RE-ESTABLISHING JUSTICE AND
CREATING A FIRST RATE MENTAL HEALTH SYSTEM
A REPORT TO THE PEOPLE
SUMMARY
The tragedy in Carson City, not to mention
those in Tucson and other places around the nation and world, has served to highlight the many failings of the mental health
system. “Today’s mental health care system is a patchwork relic – the result of disjointed reforms and policies.
Instead of ready access to quality care, the system presents barriers that all too often add to the burden of mental illnesses
for individuals, their families, and our communities. “I Unfortunately, the political leadership has largely chosen
to ignore systemic problems, fighting nearly every effort to implement meaningful change resulting in increased opportunity
costs paid in loss of liberty, loss of potential earnings and decreased standard of life by those most affected; the consumers
and survivors of the mental health system as well as their families.
Much has been learned about the brain and recovery
from mental illness during the past twenty years, but little of it has so far found its way into our mental health system.
Largely, it is a bureaucratic failure. Despite this, there are bright spots in Nevada, such as the Mental Health and other
Specialty Courts, and the award received by Northern Nevada Adult Mental Health Services (NNAMHS), one of five in the nation,
for maintaining a near zero rate of physically restraining individualsii.
We are on the precipice of making recovery
from – and prevention of – mental illness a reality during the current generation, but we are also in danger of
psychiatry become a tool for mass drugging and incarceration of even larger segment of the population due to the expected
May 2013 release of the of the DIAGNOSTIC AND STATISTICAL MANUAL - Fifth Edition (DSM-V), the bible of psychiatry, which –
among other things -will make it a disease, punishable by drugging, to oppose any authority figure.
Many prefer
living on the streets rather than enduring abuse masquerading as treatment from care providers in the mental health system.
Some individuals endure these hardships, arising from the difficulties stronger and better prepared to meet challenges, but
most spend years on the streets, typically forced back into the mental health system, or prison typically in worse shape
than when they first abandoned the mental health system. The longer one goes without adequate mental health intervention;
the chances for optimal recovery diminish.
“Training in behavioral health now occurs in disciplinary or sector
silos. Furthermore, there is little collaboration among the disciplines on workforce development efforts, such as competency
development, despite the presence of many shared competencies across professions. Three other tensions impede cooperation
on a strengthened national workforce development agenda or dissemination of workforce innovations across sectors and disciplines:
the divide between the mental health and addiction portions of the field; the split between treatment and prevention that
exists within mental health and within addictions; and, in all sectors, the separation between the traditional treatment system
and the recovery community.”iii
“Mental health recovery is a journey of healing and transformation
enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving
to achieve
his or her full potential… Mental health recovery not only benefits individuals with mental health
disabilities by focusing on their abilities to live, work, learn, and fully participate in our society, but also enriches
the texture of American community life. America reaps the benefits of the contributions individuals with mental disabilities
can make, ultimately becoming a stronger and healthier Nation.”iv
The mental health system began as a way
to isolate individuals who were violent, non-rational, and unable to control their actions. This function still is a minor
portion of the mental health system, carried out by the forensic unit at Lakes Crossing in Sparks. However, the number of
people served by the mental health system has grown tremendously and primarily serves individuals who have little, if any
history of violence. Despite a number of good workers who do their best to aid individuals recover, the focus of the mental
health system has largely remained to isolate and drug individuals while instilling fear that if they go off medications they
will need to be removed entirely from the community.
“… it has become customary to treat psychiatric
symptoms pharmaceutically, without considering the cause. Additionally, once a patient has been labeled with a psychiatric
disorder, there is a tendency on the part of doctors and hospital staff to not look further. Lastly, a psychiatric patient
may be unable or unmotivated to voice physical complaints.” v
For years the Nevada mental health system,
like much of the nation, has labored under the belief that “Recovery happens outside the mental health system.”vi
More than anything else, this points to the need for systemic changes, including the setting of goals and objectives within
the mental health system. While many choose to avoid the mental health system, others are frightened into living a limited
life within a drug haze of prescribed medications; a small portion of these individuals, feeling trapped, display a slow burning
anger. Recovery, when it does occur is typically attributed solely to medications neglecting, and at times even deriding efforts
individuals make of their own volition.
