Wellness-Focused Action Plans For Mental Health With Steve Miccio

 

When faced with difficulties, we tend to lose hope in everything and question our purpose. It’s absolutely the time to turn your struggles into positivity and take care of your mental health. Steve Miccio discusses wellness action plans with your host, Timothy J. Hayes, Psy.D. Driven by his personal experience of being diagnosed with a mental illness, Steve has spent over two decades creating, providing, and promoting innovative crisis response services. In this episode, he shares the struggles he experienced, the ups and downs, and figuring out what he wants to do in life. He also dives deep into how he formed his organization, what they do, and how they provide positive expectations for people’s recovery and wellness outcomes. He talks about the marginalization of people with mental health issues and then thinking of alternative solutions. What is more, Steve also shares the unique models and approaches he uses that significantly reduce hospital utilization, incarceration rates, and overall healthcare spending.

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Wellness-Focused Action Plans For Mental Health With Steve Miccio

Steve Miccio is the Chief Executive Officer of People USA, inspired and driven by his personal lived experience. Steve has spent over two decades creating, providing and promoting innovative crisis response services and systems-level improvements, both across the United States and internationally. These improvements raise the bar on customer service, person-centered communication, trauma-informed care, empathy and positive expectations for people’s recovery and wellness outcomes. Steve’s unique models and approaches significantly reduce hospital utilization, incarceration rates and overall healthcare spending.

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Steve, thanks so much for being here.

Thanks for having me.

It’s a delight to finally meet you face to face. I’ve heard a lot about you. I wonder if you could start us off by telling us how you got into the work you do and what drives your passion for it.

What got me into the work was my lived experience of what happened to me and how I ended up in the mental health world. Prior to being diagnosed with bipolar disorder, I had been struggling through life with ups and downs and never could figure out what was wrong, happening or anything. I’m still able to function well, had good jobs and all that good stuff but it was challenging. I’d go into these depressed states and then into these energetic states. It was a challenge. In the mid-’90s, it all came to a head for me where I was successful in my work but then at the same time, I was dealing with this energetic existence and doing things that made no sense and my thought processes didn’t make sense.

It was strange because inside, I could feel and question myself and say, “What are you doing?” I couldn’t change the behavior and it was very challenging for me. I ended up going into a psychiatric emergency room and hospital and being diagnosed with bipolar disorder officially. It was the beginning of my experience of how ridiculous I thought the mental health system was because I ended up in this hospital and the first thing they did was give me this cup full of different medications that I didn’t question or understand. I was so scared at that point. I took it and stayed in the hospital for 7 or 9 days, whatever it was and never heard the word hope, recovery or anything that was positive coming out of it. All I heard was what was wrong with me, my diagnosis and that I was going to live with this the rest of my life.

I always tell people I went in as Steve Miccio. I came out a mental patient and I did. My self-esteem was gone. I had no hope at that point. I thought, “This is it.” I’m going to end up having to go to these services and taking this medication the rest of my life. I didn’t know what the future held for me. I came out of it, not knowing anything.

After I’d come out, I was working in the developmental disability world and I was employing people and creating innovative work for people that were now were functionally, physically capable of doing things but mentally they were non-verbal. They had all different diagnoses in the DD world and I had been training them on how to run a greenhouse, cut lawns and do things that were probably not the norm for people that you would see with the level of developmental disabilities that I had. I was successful at it and we were on our way to building this affirmative business with people with disabilities.

Peer support is important in mental health wellness.

They came in one day after my hospitalization and this was after I was promoted. “You have 1 of 2 choices. You can take a job that is more of direct care in one of our houses or you can leave. What happened?” We’ve been doing this job and I’ve been doing so well at it. I couldn’t prove the discrimination but it was right there in front of me. I did leave, didn’t know where I was going to go and did pick up another job and it wasn’t my passion as much. It was still in the developmental disability world but it wasn’t the passion that I wanted. I was more driven now towards mental health and understanding it and the system of care.

