Mental Health Concerns for Obama – by Pat Risser

Mental Health Concerns for Obama
by Pat Risser
Email: parisser@att.net

1.  Mental Health, NOT Mental Illness

The current system of care is a “mental illness” system, not one designed to create “mental health.”  The topic seldom arises of what “mental health” might look like.  In the United States, we are more concerned with trying to define “illness” and to create categories and to categorize people.  In England, however, they have been holding discussions regarding “mental health.”  The following is not meant to be exclusive but rather to stimulate further discussion.

Definitions of mental health are personal and are dependant upon our individual life experiences and life context. Therefore they can be influenced by our gender, race, religious beliefs, social class, experience of family life, aspirations and beliefs etc.

Mental health has been described as multifaceted with six dimensions: affective, behavioral, cognitive, socio-political, spiritual and psychological (Tudor K (1996) Mental Health Promotion: Paradigms and Practice. London: Routledge.).

The Health Education Authority defined mental health in 1997 as “the emotional and spiritual resilience which enables us to survive pain, disappointment and sadness. It is a fundamental belief in our own and others’ dignity and worth.”

The Mental Health Foundation has defined a mentally healthy individual as one who can:
•    Develop emotionally, creatively, intellectually and spiritually;
•    Initiate, develop and sustain mutually satisfying personal relationships;
•    Face problems, resolve them and learn from them;
•    Be confident and assertive;
•    Be aware of others and empathize with them;
•    Use and enjoy solitude;
•    Play and have fun;
•    Laugh, both at themselves and at the world.

2.  Evidence Based versus Recovery Outcomes

Comments of Grace E. Jackson, M.D. to the Federal Coordinating Council on Comparative Effectiveness Research, April 12, 2009

Recommendation #1, Prioritize the End of Corporate Fraud

Research into the comparative effectiveness of medical treatments is a laudable goal, but only if it does not repeat the same errors of the past. When, in the early 1990s, medical journals, medical schools, residency and postgraduate training curricula, and health care facilities came under the influence of Evidenced Based Medicine (or EBM), the favored treatments in American medicine came to reflect the following values and priorities:

1)    Symptom suppression (rather than elimination of root cause of illness)
2)    Short-term studies (e.g., Randomized, Placebo Controlled Trials)
3)    Fraudulent research designs (e.g., placebo washout/lead-in)
4)    Concealment of data unfavorable to the interests of the drug industry
5)    Academic censorship (e.g., non-disclosure and confidentiality agreements)
6)    Distortions in the medical literature (ghostwriting, file drawer effect)
7)    Treatment by consensus (rather than treatment based upon science)

Each of these developments contributed to the hegemony of sham standards of care.

“I prefer “Outcomes Measures” that are an interesting contrast to Evidence Based Practices, which do nothing except ‘validate’ the status quo and changes nothing.”

3. Consequences of Torture

Consequences of Inequality

“[I]n states and countries where there is a big gap between the incomes of rich and poor, mental illness, drug and alcohol abuse, obesity and teenage pregnancy are more common, the homicide rate is higher, life expectancy is shorter, and children’s educational performance and literacy scores are worse.   …  [W]e need to find ways of rooting greater equality more deeply in our society.”

The Spirit Level by Richard Wilkinson and Kate Pickett

“Adults with serious mental illness treated in public systems die about 25 years earlier than Americans overall, a gap that’s widened since the early ’90s when major mental disorders cut life spans by 10 to 15 years.”

Report from NASMHPD (National Association of State Mental Health Program Directors), May 7, 2007

People served by a system that promulgates torture cannot be healthy.

Psychiatry’s Traumatizing (and Retraumatizing) Effects

•    Incarcerates citizens who have committed crimes against neither persons nor property through the involuntary commitment process

•    Imposes diagnostic labels on people; labels that are often pejorative, stigmatize and defame

•    Induces proven neurological damage by force and coercion with powerful psychotropic drugs

•    Stimulates violence and suicide with drugs promoted as able to control these activities

•    Destroys brain cells and memories with an increasing use of electroshock (also known as electro-convulsive therapy)

•    Employs restraint and solitary confinement in preference to patience and understanding

•    Humiliates individuals already damaged by traumatizing assaults to their self-esteem

•    Teaches learned helplessness through the constant threat of the use of involuntary commitment, force and coercion

•    Lacks sensitivity to issues of trauma including being unaware or unwilling to address potential “triggers”  (Hospitals/offices may have personnel, equipment, smells, procedures, pictures, etc. that might be vivid reminders of past abuse suffered by patients)

•    Mental health professionals often just don’t listen.  They KNOW what’s best for the person so they discount the person as being the best expert on their own life so they tune out or don’t hear what the person is really saying.