While I am the first to admit that the fears and reactions of care recipients
in the mental health system are often overblown, until recovery becomes both the stated goal – and the reality of the
mental health system, systemic problems will remain. These problems permeate the mental health system, and while modest improvements
have been made, the leadership has been remiss in instituting needed changes. The current mission of The Division Mental Health
and Developmental Services (MHDS): to develop and operate programs that assist individuals who have mental illness or developmental
disabilities to live as independently as possiblevii is inadequate to the tasks it needs to perform.
Among the
needed changes are:
1: Implementing the 10 Fundamental Components of Recoveryviii - Making Recovery the Goal (The
10 Fundamental Components of Recovery: Self-Direction, Individualized and Person-Centered, Empowerment, Holistic, Non-Linear,
Strengths-Based, Peer Support, Respect, Responsibility, Hope).
2: Adopting The Koran Algorithm for screening
The marketing campaigns by the various drug companies have many believing that all mental illnesses are the result of abnormal
brain chemistry. However, many things can contribute to the development of psychiatric problems.
According to the medical
model there are four causes of brain dysfunction:ix
1. Anatomical abnormalities or damage
2. Lack of oxygen or glucose
3. Electrolyte imbalance
4. Neurotransmitter deregulation; the imbalance of brain chemistry.
While outside
the scope of this paper, research indicates other factors, including imbalances in the body’s electromagnetic fieldx,
also exist which can contribute to brain dysfunction.
Psychosis, characterized by hallucinations, delusions, and/or
a general loss of contact with reality, can be generated by many conditions that impact cerebral function. Brain injuries
or growths, neurological infections, drug reactions, and severe endocrine disorders are just some of the medical issues that
may be indicated.xi
“As a cost-effective measure to reduce these diagnostic errors, Koran and his associates
developed an algorithm—a step-by-step procedure—to efficiently narrow down the likelihood of medical disease in
psychiatric patients.”xii More than twenty years after its development, it is still little used- or known. “…the
lag between discovering effective forms of treatments and incorporating them into routine care is unnecessarily long, lasting
about 15 to 20 years”xiii. Apparently it is more convenient, or profitable, just to drug people without adequately screening
them.
3: Have Trauma Treatment and Relearning Stress Responses become Priorities, particularly in Child Services
“Trauma can occur from a variety of causes, including maltreatment, separation, abuse, criminal victimization,
physical and sexual abuse, natural and manmade disasters, war, and sickness. Although some individuals who experience trauma
move on with few symptoms, many, especially those who experience repeated or multiple traumas, suffer a variety of negative
physical and psychological effects. Trauma exposure has been linked to later substance abuse, mental illness, increased risk
of suicide, obesity, heart disease, and early death.” xiv
“One consequence of trauma is the compulsion which
can develop to repeat the circumstances of the original trauma. This can result in an individual placing him/ herself (or
others) in harm’s way due to an unconscious effort to achieve a better outcome of the traumatic circumstances.”xv
This compulsion to repeat the circumstances of the original trauma is a significant consideration for courts to consider
when individuals are charged with a crime. Legislators should take this into consideration as well when drafting or revising
legislation dealing with certain crimes, perhaps making elements of mental health and other specialty courts more common in
all courts, not to mention the need for prisons to focus on helping individuals regain competency.
At least 75%
of children in the juvenile justice system have experienced traumatic victimization. 50% of these may have symptoms of Post-Traumatic
Stress Disorder. 93% of children in detention report exposure to adverse events. These adverse and potentially traumatic events
include accidents and serious illnesses, physical abuse, sexual abuse, neglect, traumatic loss, domestic and community violence,
growing up in a household with an alcohol or drug abuser, an incarcerated household member, someone who is chronically depressed,
suicidal, institutionalized or mentally ill.xvi
Many, if not most individuals, with a mental health diagnosis have
also learned poor reactions to stress. Typically the inadequate reactions to stress begin when an individual is quite young
then become unconscious habits. The goal of the various cognitive / cognitive behavioral therapies is to help individuals
(whether or not they have a mental health diagnosis) relearn stress responses. There are videos which can help individuals
recognize problem behaviors they may exhibit; the first step in changing them.