In New York State, there are different divisions of departments. There’s the Office of Mental Health, Office of People with Developmental Disabilities and then the Office of Addiction Services. I had never interacted with the Office of Mental Health and/or their services. Now I was in their services and going to see a psychiatrist and therapist and still trying to figure myself out and what was happening for me.

I got this additional job after I started to recover and my recovery came from a book that was called You’re Not Alone. It was written by people with depression and mental health issues. I went to my first peer support group. This was a group of people diagnosed with bipolar disorder that I sat in and they all were telling their stories. I heard my story and their stories and there became my self-determination. That’s where I got my hope and started to feel empowered to do something for myself and think of myself differently.

That’s how it started for me and then I got this job at a hospital when I was in my recovery in an emergency room screening people with psychiatric crises. I was like, “This is great.” I’m going to love this job because I can treat people the way they should be treated, not the way I was treated at the hospital and that’s what I did. I knew where to get them the best food. I would go and steal it from the kitchen and I would make sure that they’re hydrated and comfortable in the small screening area that we had and I loved that job. I said, “This is how it should run.”

That was my experience there and then I was introduced to this peer advocacy organization called People Inc., they were looking for an executive director. I applied for it after five interviews, I got the job and my thought was, “I’m in advocacy. I can advocate for the hospital that I was hospitalized in and make it better.” What I found out quickly was that they wanted nothing to do with me and my organization so my advocacy mentality had to shift and it had to become a little more aggressive in what I was doing.

I was beginning to understand the world of people with lived experience, the world of psychiatric care and the Office of Mental Health services that were out there. I was fortunate because I got to be on both sides. First, I was the person that locked in the unit. Now, as the person with the keys when I worked in the hospital and I started to understand both sides. That’s what got me to where I am, which is running a peer-run organization, doing a multitude of great services in our communities.

Tell me about what this organization is and what’s the range of things you do.

This organization began as an advocacy organization. It was very small when I started it. We had maybe nine staff altogether, serving two counties and we had two drop-in centers, which were safe havens for people with mental health issues to come and hang out, have coffee, meet us and talk. A lot of peer support was going on there. The advocacy component was helping people transition from inpatient psychiatric centers into the community and advocating the services in the community to ensure that the people were getting the services that they deserved when they were released from the hospital and living independently.

The advocacy, I was throwing rocks at the system out there going to these provider meetings, criticizing the system of care, talking about the marginalization of people with mental health issues and wasn’t happy with how people were being treated because we were getting those stories every day from different communities that we were serving. I did a lot of advocacy and raise a lot of attention around hospital crises and emergency rooms. We did a whole expose on one of the hospitals here, the hospital that I was hospitalized in. We picketed and demonstrated.

In one hospital, the administration or the board of the hospital recognized that they were being criticized for the quality of care and the mental health services and the board decided to terminate the administration of the hospital and then came to me and said, “Can you put advocates in our emergency room to help us make it a better place for people to come to?” I was like, “Yes.”

 

While I was fortunate because I had the experience of working in the emergency room so I built this whole training around putting peers into the emergency room and how to greet people, how to be more trauma-informed and practice safety when people came in and making them feel safe when they came in and telling them being transparent and telling them what they were about to go through.

I started moving the organization into a peer-run service organization. That was the first new service that I introduced into our community. The next one was the peer respite and at the time when I was designing it, I designed it with the help of Shery Mead, who had a respite out in New Hampshire. She and I were starting to put together the ideas of how to run the respite and things. We had some differences and some similarities so it helped me to help design what I wanted to create.

The respite was simply more of a bed and breakfast environment for people to come to in crisis and have 24-hour peer support. They could stay 1 to 7 days at the respite and get into the crisis of what brought them to the house, thinking of the alternatives and the decisions that someone can make to avoid a crisis in the future, building a safety and wellness plan for themselves. That was the first house that was funded by the State Office of Mental Health to operate in New York State.

Let me get this clear. Is that something people would do before they would go to the hospital in crisis?

They could do it before but they could do it instead of going to the hospital in crisis.

