Saturday, September 4, 2010

Challenging the Paradigm & Systems of Care for Mental Illness

A thought provoking article:

Help Us Help Our Children

Feminism has been failing the mothers of people with serious mental illnesses.

By Susan Inman, Sept. 3, 2010, TheTyee.ca

I have been doing a lot of public speaking lately about my experiences being the parent of someone who has a catastrophic mental illness. Mainly I speak to audiences that are full of other parents, mostly mothers, in similar circumstances. I always ask the parents in the audience to raise their hands if they've been blamed, at some point, by mental health professionals for their child's disorder. There are very few people who haven't gone through this ordeal.

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My comments:

As a social worker and a human rights advocate I have a mixture of academic, experiential and theoretical knowledge on the topic of mental illness, working with children, youth, adults and families with mental illness. Amongst other foundations to my practice, I count feminist and deconstructivist theories as important to my work with individuals and families.

Having worked with many, many people with various mental illnesses and spoken with, or worked with their families, psychiatric illness is not a socially constructed state of being. I would suggest any person reading this sit by while a trained MH professional completes a psychiatric/mental status assessment of an individual who is in a psychotic state. There are objective observations, behaviour and self-reported psychotic phenomenon that individuals often can articulate that are consistent across cultures, times and places. The impacts on global functioning are very apparent and lead to a general diminished quality of life.

I would encourage the author to get to the heart of some of the arguments of some of the anti-psychiatry feminists and others. Substantial evidence exists that women have been and continue to be diagnosed and pathologized in numbers far disproportionate to men, often by male psychiatrists. As mentioned, Freud's labelling of women as possessing "hysteria" likely caused significant harm (and covered up the likely sexual abuse of many girls in Victorian times) and this is a legacy women still live with (see Borderline Personality Disorder). Labelling does create stigma and there is substantive research in the area of disability and employment that demonstrates that people with mental disabilities are much more likely to suffer discrimination in the workforce and elsewhere.

I have spoken to women who, in the past, have been involuntarily committed by family members, often parents, because they were perceived to be defiant, non-conformist and not following rules. The movie "Girl, Interrupted" is a good example of that, as is the classic "One Flew Over the Cuckoo's Nest." Psychiatric systems give their medical personnel absolute control, power and authority to pathologize and objectify clients. Anyone who has ever worked in the hierarchical medical system can attest to the control exerted over the committed. We must acknowledge that such extreme power has in the past and in the present can lead to abuses of the rights of people with mental illness. And even if they are empowered enough to make waves, their complaints often fall on deaf ears and can lead to more system-serving pathologizing of the individual.

In saying this though, accurate diagnosis, multi-model treatment, including medication and effective holistic recovery and rehabilitation can save lives, I've seen it firsthand and been part of treatment of clients who quite likely would not be alive today if they didn't get the help they needed. There is a reason the suicide rate is higher for individuals with schizophrenia, other psychotic and other classes of disorders.

I agree with Ms. Inman that many individuals going into the field do not receive adequate education, training and professional development in dealing with mental health and psychiatric illness. As a social worker and student, it was only my own initiative in writing papers and researching MH topics that I increased my knowledge of these topics that are crucial in working in every capacity in the social work profession. It doesn't matter what area you practice in - child protection, geriatric, health, etc. the mental health and sometimes illness of your clients, or family members will, at some point, become relevant to your practice.

One of the most important and pressing issues that was not mentioned in this article is the profound failure of the federal and provincial governments to fund and create an accessible, integrated, and effective continuum and system for mental health care. Since 2008, the BC government has failed to follow up, or create a plan for mental health and addictions. Instead, they have sat by and allowed their Health Authorities to gut MH and addictions community and hospital services and programs around the province.This is will impact almost all of us given enough time.
People gnash their teeth and point fingers at the mentally ill when tragic crimes occur when those same people often could only access mental health services after they are charged for criminal offenses. Canada is going the way of the U.S. our jails are becoming the default psychiatric institutions for individuals who cannot access mental health care in the community and that is just plain wrong and it is heartbreaking for people with mental illness, their families and society.

For those who are interested in expanding their knowledge and expertise, I would highly recommend "Mental health social work practice in Canada" by Regeher and Glancy.

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