They're filling my friend's job, not replacing him

            The Bureau of Behavior Health (BBH) is hiring a new director for the Office Consumer Affairs (OCA). This OCA is another NH first-in-the-nation, started in the early 1990s by HHS Commissioner Don Shumway, and directed for its first 13 years by an irritating genius named David Hilton (1953-2003).  There are now 38 state offices of consumer affairs in the 50 states.

No one will ever be like David Hilton.  He was the smartest, most interesting (even when he was wrong), and most infuriating (when he thought I was wrong) person I’ve ever known.  He was my closest personal friend. He got me involved in advocating on the state level for “recovery-based” mental health services.

“Recovery” is different from being “symptom-free” or “stable on medication” or being underemployed in a dead-end part-time job.  Those concepts are about not being sick.  Recovery is about being well.  It means improving your self-esteem and self-respect, and your comfort with the quality and balance of your life, relationships, and connections to the community.  Many people can recover completely, and everybody can recover to some extent.  Recovery does NOT mean you no longer need medicine.

Recovery programs he started or imported from other states were a statewide mental health consumer council, a network of peer support centers, and the Wellness and Recovery Action Plan (WRAP), based on the work of recovery pioneer, survivor, and author Mary Ellen Copeland.   He is more responsible than any other individual for bringing a “culture of recovery” to the state’s community mental health system.

When I began treatment in a New Hampshire Community Mental Health Center (CMHC), the people asked about my “recovery assets,” even before they talked about what was wrong with me. No clinician ever talked to me about getting well before.  That’s a culture of recovery.

 While they set me up for medicine and one-on-one counseling, they also sent me to a peer support center.  These are run by people can truthfully say, “I’ve been there.  I know how you feel.”  They teach recovery skills, and also life skills like computers, healthy cooking, and mutual support. Peer support agencies are a supplement to medical treatment at a CMHC.  David Hilton started all 15 centers one at a time.

David’s next gift to me was Mary Ellen Copeland’s 40-hour recovery training.  I learned a recovery philosophy, a toolbox of practical things to do to stay on track, and get back on track when things got shaky.  Then David sent me to Vermont for five days to learn to teach this approach.  I’ve been practicing and teaching it for 11 years, most recently to inpatients at NH Hospital.

He never resolved the conflict between his real desire to tear down the mental health system and replace it with something totally different, and the fact that he was working for incremental change within that very system.  For a guy who didn't believe in incremental change, he was responsible for more of it than anybody I knew.   

He hated being called a radical.  To him, that was the establishment's way of marginalizing him and his beleifs.  Today, most of his radical ideas are mainstream practice -- no longer radical at all.   I travel around the country teaching states, counties and agencies recovery practices I learned from David.  In his mind, the ideas people called radical were just common sense that the establishment refused to understand because they were too stupid, narrow-minded, change-averse, too unwilling to challenge their own assumptions, or too fond of money, power and professional prestige.  One day I told him, "David, radical is good.  Radicals and angry people change the world."  

David did a lot of hard time in New Hampshire’s big asylum on North Pleasant Street in his late teens and early 20s before they released its 2,700 patients to CMHCs.  He never recovered from the trauma of being locked in there against his will, undergoing forced treatments that, today, look like Medieval torture.  He joined with other victims of forced treatment to start the recovery movement, which at first the psychiatric establishment considered dangerous and radical.  Now recovery-based mental health services are state and national policy. New Hampshire made recovery state policy in 2000, and the federal government declared it national policy last year.

These recovery pioneers, like David, taught the recovery philosophy and methods to the professionals, not the other way around.  But his rage was so deep that he could never enjoy seeing the medical establishment come around to his point of view.

David never accepted that he needed to take medicine.  He would stop, be taken back to the hospital a few months later, scare the hospital staff to death for a couple of months, and finally get with the program.  Then, he’d go back to work at OCA until he stopped taking his medicine again.  On his meds,. he changed the world.  Off his meds, he could talk utter nonsense around the clock, frighten and bully people, and never lose his ability to articulate.

He investigated every “discipline” that promised a way to substitute for his medicine:  R.D. Laing, Recovery Inc., Christian Science, Scientology.  But when you need medicine, you need medicine.  Each relapse was worse than the time before.  Finally, he stood in front of a train. 

Today that big asylum is a state office complex that houses, among other state agencies, the Bureau of Behavioral Health.  In the sub-basement, right below the BBH offices, you can still see the cells where they chained the difficult patients to the walls.  When the search committee meets to interview applicants for David’s job, they will meet right next to the BBH director’s office in The David Hilton Memorial Conference Room.