Mental Health Consumer Protection Legislation - [Your State Here](in progress, still very drafty, comments welcomed)

Preface
For this reason, those receiving (or at risk of receiving) mental health care deserve legal status under American law as a protected class. Any legislation seeking to curtail the rights of class members should be treated with strict scrutiny. In addition, protective legislation is needed in order curtail current abuses and prevent further harm.
Part 1: A Consumer Protection Bill Requiring Informed Consent and Truthful Advertising in the Prescription of Psychoactive Medications
Rationale
The most urgent current abuse in need of corrective legislation is happening with regard to the prescription of psychoactive medications as a treatment for what is currently being defined as ‘serious mental illness’ (hereafter ‘SMI’).  In Anatomy of an Epidemic, Pulitzer Prize finalist Robert Whitaker explored how the number of people disabled by SMI tripled over the past two decades. Whitaker’s work received wide acclaim for its investigative journalism, including the 2010 Book Award from the Investigative Reporters and Editors (INA).  The present reality, documented by Whitaker, includes the following:
Since the advent of psychoactive medications, disability rates for ‘SMI’ have more than tripled in the United States.
About 80 percent of people who are prescribed psychoactive medications for an ‘SMI’ do worse long-term rather than better.  
Psychoactive medications are highly toxic and result in permanent disability rates 90% or more when taken as directed.  
When taken as directed, psychoactive medications cause people to die (on average!) 25 years earlier than their non-complaint counterparts.  
Before the advent of these medication, as many as 2/3 of those diagnosed with ‘SMI’ would return to acceptable levels of social functioning.  
In Third World countries where people do not have access to these medications, as many as 2/3 of those diagnosed with ‘SMI’ also recover an acceptable level of functioning.  
The most successful program in the Western world for addressing schizophrenia uses psychoactive medications only about 20% of the time and then only as a last resort after non-medication interventions.  The program, Open Dialogue, holds mental health providers responsible to provide early, intensive and comprehensive support to families upon receiving notice that a family member is distressed.  Over 2-3 decades of consistent community-based practice, Open Dialogue has virtually eliminated schizophrenia in Finland. 
Numerous other effective, non-medical-model approaches for dealing with mental distress exist. Yet, due to funding, advertising and wide scale co-optation of the medical research establishment by the pharmaceutical industry, vulnerable citizens and their families are routinely being told by well-meaning healthcare providers that the only available treatment for their distressing mental status are highly toxic disabling psychoactive medications.  
This is a bald distortion of the evidence and requires immediate and aggressive consumer protection legislation to protect the public interests.  
Following is an analogy.   Imagine you purchase a lawn mower that the manufacturer knew, when used as directed, would:
Leave 80 percent of lawns looking worse than before they were mowed.
Over time, rendered unsalvageable over 90% of the yards it was used on.
Decrease the average person’s property value by  1/3.
Who would stand for this?  
As incomprehensible as it seems, this is the state of modern psychopharmacology documented by Whitaker in Anatomy of an Epidemic.  As a result of active collusion between the pharmaceutical industry, psychiatry and the medical research establishment, there is an astronomic market for a dangerous, ineffective, disabling product.  The public relations and marketing have been used so effectively to obscure the human carnage that someday we’ll look back fondly on the tobacco industry think it was selling life savers by comparison.  
