To gain insight and a “nuts and bolts” understanding of how to transform mental health for an entire city, take a lesson from community psychologist and visionary, Dr. Arthur Evans.
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| Arthur Evans Ph.D, DBHIDS Commissioner, city of Philadelphia |
We caught up with Dr. Evans in the 10th year of his experience as the DBHIDS’ commissioner, in what has been aptly coined the decade of transformation. Through the gracious sharing of his fantastic staff, Dr. Evans outlined for us some of the intricacies and systemic undertakings that go into the transformation process. In particular, we gained a behind-the-scenes understanding regarding a decade-long transformation that occurred to a considerable extent due to the deliberate utilization of the city’s most valuable resource- it people!
Early in the process of the department's transformation was a deliberate change in language used to describe the program and it's scope. The obsolete, offensive, and deficit-focused language pertaining to 'mental retardation' was replaced with more humanizing, ability-oriented term, 'Intellectual disAbility'. Likewise, reference to 'Mental Health' was replaced with 'Behavior Health', to emphasize human choice and agency and avoid limiting language that may connote the existence of emotional or psychiatric disruption.
In tandem with a change in language, Dr. Evans partnered with other leaders and policy makers in restructuring separate and distinct programs and offices into a dynamic and integrated system with a common and discernible vision. In fact, the DBHIDS itself represents the merging of two distinct offices (the offices of intellectual disAbility and Behavioral Health) into one, integrated, department. Whereas typically, bureaucratic systems tend to be organized by their respective funding sources, the DBHIDS operates from a single operating philosophy which uses the function of the department to more clearly order its organization and operations.
One key characteristic of the DHIBDS' overarching vision, is the department's commitment to recovery models of treatment and care. This is evident not only in the nature of programs and services that DBHIDS offers, but also in the collaborative way in which the DBHIDS works with it's partners and service providers.
Distinct from a medical model in which the "patient" or "client" is viewed as being in someway "sick" or "disordered"and in need of corrective treatment to "get better", recovery models view the individual with innate capacity for recovery, which they can strengthen and develop through their own volition and by utilizing the right manner of support and assistance. In keeping with this perspective, DBHIDS views individuals that utilize treatment services and resources as being active and free agents in their own health and healing. Similarly, DBHIDS works with its community partners from the assumption that those partners have the capacity to operate independent of the direction and oversight of the DBHIDS and in the interest of the individuals they serve.
Distinct from a medical model in which the "patient" or "client" is viewed as being in someway "sick" or "disordered"and in need of corrective treatment to "get better", recovery models view the individual with innate capacity for recovery, which they can strengthen and develop through their own volition and by utilizing the right manner of support and assistance. In keeping with this perspective, DBHIDS views individuals that utilize treatment services and resources as being active and free agents in their own health and healing. Similarly, DBHIDS works with its community partners from the assumption that those partners have the capacity to operate independent of the direction and oversight of the DBHIDS and in the interest of the individuals they serve.
The fruits of the DBHIDS’ efforts are particularly exciting and illustrative of what can be accomplished of programs focused on recovery and wellness over limits and dysfunction. I have chosen a few highlights from our time with Dr. Evans and his team to provide a little more on what is happening in Philly.
City of Philadelphia Mural Arts Program
If you spend any time in and around Philadelphia you are sure to encounter one of the city’s many bright and beautiful artistic murals, thoughtfully positioned around the city, adding to the the city’s character and artistic luster.
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| Detail of mural depicting progress of women's rights |
Many of these great works have been created through the collaboration of the DBHIDS and the Porch Light Program of the City of Philadelphia. More than an effort to promote city pride and beautification, the Porch Light and DBHIDS partnership has offered a compelling way to raise awareness regarding community issues, increase community investment and social cohesion, and facilitate community healing
throughout the city’s diverse neighborhoods. Our short walking tour of the neighborhood surrounding the DBHIDS brought us in contact with four of the city’s great works, including a compelling homage to the advancement of women's rights and a touching testament to the often invisible plight of homelessness and that daunting pursuit of a home that affects so many individuals and families throughout society.
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| Mural depicting plight of homelessness |
Other murals throughout the city offer messages of hope or provide thought-provoking perspectives on the struggles and concerns that have faced the city and its people. What is most remarkable about the murals is not so much the artistry or the content of the works (although all the works we saw were striking), but the deliberate and thoughtful manner in which communities throughout the city were included in the creation process; from inception to the painting of the final brush stroke. Through the organized coordination of community members under a single artistic vision, each painting is a labor of love that, in the end, serves to adorn the very community that made it. Although, throughout the city, anecdotal evidence abounds regarding the value that the murals bring to the city, more recently, research conducted by Yale University in conjunction with Philadelphia Behavioral Medicine has provided scientific weight to the value or the Mural project, suggesting the presence of quantifiable community benefits affected by the project. A Final Evaluation completed this year by Yale University and Philadelphia Behavioral Medicine (Tebes, Matlin, Hunter, Thompson, Prince, Mohatt) found more immediate community-level results of the mural to include:
At the Community Level:
At the Community Level:
- a relative increase in collective efficacy, including greater trust and cohesion amongst neighbors
- a relative increase in the neighborhood's aesthetic quality
- a relative decrease in stigma towards mental health
At the Individual Level:
- a relative decrease in use of secrecy to cope with behavioral health stigma
- a relative decrease in rejection experiences as related to stigma
- a relative decrease in stress
Mental Health First Aid
Another wide-scale undertaking of DBHIDS has enlisted, at last count, the help of over 9,000 of its lay-citizens and emergency responders in the interest of supporting and assisting fellow community members in the face of a mental health crisis.