Instead of getting referred from the hospital, you’re talking about creating awareness within the community so that if somebody is identified as approaching a crisis point, they could go to this peer respite.

I used to call it a hospital diversion house and people told me that was rough language. When you call something a crisis or a hospital diversion house, the community doesn’t take that as well as hearing a respite house but the whole idea was a lot of people don’t need that level of medical intervention going to an emergency room and an inpatient unit. They need someone to listen to them, compassionate care and someone with lived experience to share their stories so that they can feel that they’re not alone and understand that recovery is possible and hope is important in someone’s recovery.

Hope is important in someone’s mental health recovery.

We do that in the houses by lending the vision of hope by expecting a recovery. The mantra in our organization is that hope greets you at the door and recovery is the expectation. We’ve lived by that over many years that I’ve been here. We truly believe it and that’s what the house was designed to do. It helped break the crisis. Many people go through the home to crisis to hospital and my goal was to break that cycle. We did and we’re 95% successful in doing that with the people we served over many years that we’ve been operating.

I’m very curious about how do people find out about it? How do you get the awareness in the community out there so that instead of being rushed off to an emergency room, people find your respite care?

That was a learning process for me. I expected when I opened it that people would come that they’d flock in. There were two things that were the challenges for us. Nobody did know about us. The people that did were the people that were still connected to the psychiatric hospital system or fresh into the community. We had not had a captured audience but we had a lot of people that were freshly discharged from hospitals. They were the ones that were starting to come to the house. The other was the provider community didn’t understand and trust it knowing that people with lived experience were going to run a crisis house. That was a big shift for them to understand.

 

I knew I had to build integrity and success into this house. I went into very optimistic thinking, “This is going to work and be great.” What I was hearing from the community is, “What if someone kills himself at the house? What if somebody cuts themselves at the house, they overdose or if they whatever?” My response was always, “What if they love the house and the way they’re treated? What if they realize that there’s a different way of treating people in crisis and there’s a better way of communicating, engaging and developing a relationship with someone?” That was my whole focus. It wasn’t about the danger of what it could have been. It was about the optimism of what it was and that was hard for people to grasp as well.

In the years that we’ve been running this, we’ve never had any kind of situation like that, where someone has died at the house or overdosed. There has been no violence at these houses or anything. This is a voluntary service. When people were getting agitated or if they become agitated at the house, the staff simply say, “You don’t have to stay here. You can go.” They think differently, like, “This place is too nice. I don’t want to leave. Let’s have a conversation. Let’s talk about my anger and my issues.” That’s what happens.

It is a very successful house that I’ve helped open probably 40 houses across the country and in the Netherlands now that are operating under the same principles of what we created and it’s growing. More states and communities are learning about it and wanting it. It’s to the point where I also realized I had to make or build relationships with the provider community and with the police in our communities so that they understood what the house was about and they could use it to bring people to and that’s what we did. We have this great relationship with all the law enforcement departments and community providers where they understand it.

It took some years for people to understand exactly what this was. They understand it much faster because we also market it differently, too. We’ve learned how to market and got into the marketing of coming to the respite. It was a learning experience to get people to embrace it. Now, it’s highly embraced in all the communities that we serve. We have four houses now that we run but again, I stay very close in contact with the other respites that I’ve helped to open. I try to keep things true to the fidelity of the model that we created and for the most part, people are doing that, which is nice to see.

As a provider myself, I’m curious about what the form or the model was that worked best for you in communicating and establishing that rapport with providers?

It was about being a voice at the table, not just sitting at the table. I’m a pretty blunt person and I would go to these provider meetings and people would talk about how great we all get along and how great we work together. I would sit there and say, “We’re not working together. We’re serving people under your services that are having difficulty getting entitlements and their appointments and that are being discharged for missing appointments when it should be the other way. Why aren’t you making it to the appointments and why aren’t we providing you some assistance in getting to those appointments?” I would be very honest at these meetings and I raised the bar.