As a result, protecting the public health and welfare now requires immediate, aggressive corrective action.  Such action is necessary in order to set the record straight and to prevent further, irreparable damage to innumerable  individuals and families who have already – or might still become - the unwitting victims of this deliberate, fraudulent marketing scam.  
Text of Legislation
Legislative Intent:
To protect public health and welfare from intentionally distorted information about the efficacy of  psychoactive medications in addressing mental states that distres self or others.
To protect public health and welfare from dangerous, disabling products that have been popularized as a ‘treatment’ for mental states that distress self or others.  
To correct the widespread public misconception that psychoactive medications are the only available treatment for mental or psychiatric challenges
To ensure that citizens who are considering taking psychoactive medications are adequately informed of the known and well-established risks
Required Protections:
Any practitioner who proposes to prescribe psychoactive medications to address a mental state that distresses self or others must:
provide the following warning / acknowledgement; and 
obtain, in writing, informed consent from the person (and their parent/ guardian, if applicable) before prescribing such medication: 
Required Warning
There is no proven genetic or biological cause of ‘mental illness.’
Psychiatric medications do not correct any known biochemical imbalances in the brain.  After several decades of research, scientist still to do not know how they actually work. 
Currently, there are very few current studies involving the efficacy of psychoactive medications that are not funded by Pharma and/ or conducted by Pharma-funded researchers. 
The Pharma studies that do exist show that, at best, some people benefit from psychoactive medications. However, this is often at the cost of life-limiting, disabling or life-threatening ‘side effects’. 
The non-Pharma studies that do exist suggest the following:
About 80% of people will be better off if they are never exposed to psychiatric medications;
People in Third world countries where medications are not widely available have a much higher long-term recovery rate from schizophrenia and bipolar disorder (33- 66% recovery) than people in first world countries where medications are routinely prescribed (only 8% recovery)
Recovery rates in the United States in the 1940s-1950s, before psychoactive medications were widely prescribed, were vastly higher for bipolar disorder and schizophrenia (33-66% recovery).  Today, with psychoactive medications are widely in use, recovery rates are only 8%.
People with serious mental health conditions who are medication compliant do worse and die sooner (25 years sooner!) that those who are non-compliant.
Many psychoactive medications have serious (sometimes irreversible) effects that may result in reduced physical, emotional or cognitive functioning, permanent disability and even death.   
Many psychoactive medications produce short-term, immediate relief from symptoms.  However, this should be weighed carefully because long-term prognosis often worsens as a result (including the likelihood of more frequent and more severe relapses).  
Those with the best recovery rates from serious mental illness are the people who are never exposed to psychiatric medications.
Significant evidence now suggests that Pharma and the American Psychiatric Association have been materially misrepresenting the effectiveness of psychiatric medications for their own financial/ professional gain at great cost to both individuals, families and the public at large.
Many people have successfully recovered from severe psychiatric conditions without the use of psychiatric medications.  
Many people believe that finding alternatives to the use of psychiatric medications either enhanced or enabled their recovery.  
Part 2. A Consumer Protection Bill Requiring Accurate Assessment and Diagnosis in Mental Health and Psychiatric Settings
Rationale:

