Sunday, November 8, 2015

The 'Helping Families in Mental Health Crisis Act' Doesn't

[In progress, comments welcomed!]

Short summary:
Despite its attractive name, the Helping Families in Mental Health Crisis Act (H.R. 2646/ 'The Murphy Bill') would hurt families in mental health crisis rather than help them.  Just as conventional mental health has done for decades, the Murphy Bill pits family members and identified patients against each other as a time when we need each other the most.

Longer article:

With Congress in August recess and a new ‘Murphy Bill’ on the table,  the "Helping Families in Mental Health Crisis Act" (H.R. 2646) by Rep. Tim Murphy (R-PA) may seem like history. Actually, it is more like repeating history. For families in crisis, there little help or substantive reform to be found in either bill.  Just as conventional mental health has done for decades, the Murphy Bills continue to pit families members and identified patients against each other in their mutual time of greatest need..

When you think about it, family members and identified patients have a lot in common:

We are both trying to make sense of important life changes
We are both vulnerable to discrimination, marginalization, judgment and othering by the larger community based on stereotypes about ‘mental illness’.
We often come to the mental health system already smarting from and acutely aware of those hurts.
We are both facing life difficulties that have exceeded our existing capacities and natural supports.  (Otherwise, who would use mental health services?)
We both find ourselves at the mercy of conventional mental health system  -- the socially designated default for ‘when all else fails.’
We both come in worried about finger pointing.  Perhaps this is already going on.   Perhaps we are already a bit on the defensive.
While something clearly is not working, none of us wants to be seen as -- or blamed for being -- ‘the cause’ of ‘the problem.”

The fear of being blamed and labeled is perhaps the most damaging part of all. Historically, it’s been a competition between families and identified patients to prove where the ‘fault’ lies.  According to the family, Uncle Bob sees martians and can’t be left alone.  According to Uncle Bob, the family just wants his money - and won’t stop pestering him for a ride in the spaceship.

This kind of dynamic is no doubt distressing for all concerned. ,Moreover, it’s hardly unique to mental health.  In the 1930s, AA/ Al-Anon split the difference and simply called it ‘the family disease.’  Multiple therapy approaches since then have been developed to assess and treat dysfunctional families.’  Mothers, have taken a particularly hard hit for their thankless role as socially designated primary caregivers.

Personally, I’d lose the labels and the illness metaphors all together. In the first place, life is tough all around.  There are abundant avenues to distress and derailment in any given lifetime.

Secondly, this is so much bigger than any one person or family. The fact of our existence starts with a single fragile cell, ends in certain death, and in between consists largely of a survival dance involving a zillion factors beyond anyone’s control.  So assigning blame for mental diversity - or how anyone expresses it - makes about as much sense as blaming people for thunderstorms.

Thirdly, it’s patently unfair.  What families, as a whole, do better than any other social organization to date is to care and commit.  What happens to one of us matters to the others.  We tend to stick through thick and thin.  This means that our futures - and our future happiness - are connected.  The kind of relationships we have today factor heavily in the lives we predict for our years to come.

It's fair to say then that the effects of a 'mental health crisis' affect us all. There are relational shifts afoot that feel difficult and confusing.  There is the stress of adapting to change. There may be fear, loss or grieving as capacities or opportunities appear to change.  There is the ‘stigma by association’ almost certainly comes the family’s way, compliments of the larger community.

All of this is natural, rather than pathological.  It comes from our caring and the intertwined nature of our fates and lives. It is exactly because we have 'skin in' in such powerful ways, that we feel vulnerable and uneasy about how this will resolve. Here, the insight of AA/Al-Anon is no less true today than it was decades ago:  We feel 'powerless - that our lives have become unmanageable.'

It is at this point of collective desperation that the most families come into contact with conventional mental health services.  If the Murphy Bills have their way, this will happen more often and more intensively in future years -- not less.  What’s the harm in that?

Here is the issue. As noted above, families arrive at conventional mental health services in a vulnerable state.   They are beyond their known resources and desperate for solutions.  Everyone wants relief (whatever relief means to them) - and they want it yesterday.

