In August, 2022, people from across the country gathered both in person and virtually to attend the first recovery summit (or similar) to be held by the Substance Abuse and Mental Health Services Administration (SAMHSA) in many years. Facilitated by Chacku Mathai and Elizabeth Burden, they met for two days for both large group panel presentations, and smaller group brainstorms. The goal was ultimately to develop recommendations and agenda items for SAMHSA as they move forward in hopes of re-establishing a connection, and clear practice of listening to a wide array of people who’ve “lived it” when it comes to psychiatric diagnosis, trauma, problems with substances, and more.
Wildflower Alliance Director, Sera Davidow, was invited to speak on a ‘Perspectives from the Community’ panel the first morning of the gathering. Thanks to Ann Kasper (Oregon) who recorded the talk on her phone, you can listen to what Sera had to say here.
Sera: Thank you, everyone. I’m really grateful to be able to be here, and I also want to recognize that there’s something about being here that I find a little frustrating. And, that is that when I received the notice about being invited I received it as “people from the mental health substance use and harm reductions communities,” and I know that people see me very squarely in the ‘mental health box.’
Side note on language, SAMHSA: Please listen to us on language. I don’t particularly want to be referred to as ‘SMI,’ but maybe we can work on that.
But that aside, I actually don’t see myself as in a mental health box. I actually see myself as in a harm reduction box. And I don’t think that we’re really defining harm reduction in the way that we should be. It’s very over simplified. Its seen as having mostly to do with substance use and things like clean needles, and safer consumption sites. And while that’s very important, there’s something much broader and important about the harm reduction approach that says, “Actually, when we’re doing harm reduction we’re letting go of the power to decide what the problem is. We’re letting go of this idea that we can decide where someone needs to go.” And, in that way, I see myself as doing harm reduction, and I want to give you some examples.
So, for example, I do work with the Alternatives to Suicide approach. I’m actually one of the people who developed it. Wildflower has developed it, and we’re training people worldwide. I’ll talk more about that in a moment, but the Alternatives to Suicide approach is one where people can talk about their suicidal thoughts without fear of consequences because the more other people are talking about it, the more they can talk about it themselves. And they’re able to make meaning of those experiences.
So, as I said, I’ve trained people in this country, but also as far away as Australia. I’ve trained people in peer support roles, and family roles, and provider roles. And, as we’ve trained more and more people, we’ve also seen research start to be done on this approach. And particularly in Australia, there’s some really interesting research that happened where they found that the Alternatives to Suicide approach is not successful at getting people to stop having suicidal thoughts. Sounds like problem, right? Let me tell you what I mean. It’s not successful at getting to stop thinking about suicide – for the most part, some people do; But, it is successful at getting people to have more power over those thoughts. And, to learn to read those thoughts as signs. For example, that maybe a part of someone’s life is not working.
That is harm reduction. I’m also a part of the Hearing Voices USA Board of Directors. And Hearing Voices, if you’re not familiar with that approach: It says we don’t need to be the ones to decide if hearing voices, seeing visions, etc are a problem. Instead, we can let people decide “Is this something I actually want to get rid of?” A lot of people don’t. A lot of people hear good voices. They have lots of different experiences. And through the Hearing Voices approach, instead they can learn things like how to navigate making an appointment with their voice. So, I might be working from 10 to 6 today, and my voice might interrupt my ability to work. And, so maybe instead, I’m saying ‘hey [whoever this voice is], can I make an appointment with you for 7 o’clock?” That works for some people. That is a harm reduction approach.
Now, when I talk about these approaches, I’m not talking about just getting to this extremely low bar sort of place that sometimes people talk about how they can find meaning for us where like maybe I’m sort of barely skating by, and sitting on a couch, and smoking, drinking coffee. I’m talking about people living full lives. I’m talking about people reaching their full potential. So, you heard in the conversation this morning. Yeah, in some ways, it’s more aligned with the social model of disability.
The social model of disability says I am not disabled because of something within me. I’m disabled because I live in a society that is not made with me in mind. So, a part of this is about changing that. I’m also not trying to glorify and say, you know, oh this is all great. Everything you need is all roses. Sometimes people say, ‘Are you saying that there’s no actual suffering? That people are just skipping through Flowers?” No… No. The pain is real that people are experiencing. But sometimes that pain happens because of the systems of treatment. Because those treatment systems get us stuck where we are, and sometimes make things worse.
And, I also want to talk to you about anti-oppression and anti-racism work. So, we’re talking about these things.. I hear people say “I want to have the priority of being anti-racist. I want to have the priority of many voices coming to the table.” Absolutely. But we say those things, and they become buzz words. Unless we figure out how to do them. And too often, I hear people saying, “Let’s get people to this table. Let’s translate things into other languages, so we can get people to this table.” But, this table was still designed by a particular group of people. Instead, we need to be getting to a point where we’re building thousands of tables with people as their own architect of each table. And harm reduction makes space for that, because harm reduction makes spaces for many lenses; For many ways of seeing things.
Now, I also want to talk about this as a potential bridge for all of us. We sit here in these boxes, but we are in many ways, the same people. Paolo talked about this a little bit already. Many of us have experienced trauma, and we learned to adapt and find our way through this world. And, ended up in different boxes, but often we’re the same people with many of the same experiences that have landed us where we have. And, we also are experiencing many of the same harms from these systems. So, for example, people who are put in psychiatric facilities because they are suicidal – and frankly, even people who are put in psychiatric facilities because they are struggling with something else – see their suicide risk go up when they’re discharged. Similarly, people who are put in treatment facilities because they’re struggling with substances see their risk of overdose go up upon discharge. They’re all being hurt by these losses of power – by these traumas – and then by these systems that take more power away from of us.
