Mental health, like so much else in our society, has become infected with prejudice, power and money. (Originally published at rabble.ca.)
The Senate report on mental health, “Out of the Shadows at Last”, bulges beyond 500 pages and packs in many recommendations for bulking up Canada’s beleaguered public mental health care system with “options” and “choices” for people struggling with psychological difficulties. Unfortunately, one crucial, politically-motivated omission turns the report into an insult to these very people, and a threat to the civil liberties of us all.
What the Senate got right
Since the advent of modern psychiatric medications and the closing of major mental institutions, there’s been a desperate, growing need for community-based supports. Drugs aren’t the magic cure-all it was once believed they would be.
What we’ve actually got, of course, are decades of social service cutbacks for everybody. Today, a prolonged battle with severe emotional problems is often an express ride to life on the street.
Most of the Senators’ recommendations focus on our communities, then. And there are some very good (if old) ideas, like increasing funding for peer networks, home support workers and affordable housing.
They also recommend a wide range of ways for getting mental health professionals more involved in our daily lives, to prevent us from landing in overcrowded hospitals: extra funding for mental health professionals to put specialized teams in our elementary schools, to make home visits to the elderly, to educate employers and workers, and to reach out to rural communities.
Predictably, then, the report has been almost universally applauded by organizations representing mental health professionals, or predominantly run by mental health professionals, such as the Canadian Psychiatric Association, the Canadian Psychological Association, the Schizophrenia Society and the Canadian Mental Health Association — for these folks, it’s a potential cash cow.
Nevertheless, it all sounds altruistic and helpful. Until you notice what’s not in the report.
What’s not there is any support for your right to say, “No, thanks.”
The Senators scarcely discuss, let alone make any constructive recommendations about, involuntary treatment — the practice of forcibly subjecting people to psychiatric treatments against their wills.
It’s a grave omission. Involuntary treatment laws are one of the foremost concerns of most mental patients, and potentially affect us all.
Most of us imagine such laws are used only in extreme cases, when a person is completely unhinged and physically dangerous. In fact, they’re used by psychiatrists in our hospitals daily, and can be used on virtually anyone.
Even if you walk in voluntarily, if you disagree with the presiding psychiatrist, a simple one-page form can instantly terminate your voluntary status. This is because, in most Canadian jurisdictions, even the relatively vague “danger to self or others” clauses have in recent years been deliberately reworked to provide substantially more discretion to psychiatrists. In Ontario and B.C., for example, you can now be treated against your will if you’re at risk of “mental or physical deterioration.”
What’s “deterioration,” and how do we distinguish it from, say, aging, or simply being overworked? The legal answer in a nutshell: Trust your doctor.
Essentially, these laws put psychiatrists, with their medical perspectives on emotional problems, in the supreme position of power in our mental health system. Even when not literally used, the laws implicitly give psychiatrists substantially more leverage and leeway than our police forces have.
And strong concerns about this were articulated to the Senate by independent observers like myself, numerous patients and ex-patients, and legal advocates.
Survivors of psychiatry speak out
Jennifer Chambers of the Empowerment Council provided submissions showing a “consistent abuse of rights of people in the mental health system.”
Our Voice editor Eugene LeBlanc testified that “a human rights violation… often consists in treatment itself.”
Ron Carten of the Vancouver-Richmond Mental Health Network, argued the “inordinate power” of psychiatrists requires “stricter oversight.”
The B.C. Ombudsman’s 1994 report, which I cited, found “systemic” abuse, and argued for a charter of patients’ rights.
Former government-appointed Mental Health Advocate Nancy Hall noted most provinces don’t even provide legal advocates for people being committed. “Not only are people badly treated, but due process is not often followed.”
Survivor-activist Francesca Allan provided changes to involuntary treatment laws she’d worked out with Victoria members of the B.C. Civil Liberties Association, and noted many lawyers argue our laws violate Charter rights.
(Indeed, both the Supreme Court of Canada in the famous Scott Starson case and the Alaska Supreme Court have recently struggled with these issues, and ultimately came down squarely on the side of protesting patients. Of course, it’s telling that these people had to go all the way to Supreme Courts just to maintain their right not to be forcibly treated.)
Such ardent concern may be difficult to understand, until one understands modern psychiatric treatments.
Treatments dangerous, sometimes deadly
Despite wishful hype about rectifying “brain chemical imbalances”, psychiatrists still today mainly diagnose people by judging behaviour. Most never give patients a physical check-up let alone a brain chemical analysis. And though pharmaceutical companies have given their drugs scientific-sounding names like “antipsychotics” and “mood stabilizers,” most psych meds are simply tranquillizers, sedatives or amphetamine-like stimulants — “chemical straightjackets”.