For the past few years, DBHIDS has been preparing police, fire fighters, clergy and other community members to effectively respond to mental health crises, through offering formal Mental Health First Aid (MHFA) trainings. In the creation of MHFA, DBHIDS has set a foundation for managing and averting psychiatric crises before mental health treatment can even be pursued through the wide spread training of it's citizens. Under ideal circumstances, the availability of mental health first aid may avert the need for higher-level psychiatric intervention or mental health treatment. In other circumstances, the presence of MHFA will mean more efficient and quicker access to the right level of psychiatric support and care. The MHFA prepares it’s participants to 'Know the Signs. Learn the Actions. Be a Lifeline', as it offers its trainings free of charge to it’s citizens.
A related initiative of the DBHIDS has been to make available simple resource cards that provide information regarding the DBHIDS and the Mental Health First Aid program, as well emergency hotlines and contact information on where citizens can go to acquire services and supports on a broad range of issues and concerns. Included on the informational card is the web address to the DBHIDS’s user-friendly HealthyMindsPhilly.org website, with it’s numerous online tools and resources, all designed around the goals and mission of the DBHIDS.
HealthyMindsPhilly
One important aspect of DBHIDS' transformation is it's virtual facelift through the development of a dynamic and user-friendly web presence. HealthyMindsPhilly is DBHIDS' interactive format for providing up-to-the minute developments regarding all things behavioral health.
Included on the website are links to a calendar of events, resources, information on mental health first aid trainings, and an online mental health screening tool which you can quickly complete yourself in minutes (get a check up from the neck up!). HealthyMindsPhilly also posts regular blog entries that offer a brand range of perspectives, allowing an opportunity for Dr. Evans and the DBHIDS team to more directly connect with their community.
I WILL LISTEN Philadelphia
Finally, DBHIDS' mission to connect with and support it's community could have no better illustration than the I WILL LISTEN initiative that first took place in June 2014. I WILL LISTEN served as an unprecedented opportunity for the city of Philadelphia to literally come out and be heard by a listening, nonjudgmental ear. On this date, community members from all walks of life were given the chance to have their concerns (what ever they may be!) heard by a group of listeners organized by DBHIDS. The spirit of the event was to provide the people of Philadelphia a moment of human connection and support, and a moment's assurance that someone, somewhere out there, cares how they feel.
I WILL LISTEN Philadelphia
Finally, DBHIDS' mission to connect with and support it's community could have no better illustration than the I WILL LISTEN initiative that first took place in June 2014. I WILL LISTEN served as an unprecedented opportunity for the city of Philadelphia to literally come out and be heard by a listening, nonjudgmental ear. On this date, community members from all walks of life were given the chance to have their concerns (what ever they may be!) heard by a group of listeners organized by DBHIDS. The spirit of the event was to provide the people of Philadelphia a moment of human connection and support, and a moment's assurance that someone, somewhere out there, cares how they feel.
These are but a few of the areas that we learned about during our time at DBHIDS. Other programs and services we were informed of included the provision of time-limited intensive in home services, camp experience for high need youth, short-term respite child care for parents experiencing distress in their role, and numerous programs working directly in the schools and with educational professionals in the promotion of healthier school systems.
For a department its size, DBHIDS remains a surprisingly nimble and timely responder to the ever evolving needs of the city. When the city experienced a rash of suicides across its numerous college campuses a couple years back, DBHIDS took an active assertive role partnering with the city's educational departments and lending its support in addressing the distinct mental health needs of university students. More recently, the DBHIDS has become a player in the discussions and trainings that are currently underway to address the growing sex trafficking crimes that are being experienced in Philadelphia and across innumerable other major U.S. cities. On all of these issues DBHIDS continues to partner with top consultants and experts in addressing these concerns, including an ongoing partnership with cognitive behavioral expert Dr. Aaron Beck, in designing programs and interventions that can aid DBHIDS and the city of Philadelphia in the promotion of improved mental health and wellness for its citizens.
In the end, our time with Dr. Evans and his team, provided a humbling example of what can be accomplished on a large scale, when the city officials take an invested interest in the promotion of happier, healthier communities.
For a department its size, DBHIDS remains a surprisingly nimble and timely responder to the ever evolving needs of the city. When the city experienced a rash of suicides across its numerous college campuses a couple years back, DBHIDS took an active assertive role partnering with the city's educational departments and lending its support in addressing the distinct mental health needs of university students. More recently, the DBHIDS has become a player in the discussions and trainings that are currently underway to address the growing sex trafficking crimes that are being experienced in Philadelphia and across innumerable other major U.S. cities. On all of these issues DBHIDS continues to partner with top consultants and experts in addressing these concerns, including an ongoing partnership with cognitive behavioral expert Dr. Aaron Beck, in designing programs and interventions that can aid DBHIDS and the city of Philadelphia in the promotion of improved mental health and wellness for its citizens.
In the end, our time with Dr. Evans and his team, provided a humbling example of what can be accomplished on a large scale, when the city officials take an invested interest in the promotion of happier, healthier communities.
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| blog author Ben Rader with wife Melissa |
Extra special thanks to Deborah, Dana, Nichole, L'Oreal, and Arthur for the experience!
Tees, K., Matlin, S.L., Hunter, B., Thompson, A.B., Prince, D.M., Mohatt, N. (2015). Porch Light Program Final Report, Yale University and Philadelphia Department of Behavioral Medicine
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