Furthermore, how can we make the appointments something these people want to go to? How do we make the appointment something that we don’t have to drag people, kicking and screaming to get them to go? Which is essentially what you did with the respite houses. You’ve taken that model of compassionate care and made this something that not only did people want to go there but when difficulties happen there, they want to work to stay. It’s that nice.

I even have now a crisis stabilization center that we run and it’s peer-run. It’s probably the only one in the country that’s peer-run crisis stabilization but we do have clinicians, case managers and some chronically normal, traditional people working in it as well. It is exclusively peer-focused and trauma-informed the way we designed it, which is also very successful and people want to come to that. I keep telling people we want to be the Disney World of mental health, not for the fun of the crisis but for the actual care that people are going to receive when they come into our services.

I was fortunate enough to work in Brooklyn for a while. A judge had asked me to work in Kings County Hospital because a woman, Esmin Green, had passed away in their psychiatric emergency room in the waiting room and she was dead for an hour before anyone came over and checked. It was unfortunate. The fortunate piece that I say that I had was they asked me to bring peers into the hospital to help engage people that were coming into the emergency room and help engage people that were in the mental health units. I developed training on how to do that and what that looked like.

One day I was standing in one of the mental health units and one of our peers came walking in for their shift. Many of the patients in the hospital saw the peer come in, they all surrounded that peer and wanted to talk to that peer and tell them about their day. I was standing in the nursing station. There were social workers, nurses and other staff sitting there. One of them said, “Look at this, when I walk into the unit, nobody comes and greets me like that,” I said, “It’s because you suck at it.” What I meant was you don’t engage. You’re not engaging in a very compassionate way with the people you serve. I did training for the traditional staff as well, which shifted the paradigm of that hospital to a better quality of care from the emergency room into the mental health units. It took about eighteen months to do that.

It puts me in mind of talking to, I believe her name is Kate Duffy. Do you know the name?

I know the name.

She tells a story about how she couldn’t get people to agree to talk with her. She was a social worker and finally, she settled on instead of they want to talk to a social worker, ask them if they would be willing to talk to another addict. The yeses went through the roof over 90%. She met them as a peer. She could bring all of her other expertise after she connected with them as a person.

The lived experience is the secret sauce in substance use and mental health care. We know, live and experience it. It’s a powerful tool that complements tradition.

First, I have to connect with the person as a person. One of the things I was going to say when you’re standing there in the nurse’s station with the social workers and nurses is, “Nobody comes to greet you because you don’t connect with them as a person. You look at them as a compilation of symptoms, a label and notes that need to be made instead of connecting as a person.”

Don’t focus on the danger of what something could have been. Hope is about the optimism of what it was.

We’ve changed the whole engagement process at the stabilization center to you don’t come in and start doing paperwork. You come in and we get you comfortable. We say, “What brought you here and how can we help you? Here’s what we can offer you,” and tell them we’re very transparent about what they should expect from us and what we expect from them as a guest. We call them guests when they come to our houses and our stabilization center.

We tell them, “We do have to do some documentation and here’s why we have to do it. One is because we got to get paid for this but the other is, we want to get to know you better.” We use a motivational interview process when we go through the documentation to get the story and within that story are the notes that we would have to write. The staff is trained on how to do that and it’s much calmer and I keep saying trauma-informed but it’s a more respectable way of working with people and understanding what they’ve been through and what happened to them and how we can help them. It works well.

I feel like I interrupted you on a flow of talking about all of the things that you do. Do you want to come back to that?

The respite was the one big thing we created that was a paradigm shift but as time went on, I realized infusing my staff into not only the emergency room but into other services would also make sense. I started working with the provider community and the county governments that we work with. We serve nine counties so we’re in a bunch of counties doing this stuff. I started asking them if we could put our folks in their services. They’re in the partial hospitalization program, in the clinic and on the streets doing the outreach as well and greeting people.

