Moe's Corner

These comments are by Moe Armstrong, MBA, MA. Moe is a landowner in southwest Virginia and has experienced mental illness. He works in mental health in Connecticut and Massachusetts and he tries to make a contribution to public mental health. Moe has received a variety of different care from the public mental health system over the years. These are his observations about what has worked and what might work in the next generation of mental health care that we are trying to build.

"How to Develop a Healthy Sleep Routine" By Moe Armstrong, MA, MBA .

Mental illness is real and biological; the brain has changed the ability to function in consistent ways; a disrupted sleep routine is common. Most sleep patterns may be wild and frightening -hearing voices, having racing thoughts, experiencing middle of the night anxiety to the point of paranoia.

We can live with mental illness, but the first step is getting a good night of sleep and/or rest; whatever happens, try to stay in bed and rest; when we have a cold we take extra time to rest; with mental illness we need extra rest to survive and get better; it's like having pneumonia in the brain. Don't get up and wander around the house or leave the house to go down to the corner store for something to eat at two in the morning. DON'T MAKE A POT OF COFFEE! .Just lie in bed, listen to your breathing, count your breaths and wait for the wakefulness to end and sleepiness to take over; there is only so much that medication can do -if we wait for medication to kick in, we might be surprised; the brain can eventually override some medications.

Daily activity is very important: by learning to go to bed at the same time and wake up at the same time and keep our medication level at the smallest dose, we can be fairly effective the next day. Going to a mental health program is a good way to get daily activity and learn techniques for understanding and managing your mental illness.

There seems to be two kinds of people who have difficulty with sleep; one person might have difficulty falling asleep at night; another person might have difficulty staying asleep; sometimes people have both conditions; sleepy Time herbal tea either at the beginning of the night and/or in the middle of the night may help. Don't drink coffee or take any kind of caffeine in the afternoon, including chocolate.

Learning the importance of sleep and rest, and learning how to structure sleep and rest into my life is the foundation of my stability and sanity. Moe Armstrong August, 2003

"Possibilities for Continued Mental Health Care" By Moe Armstrong, MA, MBA .

The percentage of people with schizophrenia and major manic and/or depression stays fairly constant in the world. About three percent of the people in the world are going to have a major mental illness which will leave them incapacitated and disabled. Our job is to work with them. We need to set aside the money to work with people who have mental illness. Mental illness is a no-fault biological condition which happens to some people. And, mental illness leaves that three percent incapacitated and disabled. Mental illness is a health concern and not a social problem. Mental illness with individuals is unpredictable and episodic.

We need to build a mental health system which is always there for people. Mental illness is a very complicated condition. We know little about human brain activity and behavior. We have spent more money exploring outer space than exploring the human brain. We need to build a system which is not a containment model but a learning model. There won't be a machine or pill which cures people. People will be able to become sane, safe, stable and sober through some medication and lots of knowledge. That knowledge will come from a staff which will be both those with mental illness and without mental illness. Learning, discussing, discovering, and internalizing this new knowledge about what is mental illness and how to live with mental illness will be the new environment for mental health care of the future. Eventually, with enough knowledge people will be able to acknowledge and to make adjustments in their lives to be able to live with mental illness.

The amount of crisis can be reduced. However, the need for day to day outreach and education will increase. The need for mental health services will continue from one generation to the next. The work that mental health practitioners presently do will change. Most mental health professionals have never been taught how to be an educator . Many people in mental health have never been taught how to find materials and build a lesson plan and teach a class. Also, most mental health professionals have difficulty finding and training people with mental illness to team-teach a class or be independent educational facilitators.

The mental health system has to do a better job of recruiting, training and developing participants from the mental health system to make a contribution back to the mental health system. Mental health of the future will look more like an old fashioned one room school house in the our community .There will be education (both peer and professional) up front and reduced crisis later in the person's life.

The clubhouses in Virginia should become the community center for people with mental illness. Each clubhouse should have many classes and lots of education. There should also be a strong vocational component. Each clubhouse should offer an enclave work opportunity out of the clubhouse as well as looking for jobs in the community. Each clubhouse should be recruiting, training and developing the people who attend the program to become future staff members. There will be many participants in our programs who will be able to fill-in future valued staff roles.

We must be prepared that the workers, who are participants in our programs, will still need a lot of support. Mental illness will not go away. We are only asking people to do different jobs and have different roles in our mental health system.

For psychiatric crisis care, the club house will need about four to six crisis beds in a residence close to the club house. This will be so that members can stay in the community and get turned around by gaining stability locally. However, that residential crisis program will also have to be trained and practicing skills in co-occurring disorders. The crisis residential program will be both a detox program and crisis program. This will be staffed 24 hours a day. This residential crisis unit could be Medicaid billable. Rather than contract with local hospitals who have no knowledge of psychiatric rehabilitation, I would suggest another alternative. Divide old units of your state hospital wards into sections and have each clubhouse provide crisis care under contract in your facility .The clubhouse might also be the transportation to the facility . And, the clubhouse would provide the crisis services for a very few people in need. These services might be Medicaid billable. (The facility is leased and/or contracted by the clubhouse and not part of the institution).

 Virginia has invested a great deal of money having people trained in psychiatric rehabilitation. These trained psychiatric rehabilitation practitioners are centered both in your state hospital system and clubhouse programs. Virginia needs people with knowledge about psychiatric rehabilitation and recovery. Virginia needs to keep people with that knowledge in our mental health system. Virginia also needs to recruit, train and develop recipients of mental health services to also fill valued staff roles.

Virginia has invested money in sending people from the mental health programs to national, state and local conferences. Virginia needs to utilize the knowledge and talent of the participants and members or Virginia's mental health system to become the new staff members of the future. People with mental illness taking on mental health work will be like people who are blind working in blind services. Many years ago there were almost no blind people who worked in blind services. Today that is not the situation. Most people who work in blind services are people who have experienced blindness and teach other people how live with blindness. The same will be true someday of our mental health system. People with mental illness will play a major role in teaching other people how to live with mental illness.

Through early detection, intervention and education we can change the course of mental illness. Through the skills and practice of psychiatric rehabilitation based on the recovery model we can keep people fairly sane, stable, safe and sober and keep people living without disruptions in life. Virginia's reinvestment dollars should be well spent with the many wonderful people in your state who have already made a commitment toward psychiatric rehabilitation and recovery. We should ask Virginians, some who have national recognition for their skills with psychiatric rehabilitation and recovery, to help construct the next generation of mental health care. Many of these people are from your clubhouses. Virginia will have to invest money in the club house community to provide these new mental health services. You will have to financially factor in that next generation of mental health care will need lots of outreach and education. Mental health will have to learn how to become warm and welcoming and educational. We can not wait for crisis before we intervene and take action. Strengthen and amplify the relationships that you have already established between your state institutions and clubhouse programs. With psychiatric rehabilitation and recovery as your fundamental values for mental health care you will succeed in wisely using your reinvestment dollars. I support and encourage the increased utilization and funding of South West Virginia Consumer and Family Involvement Project to be the eyes, ears and glue to bring the system of rural mental health in south west Virginia together. This project and the director have the capability to double in scope of services.

Yours truly,
Moe Armstrong, MBA, MA
Glade Spring, Virginia.