The Ten Rules for Quality Mental Health
Services in New York State
RULE # 7
It Must Have a Focus on Cultural Values

There is a desperate need for services that are effective across all cultures. Many of us report having language
differences with service providers that impede our progress and having less access to quality services because of
where we live. Once services are accessed, some of us reported feeling discriminated against because of our
culture and our beliefs. Below are concrete ways in which culturally competent mental health services should be
provided:

  • Consider that mental health services are unique based on regional differences throughout New York State.
Those of us in New York City may have many service options, where those of us in Saranac Lake may be limited
to one. When you speak of choice, please remember that this is our reality.
  • Mental health service providers and the community at large should not be afraid to ask us about our beliefs.
Many of us reported using mental health services and never being asked about our culture and how that might
impact our recovery. Your questions are welcomed because they foster understanding.
  • Train providers on how to provide culturally competent services and expose them to the beliefs of other
cultures through speakers and presentations.
  •Hire staff that is reflective of the community the program serves.
  • The professional community must recognize differences in individuals and adjust treatment according to our
cultural experiences. Get to know the cultural groups that make up our communities. Don't just assume that you
know who we are.
  • Providers must "embrace" differences in those of us who are not from similar backgrounds by working to
understand language and being understood. It is too often that we cannot understand what our psychiatrist is
saying or he/she can't understand us.
  • More information needs to be translated into other languages.
  • Providers need to offer more culturally-competent peer advocacy for recipients.
  • Cultural values unique to the hearing impaired community as well as those relating to the consumer/survivor
community should be considered.

Additionally, there is a need to develop an educational program that teaches providers, local and state
governments and other recipients in the community about the culture of healing and recovery that is socially
sensitive and progressive.
RULE # 8
It Must Be Knowledge Based

Providers must have accurate, up-to-date knowledge of clinical practices, treatments, holistic healing methods
and complementary methods. This knowledge empowers us as well as the professional in making sound decisions
as partners with full understanding of the risks and possible outcomes. All different modes of care should be
explored and learned so that we do not have to "settle" for services that have not worked for us in the past. There
are some very helpful alternative or holistic ways in which to get well and stay well.

Additionally, it must be understood that knowledge does not just come from books and research, but it comes
from all of our stories, our experiences, our failures and our successes. Part of a knowledge-based   service   
approach   is   gaining knowledge about what we already know about ourselves, our experiences with medications
and services, our culture, etc. Maintaining this kind of asking stance promotes greater sensitivity towards all
parties, and it promotes respect, which is essential to a supportive healing relationship. Life experience and
qualitative research should be considered valuable evidence to support or denounce a particular practice and/or
service.  Some of us believe that knowledge is built upon the bias and preconceived  notion   of whoever  builds   
that knowledge base. We are not asking that die only knowledge that be considered be that of peers, but that the
knowledge and experiences of peers be considered equally as valuable as book knowledge and scientific
research. Additionally, knowledge of what experience proves ineffective is also valuable as it aids in
understanding what doesn't work and creates an opportunity for quality improvement.

If shared in partnership with the recipient, we feel that patient rights education and sharing knowledge that is
offered in the spirit of genuine informed choice reduces coercion and promotes trust. Some of us reported being
informed of our rights and responsibilities as recipients for the first time when we were in a full-blown crisis. There
must be a commitment to wide spread education about our rights, our responsibilities, medications, service
options, etc and it must reach far beyond our admission to a facility. This knowledge also needs to be more widely
dispersed and done much sooner.

We would also like to see consistent communication developed between providers and not just "chart updates."
Our information should also be kept updated and communicated so that we do not have to constantly repeat our
story over and over. Knowledge of our advance directives must also be communicated, respected and
implemented.

In the past, many of us have been labeled as "difficult" or "non-compliant" when we spoke up on our own behalf or
on behalf of someone else. Our knowledge of self-advocacy must also be respected just as many other people
advocate for themselves in other health care or human rights situations. Our ability to speak up on our own behalf
is indicative of our growth and should be celebrated by providers as a success. We also need to be able to
educate families, professionals and the community about recovery and healing through success stories and even
stories of despair that show the resiliency of the human spirit.
RULE # 9
It Must Be Based On A Partnership Between Consumer & Provider

We would like a partnership with the providers where needs and expectations are clear to all parties. This
partnership would be marked by equal participation in treatment and open, honest communication. We want a
relationship with a service provider that leaves us feeling safe to agree or to disagree on issues without fear of
repercussion or punishment. It should be an environment void of coercion and one that encourages the asking
of questions by all parties. This reinforces trust between consumer and provider and vice versa. This
partnership also includes treatments that are more individualized and more comprehensive in relation to us as a
"whole person.

A professional sharing something about him/herself helps create trust with us as well. Examples of information
that can be shared is 'where you went to school', "why you are a psychiatrist or therapist', etc. When we see the
professional reach out to us and open up, we think of the professional less as a drug dispenser and more as a
person helping us maintain trust and hope. When this occurs, it shatters the "us versus them" mentality that has
existed in the mental health culture by making a statement that we are partners, and we are working together on
common goals.

Another important part of developing a partnering relationship is to open up the communications to negotiations.
Being flexible and open to new ideas and trusting that our opinions and feelings count and are important. These
ideas, opinions and feelings are what keep us well at times, whether the professional agrees or disagrees with
them. This idea of developing a partnership suddenly puts us all on the same page. We become collaborators
and advocates together and begin a new vision of recovery and healing.
RULE #10
There Must Be Access To Care Regardless Of Benefits/ Lack Of Benefits

This rule, which was first suggested in Buffalo, New York, grew to become a very important issue with most of us
in New York. The rule is simple. There must be a total elimination of "sanctioning" of people that are in need of
public assistance. This includes social services public assistance, Medicaid, food stamps and temporary
housing. These are the services that we need to begin our road to recovery.

It is often difficult for some of us to obtain the proper paperwork that DSS or the Medicaid office may need and
this is often what prevents us from getting the services that we so desperately need. It is reported that many
times it is the social services worker or caseworker that can prevent some of us from getting benefits. There are
also programs or treatments that we cannot attend due to not having the proper benefits. This is a major
problem among many of us in New York that inhibits or completely prevents our ability to recover.
Next Steps

This White Paper is a call for action to the Office of Mental Health (OMH), county governments, elected
officials and providers to stop talking about what is not working in the mental health system and start
focusing on what will bring positive outcomes to people who use services.
As a next step, we identified the need for state and local offices of mental health to collaborate with
consumer, survivors and ex-patients for the purpose of developing recovery-focused outcomes and
quality indicators based on the ten rules that we have collectively identified as priority. These quality
indicators should be interwoven through the Evidence-Based Practices   (EBPs)  initiatives   and
offered as a recommended framework or foundation for all OMH licensed and operated programs.
Additionally,   the   development   of instructional and/or collaborative tools that would help
operationalize our rules into practice would be a way to move beyond talk towards action. For example,
an interactive computer tool might be created that would assist a person who is using services in
making informed treatment decisions with his or her service provider. It is our deepest hope that state
and local governments will also use this as an opportunity to create a new vision that looks at a culture
of wellness and the elimination of discrimination and coerciveness.
This document is just the beginning of a very important movement. This process has left many people
eager to get involved in participating in a collective effort to change the mental health system and
improve the quality of life for so many New Yorkers by bringing the promise of a better future. It is our
sincerest hope that all stake holders will rise with us to meet this occasion.