I was part of a panel discussion at the University of Toronto recently on community engagement work in the mental health sector. It was exciting to see so many people interested in working in mental health. The questions and comments from the audience made it clear that they understood the need for patient-centered innovation and they wanted to create change in the sector. But with innovation, there’s turmoil, in any industry. So here are five things to consider if you’re looking at a career in mental health as the sector undergoes transformation:

1. Get comfortable with technology and design skills.

   Most mental health jobs that you know of will be eliminated by technology in the near future. Self-directed, digital therapy tools are improving–they’re much easier to scale up consistently, test, and redesign for effectiveness than a human therapist. Digital tools also empower patients to get help when they need it, at a fraction of the cost of seeing a therapist that only has limited availability, likely only when the patient needs to be working or at school. Digital tools increase accessibility. Do you really want patients out of work, kicking their heels for six months on a waitlist, their mental health progressively worsening, just so they can sit across from you while you try to read their mind and get them out the door as quickly as possible because your day is already crammed with patients and paperwork? No. Learn how to code. Solve the Counselor Troi Problem.

   

   Men’s Ward, Goodna Mental Hospital, Queensland, Australia, 1950. Wikicommons.

2. Don’t deliver any product or service that you would not tolerate as a customer in any other industry.

   In the mental health sector, the level of customer service, along with the quality and efficacy of the services being delivered, have been of such poor quality for so long that it’s very easy for somebody to shrug their shoulders and say, “that sucks but that’s just the way it is.” We expect something only slightly better than Bedlam. Don’t tolerate that, on any level. If you go into work somewhere and it’s all shiny and new and everybody is nice but they have a nine month wait-list, that’s not acceptable. That’s a design failure. Think of your expectations in a restaurant or with a smart phone. Those experiences are designed around your needs. Any company that fails to design around your needs, fails. Most people in North America waiting for mental health services are waiting for failed services. We have to start designing mental health services around the needs of patients.

   

   Detail from an asylum’s Medical Visitation Book, 1880. Wellcome Library.

3. Nobody is non-compliant.

   If somebody drops out of therapy because it’s difficult, that’s a design and delivery failure. It’s not the patient’s problem. If you walk out of a restaurant because the menu is difficult to understand, the waiter tells you to cook your own appetizer, and the dining room has complex rules you can’t follow, the restaurant is welcome to label you as “non-compliant” all they want, but the reality is it’s just a bad restaurant. Behavioral therapies like Exposure & Response Prevention, Dialectal Behavior Therapy, or Acceptance & Commitment Therapy are incredibly effective IF the patient completes the course of treatment. We have very sound, well-researched therapies that can completely change a person’s life, but the real challenge is helping a patient navigate that therapy within the complex context of their everyday lives. It’s those external complexities that will make a person stop therapy, so how will you help your clients navigate those challenges?

   

   Bergonic Chair for administering electric shocks to patients. Wikicommons.

4. Be awesome at change in your own life.

   The journey of recovery from a mental illness is about complex change. It’s about a person having experiences, internally and externally, that they’ve never had before, experiences they’ve likely invested significant amounts of time and energy in trying to avoid. Quite often, that’s because they believe those experiences will cause harm to themselves or others. How will you help people handle those terrifying experiences and make sustainable changes in their lives if you can’t even stick with the simplest new year’s resolution? If you can’t stop procrastinating on Facebook long enough to finish a paper for class, how will you help somebody stop compulsively showing up at the ER and demanding tests because they believe they’re dying? If you were going to the gym to get into better physical shape, you’d expect your personal trainer to be in better shape than you. You’d expect them to know how to maintain a much higher level of fitness than yours. Mental health patients should expect nothing less. You can only share tools that you actually know how to use.

   

   Detail of the chapter index from “Lunacy Practice: A Practical Guide for the Certification and Detention of Persons of Unsound Mind” by William H. Gattie, 1905. Wellcome Library.

5. Go into mental health work because you’re skilled at it.

   When you go to a restaurant, you probably want the chef to be skilled at cooking. You don’t care how much they want to cook for people. It’s about skill. If you want to get into the mental healthcare system because you want to help people, that’s fine, but have some respect for your patients. They can’t do anything with your desire to help. They need your skill. Sharing mental health tools for recovery with someone is like serving the most important, life-saving meal you’ll ever cook. So you’d better fucking know how to cook it. Take that skill seriously. Learn. Keep developing your skills. Track the efficacy of your work. Be honest about your shortcomings–again, if you can’t do that, how will you help your patients be self-reflective and honest? Develop the skills to make help accessible in ways that meet the needs of your patients. If your patients want videos, you need to learn how to make videos. If research shows the type of therapy you’re most comfortable providing is less effective than another type of therapy that you find challenging to deliver, get ready to get challenged. Keep growing your skills in your own life so you have even more tools to share.

   

   Bethlem Hospital (Bedlam), England. Wikicommons.

6. And one more thing…

   You probably noticed the archival images. Learn more about the history of psychiatry. Keep in mind the origins of this industry. It has a well-documented history of abuse, torture, sexism, racism, homophobia, and every other kind of oppression you can think of. Many would argue that legacy is alive and well. People still go through the mental healthcare system and then join support groups for “psychiatric survivors”. That’s not referring to surviving the illness. The term refers to surviving psychiatric “care”. 

   You can have a major impact on somebody’s life through your work in mental health. Strive to make that impact a positive one.