4: Educating the workforce - Making
Information about Recovery and NON-DRUG therapies available
“A patient who is given one therapy as his only
option can lose all hope if it fails. Many psychiatric patients live lives of quiet desperation, suffering side effects from
meds they dislike but feeling they have no other choice.”xvii
“A client who is told there are other
possible modalities of treatment—such as CAM [Complementary and Alternative Medicine] therapies that can boost chances
of symptom reduction or recovery—is given hope. Even if a treatment fails, if other options are on the horizon, this
expectation can keep a patient working toward wellness and putting one foot in front of the other on the road that may lead
to partial or full recovery. It can even cause the patient to make improvements in his lifestyle as he strives to do his part
in the recovery effort. For many, hope is the most powerful medicine of all”.xviii
Despite the many obstacles,
recovery from mental illness and the many symptoms which are mistakenly attributed to mental illness is currently a fact for
thousands of individuals across America. Many more would recover with a knowledgeable workforce helping to create a No Wrong
Door mental health system.
5: Eliminating bureaucratic boundaries including:
A. Changing
the Mission Statement of MHDS to: To Optimize the Ability of Individuals to Lead a Full and Satisfying Life
B. Reforming HIPAA regulations
C. Blocking the implementation of the DSM-V while replacing it
with a standard more in line with the findings of the National Institute of Mental Health
Bureaucratic barriers
and boundaries stymie individuals seeking recovery every step of the way in the mental health system. The mission of MHDS
is: To develop and operate programs that assist individuals who have mental illness or developmental disabilities to live
as independently as possible. The mission should be: To Optimize the Ability of Individuals to Lead a Full and Satisfying
Life
Federally mandated barriers include Health Insurance Portability Accounting Act (HIPAA) and the DSM-IV. HIPAA is
considered by some primarily as a tool to keep disabled individuals from becoming fully integrated into the community and
as a way to cover up abusive treatment. Aside from those with disabilities, it also affects segments of the population from
seeing loved ones in hospitals and other care facilities as well as covering up deaths in jails and prisons. It is in need
of serious reform.
Despite the caution in the DSM-IV “It is important that the DSM-IV not be applied mechanically
by untrained individuals.”xix The fact of the matter is the DSM-IV is frequently used in a cookbook fashion, even by
trained individuals.
“Currently, the diagnosis of mental disorders is based on clinical observation—identifying
symptoms that tend to cluster together, determining when the symptoms appear, and determining whether the symptoms resolve,
recur, or become chronic. However, the way that mental disorders are defined in the present diagnostic system does not incorporate
current information from integrative neuroscience research, and thus is not optimal for making scientific gains through neuroscience
approaches. It is difficult to deconstruct clusters of complex behaviors and attempt to link these to underlying neurobiological
systems. Many mental disorders may be considered as falling along multiple dimensions (e.g., cognition, mood, social interactions),
with traits that exist on a continuum ranging from normal to extreme.”xx
The expected May 2013 release of the DSM-V
will make it a disease, punishable by drugging, to oppose any authority figure. This includes just speaking up, and is not
limited to use of violence or threats of violence. At first this will be limited to those 18 or younger, but once imposed
would likely follow an individual for life. Oppositional Defiant Disorder (O.D.D.) threatens to turn this nation into a de-facto
dictatorship. It perpetuates stigma, forcing individuals into boxes designed in 1952, doesn’t reflect current scientific
knowledge, and has been a major factor in the drugging of America. Its release should be prevented.
Conclusion
- Overcoming barriers to a First Rate Mental Health System
Many barriers exist to making prevention of, and recovery
from, mental illness a reality. These include the silos of expert information which prevent effective treatments from becoming
commonplace; advocacy groups which are perceived as little other than hate groups, the undue influence drug companies have
on governmental policies and goals, as well as the financial incentives offered to physicians to use certain drugs. The student
debt many physicians and other labor under may also be a factor delaying implementation of a first rate mental health system.