That began expanding and then we got more into supported housing and we have over 200 units in different communities where people live in our housing services. We pay 2/3 of their rent. They pay 1/3. We help them to get work, how to live and be successful independently. We use a housing-first model, which means you’re not going to lose the roof over your head ever. Even if they’re asked to move because of some issues with the landlords or whatever, we always find them a place to live. They don’t lose the housing, which focuses them more on their own wellness and the recovery when they don’t have to worry about losing the roof over their heads. That’s also been very successful.

 

We have a mobile forensic, peer-driven team down in Westchester County, New York that works with police organizations and helps engage people. When the police are working with someone to say, “There’s an alternative to the incarceration here and arrest and we can help you with that if you agree to go to services and we’ll get you to those services within the 24 hours that we need to and then we’ll follow-up with you.”

We’ve been successful, also working with the court system, getting to know the judges and saying, “There’s another option instead of putting this person in jail, treatment probably would be a better outcome for this individual and they’re willing to do it.” We work with the judges and the court systems on that alternative as well and again, has been successful when the judges embraced that. They use it and have been more, which has been great.

All the other services we have are mostly staff mobility, getting out there, meeting people and providing support groups, education, wellness groups and resource groups for different folks in different communities, which ties everything together and then we have 24-hour phone support for everybody that’s within our services. If they’re in trouble, they can call us anytime and they’re going to get another peer on the other end. That’s going to help walk them through whatever it is they need in their support.

How do you fund all of that?

We’re pretty fortunate that the State Office of Mental Health has funded most of it over the years but some counties that didn’t have the funding that was coming through the state went to their own legislation. The legislature in the county has funded the services because they see the value in it. We show a lot of return on investment in the work we do. I didn’t do this to save money but when we sat back and looked at what the effect was of not using Medicaid or not using the level of intensive acute service delivery, we found that we were saving millions in the communities. The stabilization center itself is able to save $12 million a year on cost avoidance. The Rose Houses, the respite houses that we have are able to stay between $6 and $10 million a year in cost avoidance.

It makes a big impact and it’s getting more noticed now in the political communities. We have more representatives, senators and folks coming through our services and looking to replicate those models that we’ve created. We’re working with the State of New York on the licensing and replication of these services. They’re funding these services through their own dollars, which is allowing us for expansion as well.

Feel free to push this question off. You started with your own story. Part of my mind is saying, how did you make a transition from that diagnosis and that disrupted functioning to this higher functioning? What forces and factors whether it’s medication, therapy or other things have you found most useful in getting your life back in balance?

I found, for a while, certain medications that helped me. As time went on, they were hurting other parts of my body. My kidney functions were starting to get a little screwy and my liver functions were not the best. I wanted to find a way of being medication-free and I would have these arguments and disagreements with my psychiatrist but I started doing it.

What I found was my passion for what I was doing, that structure drove my behavior. Becoming a strong advocate, a visionary and somebody that could create these services was my wellness and is my wellness. Over the years, I titrated off my medication, found that I didn’t need it, still use peer support and that mutuality to support me. I also do a lot of self-help for myself, develop my own Wellness Recovery Action Plan, which is called the WRAP plan to maintain my wellness. People around me, if they see something that might be a little off, they’ll let me know and I’ll get back on to my wellness to figure out what I need to do. As I’ve gotten older, it’s gotten easier. My passion is my wellness.

I love the idea of the Wellness Recovery Action Plan, that advanced mental health directives kinds of things. I’m taking a proactive approach to my whole mental and emotional health. People like to talk about mental and emotional hygiene and how it’s so important we do physical hygiene on a regular basis but we’re not conditioned, trained or even aware of the possibility that there is a good tool that I can use to clean up the inside on a regular basis.

There’s so much we can do for ourselves and people don’t know. Our organization and staff know and train and help educate others in our communities on how to do that.

If we have somebody who’s reading this who says, “I didn’t know they had that stuff. How do I start that in my community? Where do you point them?”

That led to something that I didn’t expect was consulting. We now consult. That’s how we were able to help open 40 respites around the country and in the Netherlands. People heard about it. I started to go to conferences and do workshops. When I first started, we were freshly new and maybe 5 or 6 people would show up on my workshop but as word has gotten out, the room gets pretty full now. Out of that, people call and say, “We want to start this in our community.” I did a webinar and I’ve gotten three people that have come forward and said they’re in different parts of the country and they want to start this.