People diagnosed with PTSD have the highest costs for mental health care among all people diagnosed with mental illnesses. When untreated PTSD complicates other psychiatric issues, or prolonged, severe PTSD leads to development of other psychiatric issues, the person often has high inpatient service utilization, long lengths of stay, and may eventually be seen as a treatment failure.  Research has shown that small percentages of such patients account for large percentages of the costs for care in public systems.

Trauma among people using psychiatric services

•    43% of psychiatric inpatients reported physical and/or sexual assault history (Carmen, 1984)

•    42% of female inpatients of state hospital reported incest (Craine,1988)

•    52% of consumers in urban psychiatric emergency department reported incest

•    Actual numbers are uncertain due to differences in how data were collected (chart review vs. interview) – may be as high as 50-70% of female consumers

•    40-50% of male consumers, sexually abused in childhood

Does not include post-traumatic effects associated with poverty, exposure to violence, homelessness, trauma within the mental health system, other life experiences (military), etc.

Studies have shown that roughly half of persons in inpatient mental health settings have experienced physical or sexual abuse as children.

Some estimates are even higher. One urban mental health center showed that 94% of its clients had a history of trauma/abuse and that 42% of these individuals had PTSD. But only a small fraction of these persons (20%) had received proper treatment for the lasting effects of trauma.

Co-occurring Disorders

A high prevalence of trauma exposure and PTSD exists among the dually diagnosed.

Trauma alone is an important issue in increasing the risk of alcohol abuse.  When combined with psychiatric disorders, risk significantly increases.

55% of consumers and former consumers at a Maine state hospital with a dual diagnosis of mental illness and substance abuse report histories of physical and/or sexual abuse.

In a sample of 100 male and female subjects receiving treatment for substance abuse, more than 1/3 were diagnosed with some form of a dissociative disorder stemming from childhood sexual or physical abuse.

Nearly 90% of women who are alcoholic were sexually abused as children or suffered severe violence at the hands of a parent.

71% to 90% of adolescent and teenage girls and 23% to 42% of adolescent and teenage boys in a Maine inpatient substance abuse treatment program reported histories of childhood sexual abuse.

Children and Families

    Among juvenile girls identified by the courts as delinquent, more than 75% have been sexually abused.

    82% of all adolescents and children in continuing care inpatient and intensive residential treatment programs in Massachusetts have histories of trauma as discovered in medical record reviews.

Homelessness

    92% of homeless mothers have experienced physical and/or sexual assault.

    70% of women living on the streets or in shelters report abuse in childhood.  Over 70% of the girls on the street have run away from violence in their homes.

    79% of homeless women diagnosed as mentally ill, have experienced physical and/or sexual abuse.  87% experienced this abuse both as children and as adults.

Trauma and psychological effects

    50% to 90% of all adults and children are exposed to trauma in their lifetimes.  As many as 67% of these individuals experience some lasting psychological effects.

    Approximately 50% of the people in inpatient mental health settings have experienced physical or sexual abuse as children.

    One urban mental health center showed that 94% of its clients had a history of trauma and 42% had PTSD.

    One study of 275 mental health consumers, 98% had a history of trauma. 43% suffered from PTSD.

    The majority of adults diagnosed with Borderline Personality Disorder (81%) or dissociative identity disorder (90%) were sexually abused and or physically abused as children.

    Women who were molested as children are at four times greater risk of major depression than those with no such history.  They are more prone to develop bulimia and chronic PTSD.

    Childhood abuse can result in adult experiences of shame, flashbacks, nightmares, severe anxiety, depression, alcohol and drug use, feelings of humiliation and unworthiness, ugliness, and profound terror.