Even more concerning, electroshock and even lobotomies are making comebacks, while many newer drugs have clinical pharmacologies that state “mechanism of action… is unknown” and have increasingly dangerous side effects. Antipsychotics, for example, now kill more mental patients annually than were ever committing suicide, by causing cardiovascular disease and diabetes.
System in crisis
Now it’s obvious why there’s a crisis.
On one side, while some patients certainly feel they’ve benefited, for a growing percentage drugs and electroshock aren’t helping, don’t feel good, and create frightening and debilitating problems.
On the other side, evangelical psychiatrists whose only training is in such treatments, and even many family members who themselves feel better when their relatives are in hospital or on drugs, believe the solution is to force more people to take medications earlier in their lives and stay on them longer. Therefore, more jurisdictions are giving psychiatrists greater powers to reach beyond hospitals into our private lives through “Community Treatment Orders” and “Assertive Community Management”.
So why did the Senate report largely ignore all this?
Even more strangely, in the one section where involuntary treatment is actually briefly mentioned, the Senators admit testimonials made them have “reservations” about the practice except in “very rare circumstances” — and then they recommend expanding involuntary treatment laws even more.
Committee chair Senator Michael Kirby told rabble.ca that the topic of involuntary treatment was largely left out because it was “wildly controversial.” Nevertheless, Kirby conceded the differences of opinion weren’t so much between patients, but primarily between people on opposite ends of the treatment knife.
And this leads us to the real answer: Mental health, like so much else in our society, has become infected with prejudice, power and money.
The mental health industry
Once “certified crazy,” you instantly become part of one of the least-respected opinion groups in our society. And these people most often come from within vulnerable and oppressed groups. You’re more likely to be involuntarily treated if you’re Aboriginal, elderly or poor.
Meanwhile, under current laws, psychiatrists hold virtually all the power. Why would they want to give that up?
Most importantly though, mental health has become an industry — one of the biggest and most profitable industries on the planet. And just like in the energy or resource sectors, professionals move among positions in government, pharmaceutical corporations, professional associations, and Big Pharma-supported social service agencies, providing an effective wall of unanimity for gullible media and helping ensure their perspectives and goals always dominate the public agenda.
Consider the presenters to the Senate: Mental health professionals, organizations largely run by mental health professionals, and agencies partially funded by pharmaceutical companies vastly outnumber individuals and truly independent organizations speaking as, or for, patients and ex-patients. My rough estimates put the number of patient/consumer/survivor representatives, generously, at 10-30 per cent.
Imagine a national consultation process on women’s issues whose participants were only 20 Per cent women! Or one on improving the living conditions for people in wheelchairs 70 per cent dominated by people who’d never been in a wheelchair.
But what makes the mental health industry uniquely powerful is its ability to discredit as “mentally ill” and even incarcerate and tranquillize, its critics — while getting public commendations in the process.
So what meaning have “choices” for patients, as long as their treating psychiatrists hold the power? This draws a different picture of what the Senate report, if implemented, will deliver.
More outreach to the elderly? Our underfunded care homes are already transforming into zombie warehouses of the heavily overmedicated.
“Telepsychiatry?” We’ve already seen companies using such help-lines to seduce callers to all-expenses-paid spa-like retreats — which turned out to be sterile, barred, for-profit hospitals. When the Ontario government finally sued them in 1998, Tenet Healthcare had already repeatedly been found guilty of giving kickbacks to psychiatrists to arbitrarily declare people mentally ill and incarcerate them as long as government or private insurance kept paying.
Nevertheless, the Senate report declares, mental health professionals should “intervene immediately” when “symptoms of distress” appear in even a child, “regardless of age.” Naturally we want to help troubled children — but what will we really get?
Antidepressants for infants.
And even though medical studies show no support for early intervention by mental health professionals, “teenscreen” programs are already pushing into U.S. schools. Skyrocketing numbers of children are being labelled “mentally ill” and prescribed psychotropic drugs often untested in children. Some parents are being forced to sue the state to prevent their children from being needlessly stigmatized, while certain states regard parents’ refusals to drug their children as tantamount to “child abuse” and grounds for child apprehension.
The critics are crazy
Despite all this, ironically, even reputable groups like Human Rights Watch spend more time criticizing Chinese psychiatrists for declaring anti-communist protesters “mentally ill” than dealing with western psychiatric abuses. But is our system so different?
The people most likely to be involuntarily treated in Canada today are precisely the people most likely to be critics of the mental health care system.
On one level, that’s a tautology — who else would be forced to comply with treatment except someone protesting against it?
But on another level, it’s a painfully accurate diagnosis of the conundrum we’re facing as a society — and a savage indictment of our Senate for refusing to confront it.