For the most part, I will reach out and talk to people about what the possibilities are. I’ll explore their system because every system is different in every state and county. I’ll get to understand what their system looks like and I’ll give them tips and ideas on how they can start to develop a business plan on starting those services in their community. If they want to consult, we have a whole fee schedule that would help them to hire us to come out and literally help them design this and develop it.

If you take a minute to settle in and think about this range of things you’ve already shared with us, what’s something about either you personally, your journey or the work you’re doing that we haven’t even touched on yet that you want to share with us?

There’s always a better way of communicating, engaging, and developing a relationship with someone.

I’ve gotten big into understanding what integration and collaboration are and in communities. To me, asset-based community development became important for me. It’s something that we still need to work on as a nation, in building systems of care that work because if you look at the system, law enforcement is becoming the first engagement for people with mental health or addiction issues. Why are we okay with that? We shouldn’t be as a society. I asked people that constantly.

I’m even a CIT trainer and a CIT is a Crisis Intervention Team training that police officers get. It’s a 40-hour training. It teaches officers how to engage differently because officers are taught to use command voices and control the situation. CIT brings it back to compassion and says, “Slow down to speed things up.” You need these tools on engagement to talk and listen to the person, find out a little more in-depth what’s going on with them and then having the resources to understand as an officer where can I send this person instead of arresting them or instead of the emergency room. Is there an option?

It’s saving lives. It’s helping officers do their job better. It’s another tool for them. I love the training and it’s vital for everyone to have but we shouldn’t just sit back and say, “We’ve got CIT. They can engage and get people to where they should go.” It should be a system of care that should be the first engagement in working with people in our communities and helping them avoid the criminal justice system. We’ve become so criminal justice-focused. If you look at it in the country, there are criminal justice conferences everywhere all the time on engaging people and working with the behavioral health community on helping people through crisis.

We’ve gotten too comfortable with that and we should think about how do you develop a system of care that is pre-law enforcement and pre-criminal justice and we should be able to do it. We’re pretty smart humans and it’s convincing people though to do it because some police departments have completely embraced it. They’re like, “We love it and having a social worker in the car with us.” That’s good. It is needed and important because we don’t have that system of care that I’m looking for.

My vision is to develop an asset-based community that focuses on understanding mental health and addiction so that our mobile teams can go out instead of a police department and engage people and get them to the services that they deserve and need before it gets to that level of crisis. That’s one piece of it. The other piece is that provider organizations do what they do but they still live in silos. People will say, “We’re community integrated and we do whatever.” I’m always asking for proof of that. I can always find limited proof. We have a long way to go in developing systems of care that are engaging and trauma-informed that people want to go to instead of being forced to go to something. We can do it.

We’re showing, with our services, that people want to come to us. They want to be part of us. Traditional organizations are asking us, “How do you do it?” It’s a whole engagement training that we will give them in doing that but I believe that the community needs to step back a little bit and say, “Are we doing what’s right for the people in our communities? How can we do it better?”

Unfortunately, our paying system doesn’t fall in line with that yet. There’s a lot of advocacy nationally that we need to be doing on getting the pay system to understand that there’s a better way of doing this. There’s a return on that investment if they do it and we can create a community that is much safer for everybody if we’re all on the same page. It’s the challenge of getting everyone on the same page.

That’s one of the great benefits of what you’re doing and it being evidence-based and collecting this data that you’re able to show. Here’s all this money that you don’t have to spend if you put this money into this program. It’s millions of dollars and the people who want to focus on the dollars and cents, you’re helping them. Those of us who want to focus on the humanity side and the compassionate care, they’re seeing the results too.

We’ve got work to do still. That’s what keeps me going at least in trying to shift that paradigm to a wellness focus rather than an illness focus.

The other question that pops into my head is what training do you give your peer support people?

