A Perspective in Opposition to
Mental Health Courts
A Compilation of Writings
Addressing the Issue of Mental Health Courts,
Coercion, and Recovery Approaches
2007
Contents
ÿ Mental Health Courts by Pat Risser
ÿ National Mental Health Association
position on Mental Health Courts
ÿ Quote from William A. Anthony, Ph.D.
ÿ Additional Thoughts from Pat Risser
ÿ Mental Health and Human Rights by Sylvia
Caras, Ph.D.
ÿ Blood Pressure Court (Satire)
ÿ A Fairy Tale by Coni Kalinowski, M.D.
Mental Health Courts
(compiled
and written by Pat Risser)
In
advocating for mental health courts, Rusty Selix, the executive director of the
Mental Health Association in California, wrote, "Unfortunately, across the
United States, people with mental illnesses are overrepresented in prisons and
jails. In California alone, it is estimated that between 20 percent and 25
percent of all California prisoners are afflicted with serious mental health
problems such as schizophrenia and bipolar disorder." (http://www.nctimes.com/articles/2007/07/15/perspective/20_15_047_14_07.txt)
Mental
illness is a concept subject to debate. There are no biochemical markers,
no biological tests, no hard evidence at all, to "prove" the
existence of "mental illness." Proof = demonstrate a reliable
association between a clearly specified pattern of observables and other
reliably measurable event(s) which operate as antecedents. (This is same level
of proof used for TB, cancer, diabetes, etc.) In addition, I don't believe
that our thoughts, moods, feelings or emotions are a disease, disorder or
illness.
It
is claimed by some that mental health courts will provide a stopgap to prevent
mentally ill offenders from becoming part of the prison system. Part of my problem is that while we're
allegedly seeking equality, we're also seeking "special"
treatment. So SB 851 provides a stopgap for "mentally ill"
offenders. What's next? A stopgap for offenders with blond hair and
blue eyes? How about offenders who can wiggle their ears? Why should
any "offender" be treated differently? Allegedly, mental health
courts will offer alternatives to defendants with "mental
illness." Isn't that everyone? Hasn't the DSM just about reached
the point where we're all in there somewhere? Most legislation for mental
health courts claim that they will, when appropriate, offer defendants an
opportunity to participate in court-supervised, community-based treatment in
place of typical criminal sanctions. What is "community-based"
treatment and is it anything but forced drugs administered by the decree of
psychiatrists? It's a shame to surrender the criminal justice system to
psychiatry. I believe our criminal justice system belongs and should
remain the purview of those who have been trained in the law. Lawyers,
judges and other legal advocates have a much greater awareness of peoples'
rights and their obligation to defend those rights.
Setting
aside the "mental illness" debate for a moment, there are at least
two other obvious solutions. First, law enforcement can choose to not
arrest folks. There would be fewer problems if they turned an unseeing eye
toward minor offenses. The other solution is that people (not just those
labeled "mentally ill") should not break laws. Fewer broken laws
equals fewer arrests equals fewer in jails and prisons. If people choose
to break laws, perhaps they should heed the saying, "if you can't do the
time, don't do the crime."
Mr.
Selix states that, " Effective mental health treatment is the missing
element of corrections reform." The "system" has been working at
getting better and more "effective" for many, many years. If their
efforts are tied to the increase in prison population then I guess they haven't
done a good job. The only folks I'm seeing get much better are those who
are connected to solid peer supports and services. It seems a shame to refer
people (or rather "sentence" them) to a system that the President's
New Freedom Commission said is, "in a shambles." Of course,
folks in California (like Mr. Selix) should be aware of that since Steve
Mayberg (Mental Health Director of California) was on that Commission.
Mental
health courts are segregationist apartheid. (I first heard this term used by
Judi Chamberlin.) Any time we take one group and set them apart from
everyone else, we are practicing discrimination. What's next? Separate
drinking fountains and bathrooms and eating areas and then moving people into
ghettos and then labor camps from which they are never heard from again?
