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I was recently ushered into retirement from a long career managing services for people labeled as psychiatrically disabled. In that career I started up a couple of clubhouse programs and oversaw day treatment programs, sheltered workshops, IPS employment services and PACT teams. I got involved with NAMI during its early days, supported family groups and started an early family support program. I served on the Massachusetts Transformation Committee for many years and helped bring peer support services to my agency. …

For a while this had been the paradigm for our society. Mental illness is just like physical illness, and ‘deserves’ the same treatment.

I remember early in my career, when I was on the national board of IAPSRS (the International Association of Psychosocial Rehabilitation Services, predecessor to the current Psychiatric Rehabilitation Association) in the early days of psychiatric rehabilitation, in the late seventies (I think). I was talking with then-Executive Director Ruth Hughes about the exciting possibility that Medicaid funding …

Use of the term ‘behavioral health’ to reference mental health services seemed to arise from managed care. Outcomes had to be measurable in order to render services accountable, so they could be managed. Like most aspects of managed care that made it so unpopular at its inception, and led to a backlash for most medical services, these terms shift the priority of services from benefiting the individual service recipient to benefiting shareholders and the society at large.

Somehow …

I worked continuously in the rehabilitation part of the public mental health system from 1968 through 2012. Until nearly the end, I was proud of the work I did, with colleagues of all sorts. I always strived for a big-picture perspective, to understand my work in context, and there were lots of challenges and knotty dilemmas built in. Mostly, they made the work more interesting and, ultimately, fulfilling, until late in the game.

A great many things conspired to pull …