We give them a lot. In New York State, there’s a peer certification. They go through the Academy of Peer Services, which we also and I was also a big part of developing that and what kind of training that is. It’s more of the mutuality, peer support and compassionate care training that is important. Motivational interviewing and supervision of peers are part of it. The certification is good but then we also had to create our own training for the respite services because there wasn’t any out there.

We created a whole ongoing training on how to work in the peer respites, which does include dialectical behavior therapy groups that staff gets trained on. They trained on applied suicide intervention strategies so if somebody is suicidal, we don’t dial 911. We go into the water with them and say, “Let’s talk about this.” When people will talk about suicidality, there’s ambivalence. There are reasons for living and dying. As we’d have that discussion and intervention, we get them closer to the reasons for living through that discussion. That’s a big part of our training.

A lot of psychiatric rehabilitation out of Boston University is a big part of what we do and how we train people in our services. Wellness recovery action plans, we train them on how to put those together, advanced directives, how to use those and train people in our communities but it’s ongoing training that we give our staff and make sure that any models of care that are working out there, they’re going to be trained on it in our organization.

 

I had the privilege of interviewing Paul Hendry who worked for the Jacobs. Do you know Paul Hendry?

Yes.

The One Million Lives program that I thought of when you were talking about suicide and their check-in at the OML.world that’s free to anybody so they can do the ongoing status check of their own mental health, their feelings or resources. Anything else you want to throw in here before we wrap this up?

I can’t speak enough to the power of peer support and providing services that make sense that is logical by focusing on people’s wellness and their strength. I didn’t mention how strength-based we are. We work with some people that are in dire straits, homeless, have no food resources, living a rough life and yet all of my staff are trained to look for the strength in someone.

They’re still living. They live in some of the worst situations. A lot of us say, “This guy or this woman is so successful.” They don’t face what a homeless person face. There’s a lot of strengths there.

We point out those strengths. When we get calls from the county that say to us, “We’re working with somebody that we can’t work with anymore. We don’t know what to do.” We always take those folks on because what I’ve learned is that people aren’t trying to get over on a system. We hear that often that they’re manipulating the system or they’re coming to the emergency room because they’re hungry. What I tell them is, “That’s great though.” That’s a strength because they learn how to survive. You can use that skill that they have and direct it in a different direction for them so that they can live an even better quality of life for themselves. We don’t take the time to do that. In my agency, we take that time. We look and build on those strengths of the people we serve.

You build the resources that you can point them to.

We’ve seen thousands of success stories in this organization over the years. It’s something to be proud of. We want everyone to embrace not only what we do but what works for the people in our communities because we can fix this issue. We have to have a concerted effort. One of the things that I often say is that I always ask who’s in charge. If you think about it, there’s never been a mental health czar in our country that has said, “We’re going to look at all of the evidence-based and the systems of care and we’re going to help design it so that there’s fidelity in the services that people receive in our country.”

I don’t know why that hasn’t happened because it would make sense for me if somebody would take that task on and say, “We’re going to develop it so that when you do walk into a different state, you’re not going to get different care. You’re going to get the care that is consistent with the way people should be treated.”

I understand the cultural differences and that’s got to be a part of it but there’s no reason why one county is one county or one state is one state and the way they care for the people in their communities. That would be another thing I’d want the government to eventually look at and say, “We need to do something about that.”

I thank you so much for your time. I appreciate it. I know you’ve got to run but it’s been a delight. I will circle back in a year or so and see what’s new in your life and if you’re willing to talk to us again.

I’d love to. Thank you so much for the opportunity.

It’s my pleasure and you’re most welcome and deserving.

Thank you.

—

Steve Miccio is the Chief Executive Officer of People USA, inspired and driven by his personal lived experience. Steve has spent over two decades creating, providing and promoting innovative crisis response services and systems-level improvements both across the United States and internationally. These improvements raise the bar on customer service, person-centered communication, trauma-informed care, empathy and positive expectations for people’s recovery and wellness outcomes. Steve’s unique models and approaches significantly reduce hospital utilization, incarceration rates and overall healthcare spending.

