Dr. Arthur Evans’ introduction to Hollywood Beauty Salon screening at Philadelphia’s Department of Behavioral Health and Intellectual disAbilities
I think today’s film that you are going to see is a great piece of work. I had the opportunity to see it a few weeks ago, and I think it’s a great testament to the lives of the people who are starring in the film, and I think it’s also a testament to changes that have happened in our service system that really helped to facilitate what you’re going to see.
How many of you have worked in behavioral health for more than 15 years? Raise your hand. So a lot of you, OK. (laughing) So, I want to take you back to the 1960s. In the 1960s, 1950s, you know, when you think about our field, and behavioral health and mental health, in the 1950s, if you had a diagnosis of schizophrenia, a major mental illness, it was scary. People thought that that was the end. And in fact, there are people today who will tell you that when they got their diagnosis in the 1950’s 60’s and even the 70s they were taken to a state hospital – like Norristown – their family members were told, “Your loved one, your family member, is going to stay with us. Go live your life.” And that was it. And some people never left. People will tell you that that was what their experience was.
And fortunately in the 1960s, John F. Kennedy wrote the Community Mental Health Act, which started the process of deinstitutionalization that even continues until today.
And one of the things that happened when that act happened was that for the first time our country understood that having a major mental illness did not mean that that was the end for you, that people could be a part of the community.
But one of the things that didn’t happen in the 1960s was that even though there was a shift to believing that people could live in the community, what we didn’t shift was our belief about people’s ability to recover.
That didn’t start happening until the 1980s, When people like Courtney Harding the psychologist who did research that showed that people from Vermont State Hospital who had been discharged to the community – she looked 10 years later, 15 years later, that the majority were doing well. That about a third were living in the community, asymptomatic, meaning they didn’t even have any symptoms of mental illness. Another third were living in the community. They had a few symptoms, but they were still doing well. Then about a third of the people were struggling.
So what does that mean? That means that two-thirds of people with the most serious forms of mental illness, when given the opportunity, can recover. And do well.
The challenge for our field was that our field was built on the notion that people didn’t recover. That’s why we have big – you go to any state in the country and you will see large campuses of institutions that were built on the premise that if you had a major mental illness, that’s where you were going to go, that’s where you were going to live out your life. Every single state has that.
And so the work of Courtney Harding really helped to propel our field to start thinking that “You know what, having a major mental illness – people can recover.” And so in the 80s and 90s you started seeing people like Bill Anthony start to doing the rehabilitation work, which basically said that even though you have symptoms you can have a fulfilling life. And you started to see the movement with people like Joe Rogers, who’s here, nationally known, who started a saying “Nothing about us, without us.”
In other words, people who were in our system should have a voice.
So you could see this whole movement of people with voice starting to take off.
And you started to see a lot of critique of our health care system, like reports of the Institutes of Medicine crossing the quality chasm report. You really want to understand transformation in Philadelphia? Google “Crossing the Quality Chasm” and read that report. You can read the executive summary of that.
But all of that coalesced in the 2000s, about the idea of recovery. And systems across the country, including here in Philadelphia said, “We’re going to consciously reorient our system with the hope of recovery as being the ultimate goal of what we’re trying to do.”
And you’ve seen some fantastic work . Some of you were here when Tom O’Hara was here. Tom said “one of the first places we should work is what we call our day treatment programs.” Back then we called them partial programs. Anybody remember that? So with the basic idea of partial programs – we actually called them “maintenance partial” – that tells you what we thought, right? The idea was that people came out of state hospitals, people would be in residential programs that we had created, and they would go to these day treatment programs, these maintenance partials all day.
And when Tom suggested, we should take a look at these programs, because we can make these programs much more recovery oriented. And so around 2005 we started that process, moving those programs to recovery orientation in concert with people in recovery, our staff, and providers. Fantastic work that has happened.
I’ll give you one quick example. I went to a number of programs early on and we’d just talk. And I had a group of people who were in the programs. And I remember so distinctly going to one of the programs and saying “What does recovery mean to you?”
And the first time I went, nothing. I went a couple years later after the programs had gone through the transformation, I was supposed to be there an hour, I was there 2 and a half hours, people started talking about “getting a job, being a part of the community,” all kinds of things.
And I wanted to give you that backdrop, because when you look at this film, if you don’t understand where our field has come, you won’t really appreciate what you’re about to see.
I want you to understand where our field has come. It has come a tremendous distance, and I can’t tell you how proud I am of the people who you are going to see in this film, I think they epitomize what we’ve been trying to do in our system, which is to hold up hope as the driving factor in our system, that it doesn’t matter what your diagnosis is, that we have the hope that every single person who is here can recover and do well. And you’re going to see very powerful stories of that.
I want to thank Glenn Holsten. It is so refreshing to have people who get it, at that level and are willing to put their resources and commit their life’s work, really, because this is not the first time you’ve done this kind of work, sharing this story.
I also want you all to not only understand the significance of what you’re about to see historically, but to share the message, because we’re an organization of about 800 people and most of us everyday are just working, just trying to get the work done. I think this – my personal view – is that this work is a celebration for me. To see the fruits of our collective labor, so I hope you tell people about this.