Next thing you know a curtain is swept aside.  A man in a white cape strides in and announces a seemingly simple explanation and a seemingly simple solution.  The designated patient is very ill -- quite possibly too ill to recognize that s/he has a problem. The problem is the result of a ‘brain disease’ that causes a 'chemical imbalance.'  The disease/ imbalance can be fixed with a simple pill.  Compliance with this simple regimen is all that is needed. If the patient takes the pill, the problem will go away.  Everyone's life can go back to 'normal.'  (Okay, as 'normal' as it can be for a family that has been diagnosed with the social stigma equivalent of AIDs)
Not surprisingly, the approach is highly attractive.  People come in begging for answers and immediate results.  Someone in a white coat offers them.  What’s not to like?,

Sadly, it is becoming increasingly apparent that families need to take even the advice of professional helpers with a grain of salt.  According to Independent analysis, both the chemical explanation and pharmaceutical solution are demonstrably partisan.   They appear to be more reflective of industry financial and guild interests than objective medical science.

Indeed, critical examination of relevant research suggests that conventional mental health has vastly overrated the benefits and effectiveness of  pharmacological solutions.   Families are routinely told medications are 'essential' for treating their loved one.  Yet, independent analysis suggests that the medications are associated with higher rates of long-term disability, poorer overall functioning, loss of brain tissue, damage to the basal ganglia and increased susceptibility to relapse. Concerns like these led Jonathan Cole, the former head of the NIMH Psychopharmacology Service Center to ask “Is the Cure Worse than the Disease?”  He further urged that “every chronic schizophrenic outpatient maintained on an antipsychotic medication should have the benefit of an adequate trial without drugs.”

Equally disturbing is this:  In general, people with 'serious mental illness' are dying fifteen to twenty-five (15 - 25!) years before the rest of the population.  Medication compliance - and associated health risks like heart attacks, metabolic syndrome and tardive dyskinesia - appear to play a significant role.

In other words, when you look at the non-Pharma studies, by all appearances, taking medications as directed lowers our life expectancy and increases our disability rate.  This is tantamount to saying that non-compliance with current, conventional mental health treatment advice is an evidence-based practice.

Yet, families are routinely trained by mental health providers that medications are the 'only' treatment available. When loved ones question medications or request alternatives, professionals commonly tell concerned family that this is 'part of the illness.'  When loved ones complain that medications aren't working or are in fact making things worse, professionals routinely school family members to ignore these complaints and convince 'the patient' to follow professional advice. Anything else, family members are sternly admonished 'would be irresponsible.'

This is inexcusable.  We live in an age where many safe, effective psychosocial alternatives are emerging. At a minimum these promising practices produce far less harm and, from the reports of many, lend themselves to far better results. Such alternatives include: Consumer operated services like Intentional Peer Support, the Hearing Voices Network, Alternatives to Suicide, Wellness Recovery Action Planning, Emotional CPR, peer respites and drop-in centers,  Icarus project groups and online communities.  They also include many professional modalities, including: Open Dialogue, Need-Adapted Treatment Method, person-centered therapy and trauma-informed therapy. Information about these approaches can be found on line or through the numerous the peer-run wellness and recovery initiatives are now offered in practically every State.
 

There is good reason why psychosocial approaches are both safer and more effective than pharmaceutical approaches. According to the National Council for Behavioral Healthcare, ninety (90!) percent of those who end up in the public mental health system are survivors of trauma.  Trauma includes things like interpersonal violence, sexual abuse, harassment, discrimination, bullying, homelessness, poverty, crime, witnessing abuse, overwhelming life transitions, grief, loss, disaster, or significant relational conflict.

While the causes of trauma are diverse and varied, the effects of trauma commonly have distressing impacts for individuals and/ or those who love them. Yet, biological psychiatry, in partnership with the pharmaceutical industry continues to ignore these obvious, proven life affects.  They continue to insist, instead, on an out-dated 'chemical imbalance' theory that, despite countless industry-funded studies costing millions of dollars, has never been validated.

The travesty of this intentional (“almost willful”?) ignorance on the part of the highest status professional group in mental health is that they are irreparably damaging the very people who trust and need them the most. Their most loyal patients are in fact paying with their lives for the price of psychiatry's proprietary allegiances. (Not sure what “proprietary allegiances” means.) Moreover, the most devoted, caring family members are, far too often, put in the painful position of having to choose between stern professional admonitions that medications are 'absolutely necessary' and listening to their loved one's self-reports that the medications are damaging them and making it harder, not easier, to deal with their distress.

Sadly, even the most devoted family members are frequently cowed and intimidated by such 'expert opinion.'  At the same time, the relational stakes could not be higher.  The unfortunate, but very real, practical impact of giving into professional pressure is that you end up betraying someone you dearly love in their time of greatest need. Many relationships never recover.

Unlike other life traumas, this trauma is entirely avoidable, and it has to stop.  It is produced entirely by the psychiatric profession - with the assistance of pharmaceutical industry advertising and public relations money.  The profession needs to be held to its hippocratic oath.  It needs to embrace - for the first time in its history - not its status as 'scientific brain experts', but its actual mission of helping people.  Perhaps it could start by predictably delivering some semblance of the miracle cures -- including the smiling faces and attractive lifestyles -- that its industry advertising dollars promise in every American living room every night on TV.

