Repairs Needed For A Broken Mental Health System

Psychiatric hospitalization disrupts lives. After hospitalization occurs, we are not only talking about the need for recovery of rationality and emotional stability, we are also talking about the need for recovery of economic status, and the recovery of, and possibly even reinvention of, family, friends and lifestyle.

The creation of an unbridgeable gulf between before hospitalization and after hospitalization is a professional cop out.

I think an over reliance on psychiatric drugs has a great deal to do with why this is so, but I don’t think that this over reliance on psychiatric drugs is the only culprit when it comes to low recovery rates. I think a lot of it is built into the mental health system, a system that encourages people not to work and, in fact, rewards them for not doing so.

Among these other culprits are:

1. Cynicism, cowardice, and pessimism among mental health professionals.

2. Paternalism and the devaluation of people into “adult children” (i.e. people with “chronic” uncontainable “mental illnesses”) deemed unworthy or incapable of making their own decisions and managing their own affairs.

3. The results of this paternalism: a poverty that forces people to live on federal benefits within the mental health ghetto. The lack of any upward mobility, for people who have had “issues”, outside of the mental health field.

4. The business advancement end of mental health treatment: facilities would prefer expansion over closure. More patients foster greater job security and more status for employees, a more pressing need that also encourages more bucks to be spent in the field. Fewer patients are bad for business. (Doctors and mental health facility staff, in other words, get rewarded for their failures rather than for their successes.)

5. Mental health consumerism: there is no mechanism for cessation of consumerism except personal decision, a decision that need not ever be arrived at. Mental health recovery (i.e. the cessation of consumerism) is a tag word. Recovery is not a consumed “service”, or a consumer “product”. Treatment junkies just aren’t recognized for being what they are–addicts. The dependency habit can be a very difficult habit for some people to overcome and break.

6. People are prejudiced. Employers won’t hire people labeled “mentally ill” on account of their sketchy work histories. NIMBYism [Not-In-My-Back-Yard-ism] prevents them from getting decent housing, and from building workable alternatives to what the public mental health system provides. Legislation enacted to deal with these matters is often, if not inadequate, unevenly enforced or unenforced.

7. The mental health system has not yet seen its role in promoting community integration, recovering people from mental health consumerism, and remedying a situation it has created (i.e. the disruption of lives caused by hospitalization.) Until it does so, it is only managing the convalescence of the artificial invalids it has created. It is also avoiding responsibility for its own part in these matters.

We’ve got a system that is going from bad to worse. Warehousing people labeled “mentally ill” in a community setting is little better than warehousing people in state mental hospitals. Until the overall treatment paradigm changes dramatically as practiced by community mental health facilities across the country, this situation is bound to grow even worse.

Let’s return to the 7 criticisms offered above, and let’s take a look at the improvements that are implicit within them.

1. Experimentation and guarded optimism from professionals. Exceptions should be permitted to the professional standard of care. Different results are bound to result from doing things differently, and these are matters that take a long time to register in meta-analysis.

2. Empowerment of mental patients and mental health consumers is bound to result in improved performance. Responsibility breeds responsibility. Give them something to do with their hands, and pay them for it! Having them pay you to pretend to work…Hey, it’s not really rehabilitation either, is it?

3. I never had much faith in the “self-esteem” theory of mental health. It is, in fact, one of those myths exposed in research that we haven’t yet disposed of entirely. I think other esteem has a lot more to do with it. Finding ways to advance human interests outside of those in the mental health system I feel can help improve our other esteem. Relationships matter much more in these matters than do smoke and mirrors.

4. Facilities and professionals need to be judged more on their outcomes and recovery rates than on their acceptance of the problem as a permanent fixture. It’s a growing problem, too, and what it grows upon is this “acceptance”. Why pay people to acknowledge a failure when maybe it’s a failure they can do something about? Unworking and unworkable treatment programs don’t need to be paid for with taxpayer monies.

5. Incorporate cessation of mental health services into mental health services. Cease to use the terms “chronic” and “long term”. Don’t adopt treatment plans without beginnings, middles and, most importantly, ends. Treatment plans should have timelines and deadlines, extensions are permitted, but they should never be permanent or indefinite.

6. Enforce and extend legislation directed against discrimination in education, employment and housing practices. Enact more legislation where appropriate and possible. Direct public relations campaigns at showing that people can leave mental health treatment, perform responsibly, and advance in the community.