All done with the approval and acceptance of the law and respecting our
'rights.' What's needed is something where the treatment system is the
one ordered to provide real supports to people to help them to live and thrive
successfully in the community of their choice. (Federal definition of
'recovery' is, "a journey of healing and transformation enabling a person
with a mental health problem to live a meaningful life in a community of his or
her choice while striving to achieve his or her full potential.")
Mental
health court should be the court of the mental health system and not the court
of people being forced or coerced into treatment that doesn't work. It
should not be the court of 'compliance.' Imagine jailing a diabetic for
having dessert or incarcerating a person having chronic bronchitis for lighting
up a cigarette or forgetting his/her inhaler. No one would find such a solution
to public health problems acceptable because it violates people's right to
choose their lifestyles and medical treatment. In virtually all other
medical concerns, we have upheld individuals' rights in this regard
irrespective of the possible risks to self or others. It is absurd to
imagine jailing (or threatening to jail) someone for non-compliance with
medical treatment. We wouldn't jail someone for not adhering to a diet and
eating fast food. We don't treat people "for their own good"
over their objections.
Mental
health courts are courts of force and coercion are indicative of treatment
failure and should not be used. Force isn't treatment. A
therapeutic alliance is impossible in the face of force/coercion. Force
and coercion are abuse. MH Courts are solely designed to
"force" medication "compliance." Sure, they claim to
only be helping people to comply with "treatment" but in this day and
age, "treatment" more and more consists solely of medication.
People are just plain contrary and generally non-compliant. Most people
don't take the full ten days of antibiotics as prescribed. They stop when
they feel better. There are endless other examples. However,
compliance is the major concern of the mental illness system and families who
expect those in the mental illness system to uphold a standard of compliance
higher than everyone else.
While
complying with 'treatment' consisting of medications, it's good to remember two
particularly damning recent research studies. One found that mental patients
in the United States are now living an average of 25 years less than those who
escape notice by the psychiatric system. The other study by the World
Health Organization found that third-world countries that practice far less
'western medicine' actually have far higher 'recovery' rates. Perhaps less
invasive 'treatments' should be emphasized. Perhaps mental health courts
should consider that they might be sentencing people to a death sentence of a
shortened life span.
Mental
health courts create another 'in' door to the system yet the system is
chronically overcrowded and without enough 'exit' doors. It is not the
job of the legal system to adjudicate 'treatment.' The legal system lacks
the knowledge and expertise to dictate terms of 'treatment' for people and the
legal system incorrectly relies upon the medical model of psychiatric care to
help people. The medical model of psychiatric care is a failure.
Mental health courts are a wasteful diversion of people and resources from the
mental health system to a criminal justice system that also lacks resources and
connections to the community. And, what about the people who, because they are
difficult to treat, will get labeled as 'treatment resistant' or
'non-compliant' and it is due to the inadequacies of the mental health provider
or the treatment program. It is claimed that mental health courts are
necessary to stop the revolving door of the mental health system and the
criminal justice system. Yet, there are no studies to indicate that using
the coercion or force of a court system does anything to reduce
recidivism. There is no proof that forcing people into
"treatment" either reduces recidivism in the mental health system or
the prison population.
Mental
health courts are typically funded by mental health funds. How did that
happen?Was it put to a vote? And, does the mental health system have any
obligation to the criminal justice system or should the funds of the criminal
justice system cover their own? The mental health system is for those who are
psychiatrically labeled and the criminal jus tice system is for those
incarcerated for breaking the law. The two aren't the same and certainly
aren't funded the same. Do we want the funds of the mental health system
diverted to criminal justice? Doesn't the criminal justice system have
lots and lots of their own funds? Besides, there really isn't any mental
health system. There's only a mental illness system. People are
labeled as mentally ill, treated as mentally ill and given mental illness
drugs. As a result, we die an average of over 25 years sooner but hey,
aren't we mentally "healthier?"
