Mental health system due for radical reform
Source: Register-Guard, Eugene, Oregon, USA
The mental health system is expected to care for people whose apparently mistaken beliefs, or "delusions," make them disabled or possibly dangerous. One might hope that mental health professionals would be the first to notice when their own beliefs become mistaken enough to be disabling or dangerous.
Unfortunately, nothing more illustrates the need for radical reform than the huge gap between the beliefs guiding much of current treatment and the actual evidence about mental health problems and outcomes. This gap is most extreme with regard to the most serious and costly problems, such as those labeled as schizophrenia.
The beliefs shaping most current schizophrenia treatment might be summarized as follows:
"These people have a brain disease. Their bizarre thoughts, emotions and experiences are not understandable, and are simply due to the disease, not to their life experience. Psychotherapy is ineffective with them. Their best hope is to adjust to their disability, relying on modern medications for the rest of their lives."
These beliefs themselves qualify as delusional when compared with research evidence.
True, people diagnosed with schizophrenia often show brain abnormalities - but then again they often do not, and people not mentally troubled frequently show the same abnormalities. Trauma, especially childhood trauma, has been demonstrated to make a later diagnosis of schizophrenia much more likely. Children who have been traumatized are also more likely to show the same brain abnormalities sometimes seen in people diagnosed with schizophrenia. Some forms of psychotherapy have been proven significantly effective and helpful.
In the long term, many people diagnosed with schizophrenia recover completely, eventually not needing any medication or other treatment. When people do recover, they credit a trusting relationship with someone who believed in them more frequently than they credit medical treatment. Such recoveries, according to two World Health Organization studies, are twice as likely in less developed countries, which mostly lack our modern medical approaches.
If recovery from a particular cancer were found to be twice as likely in less developed countries, we would fundamentally question our treatment methods. Yet critical self-examination has been rare in the mental health field. Since the second WHO study was released in 1992, it has been mostly business as usual, with the emphasis on biology and more medications.
So how do we make the transition from ineffective mental health care based on misinformation to an effective system that actually helps people recover?
In many fields, consumer demand leads to changes in services. But the mental health field has discounted consumer opinions, has defined "mentally ill" people as incapable of making useful choices, and has insisted that diagnosed people passively accept whatever treatment is offered. When people resist, treatment is often forced, commonly resulting in emotional trauma that in turn increases emotional problems.
More recently, however, mental health consumers and ex-consumer "survivors" are organizing to resist this paradigm, and are asking both for a voice and for choice in the treatment they receive. While some see this push as disruptive, it seems more likely that it is our best hope for a transition to a more effective (and ultimately less costly) mental health system.
Perhaps our most fundamental human quality is our ability to choose. Psychiatrist Victor Frankl wrote that his ability to choose his attitude toward unfolding events was the one thing the Nazis couldn't take away from him in a concentration camp. Yet mental health treatment is designed to change people's minds and attitudes, and if it is delivered without consent or choice of alternatives, people feel dehumanized.
On the other hand, when people are given treatment choices, and especially when some of those choices involve collaborative relationships with others who assist them in learning to sort things out and make better choices in the future, people feel respected and real recovery becomes possible.
Ron Unger, a member of the Eugene Human Rights Commission's Subcommittee on Mental Health and Human Rights, is a mental health counselor specializing in recovery-focused psychosocial methods. The commission is sponsoring a free conference, "Choice in Mental Health Care as a Human Right: a Vision of Recovery and Success," [all day] Oct. 20  in the Erb Memorial Union at the University of Oregon. For information and registration, contact Anne Johnstone-Diaz at firstname.lastname@example.org or (541) 682-6378.