While most might agree that there are people dealing with mental health conditions who are not doing well – living in their parents’ basement, closet, on the street, under arrest, cycling in & out of hospitals – there is a lot of controversy about what should be done about it. 

Folks who have experienced the coercive nature of our current mental health system will say that trauma is the root cause of many issues so engaging with a system that inflicts additional trauma (through coercion) is no way to solve the problem. 

Parents will say “we let them die with their civil rights on” in frustration that they cannot help their loved one. 

Both sides have amassed “evidence” of their way being the best. 

WHat if we changed the conversation?

Healing happens where there are relationships and trust. Oncologists know that the odds of beating cancer are increased by connecting with others experiencing cancer. Connecting with their peers – those who know what is happening. Those who have gone through it or are going through it with you.

Without trust, none of us accept advice. Or do what we are told. And “once bitten, twice shy” as the saying goes. 

Yet, we all agree that we want everyone to achieve the life and existence they want for themselves. 

where we are going

Taking inspiration from INSET in Westchester County, NY and Roca in Chelsea, MA, we can focus on building trust and building relationship with those who are unable or unwilling to connect with others.  These programs never give up; they consistently and persistently show up for the individual. It typically takes six months of persistent outreach for the individual to crack open the door and start a conversation. 


Persistent outreach by peers does not require treatment or dictate any specific pathway to recovery. The focus is on the individual’s desires for how their life might change and then helping them devise the steps to get there. For some, this will mean traditional treatment and/or medication. For others, it will be another path – meditation, healing practices, communing with nature. For most, it is likely to be a combination of those approaches, custom fit for the person. 

Why this will work

First of all, because it has. Both INSET & Roca have track records of connecting with folks, helping them focus on their hopes and aspirations and helped them get there. 

It could also work because family members and other loved ones could turn to the persistent outreach program without resorting to the legal system or waiting until the person is “a danger to themselves or others.” 

It could also work because it is intentionally avoiding trauma and coercion. Rather than making a bad situation worse, it is focused on the best path forward. 

how to do it

It’s important to have all voices involved in thinking about how to make this work. If we leave anyone out, we will still be talking past and at each other. This will mean creating opportunities like focus groups and forums where people can raise concerns, offer suggestions and volunteer to help and design the program. 

We will need to build a program that is peer-led, grounded in the principles of peer specialist training – building trust, building relationship, building community. 

That same group of leaders implementing persistent outreach should inform how additional supports are identified and provided. We envision offering a wide variety of choices and support in decision making for the individual. 

it’s financially feasible

In New York State, INSET was originally funded with a $500,000 grant to pilot the program. They were able to fund their planning phase and first 18 months of the program with that amount of money. Today, they are providing persistent outreach to two counties with a total of 4 peer support specialists. Each CPS can handle up to 20 individuals with an annual budget of XXX.