Mental
health courts need to assure that they don't blame the person for the failures
of the mental health system. Instead of creating courts to force
medication compliance, we should spend our valuable time, energy and resources
creating true alternatives that work to divert people into proven successful
self-help programs (that they will desire and therefore automatically 'comply'
with). How do we get people 'out' from under the thumb of the mental
health courts once they are in? In Oregon, people can remain under the
PSRB system for far longer than necessary. People who are no longer
considered a danger to themselves or others are often forced to continue to comply
with 'treatment' (forced drugs) despite the known dangers of these drugs.
Most
people who have been labeled with psychiatric disabilities have experienced
abuse, neglect and trauma – it is wrong to label the result of those
experiences as sickness or illness. It is also wrong in a similar
way to label the control of the natural thoughts, feelings and emotions that
result from abuse, neglect and trauma as: healing, recovery or wellness and it
is even worse to drug or shock those thoughts, feelings and emotions into
control or submission. This IS the medical model and 'treatment' at it's
worst. Mental health courts that force people into medication compliance
do not consider the whole person and their background, history and other factors.
Forcing someone into submission may cause him or her to no longer be a public
nuisance, but there is no consideration of how miserable or incapacitated it
may make him or her. There is likewise no consideration of how toxic his
or her environment may be. Drugs do not help poverty, joblessness,
homelessness, abuse and other social ills that contribute to the emotional
distresses that cause people to come to the attention of the mental illness
system.
The
mental illness system deludes, diminishes, discounts and distorts the reality
of consumer/survivors by diverting attention from abuse, neglect and trauma and
victims' natural reactions. The mental health system shifts the focus to
sickness/healing rather than remediation of injustice. While our children
are locked in psychiatric units, the parents and other adults who abused,
neglected and otherwise mistreated them are continuing their lives free of any
consequences. While adults languish in hospitals or drug induced stupors
in 'treatment' programs, those who originally abused, neglected or otherwise
mistreated them are continuing their lives free of any consequences.
The
system blames the victim instead of seeking remediation and providing
validation. The system often fails to acknowledge that the people it serves
have usually been victims. The system 'treats' these victims by blaming
them in the form of labeling them as 'mentally ill.' The system
invalidates our experiences and us through the use of its language. Not
only are the labels invalidating, so is much of the language. For
example, the term 'side-effects' minimizes and trivializes the impact of the
very real effects of medication and makes it easier to blame the person for
non-compliance. Statements like, "Oh, it's just a side-effect,"
gloss over our very real suffering and refocus on coercing our
compliance. It's tragic how often psychiatrists will dismiss tremors
and other uncomfortable and even more serious maladies as "just a
side-effect." Sometimes, even death is a
"side-effect." In any other social structure, the use of
seclusion and restraints would be considered torture and locking people up
against their will would be called incarceration and not 'treatment.'
POSITION OF MENTAL HEALTH
AMERICA (FORMERLY THE NATIONAL MENTAL HEALTH ASSOCIATION) ON MENTAL HEALTH
COURTS: |
"Mental health courts, and all other courts
dealing with mental health treatment issues, need to be vigilant to minimize
the use of coercion to compel treatment. The danger is that in the hope
of improving access to scarce treatment resources, mental health courts will,
in the end, increase coercion and stigma. There is also the risk that
they will fail to effectively triage available treatment resources to achieve
the best overall public health outcomes. The basic problem is that the
courts cannot run the mental health system from their limited vantage point
and cannot provide the resources needed to fill the gaps. Therefore,
mental health courts risk inappropriate intervention of the criminal justice
system, with no real improvement in treatment outcomes. At best, they
may effectively determine individual needs and advocate for good individual
treatment. At worst, they risk further criminalizing people with mental
illnesses and fragmenting the mental health and criminal justice
systems." http://www1.nmha.org/position/mentalhealthcourts.cfm |
Drugs
are not solutions. Psychiatric drugs need to be used with more caution
and restraint. Underlying causes of people's distress needs to be
addressed. We can't solve homelessness, poverty, joblessness, abuse and
other social issues with a prescription pad. Drugs don't solve poverty
issues and they don't heal emotional wounds. People who have poverty
issues ought not have to be labeled mentally ill to get housing, meaningful
employment, social opportunities, etc. Staff have been mis-trained to
equate subduing a person with treatment; a quiet client who causes no community
disturbance is deemed 'improved' no matter how miserable or incapacitated that
person may feel as a result of the 'treatment.' Someone may go for years and
years to a day treatment program where they live from cigarette to cigarette or
from Big Gulp to Big Gulp (a 7-11 soft drink) but they have no life. They are
essentially 'soul dead' but as long as they stay out of the hospital and comply
with taking their drugs, they are considered a success. We need to define
success differently! Mental health courts contribute to the distress of
people by becoming a 'compliance enforcement' branch of psychiatry.
