The fundamental illusion of involuntary mental health treatment
Posted Mar 11 2013 11:06pm
As a systemic response involuntary mental health treatment is not a solution to the issues of mental health reform, but part of the problem. In fact, it helps to create and even exacerbate the very problems it claims to solve.
It fundamentally misunderstands the basic issue. The problem is not the lack of involvement in the mental health system by those needing help, but the lack of a mental health system to be involved in. There is, particularly with the massive budget cuts of recent years, for many people little services availible. And many of the services availible are often inadequate to meet the needs of someone with serious issues. Finally the experience of the mental health system for many is stigmatizing, dehumanizing, disappointing, and often simply confusing.
Even if you ignore all the ethical issues associated with involuntary treatment, if you ignore the trauma it is for many, even if you ignore the fact that there is little proof it works there is still one troubling point. It matters what you commit people to. To coerce someone into paltry, inadequate or even hurtful services and expect positive outcomes is naive at best and dishonest at worst.
Coercion is expensive. Putting people in psychiatric hospitals is extraodinarily expensive. In Tennessee the state hospital system serves 10% of those served in the community system for exactly the same money. The guidelines of the Treatment Advocacy Center would have Tennessee triple the amount of state hospital beds. It would bankrupt the community system. It would leave it less than skeletal. It would leave more and more people living in the cracks and in effect creating more people who “need the help of involuntary treatment.” It is a blind policy masquerading as sight. There is little evidence that psychiatric hospitals, particularly state hospitals, help in any lasting ways. You are left with a system that recycles people rather than helping them.
The poster child of the coercive movement is AOT (assisted outpatient treatment). It has the same problems as hospitalization. It matters what you commit people to. There is little evidence that apart from substantial investment in new services it has any impact.
In Tennessee there is a pilot program for Aot. With no provision of new services it will spend $125000 a year to “help” 10 people. The state behavioral health safety net provides basically the same services to over 20000 people who voluntarily seek help for around $700 per person. Does this seem as strange to you as me?
The drive to coercive treatment rests on advocacy by boogeyman. It relies on fear and the distortion that the “mentally ill” are basically violent and out of control and unable to see they need any help. It ignores the real issues in the mental health system. It advocates expensive options for few that in the end will bankrupt options for many. It stigmatizes “mental illness” even more than it is already is. It solves little. It is a pseudo solution for a pseudo problem.
And the very real catastrophe that mental health issues are in the lives of so many will sadly remain unaddressed.