“The seriously mentally ill die, on average, 25 years earlier than the general population…”
Yes, in 2006, this statistic, one sentence gleaned from a 50+ page report by the National Association of State Mental Health Program Directors [NASMHPD], made a big splash.
And as pointed out recently here, though the report does acknowledge psychotropic drug use and polypharmacy as causative factors for this horrible trend in mortality of the mentally ill, the report’s foremost policy recommendation for care providers is to promote compliance with treatment regimens despite side effects, meanwhile creating a [false] feeling of empowerment and equality in mental health patients/consumers merely by changing the language of “compliance” to “adherence,” and by encouraging patients to “ask questions.”
Ah, but it’s a thing of the past! This is 2011 – what do a few offensive policy recommendations from 5 years ago have to do with the present?
Spawn of a statistic
This report was THE inspiration for the SAMHSA 10X10 Wellness Campaign, launched about a year ago, whose mission is to “to promote wellness for people with mental illness by taking action to prevent and reduce early mortality by 10 years over the next 10 years.”
Anyone with knowledge of the mortality of the seriously mentally ill that extends beyond page 5 of the NASMHPD report [which is where it seems most people gave up reading the damn thing] would expect a campaign with that kind of a goal to seriously address issues of polypharmacy, iatrogenically caused illness, the debilitating effects of long term psychotropic drug use, etc – as these things play a very important role in the increased rates of diabetes, heart disease, high cholesterol, and obesity in this population.
But, like the report that spawned it, this campaign, of course, does nothing of the kind. [And the campaign is therefore doomed; without addressing this issue they cannot hope to achieve the abovementioned goal.]
Instead, the emphasis is on re-defining terms, creating false empowerment amongst consumers, promoting medication “adherence,” and extensive and invasive data collection on the mentally ill population.
What is wellness? Because you can’t very well have a wellness campaign without defining that.
[And, please, let’s not even think about letting folks define wellness subjectively, on an individual level, based on their own experiences, preferences, wants, desires, values, etc. Because you can’t standardize subjective definitions – and anyway that kind of approach would tend to make SAMHSA superfluous. And we are talking about 100s of jobs here!]
No, here is how wellness is defined:
[click image to enlarge]
What I think is key is the sidebar; first, the image of the stethoscope (that stands for “doctor”), practically strangling the statement “Wellness connects all aspects of health” and of course this quote:
Communication among mental health consumers, professionals, and primary care providers about health information is essential to overall wellness.
Not only is SAMHSA dictating that the professional medical establishment’s involvement in your life is essential to overall wellness, but this also feeds right into the data collection goal: providing the medical establishment with whatever health information they require (and if I know evaluation – which I do – it’s going to be a lot) is also an “essential” part of that wellness.
In the 10×10 Wellness Campaign’s brochure for consumers, the same definition of wellness (8 dimensions) is used, with a small caveat at the end that it may “differ from person to person.”
Very little room for individual difference in that already overcrowded Venn diagram on steroids…
The message is clear: wellness has nothing to do with trusting yourself (instead, trust the medical establishment) and polypharmacy/iatrogenic illness is certainly not part of the picture. In fact, SAMHSA’s idea of achieving wellness could be summed up like this:
In addition to doing whatever the medical establishment tells you to, you people need to quit smoking, quit eating junk food, and get off your off your butts and exercise. *
Promoting “adherence” and creating false empowerment
Let’s start with the basics: if you clicked the link to the 10×10 homepage, you may have noted that the URL is actually www. “promote acceptance”. samhsa.gov/10by10.
Promote acceptance of what?
Nowhere in the stated goals of the campaign is the word “acceptance” even used… (they do, however, note that the mortality rate for the seriously mentally ill is “unacceptable.”)
My friends, though SAMHSA would likely argue this is meant to be a statement against stigmatization of the mentally ill, I am more inclined to interpret this as part of their “adherence” agenda. Promote acceptance of… whatever the medical establishment tells you to accept, be it diagnosis as identity, medication for life, chronic illness, et al.
There are stronger evidences of this agenda elsewhere, of course. Take the campaign’s “3 Ways to Promote Wellness” poster, for example. Patients are reminded that “communication between people with mental health problems, mental health professionals, and primary care providers is essential” and to “review and act on results of check-ups and health screenings” (ie, fill those prescriptions).
Remember the irony here: the original 2006 NASMHPD report did acknowledge polypharmacy and long-term psychotropic drug use as significant causative factors of the mortality rates of the seriously mentally ill, and then turned right around and stressed compliance with medication-centered treatments. It seems SAMHSA has pulled the same Orwellian maneuver.
A wellness campaign for whom??
So I am compelled to ask: whose wellness is the SAMHSA 10×10 Wellness Campaign talking about? Without addressing polypharmacy and iatrogenic illness, it seems obvious the answer is not “the seriously mentally ill.”
No, I think we are talking about the financial and corporate wellness of the medical establishment and SAMHSA itself, because the campaign stresses, repeatedly, how essential they are to “wellness.” As previously mentioned, that’s a lot of jobs – a lot of house payments, kids in college, newly-constructed vinyl suburban homes with Toyota Camrys and Ford Expeditions (and perhaps even the occasional Cadillac Escalade!) parked in the driveways.
In the name of job security…
[to make comments, visit the original post here]
* Thanks to commenter Darby Penney for summing it up so nicely the other day.