Mental health courts know little to nothing about how psychiatry contributes to
peoples' misery. Re-traumatization is common.
Mental
Health Courts don't really solve the criminalization of psychiatric disability.
In many places, they are a well-meaning response to the discrimination and
stigma of the regular court system, the lack of mental health care in the jails,
and the tendency of police to arrest people with psychiatric disabilities in
order to get them off the street. A better, although more difficult, solution
is to educate judges and ensure that they do not treat people with psychiatric
disabilities with contempt; make sure that jails provide adequate mental health
care, and make clear to police that it is not their function to clear the
streets of idiosyncratic people who make shopkeepers nervous. In other words,
mental health courts don't solve the root problem. Part of the problem
with the mental health system is that there is a lack of clarity regarding the
product, goals, mission and purpose. It is unclear whether the primary
task is to produce 'Medicaid billable units of service' or treatment hours or
tenure in the community for the clients or cost savings for the agency.
It is unclear for whom the clinicians work, whether it's on behalf of the
clients or the agency or the system and whether their task is to help people
improve their quality of life (as defined by the clients) with successful
living in the community of their choice or whether it's to improve company
profits.
Mental
health courts are usually only for misdemeanors, and minor ones at that. They
basically use 'crimes' like loitering or shoplifting less than $5.00 worth of
goods to sweep people into a treatment system. Some objections to mental
health courts might be muted if they were only used for major (i.e. death
penalty or life imprisonment) felonies.
People
don't usually exercise much in the way of informed consent over whether they
will go to a mental health court or regular court. Additionally, mental
health clients are not given the right to make mistakes (fail) without it being
judged negatively. Thus, they are deprived of the growth opportunities
that everyone else experiences through trial and error. People don't know
when they 'consent' to mental health court that they may be caught in a web of
force and coercion lasting many years longer than if they just dealt with the
offense that brought them to the attention of the system. In addition,
they may not realize that they might essentially be sentenced to a shorter life
span by taking medications that can result in that shortened life span being
filled with misery, pain and suffering.
The
jurisdiction of mental health courts can go on much longer than a person would
have served for the misdemeanor for which he or she was arrested. If the court
requires that a person be involved in mental health treatment for anytime
longer than the time required for jail and probation /parole, then the court is
participating in 'unnecessary' coercive treatment. Mental health treatment
should be a choice. Just as some people choose to be treated or not treated for
certain medical problems, they should have the same choice regarding mental
health treatment. It is a fairness in sentencing issue (although it is at the
opposite end of what is usually presented as fairness in sentencing). I do
believe that people with mental health issues involved in the justice system
should be able to access treatment if they so desire. There is no
'treatment alliance' (that which psychiatrists claim contributes to 'success'
in the mental illness system) in the court system.
Having
worked in community mental health programs and having been a client of
community mental health programs, I am also concerned about the people who
because they are difficult to treat will get labeled as 'treatment resistant'
or 'non-compliant' due to the inadequacies of the mental health provider or the
treatment program. A program that 'fails' the client will result in blame
and 'punishment' directed toward the client. A provider who 'fails' in
their job will be ignored while the client will be chastised, penalized or
sentenced.
In
Florida, the judge in the mental health court got state appropriations for
specific mental health treatment units to which she sent people who came before
her court. Legally that violates separation of powers doctrine. While many
praised this judge for her kindness and creativity, there is no guarantee that
other judges will be as kind or creative in their efforts.