Steve’s professional highlights since joining People USA in 1999 include being the first in the United States to embed peers in a hospital psychiatric ER, blazing the way for a best of an evidence-based practice standard. He created the Rose House model of peer-operated crisis respites, which are home-like alternatives to hospital psychiatric ER and inpatient units. He has the first peer-run hospital diversion of houses in New York. He helped open 39 peer-operated crisis respites using the Rose House model across the United States and Europe.

He has developed the OMH White Paper, infusing recovery-based principles into mental health services with input from over 40,000 New Yorkers. He created the Dutchess County Stabilization Center, which is the first peer-run crisis stabilization center in the world and the first crisis stabilization center in the Northeastern United States. He created the Transitional Care Wellness Team model, a unique hybrid of transitional care management and wellness coaching. He’s developed unique training programs for hospitals, local government units and behavioral health organizations across the United States to help them build tomorrow’s behavioral healthcare workforce and culture.

He organized and provided crisis intervention team training to hundreds of law enforcement throughout the New York area. Steve is active with a variety of groups including the National Psychiatric Rehabilitation Association and he’s a board member of CIT International. He’s a subject matter expert for the re-entry police academy headed by the SAMHSA’s GAINS Center and Policy Research Associates.

Important Links:

• People USA
• You’re Not Alone
• People Inc.
• Academy of Peer Services
• OML.world
• Transitional Care Wellness Team
• National Psychiatric Rehabilitation Association
• CIT International
• SAMHSA’s GAINS Center
• Policy Research Associates
• https://People-USA.org/about/leadership/

About Steve Miccio

Driven by his personal lived experience, Steve has spent over two decades creating, providing, and promoting innovative crisis response services and systems-level improvements – across the United States and internationally – that raise the bar on customer service, person-centered communication, trauma-informed care, empathy, and positive expectations for people’s recovery & wellness outcomes. Steve’s unique models and approaches significantly reduce hospital utilization, incarceration rates, and overall healthcare spending.

Steve’s professional highlights since joining People USA in 1999 include the following:

First in the United States to embed peers in a hospital psych. ER, blazing the way for a best and evidence-based practice standard today.

Created the Rose House model of peer-operated crisis respites / home-like alternatives to hospital psych. ERs & inpatient units; first peer-run hospital diversion houses in New York.

Helped open 39 peer-operated crisis respites using the Rose House model across the United States and Europe.

Developed OMH White Paper, “Infusing Recovery-Based Principles into Mental Health Services” with input from over 40,000 New Yorkers.

Created the Dutchess County Stabilization Center; first peer-run crisis stabilization center in the world; first crisis stabilization center in the Northeastern United States.

Created the Transitional Care Wellness Team model, a unique hybrid of transitional care management and wellness coaching.

Created the Westchester Forensic Mobile Crisis & Response Team; first peer-run criminal justice-focused mobile team in the United States.

Engaged in community-wide systems transformation – across sectors – in multiple counties throughout New York’s Hudson Valley region.

Developed unique training programs – for hospitals, local government units, and behavioral health organizations across the U.S. – to help them build tomorrow’s behavioral health workforce and culture.

Organized and provided Crisis Intervention Team (CIT) trainings to hundreds of law enforcement throughout New York.

Steve is active with the following groups: Chair of the National Psychiatric Rehabilitation Association (PRA); Board member of CIT International; Subject matter expert for the Re-entry Policy Academy headed by the SAMHSA GAINS Center and Policy Research Associates; Member of the International Crisis Now coalition; Member of the Crisis Residential Association; Member of New York State Suicide Prevention Council; Board member of 2-1-1 policy board of Hudson Valley; Executive member of the Dutchess County Criminal Justice Council (DCCJC); Chair of the Diversion Committee (DCCJC); Member of the Dutchess County Police Reform and Modernization Collaborative; Advisory Board member of the Northeast Caribbean Mental Health Technology Transfer Center.

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