Education and awareness of these problems hopefully will be sufficient to overcome them.
A bottom to top overhaul
of the Mental Health system is needed. Those at the entry points to the mental health system; emergency rooms, jails, primary
care physicians, social serve agencies, police forces, as well as staff and first line personnel need to be made aware of
the range of possibilities which exist so individuals can recover and flourish. A No Wrong Door philosophy needs to replace
the maze of bureaucratic confusion which currently exists every step of the way.
Some Court Cases which Negatively Impact
the Justice System
The Supreme Courts has essentially imposed a feudal system upon the people. While this is most
evident within the mental health system, many in this nation are suffering negative effects, including loss of liberty which
violate the VI th and XII th Amendment, The court has insulated itself from the general public. Miranda v Arizona 384 U.S.
436, 1966; REHBERG v. PAULK No. 10–788. Argued November 1, 2011—Decided April 2, 2012, as well as Imbler v Pachtman,
424 U.S. 409, 1976; and even Bennett v. Nevada Employment Security Division, CV 10-02320, 2011 work to impose a feudal system
by not allowing claims by a citizen against a State. Contrast this to CHISHOLM v. STATE OF GA., 2 U.S. 419 (1793), which states:
Government itself would be useless, if a pleasure to obey or transgress with impunity should be substituted in the place of
a fanction to its laws.”
i Achieving the Promise: Transforming Mental health Care in America; Final
Report July 2003(pg.1)
ii SAMSHA NEWS May/ June 2010, Volume 18 Number 3 iii AN ACTION PLAN ON BEHAVIORAL HEALTH WORKFORCE
DEVELOPMENT (2007) pg. 12 iv NATIONAL CONSENSUS STATEMENT ON MENTAL HEALTH RECOVERY -http://store.samhsa.gov/shin/content//SMA05-4129/SMA05-4129.pdf
v Complementary and Alternative Medicine Treatments in Psychiatry 2012 Edition by Dan Stradford, Garry Vickar, Christine Berger,
& Hyla Cass (pg. 23)
vi Voiced numerous times by former Director Harold Cook; Ph.D.
vii http://mhds.state.nv.us/index.php?option=com_content&view=article&id=10&Itemid=19
(downloaded 3/18/2012)
viii NATIONAL CONSENSUS STATEMENT ON MENTAL HEALTH RECOVERY
ix Biology and Human Behavior
Professor Robert Sapolsky, Stanford University, The Teaching Company
x Vibrational Medicine for the 21st Century , Richard
Gerber, M.D., 2000
x IBID Vibrational Medicine for the 21st Century , Richard Gerber, M.D., 2000 (pgs. 292-306)
xi
Complementary and Alternative Medicine Treatments in Psychiatry 2012 Edition by Dan Stradford, Garry Vickar, Christine Berger,
Hyla Cass (pgs. 26-27 )
xii Complementary and Alternative Medicine Treatments in Psychiatry 2012 Edition (pg. 32)
xiii Achieving the Promise: Transforming Mental health Care in America, July 2003 (pg.2) Bales, E.A. & Boren, S.A. (2000),
Managing clinical knowledge for health care improvement. In Yearbook of Medical Informatics (pp. 65-70) Bethesda, MD: National
Library of Medicine
xiv Leading Change: A Plan for SAMHSA’s Roles and Actions 2011–2014 – pg. 8
xv Healing Trauma by Peter Levine Ph.D. (pgs. 20-25) ©2005
xvi Child Trauma and Juvenile Justice: Prevalence,
Impact and Treatment, Dr. Gene Griffin, Department of Psychiatry Northwestern University’s Feinberg School of Medicine
in Chicago
xvii Complementary and Alternative Medicine Treatments in Psychiatry (pg.20)
xviii IBID (pg.21)
xix
Diagnostic and Statistical Manual of Mental Disorders Fourth Edition DSM-IV , Introduction, pg. xxiii
xx National Institute
of Mental Health Strategic Plan 2008 (pg. 8)