Adults who were abused during childhood are:

    More than twice as likely to have at least one lifetime psychiatric diagnosis;

    Almost three times as likely to have an affective disorder;

    Almost three times as likely to have an anxiety disorder;

    Almost 2 1/2 times as likely to have phobias;

    More than 10 times as likely to have a panic disorder;

    Almost 4 times as likely to have an antisocial personality disorder.

    There is a significant relationship between childhood sexual abuse and various forms of self-harm later in life, i.e., suicide attempts, cutting, and self-starving.

    For adults and adolescents with childhood abuse histories, the risk of suicide increases 4 to 12 times.

    Most people who self-injurer have a history of childhood physical or sexual abuse.  40% of those who self-injurer are men.

Social Problems

    More than 40% of women on welfare were sexually abused as children.

    Promiscuity and prostitution, have a correlation with prior sexual abuse.  95% of woman engaging in prostitution, pornographic movies, and nude dancing were sexually assaulted as children.

    Among juvenile girls identified as delinquent by a court system, more than 75% were sexually abused.

    Childhood abuse has a correlation with increased adolescent and young adult truancy, running away, homelessness, and risky sexual behavior.

    Women sexually abused during childhood are 2.4 times more likely to be re-victimized as adults than women not sexually abused.

    68% of women with a history of childhood incest report incidents of rape or attempted rape after the age of 14, compared to 38% of women in a random sample.

    Girls who experience violence in childhood are 3 to 4 times more likely to be victims of rape than those who do not.

    Twice as many women with a history of incest become victims of domestic violence as women without such a history.

    95% of male serial killers were sodomized as children.

    Girls in high-income families are more frequently victims of incest than girls in lower-income families.

    38% percent of women report at least one experience of incest or extra-familial sexual abuse before age 18; 28% report at least one experience before age 14; 16% were abused by a relative and 4.5% by their fathers.

    The United States has the highest rate of rape of any country that publishes these statistics. (13 times higher than great Britain and 20 times higher than Japan)

    The most frequent crimes against people with disabilities, sexual offenses (90%).

    25% of infants one to six months are hit.  The figure raises to 50% of all infants by six months to a year.

Serious Medical Problems

➢    Severe and prolonged childhood sexual abuse causes damage to the brain structure, resulting in impaired memory, dissociation, and symptoms of PTSD.

➢    Between 20% and 50% of abused children will suffer mild to severe brain damage.

➢    3% to 6% of all children will have some degree of permanent disability as a result of abuse.

➢    People who are abused as children may be more prone to developing schizophrenia.  A high rate of physical and sexual abuse is reported among children who were later diagnosed as schizophrenic.  A particularly strong link exists between childhood abuse and the hearing of voices.  Changes to the brain seen in abused children are similar to those found in adults with schizophrenia.

➢    Stress sculpts the brain to exhibit various antisocial, though adaptive behaviors.  Whether in the form of physical, emotional, or sexual trauma and other forms, stress can set off a ripple of hormonal changes and key brain alterations that may be irreversible.

➢    New brain imaging surveys and other techniques show that physical, emotional, or sexual abuse in childhood,  (as well as stress in the form of exposure to violence, warfare, famine, and pestilence) can cause permanent damage to the neural structure and function of the developing brain itself.  These changes can permanently affect the way a child’s brain copes with the stress of daily life, and can result in enduring problems such as suicide, self-destructive behavior, depression, anxiety, aggression, impulsiveness, delinquency, hyperactivity, substance abuse, and conditions such as borderline personality disorder, volcanic outbursts of anger, dissociative episodes, hallucinations, illusions, psychosis, paranoia, and impaired attention.

The Costs

The total cost of substance abuse and mental illness per year is more than $300 billion.  Of this amount, 75% or $225 billion may be attributable to unaddressed childhood trauma.

According to the National Mental Health Association, American businesses, governments, and families contribute $113 billion per year to the cost of untreated and mistreated mental illness.  Between 50% and 75% of these untreated and mistreated people have a history of trauma that either caused or is contributing to their mental illness.  Based on the above figures, the cost of untreated trauma is between $65,500,000,000 and $84,750,000,000 per year.