No one can do this with the real human traumas involved in only 5-15 minutes a month.   - Or with the press of a button. -- Or with the pop of a pill.  It is insulting to human dignity, reason and conscience to even imagine this.

That our government officials have been lobbied, catered, and campaigned into supporting this farce that passes for medicine with our public health dollars (literally trillions of dollars) is madness.  This madness, like the trauma induced by psychiatry, is entirely preventable.  One only needs to look at the independent evidence on psycho-pharmaceuticals, and their vast counter-productiveness becomes obvious. Yet, U.S. taxpayers continue to pay billions of dollars every year for a primary treatment strategy that causes far more harm than it ever prevents, and is not even close to the most safe or effective public health response that we could be offering.

The sad fact, however, is that this is a madness that only We The People can stop.  The pharmaceutical lobby is the most effective lobby in the United States.  It is hardly surprising, therefore, that our politicians - like psychiatrists - have surrendered to its influence.

So it's up to us to stop the madness.  It will only keep getting worse until we stop it.

To do that, we need you.  We need your voice and your vote. Demand better for yourself.  Demand better your family.  Demand responses that offer humanity not technology when people come in hurting.  Demand providers who take time to get to know you and your loved ones and who ask about what is really going on for you.  Demand providers who have time -- and organizations that offer it -- when you most need it, for as long as you need it, and as much as you need of it to actually feel and get better.  Demand providers who really listen to you and your loved ones.  Demand providers who treat you all with the respect and dignity to which you are entitled as members of the human family.  Demand professionals who are capable of supporting you to communicate, to make sense of differing realities, to learn together, to work together, to move forward into something new, healing and far better than you ever imagined.

Those are mental health services worth paying for. And, it really is possible. In fact, that's exactly what Open Dialogue does in Finland.  As a result, they have eliminated schizophrenia in their region over the past 25 years.

So, if someone tells you it can't be done, demand your money back.

Better yet, take your life back.  Join the movement, find a peer.  We're here.  We can do it. Differently. Together.  Way better.


On Jul 31, 2015, at 1:02 AM, skknut@gmail.com wrote:

The "Helping Families in Mental Health Crisis Act'  Doesn't.  Please Oppose It.

Despite its attractive name, the Helping Families in Mental Health Crisis Act (H.R. 2646/ 'The Murphy Bill') will hurt families in crisis rather than help them.  Families are routinely trained by mental health providers to ignore the loved ones who need their support in favor of 'professional' advice.  This advice has repeatedly been shown to be partisan and consists primarily of coercing vulnerable individuals to take psychiatric medications in times of intense distress.  While cosmetically attractive in the short run, independent research demonstrates that these medications actually render up to 80 percent of those those who take them worse off rather than better over the long term.  They also reduce the average life expectancy of those who take them by fifteen to twenty-five (15 - 25!) years when taken as directed.  Thus, people who comply with their doctor's orders will die (on average!) fifteen (15!) to twenty-five (25!) years ahead of their time as a reward for their obedience.

This is inexcusable in an age where we know that many safe, effective psychosocial alternatives exist and produce far less harm and far better results. These alternatives include: Consumer operated services like Intentional Peer Support, the Hearing Voices Network, Alternatives to Suicide, Wellness Recovery Action Planning, Emotional CPR, peer respites and drop-in centers, Icarus project groups and online communities.  They also include many professional modalities, including: Open Dialogue, Need-Adapted Treatment Method, person-centered therapy and trauma-informed therapy. Information about these approaches can be found on line or through the numerous the peer-run wellness and recovery initiatives are now offered in practically every State.

There is good reason why psychosocial approaches are both safer and more effective than pharmaceutical approaches. According to the National Council for Behavioral Healthcare, ninety (90!) percent of those who end up in the public mental health system are survivors of trauma.  Trauma includes things like interpersonal violence, sexual abuse, harassment, discrimination, bullying, homelessness, poverty, crime, witnessing abuse, overwhelming life transitions, grief, loss, disaster, or significant relational conflict.

While the causes of trauma are diverse and varied, the effects of trauma commonly have distressing impacts for individuals and/ or those who love them. Yet, biological psychiatry, in partnership with the pharmaceutical industry continues to ignore these obvious, proven life affects.  They continue to insist, instead, on an out-dated 'chemical imbalance' theory that, despite countless industry-funded studies costing millions of dollars, has never been validated.

