The Coalition for Community Living Blog

A post by John K. Trepp

I’ve already written about the Why & How of Group Autonomy. The third question I hear most often, is Seriously?

Mental health “professionals” (called “professionals” because of their academic credentials) are consistently skeptical that groups of mental health “consumers” (called “consumers” because they consume mental health services) can manage their own affairs. Mental health professionals almost cannot comprehend that groups of mental health consumers could make better decisions than mental health professionals.

I explored this years ago with a survey of a broad variety of mental health professionals around the Twin Cities. The survey (which was not identified as conducted by anyone connected to a Fairweather Lodge program) described a “new” model under consideration, one where groups of consumers would manage their own affairs without staff supervision. The response was overwhelmingly negative; virtually every respondent checked the box that read, “There is no way that this could possibly work.” This result despite the fact that there were approximately ten, highly successful Fairweather Lodges operating in the Twin Cities at the time.

When Dr. Fairweather recalled his thinking in creating a model that put the consumers in charge. He made the following points (I’m paraphrasing from memory):

• Mental health professionals are generally well-intended, and do their best to help mental health consumers. But, they punch out at five o’clock. They don’t spend their evenings or weekends thinking about the needs of consumers. We shouldn’t expect them to; professionals have other things going on in their lives. But the challenges experienced by consumers continue after five o’clock.
• Mental health professionals rarely, really, understand mental illness. They’ve studied it, they use all the right jargon, but they have not experienced mental illness. And there is a limit to how well any of us can really understand something we have not directly experienced.
• And the fallacy of putting mental health professionals “in charge” of decision-making for mental health consumers is demonstrated pretty clearly by the fact it doesn’t work! At least not for the consumers. Everywhere you look, mental health professionals are making decisions for mental health consumers, and the results are in:

• Mental health professionals earn a comfortable living; and
• Mental health consumers rarely get better.

To Dr. Fairweather’s list, I will add a couple of my own:

• Although (I agree) mental health professionals are generally well-intentioned and generally hard-working, they generally do not believe in recovery. They talk the jargon of recovery, but they don’t really believe in it.
• And because they don’t often see people with serious mental illnesses thriving, they don’t expect people with serious mental illnesses to manage their illness, to hold jobs, to maintain meaningful relationships, etc., or treat such outcomes as plausible goals.

It would be misleading, of course, to claim that every Fairweather  Lodge achieves “full” or “total” autonomy.”

• Some Lodges have get very close to total autonomy, and maintain this “almost total autonomy” for years (decades, even).
• Some Lodges seeking total autonomy have gone so far as to decline on-going contact with mental health professionals. This decision prevents us from knowing how they have fared. (To be honest, anecdotal evidence suggests not as well as one would hope.)
• But we know for certain that Lodges who have not been allowed (by mental health professionals) to pursue “total autonomy” have fared poorly (i.e., producing outcomes similar to those of the mainstream mental health system).
• Remember, the “pursuit of happiness” referenced in the Declaration of Independence doesn’t guarantee happiness for every American, all the time; it merely states that every American’s “pursuit of happiness” is the point of our country. My experience shows me that making full autonomy (or very close to full) the goal for Lodges, i.e., “the pursuit of total autonomy,” creates the opportunity for truly great outcomes!

So yes; I am completely serious about Lodge Autonomy.