Thinking about Mental Health Reform

Image: Project Management

A short meditation on mental health reform

 
These are some of my thoughts about the changes I think we need to make in mental health. This doesn’t aim to be a comprehensive or detailed list, but rather I am trying to think, from a philosophical perspective, what changes would naturally lead to all of the little (and big) things that stand in the way of recovery?

I welcome your comments!

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If we can remodel our mental health system into something which shifts from being medically driven to being community owned, we will have made a good start.


This business is all of our business. Medicine and science has some good stuff to contribute, to be sure. But they’re only one little piece of the puzzle, and resting the majority of our funding, policy and practice within medicine is a big part of why recovery rates have not changed for decades.

I understand the seduction of believing that one day we’ll find the right gene or the right medication that will fix everything. But this is too simplistic an idea – human suffering and strangeness will always be in our world, because, well, it’s a part of the human condition. Medicine alone will never be enough to substantially address the great question of human suffering, nor should it be.

Having medicine in the driver’s seat will always skew the direction too much into the biological paradigm, which narrows everyone else’s field of opportunity. Let’s be clear though – I’m not saying psychiatry shouldn’t have a role, just that psychiatry is only one role amongst many. Power needs to be shared.

 

When we can understand that coercion does harm and is the opposite of healing, we will have come even further.


I understand that madness is frightening to those on the outside. It’s frightening to us, as well. And as humans, I understand that our history is punctuated with taking things that frighten us, and putting them somewhere else so we feel safer. We label and attempt to control them. Or we shun them, avoid them, disown them. And then, sometimes, we learn that these things actually aren’t so frightening, that maybe we can even learn and become enriched by them. And we ask them over for a cuppa and start a dialogue. And then we end up with these brilliant multicultural communities where you can order macchiato at a Chinese restaurant.

Dragging us off to hospital, locking us in small rooms or restraining us, forcibly injecting and shocking us, telling us what we can and can’t do, well, it’s not nice. None of these things have helped me to improve my life, or overcome my madness or deal with my pain. They have made me rebellious and non-compliant at times, and a great big liar at other times, and mostly, they’ve made me feel alone, more frightened, and more pained. I am not trying to point fingers by saying this. I am asking that we stop hurting people who are already in pain.

Incidentally, it confuses me when we say that we follow evidence-based practice, yet we conveniently forget to talk about the lack of evidence for therapeutic benefit from such practices as seclusion and restraint. It is not OK to just gradually reduce their usage, the time has come to end violent practice.

Consider this: if seclusion had never been used before, if it was a new idea in mental health, do you think it would ever be approved by an ethics committee? What about restraints? Or even ECT, for that matter?

I think that coercion must make others feel better, safer, and I understand the drive. But we need to mature as a system and as a society, and recognise that traumatising people who are already traumatised, then pretending that it’s for their own good, does not and will not work. Mahatma Gandhi kind of covered this one:

There is no road to peace, peace is the road.

It’s the same thing, whether we’re talking about peace between nations, or peace within one person’s mind.

 

When we can start to recognise that madness has meaning and validity, and that people need a phenomenally broad variety of choices to make sense of their madness and get on with their lives, we will have come further again.


Trauma is real, life is actually difficult, but also, thankfully, we humans have the capacity to find meaning and purpose in these things. The search for meaning is ubiquitous for humanity, and I think it’s central to recovery from madness. Please, stop telling us we have meaningless symptoms that are the product of broken minds. Ask us how we got here, help us understand why things seem so strange, or why it hurts so much. Be open to diverse explanations.

This is a challenge for the current medically-based system, of course. Because I can see a psychiatrist under Medicare at least 52 times a year, and the government will happily pay for it all. But I can only see a psychologist ten times (even if that’s of more help to me, and it costs less than a psychiatrist). And if I need to see a grief counsellor, well I better get a job to pay for it. And if I want to see a peer worker, first I need to find a service that employs and supports them.

In examining meaning, we also need be honest about the cruelty that exists in our society. This is not about attacking families by the way, families are great things the vast majority of the time. But I have met many carers who become defensive when I talk about trauma. But I really am not attacking families; I know that the best parent in the world can’t always be there for their child. But bullying, childhood abuse, rape, violence – these things are real and widely prevalent. And they leave wounds: big messy wounds which are hard to heal.

So maybe even remind us that we’re not so weird after all, but the world definitely is.

 

And when we finally reach the place where we recognise that madness is, after all, just another spectrum of diversity in the human condition, rather than a disease state that we feel compelled to fix, we just might have come home.


You can’t fix us. And really, should you even be trying? Madness has brought the world some of its greatest talents and gifts. Like Socrates, Mozart, Churchill, Van Gogh, and so many more artists, musicians, philosophers, scientists, actors and leaders. Not to mention that most of the world’s prophets and religious figures would all be heavily medicated if they fronted up today.

Yes, we may make the world more uncomfortable, and yes we do need support (sometimes a lot of it), but we also have much to give. In calling madness a disease and trying to medicate our diversity away, we forget what the world would be like if we really did achieve that end, all the richness that we would lose. Let’s focus on accepting and healing distress and suffering, rather than trying to sanitise difference.


 

If we have hope for every person we work with, then we must also have hope for our mental health system. And if we believe that the vast majority of people do the best they can with what they have, then we must also believe that eventually people will listen to us, and really hear us.

I do believe we can transform mental health. We just have to keep talking about it.

 
 
 
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