The National Council for Behavioral Healthcare is a national trade organization which represents behavioral health organizations nationwide.  In 2011, the National Council ‘broke the silence’ on the impact of trauma in behavioral healthcare.  In a special publication devoted entirely to the issue of trauma, National Council leadership called for behavioral health providers in mental health, substance use, criminal justice and public housing settings to recognize and respond to role of trauma in behavioral health.   In this publication, the National Council recognized that more than 90 percent of clients the public mental health system are trauma survivors.  Notably, A. Kathryn Power, then-Director of the Center for Mental Health Services (a division of SAMHSA) wrote:  “Interpersonal violence … is widely accepted to be a near universal experience of individuals with mental and substance use disorders and those involved in the criminal justice system.”  Many also have suffered serious neglect and deprivation related to basic human needs like food, shelter and protection from the elements. 
The National Council also recognizes that trauma survivors have rights.  Significantly, these rights are based on our status as human beings and entitle us to effective, trauma-sensitive treatment and care. http://www.thenationalcouncil.org/wp-content/uploads/2012/11/Survivor-Bill-of-Rights.pdf.  Just as important, according to the National Council, universal trauma-informed care is a do-able, effective, cost-saving response to public behavioral healthcare needs. 
Accordingly:  Mental health providers can and should be required to uniformly screen for trauma and provide trauma –informed treatment.  There is no longer any excuse for providers – in Vermont or elsewhere – for offering citizens anything less than complete and competent trauma-informed responses to the behavioral health needs of its citizens.  The premiere organization representing behavioral health providers nationwide has spoken.  Trauma-informed care is the most effective standard of care for behavior health – both from a results and cost-containment standpoint.  There is no reason not to do it.  It is good for everyone.
Here is an analogy:
Imagine you went to your doctor with a common cold.  (Many people think that trauma is the ‘common cold’ of behavioral healthcare).  The reality is that most common colds get better with time even if untreated by conventional medicine.  Your symptoms including a cough, congestion and some wheezing,, which are also symptoms of lung cancer.  
The doctor you went to was a sincere, conscientious competent practitioner.  He read the medical journals and regularly attended meetings of his professional society.  
Unbeknownst to your doctor, however, his professional association had started making a lot of money by promoting cancer drugs and thus was no longer a trustworthy source of information. Consequently, by the time you presented with your symptoms,  everyone was convinced there was a ‘lung cancer epidemic.’  Moreover, aggressive, early high-dose cancer drug intervention had  become the standard of care.  The clear message from the professional licensing and medical research communities was that any medical provider who did otherwise was committing malpractice.  To the contrary, the paradigm shift had progressed so far that many professionals questioned whether the common cold had ‘really’ ever existed.  At the very least, nearly everyone was confident that the common cold was not the cause of the coughing, wheezing and congestion they were seeing today.    
As a result, your doctor never bothered to assess you for a common cold and proceeded to treat you as if you had cancer.  You got worse – because the drugs are highly toxic.  You eventually died (25 years before you would have!) from the effects of the drug.   At that point, people said how sad it was that there is a lung cancer epidemic and that you were its latest victim.  No one ever knew, because no one ever assessed you in the first place, that you had a common cold that probably would have gotten better with time if they had just left you alone.  All you really needed was a bit of support to rest and heal. 
Sound outrageous?  It is.  Yet, this kind of thing is happening in the mental health system every day.  The sad fact is that roughly 90% of those who present in clinical settings are trauma survivors.  Yet, they are being diagnosed and treated as if they have a serious mental illness of genetic or biological origin.  They are further being told that their only treatment option is to take highly toxic pharmaceuticals, which:
make 80% of those who take them worse instead of better; 
lead to permanent disability in over 90% of those diagnosed with SMI; and 
cause those who take them to die, on average, 25 years earlier that their untreated cohorts.   
The travesty this is wreaking on individuals, families and communities in Vermont is unforgivable. It is highly likely that, every day, thousands of Vermonters are being treated with highly toxic drugs for presumed illnesses that they do not have.  The damage being done is potentially huge and almost entirely preventable through proper assessment and treatment.  Accordingly, immediate, corrective action is now indicated in order to protect the public health and welfare from further damage, as well as to seek remedy the damage that has already been done to unknowing, unwitting citizens. 

