Second look: Another voice on mental health- The Treatment Advocacy Center
Posted Jul 29 2010 8:35pm
The Treatment Advocacy Center believes that consumers have too much voice now and that stricter measures need to be taken. They believe for example that we should make much more use of psychiatric hospitals. They think that there should be 50 beds for every 100,000 in population. For Tennessee if I have done the math right that would mean about 3000 beds. With the current budget crisis the state plans to have 692 beds and cut outpatient services while they are at it.
They do not believe people should have choices about treatment either. They believe in “assisted outpatient programs.” This means if you refuse to take meds or participate in treatment and it appears you will go further downhill without treatment, that you have trouble meeting basic needs, you are a danger to yourself, or a danger to others that you can be court ordered to take meds/treatment or be locked up until you do.
They believe that about 50% of people with serious mental illness have anosognosia which basically means they are not aware there is something wrong. They say this is biologically based and part of the mental disorder and because of it we can not be too concerned about what they want to choose in regard to their treatment options.
There are a bunch of problems with all of this:
The TAC keeps a catalogue of all the violent acts they can find committed by “emotionally disturbed ” people and tries to say that lack of treatment is the cause. This scare tactic conveys the idea that in some way the mentally ill are more dangerous and violent than “normal” people. This is simply not true and greatly reinforces a stereotype which reinforces the stigma about mental illness. Violence is not an emotional illness issue per se. It is a people issue. Meaness and cruelty are not psychiatric categories. If anything they are moral categories.
The whole idea about anosognosia has tremendous holes in it. First of all it assumes that not doing what your doctors say and not knowing you are sick is the same thing. If you are bipolar and you have went 10 years being diagnosed incorrectly you are likely to grow a healthy skepticism about what any doctor says. Maybe I don’t know the right people, but I have never met anyone with bipolar disorder that doesn’t know that something is very wrong. Might they have personal moments of blindness about their problems. Sure- but don’t all of us have that. We all have the ability to rationalize and close our eyes to the most stupid and self destructive things in the world. That is not confined to those with mental illness. They say that this anosognosia is because of problems with the right hemisphere. Where exactly is the evidence that bipolar disorder or any other disorder is a disease of the right hemisphere. I think in the end doctors believe that anyone who doesn’t do what they say must be mentally ill. It seems more a matter of the personal blindness of medical professionals than the blindness of mental health consumers.
Related to the above- The TAC prescription implies that treatment is a cut and dried, black and white affair. It isn’t. It varies widely from doctor to doctor. They can’t even agree what is bipolar and what is not. Medication is for sure not a cut and dried affair. When you are being given a medicine that may cause diabetes, heart problems, obesity and many other life altering events how can you criticize anyone who is reluctant to take those meds– even if they do help.
Their proposal would result in a radical increase in the number of people in psychiatric hospitals. This goes against everything that has been discovered about the dangers of institutionalization. There is very little evidence of the efficacy of hospitalization. It further perpetrates the myth that the mentally ill cannot function in the real world and by doing that drastically increases the stigma of mental illness. I think it is that stigma that makes people hesitant to seek treatment and thus the TAC would be making less likely the very thing they say they want.
Because this system would rely so much on compulsion and force it would create a system that would be very easy to get into and very hard to get out of. We already have a system like that. It is called the correctional system. Look how effective that is.
These suggestions are so far out of touch with the economic realities of the world as to be psychotic in themselves. They if anything are likely to have a rebound effect. The system they describe would be much larger than the present one. Because their solutions are simply not realistic I wonder how much it would make people think the problems are also not nearly as bad as made out to be. I think serious consideration of these proposals would take attention away from much more practical and realistic ideas and make it harder for anything to be done.
The mental health system is in crisis. In that the TAC is exactly right. It is true that sometimes people are dangerous and we all need protection from them. However their ideas go far past that. They make assumptions that are simply not true or based on dubious assumptions or studies. They go much further making mental illness as being even more a source of stigma than it is now. In that alone they pose a real danger to anyone who struggles with mental health issues.