I am deeply concerned about eliminating Mental Health Skill Building and replacing it with CPST.  I manage a MH Residential program, and have seen the benefits of skillbuilding services as many of my clients have progressed from being completely dependent upon family to living on their own.   Working with clients while teaching them housekeeping, paying their bills, preparing meals, or doing their laundry creates a therapeutic space that is like no other.  The client can't lie about their habits to the person who works with them in their own home.  They have the opportunity to cope with a panic attack or hallucination in real time, with someone they trust to support them.  Many of my clients still don't trust their therapist enough to share their trauma--even after hitting the maximum number of sessions allowed by their insurance.  But with Skill Building Services, trust develops naturally through everyday life and genuine friendship.

While a community based model is arguably less expensive, it puts an enormous strain on family members who have little or no choice in the matter.  As mental illness tends to run in families, community based treatment  can put mentally ill people in the care of people who are similarly afflicted, or who may be prone to abuse or substance use problems.  Many of my clients' family members do not know how to properly support their loved ones, and reach their wits end trying to cope with a mentally ill loved one's behavior.  When they reach that point, my residential program provides an answer--and I have had many grateful family members credit me with saving their loved one's life by putting them on the path to true independence. 

It's not me--the individuals do the incredibly difficult work of recovery.  However, Mental Health Skillbuilding is a key component of the process.  The integrated approach with psychosocial rehabilitation, 24 hour supervision, and mental health skill building enables my clients to overcome their symptoms in a safe supportive environment free from the trauma they have experienced.  When they are given a place to make their own decisions and set their own goals, in the presence of systematic support and encouragement, they are able to take control of their own lives and progress to independence. 

Something is lost when a person remains in their family home, perhaps seeing the person who caused their trauma regularly, or living amidst reminders of their past mistakes.  Simply relying on friends and family for support and a place to live can undermine their developing sense of self reliance and independence. 

I have two children with serious mental illnesses who lived in my home until they were 30, and continue to struggle with their own illness and behavior.  I am intimately familiar with the strain this puts on a family's time, finances, and personal freedom--and I am well trained in how to manage delusions, hallucinations, and aggressive behavior.  Most family members aren't--and this can lead to injury or abuse, both of the individual and the family.  There needs to be an option for individuals to live in a safe supervised environment where they can access care up to 24 hours a day.