The
system needs to be completely revamped. Clients are trained to be
"mentally ill" and not mentally healthy. Efforts are focused on
disability instead of strengths and abilities. Dependency is maintained under
the guise of good care. The system is staff-oriented as opposed to
client-oriented. The system is still heavily biased in favor of institutional
based containment rather than community based supports.
Criminal
records keep people from getting housing in the community, employment,
interfere with parental rights, and can seriously affect eligibility for many
social programs. Rather than operating as diversion from the criminal justice system,
the mental health system is increasingly serving as the gateway into the
criminal justice system. More and more as seclusion and restraints are
reduced on inpatient units, mental health staff call upon the police to arrest
and control patients. Outpatient systems call upon police for everything
from "welfare checks" to enforcement of outpatient commitment orders.
Compliance
is an issue of control, not treatment. People in general don't
'comply.' Many who were prescribed 10 days of antibiotics stop after a
few days when they feel better. Few actually 'comply' with diets.
We're just generally ornery and contrary and to expect compliance is to deny
our basic humanness.
Three
Faulty Medication Compliance Assumptions: |
1. Psychotropic medications are
effective (not true for many) |
2. Psychotropic medications are safe
(tardive dyskinesia and other harmful effects are all too common) |
3. People stop taking psychotropic
medications for inap propriate reasons (as you know, this is nonsense) |
There
are serious concerns about the checks and balances of the system. Where are
they? An attorney may represent the person in their defense, and if they
determine the program is not beneficial for their client, they may not
recommend it. However, for those people who do agree to the program, what
happens if they later disagree with the treatment, or if they have a grievance?
What rights do they have to disagree with their treatment protocol? To whom do
they voice their concerns? What are the treatment options? Is it solely
medication? Is therapy included? Will consumer-run and peer services be
considered to be treatment or part of the treatment? Is there room for
alternative forms of 'treatment?'
There
are no biochemical markers, no biological tests, no hard evidence at all, to
'prove' the existence of 'mental illness.' 'Proof' means to demonstrate a
reliable association between a clearly specified pattern of observables and
other reliably measurable event(s) that operate as antecedents. (This is same
level of proof used for TB, cancer, diabetes, etc.) Yet, the courts rely
upon the opinions of voodoo practitioners (psychiatrists) who claim to be
experts on 'mental illness.'
There
are many ways to interact with people. We can treat them as 'patients' or
we can try to understand and see their world through their eyes. We can
weigh the 99+% of the positive or we can look only at the less than 1%
negative. Using mental health courts enforces the view of the person as
'patient' and negates the person. People should not be defined by a
system that labels them as 'illness', 'disease' or 'disorder.' Courts
that are part of the psychiatric system don't ask: What happened to this
person? What is this person's hopes and dreams? What are this
person's loves? Who are the people (good and bad) with whom this person
has interacted? What experiences (positive and negative) has this person
had? Why did this person end up following one path rather than
another? What motivates this person? Who are this person's role
models? What drives this person to get out of bed every day and proceed
through the day? What defines this person's 'spirit?'
Characteristic
assumptions of the Disease Model are:
o A primary focus on biological
dysfunction, denying the consumer control over his or her disability;
o A belief that recovery from severe
mental disorders is highly unlikely or impossible;
o Symptom reduction and remission are the
best possible outcomes;
o Inflexible, time-limited services
designed for provider convenience rather than consumer needs;
o A belief that the doctor or therapist
is primarily responsible for the healing process;
o Lack of proactive outreach and ongoing
support for consumers and family members.
Fundamental
assertions of the Recovery Model are:
o A paradigm shift to a holistic (i.e.,
biological, psychological, social, and spiritual) view of mental illness;
o Recovery from severe psychiatric
disabilities is achievable;
o
Recovery can occur even though symptoms may reoccur;
o
Recovery is not a single event or linear process--it involves periods of growth
and setbacks, rapid change or little change;
o Individual responsibility for the
solution, not the problem;
o
Recovery is not a function of one's theory about the causes of mental illness;
o
Recovery requires a well-organized support system;
o
Consumer rights advocacy and social change;
o
Flexibility to issues of human diversity.
