Different Paths to Mental Health: Alternatives to medication for mentally ill patients
Source: Eugene Weekly
Cover theme: "Loving Your Body 2010." Page 16.
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The last few years have seen increased attention and emphasis placed on the rights of mental health patients. Changing ideas about the nature of mental illness have now led some health professionals to believe recovery is possible, even from acute mental illness, and more and more people are looking to nonpharmaceutical treatment alternatives to get there.
"There is the hype out there that drugs correct biochemical imbalances," said Ron Unger, a Eugene therapist and clinical social worker.
Unger emphasizes the importance of group therapy, a treatment option seen in many mental health practices. He leads specialized groups for people who hear voices and have paranoia and other issues.
David W. Oaks, director of the Eugene-based mental health activist group MindFreedom International, also believes that it is important to "dispel the myths" surrounding pharmaceutical treatments for mental health disorders.
"People have been convinced that these SSRIs are miracle drugs, and they're not," he said. SSRIs are Selective Serotonin Reuptake Inhibitors, one of the most common forms of anti-depressants. Oaks said that neuroleptic and anti-psychotic drugs can be expensive, and he said that long-term use can cause brain damage.
MindFreedom International has been an active participant in the movement for change in the mental healthcare system, taking a pro-choice stand in a debate that's often seen as one-sided.
"It's not about the civil war --- are we for drugs or are we against drugs --- it's just that there ought to be choice," Oaks said. "The way we put it is, 'One choice is no choice.' There should be a range of choices available for alternatives."
Oaks and MindFreedom International helped get a Eugene City Council resolution passed in October 2009 advocating for mental health patients' right to choose. Oaks said this is the only resolution he knows of that presents choice in mental health care as a human right.
Unger has been working alongside MindFreedom to revise county guidelines to include more alternative treatment options.
"I think that the existing system is much more oriented towards drug treatment than it should be," Unger said.
Oaks said that many county mental health officials see his push for immediate change as personal attack, but he maintains he is trying to prevent any more delay.
"We call for a nonviolent revolution in mental health," Oaks said. "Minor reform in mental health, we feel, is actually one of the obstacles."
Ira Aronin, a mental health specialist and the lead worker for access-related issues with Lane County Behavioral Health Services, said that the county is progressive and does a good job incorporating alternative treatments.
He said that most of the patients who would prefer not to take medications are sent to other agencies that contract with Lane Care, the organization that manages the Medicaid dollars for mental healthcare in Lane County.
"I don't think our staff push medications on people," Aronin said. "They're aware of the pluses and minuses of medications."
He said that staff at Lane County Behavioral Health Services, a government agency that is part of the Department of Health and Human Services, base most of their treatment plans around what the patients themselves want.
"People are offered therapy, and sometimes they're offered medications," Aronin said. "Not unusually, people come in that are already on medications from somewhere else or come in asking for medications that they've seen advertised."
One of the major obstacles the county faces in incorporating alternative treatments is a high demand and lack of resources, especially since nonpharmaceutical treatments require more personal and long-term care, Aronin said. Lane County Behavioral Health Services now restricts its client base to people who are coming out of a psychiatric hospital or are so troubled that they are at risk of hospitalization.
"I think the fact that we're understaffed and often dealing with crises and a lot of complex cases makes pursuing alternatives difficult," he said.
The in-patient psychiatric unit in the Sacred Heart Medical Center's University Center, also called the Johnson unit, treats people with acute mental illness but incorporates a diverse array of treatments.
Katharine Schneider, the clinical supervisor for therapy and care management at the Johnson unit, said that every patient is assigned a psychiatrist, therapist and social worker. During an average stay of seven days, Schneider said, patients do a lot of group work and participate in a creative arts program.
The Johnson unit has a movement therapist who uses yoga to help patients "be" in their bodies, a bibliotherapist who focuses on poetry and journal writing and an art therapist.
"We love our creative arts therapists," Schneider said.
Due in part to the severity of the cases on the Johnson unit, Schneider said, pharmaceutical treatment, including long-term medication, is often part of the treatment.
"My view is, and this is based on talking to many, many people throughout my career, sometimes medications are invaluable," Schneider said. She added that the degree of medication and the longevity of pharmaceutical treatment depend on the acuity and kind of symptoms a patient presents.
Private practices with the ability to be more selective in their clientele are often more able to pursue strictly alternative treatment options. Dr. Kristen Allott, a Seatte naturopathic physician and licensed acupuncturist, specializes in non-pharmaceutical interventions for mental health with her practice, Dynamic Paths. She places special emphasis on diet and nutrients.
"There are a lot of people who are either not eating enough protein or not timing their protein correctly and having a lot of anxiety and depression," she said.
Allott sees her practice as com-plementary to more mainstream therapy and treatment of mental health disorders. She said that many times, her patients are seeing therapists and taking medications but not seeing results until they correct their nutritional problems.
"If you're overtly anemic, an SSRI is not going to work, or it's not going to work well, and you're missing a big part of the picture," she said.
Allott does emphasize the importance of conventional medicine and drug treatment, saying that they often save lives.
"Pharmaceuticals and psychotropics play a really valuable role," she said. "I just wish we could broaden the primary care physician's discretion on referring not only to psychotherapy."
Full recovery from even acute mental illness may be possible without a lifelong regimen of pharmaceutical treatments. Oaks was diagnosed with schizophrenia when he was in college and told he would have to be on medication for the rest of his life. During his senior year, he connected with the beginnings of the "Mad Pride" mental health movement and began pursuing other alternatives, including exercise and diet and finding out how to thrive in a group atmosphere. He began questioning the mental healthcare system and whether he really needed the medications they said he did.
"They were wrong," he said. "I've been off them since I graduated, and thank goodness!"
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Minor point from MindFreedom: "Neuroleptic" is the scientific name for the more-commonly named "antipsychotic" drugs.
For more info on MindFreedom Lane County activities, the City of Eugene resolution on choice in mental health, and the debate over Lane County guidelines for empowerment of mental health clients, see:
You may e-mail MindFreedom Lane County at lane (at) mindfreedom (dot org
This is a good time to submit a letter to the editor of Eugene Weekly,
Ted Taylor, thanking EW and writer Kate Loftesness for exploring this
topic. EW editor's e-mail address is email@example.com