During the 1990s I worked as an outpatient clinician at the ServiceNet facility on Pleasant Street. While I enjoyed my professional contact with folks who came in for counseling support, I resigned the job not only because I found the working conditions oppressive (e.g.- lack of pay for any of the work I did other than the eyeball-to-eyeball contact with clients, and repeated decreases in the hourly wage of clinicians like me, repeated increases in the amount of paperwork required), but also because I found that my ability to interact with clients in meaningful, respectful ways, and to deliver therapeutic services based on relational and ecological theories was severely impaired due to conditions and practices at ServiceNet.

I know that many of the productivity pressures on psychiatrists and other clinicians at ServiceNet are a product of outside environmental factors, such as the existence of "for-profit" managed care companies that put the squeeze on contracts signed by mental health clinics. But I do not think that these outside pressures constitute an acceptable excuse for employees of ServiceNet to interact with mental health consumers, survivors, or ex-patients in undignified, rude, or dismissive ways. Consumers are citizens. They have rights to decent treatment that are implicit in the fact of their citizenship. Consumers are also customers of Service Net. They are entitled to be treated as decent and fully-developed human beings who choose to use the services of the local clinics or group residences. Consumers' quality of life and the competency of the services they receive is relevant to Service Net's future as a multi-service corporation doing business in this part of Western Mass. I think it's a "no-brainer" to see that the truly disabling conditions faced by people with mental health diagnoses are not the symptoms implied by these diagnoses, but the quality of treatment by institutions, organizations, and individuals in their immediate environments.

I have read the earlier letters that Freedom Center sent to ServiceNet outlining objectionable and unacceptable conditions in the treatment of its consumers. I support these letters and the intent of the Center to work with Service Net to ameliorate any systemic problems that exist across the agency's programs. This is not just about one or two grievances. There are more conditions that need to be articulated and addressed. Sometimes the question arises: So why aren't we (ServiceNet) hearing more about these conditions if they are so pervasive? One answer to that question lies in the experience of marginalization and the acute vulnerability that consumers feel when it is suggested that they report these conditions. It's highly intimidating to speak out against providers of services that may be essential for your health and well-being. But if a safe place is created for needed conversations, I am sure that together we can create improvements in how services are delivered. I call on ServiceNet to arrange such a safe place, so that the adverse conditions can be ameliorated.

In 1963, when JFK's signature on the Community Mental Health Centers Act created a national system of community mental health clinics, an amazing revolution of thinking in mental health history began. It has continued to this day. It started with de-institutionalization of people who had been long warehoused in state asylums, and it lead to the highly potent and enlightened mental health consumer movement. As we all know very well, the community-based services that were envisioned under the CMHCA, and under subsequent public laws and court orders, were never even close to adequately funded, leaving people with serious mental health issues to wage the fight for appropriate community-based services that could enhance their recovery prospects and their inclusion in society.

The mental health consumer/survivor/ex-patient movement had its work cut out for it. For one thing, members of the movement had to expose the relative lack of civil and human rights accorded other members of society. As people with mental health labels lived on the outside and noticed that they were still being dealt with in paternalistic and narrow medicalized ways, a groundswell of hopeful activist energy emerged and questioned, among other things, the continued existence of oppressive and marginalizing practices towards people with psychiatric histories as they attempted to build their lives in community with others.

Hopefully, we are all now aware that the older psychiatric literature that predicted a lifetime of "inevitable deterioration" for people assigned major diagnostic labels is now defunct. We know that recovery prospects are often dramatic, bringing return to full function for some people with mental health histories, while for some others there is a cyclical path, marked by alternating easy and hard periods that extend over decades. Visions of recovery, once thought to be unrealistic, are now commonplace and founded in real-life experience. Even the Surgeon General of the United States has recognized the critical importance of having mental health facilities across the nation bring their treatment philosophies and service delivery practices into conformance with recovery principles. The seminal 1999 Surgeon General's Report on Mental Health specifically urges all mental health facilities to not only adopt a recovery philosophy into their programs, but also work actively with members of the consumer/survivor/ex-patient movement to further implement individual practices that will support self-determination, autonomy, empowerment, and general enhancement of the quality of lives of people recovering from mental illness.

In closing, I want to say: We can do better. ServiceNet has a golden opportunity now to work closely with representatives of the Freedom Center to create conditions for the treatment of people with mental health histories that honor the values of our larger 'free society"( e.g. equality of opportunity, freedom from undue intrusions into our personal lives); that support the principles spelled out in the Surgeon General's report; and that, frankly, make "good business sense".

Consumers can lead the way to a more sensitive delivery of services by ServiceNet, and to a more culturally-competent and economically-secure corporation.

Carol Owen is an Adjunct Faculty at Smith College School of Social Work and a PhD Candidate at Boston University