4 Comments
May 22, 2022·edited May 22, 2022Liked by Ben Miller

My vision for mental health would be that it would become a priority factor considered when solving any societal and individual problem. I have hope/confidence/belief that public health, economic, political, and cultural challenges can be solved when mentally healthy and resilient diverse groups of people collaborate in an unapologetically empathetic fashion. Leveraging the influence of American pragmatism this vision is extremely practical and behaviorally focused as individuals can chose in each moment to tackle problems of all shapes and sizes knowing their greatest strengths are rooted in a deep love for self that can’t help but protect the same for others, and in doing so makes anything seem possible, even healing a society like the one we live in here in the U.S. that is wrestling deeply with its identity as a declining empire. -Kevin

Expand full comment
May 12, 2022Liked by Ben Miller

I can relate to this article.. It's easy to get caught up in the day-to-day operations of keeping a mental health startup up and running, the "micro" aspect of running a startup that the macro vision can fall to the wayside. It's a constant shift between working on the vision and at then the execution/keeping everything afloat of what is currently in motion. It's easy to get caught up in the details. My vision for mental health is to make it cool, so that taking care of it becomes a habit, like working out or brushing your teeth. No one is ashamed to say, "Yeah, I brushed my teeth this morning" or "I went for a run after work today".

Expand full comment

Dr. Miller your call for vision as a shared exercise is important. We learn from each other because, Lev Vygotsky got it right. Self-directed learning can only take our knowledge part of the way. Learning with others, you learn more. He kinda gets my long winded vision below.

My vision is rather siloed since I'm not a MHP or policy wonk. Simply, I just spend 8 to 10 hrs a week volunteering as a crisis counselor. Though in my defense my silo rocks at least to me.

From my silo crisis intervention (CI) is the middle point of three points. When a person enters into a CI there was or is a precipitating set of events or issues. The BCI (Before Crisis Intervention) where the pain or fear or anxiety was just so much they had to or needed to find help.

There is the ACI (Active Crisis Intervention) where trained folks help to dial down the crisis. Do safety planning. Provide resources. In general end the crisis moment in a safe zone. Give them resources to help for the next time.

Then there is the PCI (Post Crisis Intervention) Which is a bit of wet tissues thrown against a wall. Resources are given ways to help manage those BCI moments so they don't become a crisis again. And off they go with a wing and a prayer.

All of this is good. It works. I try hard to create a durable outcome. (I do live in my own private Idaho) Though PCI is IDK at all.

My vision is what can we do, even non policy wise, to help turn down the BCI? Reduce those needing to go from precipitating event to crisis intervention. Talk to teachers, parents, friends, calming activities, etc. etc. My vision here, make safe places/people to talk with as ubiquitous as those Heimlich maneuver posters in restaurants. If we've done our work (ACI) for those in crisis and provided resources, helped them find inner strength, etc. Then good bravo. I suspect a one time or two time ACI may not be sticky enough. Ergo more resources to blunt the need to go into a crisis intervention. Even a modest reduction is good. Right?

PCI imho. I just read a study that shouts vision. "Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department" Stanley et. al JAMA Psychiatry 2018 https://pubmed.ncbi.nlm.nih.gov/29998307/ The study looked at Safety Planning Intervention within ED's. Included were follow-up contact for 6 months. (Sorry to cut and paste my stat knowledge is limited.)

"Patients in the SPI+ condition were less likely to engage in suicidal behavior (n = 36 of 1186; 3.03%) than those receiving usual care (n = 24 of 454; 5.29%) during the 6-month follow-up period. The SPI+ was associated with 45% fewer suicidal behaviors, approximately halving the odds of suicidal behavior over 6 months (odds ratio, 0.56; 95% CI, 0.33-0.95, P = .03). Intervention patients had more than double the odds of attending at least 1 outpatient mental health visit (odds ratio, 2.06; 95% CI, 1.57-2.71; P < .001)."

I realize it's impractical to capture names etc for follow-up specific to suicide or anything else in crisis intervention. Is it impractical to have those of us who know someone at risk for suicide be that follow-up? Somehow have the basic training to help prevent suicide, support, etc. Back to Lev my dude, learning with others is cool. So is listening, hearing, supporting, etc. And at the heart of our humanity (i.e. vision) is connection.

Vision Tag Line: Call Connect Comfort

Expand full comment