Adventures in psychiatric reform: 28th April
First published case study, podcast appearances, but also covid, misc viruses, jetlag and confusion
Welcome to the update newsletter portion of the psychcrisis.org Substack. This started as an email I sent to roughly six friends a few months ago, in exchange for emails of encouragement with heart emojis in them. (Those are still, and always, appreciated.)
Woah. This month has involved a lot of being sick, a lot of thrashing, and a lot of confusion and uncertainty. An honest welcome to addressing a complex societal problem with few resources, I guess!
What did I try?
I published the Soteria Alaska case study
I got accepted, and started training, as a volunteer with a new suicide hotline organization
Anyone following along for a while knows I got fired from the last one, roughly for being too nosy and questioning the curriculum too much. In round 2 I’m going to see if I can keep my mouth shut and actually complete the training!
I went on two podcasts, one already published
I secured two board members and started the incorporation process
I’m glad to have Jasmine Wang and David Ernst at my back, both of whom have been enthusiastic supporters of the project for several months now.
I went to EA Global in London
What happened? What worked? What did I learn?
I got sick and that made it hard to take action, and got me stranded
I got ‘the nebulous SF sore throat’ that wasn’t covid for a week, and then covid, in the same month. I was not very useful at anything for the duration of the nebulous illness, but capable of working fine during covid. I discovered I had covid by testing positive before the flight that was meant to take me back to the US, so I decamped to a friend’s house in Oxford to wait out the mandatory 10 days before I’m allowed back in the US. That’s where you’re getting this update from!
The ROI on going to EA Global was...meh
I spent most of EA Global very jet lagged and unclear of my intentions. I got a few good leads for fundraising and no good leads for collaborators (very few medical or mental health people there). I met some wonderful people who were helpful at strategic thinking, but not specifically familiar with bureaucratic systems change or org-building. Everyone tried to recommend I speak to the one other EA mental health charity that has a very different epistemic and strategic approach to mine, which was funny but unhelpful.
I did a lot of messy big-picture thinking, and not a lot of experimentation
It became clear that I needed to become clearer and more specific about the vision of crisis response I want to work towards, and my initial strategy for getting there. I spent a lot of time this month thrashing about before I accepted this needed to be a priority over making immediate progress on one of the ten or so initiatives I’m currently interested in. I’ve been writing a lot on these questions but don’t yet have something publicly ready to share. I hope I’ll be able to by the next update.
What am I doing next?
I am hoping to take advantage of how close I currently am to Gloucestershire in the UK to visit Suicide Crisis Centre, who have an innovative crisis model, have never lost a client to suicide, and who I raised $20K AUD for last year, and start a case study. Tbd if this is possible.
I am writing a strategic document–I’m hoping for it to be something I update regularly and to inform what I do next. It seems like I also need this to fundraise and hire well.
I plan to publish a case study on Parachute NYC.
I would like to bring on a (at least part-time) collaborator who has experience working in acute crisis systems, is motivated by something like this vision and who is in the Bay often enough to work together in person.
I hope to develop the ‘crisis decision support’ site more, although it may change from its initial vision.
How can you help?
I’m looking for inspiring role models. Who/what organisation do you know was instrumental in making big, lasting change in a sociopolitical system? Even if you don’t know them personally, suggesting names helps.
Do you know someone who might be a good fit to be this collaborator I mentioned? I’m starting to put out feelers for them.
Encouragement, advice, support, momentum, thinking support and feedback–it is easier for me to think strategically when in conversation with someone else.
Thank you, thank you, thank you,
<3 jess
I definitely want to offer encouragement. I've been inspired by this project because you seem to be actually trying to solve the problem, rather than just going through the motions of following an approved path. And you're trying to do something so humane in a system that sounds unhumane.
Some possible role models:
NICE (National Institute for Health and Care Excellence) - the UK body that publishes evidence-based health guidance for the NHS to use. There is a case study of its history here: https://www.idsihealth.org/wp-content/uploads/2016/02/A-TERRIBLE-BEAUTY_resize.pdf
It goes into the history of the evidence-based medicine movement and traces the scientific and political currents that enabled NICE to get set up, including the individuals who contributed to making it happen. Seems to be a good example of lasting change to a sociopolitical system.
Another role model is Paul Farmer and his nonprofit Partners in Health. He started it to provide healthcare in rural Haiti, and it has expanded to be providing healthcare in several locations in the developing world. Farmer himself became very prominent in global health.
I think he's relevant to your work because his philosophy was very much against cost-effectiveness focussed interventions in global health. Instead he emphasised the idea of accompaniment, which he described as follows: "To accompany someone, is to go somewhere with him or her, to break bread together, to be present on a journey with a beginning and an end…There’s an element of mystery and openness….I’ll share your fate for awhile, and by ‘awhile’ I don’t mean ‘a little while.’ Accompaniment is much more often about sticking with a task until it’s deemed completed by the person or person being accompanied, rather than by the accompagnateur."
This talk gives a bit of a flavour of him: https://www.youtube.com/watch?v=uI5mouRRaEw
Also this post on the spread of study circles in Sweden might be a good case study of a peer-to-peer model that actually scaled: https://www.lesswrong.com/posts/tjxgbovwc5Ft7wrtc/popular-education-in-sweden-much-more-than-you-wanted-to-1