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
An Elephant in the Room
Editorial
in Psychiatric Rehabilitation Journal,
by
William A. Anthony, Ph.D., Winter 2006
The
idiom that there is an elephant in the room is used to indicate that some
issue, which is perfectly obvious to some people, is rarely talked
about. Furthermore, the use of the expression refers to an issue that
can't be avoided, much like an elephant in the room, but often is. This
phrase implies a value judgment that the issue should be discussed openly.
I
sense the elephant in the room whenever we talk about the importance and beauty
of the recovery vision while accepting the incompatibility and ugliness of the
use of force in a recovery oriented system. The danger in not openly
discussing this incompatibility is that eliminating the use of force will never
be critically examined as a necessary goal in a recovery oriented
system. As a matter of fact phrases such as outpatient commitment and
forced medication oftentimes are seemingly paired in a naÔve and incongruous
way with the pursuit of recovery-oriented systems.
I
am not offering a single strategy as to how to get force out of the
system. I don't know the most effective and efficient way to go about
it. What I am proposing is that if we do not redouble our efforts to focus
seriously on the incompatibility of force and recovery, we will never figure
out ways of eliminating force from recovery oriented systems. Force
elimination is both a necessary and reasonable goal as we move further down the
path of recovery. Let us use our most creative minds to discuss this
elephant in the room, rather than spend time trying to regulate or reduce the
use of force in the hopes of making env ironments that use force more
"humane". This incompatibility must see the light of
day. There is no such thing as "forced recovery".
--
William A. Anthony, Ph.D.
Additional Thoughts From Pat Risser:
In
2002, Dan Fisher was serving on President Bush's New Freedom Commission on
Mental Health and he was a member of the subcommittee on "Rights and Engagement"
with a focus on coercive treatment. He invited me to represent the
consumers/survivors side of the issue and provide testimony to the
subcommittee.
I
went to Washington to provide 'expert' testimony. Dan knew that I felt
passionately about our rights and that I'd been to law school, was formerly
director of Patients' Rights in a county in California and was President of
NARPA (National Association for Rights Protection and Advocacy). The other
members of the subcommittee were Ginger Lerner-Wren (Judge from the first
Mental Health Court in the Country in Broward County Florida) and Henry Harbin,
M.D. (Psychiatrist, CEO Magellan Behavioral Health and former Commissioner of
Mental Health in Maryland). Providing testimony for the opposing viewpoint (in
favor of "compassionate coercion") was Steve Sharfstein, M.D. who was
the incoming Vice-President of the American Psychiatric Association.
Much
of the original draft of this document opposing mental health courts was
developed in preparation for providing my testimony. I knew I couldn't just
come out in opposition with Judge Lerner-Wren but what I'd noticed was that she
held the system accountable. Rather than 'sentence' people to the treatment
that was available from the system, she determined what would help the person
and 'ordered' the system to provide for those needs even if they had to create
something that would work. She was also very understanding and compassionate.
Essentially, she 'sentenced' the system to meet the needs of the person.
When
I gave testimony, I credited her as the reason why Broward County Mental Health
Court works. However I also pointed out that she could not be duplicated
elsewhere so there was no way to assure that other mental health courts would
be successful. At that point, Steve Sharfstein poo-poohed with his typical
psychiatric arrogance and claimed I didn't know what I was talking about. Then,
Judge Lerner-Wren proceeded to chew him out royally and stated I was right! It
was quite a show.
In
any case, there are a number of reasons why the mental illness system does not
work. By extension, a court system that forces people into a broken system that
the New Freedom Commission declared is in disarray, would be akin to asking
people to drive safely in a broken car. It just doesn't make sense.