The travesty of this intentional ignorance on the part of the highest status professional group in mental health is that they are irreparably damaging the very people who trust and need them the most. Their most loyal patients are in fact paying with their lives for the price of psychiatry's proprietary allegiances. Moreover, the most devoted, caring family members are, far too often, put in the painful position of having to choose between stern professional admonitions that medications are 'absolutely necessary' and listening to their loved one's self-reports that the medications are damaging them and making it harder, not easier, to deal with their distress.

Sadly, even the most devoted family members are frequently cowed and intimidated by such 'expert opinion.'  At the same time, the relational stakes could not be higher.  The unfortunate, but very real, practical impact of giving into professional pressuring is that you end up betraying someone you dearly love in their time of greatest need. Many relationships never recover.

Unlike other life traumas, this trauma is entirely avoidable, and it has to stop.  It is produced entirely by the psychiatric profession - with the assistance of pharmaceutical industry advertising and public relations money.  The profession needs to be held to its hippocratic oath.  It needs to embrace - for the first time in its history - not it's status as 'scientific brain experts', but its actual mission of helping people.  Perhaps it could start by predictably delivering some semblance of the miracle cures -- including the smiling faces and attractive lifestyles -- that its industry advertising dollars promise in every American living room every night on TV.

No one can do this with the real human traumas involved in only 5-15 minutes a month.   - Or with the press of a button. -- Or with the pop of a pill.  It is insulting to human dignity, reason and conscience to even imagine this.

That our government officials have been lobbied, catered, and campaigned into supporting this farce that passes for medicine with our public health dollars (literally trillions of dollars) is madness.  This madness, like the trauma induced by psychiatry, is entirely preventable.  One only needs to look at the independent evidence on psycho-pharmaceuticals, and their vast counter-productiveness becomes obvious. Yet, U.S. taxpayers continue to pay billions of dollars every year for a primary treatment strategy that causes far more harm than it ever prevents, and is not even close to the most safe or effective public health response that we could be offering.

The sad fact, however, is that this is a madness that only We The People can stop.  The pharmaceutical lobby is the most effective lobby in the United States.  It is hardly surprising, therefore, that our politicians - like psychiatrists - have surrendered to its influence.

So it's up to us to stop the madness.  It will only keep getting worse until we stop it.

To do that, we need you.  We need your voice and your vote. Demand better for yourself.  Demand better your family.  Demand responses that offer humanity not technology when people come in hurting.  Demand providers who take time to get to know you and your loved ones and who ask about what is really going on for you.  Demand providers who have time -- and organizations that offer it -- when you most need it, for as long as you need it, and as much as you need of it to actually feel and get better.  Demand providers who really listen to you and your loved ones.  Demand providers who treat you all with the respect and dignity to which you are entitled as members of the human family.  Demand professionals who are capable of supporting you to communicate, to make sense of differing realities, to learn together, to work together, to move forward into something new, healing and far better than you ever imagined.

Those are mental health services worth paying for. And, it really is possible. In fact, that's exactly what Open Dialogue does in Finland.  As a result, they have eliminated schizophrenia in their region over the past 25 years.

So, if someone tells you it can't be done, demand your money back.

Better yet, take your life back.  Join the movement, find a peer.  We're here.  We can do it. Differently. Together.  Way better.

References:

1. Whitaker, R. & Cosgrove, L. (2015), Psychiatry Under the Influence: Institutional Corruption, Social Injury and Prescriptions for Reform New York: Palgrave Macmillan.

2. Ibid.

3. Ibid.; Whitaker, R. & Cosgrove, L., Psychiatry Under the Influence: Institutional Corruption, Social Injury and Prescriptions for Reform (Palgrave Macmillan 2015)

4. Whitaker, R. (2010). Anatomy of an epidemic: Magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America. New York: Crown Publishers, and studies cited therein including those contra-indicating routine, prophylatic use of:
5. A comprehensive review of the current science, suggests the following as best practices:
  1. avoiding exposure to psychoative medication when at all possible - including for first-episode 'psychosis' 
  2. before offering medications, allowing first for an initial trial period of non-medication alternatives 
  3. if after a period of sincere trial, no response is achieved from non-medication approaches:
    • a. if sleep is an issue: conservatively offering psychoactive sleep aids like benzodiazapines;
    • b. if sleep is not an issue (or does not resolve with less intrusive sleep aids), offering antipsychotics at low doses and carefully evaluating the response to assess whether - on whole - they are making things better or worse - not only from the provider's and family's point of view- but also from the point of view of the person of concern.

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