As I pointed out at a recent mental health system meeting in my county, people with mental health problems face two kinds of risks.
The first sort of risk is from the mental health problem itself. Unless the person finds effective treatment, mental health problems can often cause high distress, disability, and even result in death, such as from suicide.
The second sort of risk, however, is the possibility that the person may receive an unnecessarily hazardous treatment. For example, some people recover from psychosis without antipsychotics, and some people aren’t helped by antipsychotics, and some are helped but not enough to justify the hazards, and some could be better helped by less hazardous methods if such methods were made available. So when antipsychotics are used routinely for everyone with psychosis, it follows that many people will be exposed to a treatment which will be unnecessarily hazardous to them. This treatment itself can often cause high distress, disability, and even result in death.
(Some argue that most psychiatric treatment offers more risk than help: for a good summary of those arguments, see Robert Whitaker’s new book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America If you click this link you can both find out more about the book as well as get many of the main points and the supporting data on the website.)
The mental health system is organized to prevent the first kind of risk, the risk from the mental problem itself. Billions are spent to address this risk.
Strangely enough though, the second kind of risk is usually not even discussed within a mental health system. At the meeting in which I was talking, we wanted a document on guidelines for treatment to mention this sort of risk, but our attempt to get it simply mentioned was labeled as “inflammatory” and was being denied. Why?
How did the system get so “unbalanced”, so as to spend billions to address one kind of risk, while forbidding even mention of a second kind of risk, which is also potentially deadly?
One reason is that the steps needed to address the first kind of risk involve looking at possible flaws in the methods and behaviors of mental health consumers, while the steps needed to address the second kind of risk involve looking at possible flaws in the methods and behaviors of mental health professionals.
Mental health professionals are experts at looking for flaws in “patients” but are extremely poor at critically examining themselves. This partly follows from the excessively polarized nature of the way mental health problems are defined: some people are labeled as “insane” or “ill” while others are defined as “sane” and as entirely benevolent helpers: any rejection of offered” treatments” is seen as a result of “lack of insight into the illness,” rather than being even possibly due to actual problems with the treatment being offered.
I work as a therapist, specializing in cognitive therapy for psychosis. I find it is usually easier to hold a collaborative conversation with my clients about possible problems with their world view and with the way they are approaching things and behaving, than it is to hold such a conversation with mental health professionals aligned with the dominant paradigm about possible problems in their worldview and the way they are dealing with mental health consumers. In other words, it seems that the consumers have more insight into their own imperfections than does the mental health system into its imperfections.
I find that the best sorts of mental health programs allow everyone and everyone’s assumptions to be questioned, including, or even especially including, the professionals. In this kind of climate, both risks from lack of treatment and risks of possibly unnecessarily hazardous treatment will naturally be discussed, along with possible alternative options, and “balance” can be achieved, while everyone is honored as a human being with something to say. Mental health programs that do this are less sure of themselves, but in their lack of certainty, are incredibly more competent in actually helping people.