is already known, and who often has a clinical background or leaning of some sort, but perhaps once upon a time also received services. This person is often someone who is already very familiar with the system and how it currently works, and perhaps was already employed within it in some other non-peer-designated role.

Whether we consider New York’s most recent issue, the other examples offered above, or the many more that we could discuss, it is clear that the impact can lead to several negative outcomes including:

  • Re-enforcing the idea that people with psychiatric diagnoses are dangerous: We are at great risk that John Allen’s story will be used to suggest that all of us are dangerous or not to be trust in our jobs. Yet, while we all know that there are people who commit violent or sexually predatory acts who are members of all groups, a great deal of research (on top of our personal experiences) tells us that folks who’ve been given psychiatric labels are no more likely to be responsible than anyone else. In fact, research most often suggests they are less likely to commit such an act. Additionally, even when someone with a psychiatric diagnosis is the responsible party, that does not mean that the psychiatric diagnosis ‘made them do it’.
  • Perpetuating confusion about what peer roles are: When people who aren’t ready to take on the role (or who are willing to compromise it to avoid rocking the boat) are hired, it perpetuates confusion. This happens because the person is much more likely to act in ways that are inconsistent with what the role should look like.
  • Perpetuating the idea that peer roles require low bars because people with psychiatric diagnoses are not capable of the kind of quality that other employees are: One doesn’t have to look far to see that people who’ve been given psychiatric labels are doing some pretty incredible things both within and outside of the mental health system. Yet, hiring someone who hasn’t had time to develop those skills, or who’s been given the job for their own personal rehabilitation, sets up everyone (including that person) to keep their expectations low. That, in turn, perpetuates discrimination against folks with psychiatric diagnoses all around.
  • Making other people in peer roles look ‘bad’ or ‘difficult’: When someone is hired into a peer role who is afraid to ‘rock the boat’ or who is inclined toward a more clinical perspective, another negative impact they can have is making others in peer roles look ‘bad’ by comparison. In other words, when one person in a ‘peer’-designated role doesn’t hold certain lines that really should be held, it makes the others who do try to hold those lines look like they’re just being difficult. The reality is that if there is never any tension between someone working in a peer role and others in a clinical organization, then that person probably isn’t doing their job very well at all because change brings tension.

All these points are important, but for those who aren’t aware, there is in fact, a long and well established history of people who do speak up (especially in state-employed policy-level jobs designed for people with psychiatric histories) losing their jobs. One individual formerly employed in a State Office of Consumer of Affairs had this to say about the trend: “You know, thinking back, I realize that those of us who did these jobs with integrity mostly got fired or quit in despair, and the [folks who were willing to bend and compromise values] were kept on.”

In addition to these issues that can apply just about anywhere where folks in peer roles are being hired, there are added issues when we’re talking about State Departments of Mental Health, and the lead, peer-designated policy-level roles they employ. These include (but are not limited to):

  • Working for a State Department often comes with more rules and regulations of a silencing nature than just about anywhere else. This means that the most prominent ‘peer’ roles that many will see are ones filled by people who often really aren’t able to say much at all.
  • State Departments are often less inclined to listen to people in peer roles outside of their office, if they believe they’ve already checked that box. If state officials feel like they’re already hearing the ‘voice’ of people designated to represent peer roles or those who’ve received services (i.e., they’ve heard from someone in the Office of Consumer Affairs, a Director of Recovery, or similar), they are often less compelled to reach out to others. This is a particularly significant mistake given the prior point about people in state-funded peer roles being among the most silenced of us all. Additionally, this also amounts to ‘tokenization’ which is a common feature in any type of systemic oppression, and not a healthy thing to promote in systems that are attempting to transform in any way.
  • Peer Roles that are employed by the State (and particularly lead roles positioned in or connected to the ‘Office of Consumer Affairs’ or similar) tend to be among the highest paying peer-related jobs around: Previously, we spoke of the risk of hiring people who aren’t ready, or those who are too clinically oriented. However, there’s also a significant risk involved in hiring some of the strongest people working in the peer-to-peer community, too. Some of the best and brightest folks working in peer roles may be attracted to State jobs, because non-state jobs frequently pay less than $15 per hour (i.e., not enough to live on), and people want to meet their and their family’s basic needs. However, when the best and brightest in the movement shift into these jobs, they aren’t typically able to continue to work in the ways they have in the past for all the reasons named before. What this means is that the community of people working in peer support lose their strongest voices, and sometimes find themselves shocked and feeling betrayed when folks who previously were willing to take a strong stand on something just can’t or won’t anymore.
  • State dollars that could be going to support peer leadership roles that function with integrity are instead eaten up by State-employed policy-level roles for people with psychiatric histories. In other words, the peer leadership roles in the community that could be better funded (thus more able to retain good employees), that are able to work with more integrity, and that are able to push and speak in clearer and more honest voices sometimes just aren’t able to exist or be sustained because some of the aforementioned State-employed positions eat up available funds.

This isn’t necessarily about people working in any role in State Offices of Mental Health being ‘bad’. Unfortunately, those responsible for hiring often don’t even necessarily quite realize what they are doing and/or the potential impact. And, how could they? Pretty much everyone working in the mental health system is currently trapped in an environment where very little information of substance is available to them on what these roles should look like, and they’re constantly being pushed and pulled by various federal and financially-driven mandates and priorities with little time left to figure it all out. Given that’s the case, though, it only brings us back to this one basic question: Should State offices of mental health be creating and hiring into policy-level positions designed for people with psychiatric histories, or really any peer role at all?

We are interested in getting more input on this topic from people who’ve worked or are working in State Offices of Consumer Affairs, Director of Recovery positions, or any other State-employed position that is understood to be designated for people with psychiatric histories. We are also interested in input from folks who’ve intersected with or been impacted by the ways in which these roles have been designed, and/or the people working in them. Please consider taking the attached survey. We hope to compile the results and re-visit this topic in the future!


In case you missed it in a previous issue, you may also be interested in this more broadly focused topic about peer support and the system by Darby Penney!!



Registration & Login for Website Users