Adventures in Psychiatric Reform: 1 June
Starting the Lived Expertise Project, a new team member, and incorporation!
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.)
What did I try?
I recruited an intern! Raven Connolly has joined Psychcrisis part-time to learn about systems-change work, work on events, communications, research, and help me with strategic thinking. I am also personally very excited to work with a real-life other person; my devastating amount of extroversion is extremely happy to be working with her.
I launched the Lived Expertise Project, an interview-based research project aimed at sharpening the pointy end of the arrow trying to answer the question–where should crisis care even be going? There will be a public event to present initial findings on Aug 4 and you are all invited.
I published a survey looking for people who are experts at managing their own mental health crisis as interviewees, and got 15 responses. I’ve done four interviews so far, have three more, and am aiming for 20 in the next few weeks.
I officially incorporated Psychcrisis! Now the hard part is applying for tax-deductible status, which I’m still doing, with Resilia.
What happened? What worked? What did I learn?
I decided to narrow my focus on getting really deep into ‘what are the best crisis response strategies that exist?’ rather than my previous strategy of focusing on everything that is wrong with the existing approach. This is what led to the Lived Expertise project.
It has been a bit challenging to find enough people to interview; I’m using a few different channels but I still need to find more. If you know of somewhere I should post the survey, or you have a lead for someone I should talk to, I’d really appreciate that!
In preparing for the Lived Expertise interviews, I did a 12-hour online training in the interview method I’m using, called Applied Cognitive Task Analysis, which was developed for figuring out how expertise worked in people doing complex cognitive tasks like being the fire chief and needing to assign firefighters to figure out how to put out a fire.
It was pretty fun to learn, and pretty easy to do the interviews even with the little training I have!
I’m interviewing people who have encountered a variety of different kinds of crises. One challenge is to narrow the scope of what kind of expertise I’m trying to learn about, because even within ‘respond to suicidality’ for example, there are tonnes of different kinds of experiences to investigate.
I am part of a working party, along with my dad, to help the hospital system my brother was at when he escaped and ended his life to improve their emergency department’s handling of mental health patients who might run away. This involves participating in a weekly meeting involving 15 department heads which is quite rapidly trying to figure out how to make the EDs safer. Some observations:
Although I have asked for the group to hear about case studies of patients who have escaped, and also look at hospital data, in practice this seems to not be the default approach.
The default approach seems to consist of 1) copying the approach of a more prestigious hospital in the city, and 2) adhering to written state standards for mental health patients. This makes me think that in this area, convincing a prestigious hospital to change is a route to getting other hospitals to change.
The department heads are very motivated! This problem sucks and is very stressful for them. Apparently having mental health patients abscond is very common.
One of the biggest factors in whether patients abscond seems to be how long they have to wait, and wait times both seem to be a key factor and somehow outside the control of the department heads.
They don’t really seem to want to find out why patients run away; there’s an assumption that some patients are just entirely unpredictable.
I am still training to be a suicide hotline volunteer. What I’m learning is:
Most people at high risk of suicide don’t call the hotlines, and most people who call the hotlines aren’t at high risk of suicide. Personality factors seem to be much more influential on who calls the hotlines, and they seem to roughly map to ‘which sorts of people tend to reach out for help versus shut down when they’re extremely upset’. I expect to get a better picture once I’m actually taking calls.
The hotline I am training at seems to call 911 for people who are at high risk of completing suicide pretty often; the mobile crisis teams in the area tend to take a few hours to arrive, which is not very useful in a life-or-death situation, and they also won’t go to any situation where there’s a weapon.
More about Raven joining:
Raven is joining Psychcrisis as an intern for the next few months, working on events, research and communication. Raven is @spiral_virus on Twitter and is known for hosting digital salons during peak pandemic times. Her educational background is in Evolutionary Biology and Environmental Science, and she is also passionate about localism, earth regeneration and holistic living. She is driven to contribute to mental health reform due to her own experiences dealing with mental illness. She and I have known each other since 2019 and she’s told me she’s really excited to be a part of the start of a high-stakes project.
What am I doing next?
I’ll be at the CAMHPRO Peer statewide conference in Sacramento 12-15 June. This involves meeting people who run peer-led mental health organisations and legislators interested in mental health reform. I’m hoping to get a sense of what this aspect of the reform movement is like, and connect with people.
I’ll continue to do Lived Expertise interviews, and I’ll present the first findings on 4 Aug in a zoom event that you are very welcome at!
I also have a handful of interviews lined up with clinicians, although they aren’t part of the main project.
I’m learning about hiring and fundraising and hoping to make better-fleshed-out plans in both of those areas soon.
How can you help?
Connect me with people with lived expertise! I am really, really interested in finding more people to interview. The set of people I could interview is small but I know they are out there because I have already found some. They are people who have experienced one or more psychiatric crises and are now thriving (even if they still encounter crises). If you are one of these people or you know one, please email me or introduce me!
Connect me with mentors. I’m in a stage of org-building where I could really use mentors who have done similar things. If you know of someone who has built an organisation targeting a specific wicked-looking systemic problem and been successful at it, I would love to meet them, read their biography, or stalk everything they have ever written. Please introduce me.
Come to the Aug 4 event, if it interests you! And tell other people about it.
Thank you for following along; I get unexpected emails of encouragement at times these days and I have never worked on a project where that happened before. So I appreciate you all and your supportive attention <3