Some of the reasons why the system is broken are:
ÿ Clients
are trained to be "mentally ill" and not mentally healthy
ÿ Efforts
are focused on "disability" instead of strengths and abilities
ÿ Dependency
is maintained under the guise of good care
ÿ The
system creates a suffocating "safety net"
ÿ Clients
are not given the right to make mistakes (fail) without it being judged
negatively
ÿ The
system is deaf, dumb and blind to research and ignores it's implications in
practice
ÿ The
system is staff-oriented as opposed to client-oriented
ÿ School-based
inculcation is so strong as to be nearly totally immutable (people get stuck
and stay stuck in what they learned from 20-year
out-of-date
textbooks)
ÿ "Mental
Illness" is perceived by staff to be an intractable condition (recovery
not possible) for at least 75% of the clients
ÿ Severe
and persistent disabilities associated with "mental illness" are
grounds for assuming clients are incapable of choice
ÿ Pervasive
belief that "treatment" (symptom control) must precede substantive
rehabilitation efforts
ÿ Belief
that impairment in one life area affects all abilities
ÿ Absence
of clarity as to the product (what it is that the system is supposed to
provide) precludes evaluation and effective management
*
There is confusion about mission, purpose and goals; What is the desired
product?
-Treatment
hours?
-Tenure
in the community?
-Quality
of life? (as defined by whom?)
-Normalization?
(as defined by whom?)
-Recovery?
(as defined by whom?)
ÿ Pay
is too highly correlated with credentials that are not indicative of the skills
required to do the job (academic degrees don't necessarily correlate to
"people skills")
ÿ Public
dollars continue to subsidize the education and preparation of practitioners
for the private sector with no pay back to the public sector despite some
fairly massive workforce shortages
ÿ Notable
major advances are accomplished by rebels yet the system rewards conformity and
punishes non-conformity
ÿ The
system subcomponents are underfunded and non-integrated
ÿ The
governor has minimal interest in mental health aside from cost-containment
ÿ People
argue about causes and attempt to make clients "compliant" instead of
teaching them coping skills regardless of causes and in spite of them
ÿ Legislators
are naÔve and pay more attention to providers' and family members' wants than
to consumers' needs
ÿ Provider
Boards of Directors are inadequately trained to do their jobs. What little
training they receive is generally done by staff within the agencies creating
inbreeding that is not beneficial
(adapted from a presentation by Paul Sherman,
Ph.D. in 1994 at the California Case Management Conference in Asilomar,
California)
Mental Health and Human Rights
(written
by Sylvia Caras, Ph. D.)
There
is no conflict between a position that generates the greatest good and at the
same time does the least harm. Coercion does the least good, the most harm, and
is disrespectful to human dignity.
Coercion
deals with a social problem by punishing the victims.
By
creating a sub-class, coercion readies the public mind for prejudice and
discrimination.
Interventions
without consent may ignore the problems of living that cause distress.
Disagreement
with medical authority is not incapacity.
Self-management
and personal responsibility save public money.
Governments
have a responsibility to protect all their citizens. The way to do this is by
strengthening self-definition and autonomy so we each define useful assistance
and accommodation for ourselves.
Determining
the needs of others by one's own needs is oppressive. The value "caring
coercion" puts another's idea of what is good for me over what I would
like for myself, whitewashes the violation of my personal integrity, dishonors
my experience of my life.
The
mental health system is a violent system, using force to impose its will,
bullying patients by withholding privileges and threaten ing charting and
isolation, subduing its subjects with leather and chemical restraints, and in
general setting a harsh example of how humans should treat one another. What is
needed is to overhaul a dishonest system.
Prompted
by Sharfstein's title: Case for Caring Coercion, APHA 2006, Boston, and
informed by internet exchanges with members of the WNUSP board and subscribers
to ActMad.
Sylvia
Caras, Ph.D., http://www.peoplewho.org
Blood Pressure Court proposed (satire)
Doctors
have noted that many of their patients with high blood pressure fail to take
their prescribed medications. Some complain of side effects, some of the
expense, some just do not have the insight to foresee the consequences of their
failure to take their meds. This has serious consequences for high blood
pressure patients, their families and for society. Patients can have strokes or
kidney failure as a result of their non-compliance with treatment and the
burden is left on their families and society to take care of them when these
tragedies are easily preventable if high blood pressure patients would just
comply with their doctors' instructions.