7. Mental health professionals and paraprofessionals need to work with employers and community members to get people engaged in their communities. Insulating people from community ultimately does more harm than it does good. The community needs to be encouraged to include people who have experienced the mental health system, too.

I’ve heard it said that nobody ever succeeded alone; the same can be said for failure, nobody ever failed alone. Failures receive a great deal of help at becoming failures. We can change the system, and by doing so, we can raise the success rates and lower the failure rates. I have always thought so called “mental illness” ultimately was about failure. Get rid of the failure, and you’ve also gotten rid of the “illness”. The human condition should be different from the wild boar condition. The ethics of the roulette wheel doesn’t need to rule our species. When more people succeed in the world, it is my belief that there will be fewer people labeled “mentally ill” among them.

5 Responses

  1. Here’s how I’d do it if I was el supremo.

    Totally ban coercive and compulsory psychiatry. Current involuntary patients, and the general public, will be told that there is no evidence they have an illness. If the person is fearful of withdrawal or rebound they can be supported. Or they can be locked up in prison if that’s where they really belong.

    All psych workers who actively promoted the need for coercive psychiatry would be sacked and declared permanently unemployable for any purpose. They can live in gulags and have rations dropped in by air.

    • I’m with you on this, Rod, but it’s easier said than done.

      I was in Virginia before I moved to Florida. In Virginia, the Chief Justice of the Virginia Supreme Court appointed a commission on mental health reform. This was even before the shootings at Virginia Tech which didn’t help matters much, and actually added fuel for his efforts to “reform” the system. He was reacting to this talk of people labeled “mentally ill” being treated in the jail and prison system. His view was that laws were too lenient in Virginia because some people in a county or two in northern Virginia had measures applied there for the protection of people’s human rights. The appointed commission included a few token “consumers”. I say token, not because they were necessarily “bought”, but because their percentage was so small as to make sure they had scarcely any real say at all in the matter. The “non-consumers” were the over whelming majority, and consequently represented the majority vote and opinion. These were people from the criminal justice, legal, and mental health fields, and the picture was and remains pretty grim. These people were for stricter laws then, and more coercive treatment in the main. I’ve had to wince when I’ve heard the word “reform” applied to mental health ever since. I’m with you, but I think the trend now is towards the more coercive measures and away from consideration for people’s human rights. The idea is that deinstitutionalization went too far. My feeling is that deinstitutionalization didn’t go far enough. I think we’re going to have to wait for a change in the atmosphere of the times before a number of people are willing to join us in opposing forced and unwanted psychiatric treatment.

  2. I agree with Rod. Coercive psychiatry needs to stop calling itself help and billing itself as being better than the penal system. It’s worse. The people who must be coerced into treatment need to sit in jail if they’ve screwed up. If they haven’t, then they have the right to be left alone.

    • I agree with both of you, BetaSheep. Some poor folks with problems who get caught up in the criminal justice system, and found Not Guilty By Reason of Insanity (if not, the more recent Guilty By Reason of Insanity) can find themselves doing more time in the mental hospital system than they would have done in the jail system. This can be almost a guarantee of the development of more serious health complications such as TD due to over use of psychiatric drugs on these “patient offenders”.

      Mental health courts and suchlike make decisions that usually apply to misdemeanor cases and not felonies. This, in itself, represents the criminalization of the “mental illness” label. People are often picked up for things that are relatively minor, and could be handled in other ways. Serious offences are going to handled differently and within the penal system.

      The problem at root is one of growing intolerance for difference in this world. When people are more tolerant, understanding, and less thin skinned, they are more willing to put up with, and entertain, a true diversity of styles, opinions, and ways of being.

      The fact of the matter is that people labeled “mentally ill” are more likely to be the victims of violent crime than the perpetuaters of violent crime. Given this fact, obviously, the labeled “mental ill” are the scapegoats, and the new Jews, of our new world order. I imagine they were scapegoats in any old world order as well. It is well worth remembering that officials in NAZI Germany took the eugenics policy that they used on so called “mental defectives” from the USA. Sterilization became euthanasia, and this experiment served as the model for the grand design that came to be known as The Final Solution or, from another angle, the holocaust.

  3. As always, great points!

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