One of my favorite conferences before the pandemic kinda killed the in-person conference thing was organized by the Drug Policy Alliance. And it was specifically a conference on anti-coercion. It brought people from all these boxes together to talk about “How do we move toward systems of anti-coercion?” And, it was great. Except that we kept finding ourselves still thinking we were in different places. I was on a panel with people who were coming from the substance use treatment system place, and they were arguing for more access to Medication Assisted Treatment (MAT), and we were arguing for no more force with psychiatric drugs, and stop overusing them, and stop calling us non-compliant. And they were saying, “You know actually we’re coming at this… some of us want more… some of us want less… What are we doing? We’re all getting each other’s way.” If we’d just taken a moment to step back, we would have seen actually at issue is power. The people who are taking choices away from us to access useful tools. The people who are taking choices away from us by pushing the tools they think that we need. We are so much more on the same page.
And another language side-note. Let’s get rid of the word non-compliant! Please! Non-compliance is violent language. And I say that because the people who hurt me most when I was a child; They told me “If you don’t do what I tell you, you are bad.” And then, I entered a system with all my pain, seeking support. And, that system told me, “If you do not do what we tell you, you are bad.” These messages of trauma and harm and loss of power, they get echoed in these systems with more of that, regardless of the system we end up in.
So, some of the things that I hope that we can take away from this… I hope that we can move together forward on including things like… Let’s integrate that harm reduction framework. It makes so much space for these. Let’s figure out how that can lead us to actually actualize some of those anti-oppression goals, and how we can build a bridge between these communities that have been housed in boxes for so long. And, let’s also expand how we see evidence-based practice. Because lemme tell ya, evidence-based practice – that term that isolates so many of us and pushes us out of the picture and discussion – is rooted in privilege. It is rooted in.. I don’t know… let’s just look at how many white researchers there are in this fields. There’s so many ways that it pushes us out, and ignores and erases cultural practices that have sometimes been around for hundreds of years. So we need to expand our thoughts around that, and divert some of the funding… more of the funding to people who’ve been there, who know the power of loss of power and its impacts.
And, you know, I think that clinical work is not bad. Some clinical work can be really effective if it takes these principles into mind. But people have so much to offer and it needs to be guided by people who’ve been there and who understand these things. And, we need real alternatives. And, I mean fully funded real alternatives. Part of Wildflower Alliance is Afiya Peer Respite. And, it was recognized by the World Health Organization as one of 24 exemplary rights-based approaches in the world. And yet, we’re one peer respite with three bedrooms in an area that has tons of acute beds and hospitals, and how do we ever fully prove our value and our ability to make change if we’re not fully funded? And, we need to fund organizing spaces that are real. Not just keeping us busy. But spaces like that anti-coercion conference where we can go about how to move things forward.
So, I want to leave you with a quick story. I know I’m right at my time. I want to leave you with a quick story… about David. Now David is someone who called me. I didn’t know who he was. DMH told him to call me, and when I picked up the phone, he said, “Hey DMH told me to call you – the Department of Mental Health told me to call you – because you would have the answers.” And I’m like “Uh oh, I don’t even know what the question is. I don’t think I’ll have the answers, but why don’t you tell me the question.” What he wanted me to hear was, “I am suicidal. You don’t even need to ask me if I have a plan,” – that’s not a helpful question anyway by the way – “you don’t need to ask me if I have a plan, because I’m going to tell you I have a plan and I’m going to kill myself.” And, I got to say – because of the freedom in my job – that “I’m never going to be the person who is going to call anyone on you against your will. I’m going to be here to listen. You can talk.”
And talk he did. He talked me on the phone. He talked to me in person. He talked to me on Facebook. He especially liked long messages on Facebook. And, we talked for a long time, but what he still picked up was – even though I was listening, and I was not calling anyone on him – I still wanted to figure out the right thing to say to get him not to be suicidal. I still had an agenda. And, he’d pick up on it sometimes, and he’d say “You don’t get it. You’re not listening. I’m going to kill myself.” And, he was right. And, I had to talk to my co-workers and think to myself “How do I let go of this agenda.” And, at some point, I went back to him and I said, “You know David, you’re right, and I hear you. You’re going to die. You’re going to kill yourself, and I accept that. I just wonder if there’s anything you’d like to do before you die?”
And, that changed the whole conversation. He did have something. He wanted to create an art show of his photography. And, he wanted me to help him do it. It was going to be his mark on the world. And, he had pictures. He sent me them in his Dropbox. We talked about which ones would work and which ones would not work, and where he wanted to go to take more of them. And, that conversation didn’t just last one day. It lasted two weeks, and by the end of those two weeks, he didn’t want to kill himself anymore because he found his own reconnection to the beauty in this world; His own sense of purpose in this world.
Harm reduction frameworks make space for that. I did not have the power to change it. I did not have the power to say the right thing to make him not want to die anymore. But I did have the power to make space, to let go of my agenda, to let him define what the problem was, him define what the solution was, and support him in that. I hope we all do more of that together. Thank you.