➢    75% of adults in substance abuse treatment have a history of childhood abuse and neglect.  The cost of un-addressed childhood trauma, based on public health care costs related to substance abuse treatment provided through Medicaid, is:
➢    $582 million for addictive disorders
➢    $84 million for diseases attributable to substance abuse
➢    Over $2 billion for disease for which substance abuse is a risk factor
➢    $252 billion for consumers with a secondary diagnosis of substance abuse
➢    The total cost of substance abuse and mental illness per year is more than $300 billion.  Of this amount, 75% or $225 billion may be attributable to un-addressed childhood trauma

ACE Study and Health

The Adverse Childhood Experiences (ACE) Study is a decade-long and ongoing study designed to examine the childhood origins of many of our Nation’s leading health and social problems.

The key concept underlying the Study is that stressful or traumatic childhood experiences such as abuse, neglect, witnessing domestic violence, or growing up with alcohol or other substance abuse, mental illness, parental discord, or crime in the home (which were termed adverse childhood experiences—or ACEs) are a common pathway to social, emotional, and cognitive impairments that lead to increased risk of unhealthy behaviors, risk of violence or re-victimization, disease, disability and premature mortality.

ACEs are common, even in a relatively well educated population of patients enrolled in one of the Nation’s leading HMOs.   More than 1 in 4 grew up with substance abuse and two-thirds had at least one ACE!  More than 1 in 10 had 5 or more ACEs!   And, ACEs are highly interrelated.   In order to assess the relationship of the ACEs to health and social problems we developed the ACE Score,  which is a count of the number of ACEs designed to assess their cumulative impact on childhood development and therefore, their impact on a variety of health and social priorities in our country.

What we found, using the ACE Score, stunned us even more. As the ACE Score increases so does the risk of numerous health and social problems throughout the lifespan. These problems are a “Who’s Who?” list of problems that encompass the priorities of many agencies, public and private, that are working to prevent and treat a vast array of problems.  A summary of the problems strongly associated with the ACE Score follows.

ACE’s increase the risk of:
•    Heart Disease
•    Chronic Lung Disease
•    Liver Disease
•    Suicide
•    Injuries
•    HIV and STD’s
•    And other risks for the leading causes of death

This vast array of problems that arise from ACEs calls for an integrated, rather than a separate or categorical perspective of the origins of health and social problems throughout the lifespan. This approach to growing up with ACEs, and to the consequences of exposure to them, may unify and improve our understanding of many seemingly unrelated health and social problems that tend to be identified and treated as categorically separate issues in Western society. Development of more integrated approaches will likely contribute to more meaningful diagnoses, improved treatment of affected persons, and better integration of research priorities, preventive and social services, and legal venues.

The ACE Study calls for an integrated approach to intervene early on children growing up being abused, neglected, witnessing domestic violence, or with substance abusing, mentally ill, or criminal household members. All of these childhood stressors are interrelated and usually co-occur in these homes. Prevention and treatment of one ACE frequently can mean that similar efforts are needed to treat multiple persons in affected families.

4.  Psychiatric Drugs

Senator Grassley is investigating Big Pharma, Schools of Medicine and citizen lobbying groups to delve into how deeply our society is dominated by the pro-drug industry. We would also urge Senator Grassley (and others) to please investigate Mental Health America, CHADD, TeenScreen, the proposed National “Mothers” Act and National Depression Screening Day too. They’re drug industry front groups just like NAMI.

Antipsychiatry activists have a critique of psychiatric drugs, not of the people who use them. Again, we recognize that people may have formed dependency on these substances and that people cope as best they can. There are all sorts of drugs that people use to alleviate their pain, and psychiatric drugs are among them. We do not judge the people who use psychiatric drugs or people who use other types of drugs (including alcohol). Antipsychiatry is opposed to presenting psychiatric drugs as a cure or forcing people to take them. By the same token, if there were a government initiative in place to force people to take alcohol or heroine due to a deficiency, then we would oppose it.  “Normal” is often considered going out to a pub on Friday night for a couple of brewski’s to unwind from the stresses of the week.  We do not promote alcoholism but suggest that perhaps the pub on Friday night is safer and holds less health risk than most psychiatric drugs.