Our
nursing homes and Emergency Rooms are becoming more and more crowded with these
non-compliant high blood pressure patients, putting a burden and a danger on
all of the rest of us. On the road, non-compliant high blood pressure patients
are even more dangerous to themselves and others as they may have a stroke and
pass out at the wheel, killing or injuring themselves and/or innocent other
drivers and passengers. E. Fullofit Whig has estimated that there are 1,000
preventable deaths by car accidents caused by non-compliant blood pressure
patients each year. When will society put an end to this plague?
Researcher
Hookeruser Votrehan has studied this tragic and difficult problem and come up
with a solution that will be helpful to the non-compliant patient, their
families and society. He has proposed High Blood Pressure Courts, similar to
Drug Courts for substance abusers but with an emphasis on getting patients to
take their blood pressure medications rather than on getting drug users to stop
using illegal substances. Patients who persist in being non-compliant could be
taken to court by their doctors or family members or even roommates or
landlords who are aware of their lack of insight and a judge would order them
to take their medication and submit to random blood pressure screenings to
ensure that they are in fact complying with the judge's order. Patients found
to be out of compliance will be admitted to a nursing home for a short stay to
help them gain insight into what awaits them if they do not become compliant
with their treatment. Further lack of compliance could result in being
involuntarily committed to an inpatient facility where means exist to assure
compliance for the patient's own good.
Commentary:
Unlike drug courts designed to force people to stop using drugs, there are
mental health courts designed to force people to use drugs. Imagine courts
for all sorts of non-compliant behavior. Perhaps there will be a
"diet" court to punish those who eat fast food and are
overweight. Perhaps there could be a "sunblock" court for those
who tan too much and risk skin cancer. These examples may be absurd but we
need to be wary of any and all forms of social control and the intrusion into
our private lives and civil rights.
A FAIRY TALE
By Coni Kalinowski, M.D.
Once upon a time in a land by the ocean, people lived in comfort and
prosperity. Over time, they came to notice that some of the people among
them had unusual experiences. Some heard voices, others saw things that
other people couldn't see, others became very agitated or very sad, some became
confused. At times these experiences caused people much pain, and they
suffered and their families suffered with them.
The families went to the leaders of the people and cried, "Our sons and
daughters are suffering. You must help us." and the leaders of the
people saw the truth in what they said and undertook to find a cure for these
ills. Whereupon they commanded wise and compassionate doctors and
profitable pharmaceutical companies to bring before them new treatments -
wondrous drugs that would heal people if taken regularly.
And so the drugs were administered to the sons and daughters who had these
unusual experiences. But apparently an evil spell had been cast upon the
medications, for they were far less effective and far more injurious than
promised. Many sons and daughters were crippled by their
effects. Many feared the medicine had been turned to poison. "This
drug doesn't help me at all....it makes me too tired....it makes my muscles
stiff...it makes me too jumpy...I gained 50 pounds on it...it makes me feel
like a zombie," they were heard to say. The sons and daughters were
frightened and disappointed, and they threw down the pills and returned to
their unusual lives and unusual experiences.
Their families were enraged and returned to the leaders and the
doctors. "You must help us," they said, "Our sons and
daughters do not see how wonderful these medications are, and they will not
take them."
"Never fear," said the leaders, "we will create a law that
will compel your children to take the drugs they need, for it is clear that
they do not have the insight and judgment to make this decision on their
own."
And so a proclamation went throughout the land requiring people who were
afflicted by visions and voices, mood swings and confusion to appear for their
required medications. Thousands upon thousands of sons and daughters were
forcibly, but compassionately injected and, Lo, they began to
heal. Unburdened by their symptoms, the sons and daughters were able to
keep their medication appointments and attend day treatment regularly.
And they all lived happily ever after, with minimal residual disability and
fewer side effects than placebo.
The end.
Like I said....it's a fairy tale.