When it comes to solving the problems in our mental health system, too many people are losing touch with reality. And I’m not referring to the patients.ConsiderÂ the recommendations from the recent coroner’s inquest into the police shooting of Saanich’s Majencio Camaso. The jury suggested police should obtain more training in handling unstable people, and mental health emergency response teams should become more omnipresent.
Sounds good. Except it’s assumed that, if only people undergoing psychological crises are safely picked up, there’s somewhere to take them where they’ll receive effective help.
What city are those jurors living in?
Yes, the Archie Courtnall Centre for mental health emergencies recently opened. Many people believe it addresses a critical local service gap-except many of the people most likely to be treated there. But ignoring consumer perspectives is common in our mental health system, and Camaso inquest jurors evidently didn’t incorporate their perspectives, either. Is this how we help them?
I asked consumer-run mental health groups and people who’ve been hospitalized during psychological crises what they thought of the inquest recommendations and new centre. Opinions were tepid. Educating police and reducing ER line-ups were considered tacitly good, but more representative was Francesca Allan’s deadpan remark: “The psychiatric establishment will continue to abuse the mentally ill; however, they’ll now be able to do it in an attractive new facility.”
It can be difficult to understand such condemnations if we’ve never been psychiatrically hospitalized. We tend to picture modern hospital psychiatrists conducting cerebral scans and neurological analyses, detecting biochemical imbalances and wayward genes, and delicately recalibrating brains with sophisticated medications. “Mental illnesses are treatable medical conditions,” we’re often told. Unfortunately, these beliefs are founded more on wishful fantasies and skillful pharmaceutical company PR than on reality.
As the U.S. Surgeon General’s Report on Mental Health states, “there is no definitive lesion, laboratory test or abnormality in brain tissue that can identify [mental] illness.” How do doctors actually determine if you’re ill? Essentially, any way they like. There are no established scientific standards for what qualifies as a mental health diagnostic examination. In real-world hospitals, doctors chat with you and observe behaviour. And what treatments are provided? Psychiatrists prefer terminology like “psychostimulants”, “antipsychotics” and “mood stabilizers”. In lay terms, the predominant medications are essentially the same as fifty years ago: amphetamines, tranquilizers and sedatives. Meanwhile, anti-depressants are stylish among the casually despondent, but the preferred treatment for severely depressed people is still electro-convulsive therapy, or electroshock.
It becomes easy to see how one person’s “helpful treatment” may become another’s “abuse”. Virtually all psychiatric drugs have damaging, sometimes debilitating side effects. Most are also addictive, producing bizarre, sometimes agonizing withdrawal symptoms that can last months, and making unexpected tragedies like Mr. Camaso’s, where someone goes off medications and during withdrawal becomes more unstable than ever before, all too predictable. Meanwhile, in certain U.S. jurisdictions, unlike BC, electroshock patients sign waivers acknowledging they may suffer permanent memory loss or brain damage. If this sounds barbaric, consider that several Canadian hospitals (including Vancouver General) are again performing lobotomies. And contrary to common belief, to be forced to submit to such treatments you needn’t necessarily be dangerous. In recognition of the inexact science of sanity, BC’s laws were broadened years ago to support doctors’ discretionary authority. Today, anyone pronounced capable of “mental or physical deterioration” may be certified.
Now it’s clear why mental health clients aren’t parading in appreciation for the inquest recommendations or new centre. Some respond positively and choose to continue with psychiatric treatments, but many don’t. And after you’ve once been submitted against your will to prolonged sedation or electrical shocks to your brain, the police, the mental health response teams, and indeed our hospitals seem threatening . So while sensitive professionals can help defuse volatile situations, too often they escalate them, because many patients dread their power.
“Being treated against my will was the most painful thing I’ve ever experienced,” Allan added. “When it was over, I felt only disgust and despair at the things done to me.”
Laws enforcing treatment would rarely be used if these feelings were uncommon. And how will someone with such memories react if confronted by armed police during a personal crisis?
Of course, many medical professionals, family members of the mentally ill, and certain non-consumer-run mental health organizations tell an opposing story. They contend the problem is too many people are receiving too little treatment, not too much. They’re lobbying for stronger mental health laws, more case managers delivering medications to homes, and “early intervention” strategies in schools.
To me, this is like noticing the brakes aren’t working, and concluding they should be pumped more vehemently.
Public mental health discussions need a strong dose of reality. A good start would be listening to the people we’re trying to help. It’s well-known that most want more options in hospitals-like conversational, nutritional, exercise-based and psychotherapeutic approaches to healing-and freedom to choose from them. They want hospital staff who aren’t hurried and overworked. They also want community supports and job training-not cutbacks wrapped in sedatives.
Changes needn’t be more costly. One eight-year study found it was a net savings for New York state to provide supportive housing, because the mentally ill were less likely to use ERs, jails and other resources.
Unfortunately, our current mental health practices reflect much more the wishes of those seeking quickfix behaviour controls than what’s best for patients themselves.
Originally published in Focus, May 2005.