5.  Broken System

“The biggest change in mental health from 1978 to today is that…we now know that recovery is possible for any individual with a mental illness.”  Rosalyn Carter

Yet, much of the system still does not accept this simple truth.  The President’s New Freedom Commission on Mental Health (2003) found:

“…that the nation’s mental health care system is beyond simple repair…that the current system is unintentionally focused on managing the disabilities associated with mental illness rather than promoting recovery, and that this limited approach is due to fragmentation, gaps in care, and uneven quality.”

Systemic Confusion

There is often confusion about mission 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?)
•      Increased agency funding
•      Generating more Medicaid billable units of service (This is the usual belief)

The system’s biological approach reduces human distress to a brain disease, and recovery to taking a pill.  The focus on drugs obscures issues such as housing and income support, vocational training, rehabilitation, and empowerment, all of which play a role in recovery.

•    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 creates a suffocating “safety net”
•    Clients are not given the right to make mistakes (fail) without it being judged negatively
•    The system is deaf, dumb and blind to research and ignores it’s implications in practice
•    The system is staff-oriented as opposed to client-oriented
•    School based inculcation is so strong as to be nearly totally immutable
•    Severe and persistent mental illness is perceived by staff to be an intractable condition for at least 75% of the clients
•    Severe and persistent disabilities associated with mental illness are grounds for assuming clients are incapable of choice
•    Pervasive belief that treatment (symptom control) must precede substantive rehabilitation efforts
•    Belief that impairment in one life area affects all abilities

Mental Health Courts

*    Mental Health Courts are segregationist apartheid.  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 we 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.  MH 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. 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.”  People are just plain contrary and 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.

*    Faulty assumptions about “compliance” that need to be addressed.
Three Medication Compliance Assumptions:
➢    Psychotropic medications are effective (not true for many)
➢    Psychotropic medications are safe (tardive dyskinesia and other harmful effects are all too common)
➢    People stop taking psychotropic medications for inappropriate reasons (as you know, this is nonsense)

*    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.  The court needs to assure that it doesn’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.  The World Health Organization points out that people with psychiatric labels live ten to twenty years less (have shorter life spans) than those who have not come within the net of the system.

*    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 them to no longer be a public nuisance, but there is no consideration of how miserable or incapacitated it may make them.  There is likewise no consideration of how toxic their environment may be.  Drugs do not help poverty, joblessness, homelessness 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 health 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 other 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.  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.’

*    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 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 has been mistrained 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.  Retraumatization 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 billable Medicaid units 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 for 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.

*    POSITION OF 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.”

*    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.

*    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, that the court is participating in ‘unnecessary’ coercive treatment. Mental health treatment is 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” and it is due to the inadequacies of the mental health provider or the treatment program.

*    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.

*    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.

*    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 disagree with the treatment, or 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) which operate as antecedents. (This is same level of proof used for TB, cancer, diabetes, etc.)  Yet, the courts rely upon the opinions of the voodoo practitioners (psychiatrists) who claim to be experts on “mental illness.”

*    There are many ways to interact with people.  We can treat them as “patient” 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 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:

•    A primary focus on biological dysfunction, denying the consumer control over his or her disability;
•    A belief that recovery from severe mental disorders is highly unlikely or impossible;
•    Symptom reduction and remission are the best possible outcomes;
•    Inflexible, time-limited services designed for provider convenience rather than consumer needs;
•    A belief that the doctor or therapist is primarily responsible for the healing process;
•    Lack of proactive outreach and ongoing support for consumers and family members.

Fundamental assertions of the Recovery Model are:

•      A paradigm shift to a holistic (i.e., biological, psychological, social, and spiritual) view of mental illness;
•     Recovery from severe psychiatric disabilities is achievable;
•      Recovery can occur even though symptoms may reoccur;
•      Recovery is not a single event or linear process–it involves periods of growth and setbacks, rapid change or little change;
•     Individual responsibility for the solution, not the problem;
•      Recovery is not a function of one’s theory about the causes of mental illness;
•      Recovery requires a well-organized support system;
•      Consumer rights advocacy and social change;
•      Flexibility to issues of human diversity.