Part A: Requirement of Truth in Advertising and Informed Consent Related to Mental Health Assessment and Diagnosis

Recipients of both voluntary and involuntary mental health services have long been the subject of discrimination and social maltreatment. The history of this in the United States is well documented and includes over 50 years of strategic eugenics on political and social levels. This historic context of discrimination has allowed egregious harms to be perpetuated against recipients of mental health services in the past. Such harms continue to this day, and urgently require effective, corrective legislative action to remediate. 

Required Protections:

Before assessing, diagnosing or treating any Vermont citizen for a mental state that distresses self or others, any behavioral healthcare practitioner in Vermont must:

• provide the following warning / acknowledgement; and 
• obtain, in writing, informed consent from the person (and their parent/ guardian, if applicable) before proceeding with such assessment, diagnosis or treatment:

Required Warning

1. There currently is no accurate means of diagnosing a mental health disorder or distinguishing one so-called ‘disorder’ from another. After decades of research, so-called experts still cannot agree. 
2. There is no known biological or genetic cause to ‘mental illness.’ To the contrary, recent advances in genetic mapping suggest that the neurological factors involved in ‘mental illness’ are even broader and more diverse than the factors involved in determining human intelligence. 
3. By far, the most common correlate of mental health system involvement is trauma. Approximately 90% of those in the public mental health system, substance use treatment or corrections settings - and more than of 90% of homeless individuals – are survivors of childhood trauma. Many others may be experiencing the after-effects of a material, emotional, physical, economic, relational or existential traumatic stressor that occurred later in life. 
4. Many of the symptoms of traumatic distress, including chronic adaptations to traumatic distress, are identical to those of serious mental conditions, including psychosis, dissociation, mood irregularities, motor/ speech/thought disturbances and suicidal/ homicidal ideation. 
5. If you have not been screened for the after-effects of distressing or traumatic life experiences, events or circumstances, your service provider must do that now. 
6. If you are suffering from the effects of traumatic distress (past or present): 
7. Your symptoms may greatly reduce when the source of your distress is addressed and/ or your sense of safety is restored. 
8. Your treatment provider should not diagnose you with a ‘mental illness’ or prescribe treatment for a ‘mental illness’ unless: 
• the source of your distress has been substantially addressed; and 
• your symptoms have not improved or remitted 
9. Psychoactive medications may provide temporary relief from symptoms while you are working to alleviate the source of your distress. However, you should weigh the risks carefully because the long-term costs may be significant and irreversible. 
10. Safe and effective alternatives to psychoactive medications exist. They include: 
• trauma-informed care, 
• Hearing Voices, 
• Open Dialogue, 
• person-centered therapy, 
• motivational interviewing, 
• family therapy, 
• cognitive behavioral therapy, 
• art or movement therapy, 
• narrative therapy, 
• Wellness Recovery Action Planning, 
• peer respite stays, 
• peer wellness centers 
• Intentional Peer Support

Part B. Requirement of Accurate, Unbiased Assessment for Pre-Existing Distress and Trauma

Required Protections:

Before assessing, diagnosing or treating any Vermont citizen for a ‘mental disorder’ as defined in the DSM/ ICD, all behavioral healthcare practitioners in Vermont must offer:

1. Proper Screening: Whenever any person presents or is presented for a mental health assessment, the following is required:

• ACES Screening upon admission 
• Comprehensive screening for current, ongoing, or previously unaddressed biopsychosocial stressors. 

2. Proper Treatment: Where ACES or biopsychosocial factors are identified:

• The admission reason for the current treatment episode shall be provisionally listed as such factor(s). 
• Such factor(s) shall be accepted for insurance purposes as the provisional diagnosis. 
• Unless and until the identified factor(s) are substantially resolved or addressed, the Initial treatment plan shall focus on: 
• Such factor(s), and 
• supporting the person to alleviate or cope with symptoms/ distress 
• The reasonable costs involved in alleviating the persons traumatic distress shall be considered legitimate medical expenses and reimbursed as such by insurance, without regard to whether such costs include ‘traditional medical services.’ 

3. Proper Diagnosis: No person shall be diagnosed with a ‘mental disorder’ within the meaning of the DSM or ICD unless and until:

• The assessments Part A.1. have been diligently conducted in good faith, properly documented in the record, reviewed with the service recipient and acknowledged in writing by both parties. 
• The service recipient has been offered a broad selection of trauma-informed interventions, including any intervention (whether medication or non-medication) that the recipient requests and could be made reasonably available with due diligence on the part of the provider or the Designated Agency in the locality where service recipient resides 
• All identified potential sources of traumatic distress have been substantially addressed; and 
• The person’s symptoms have failed to remit or materially improve. 

Part 3. Preventing Systemic Re-traumatization

Rationale:

Systemic re-traumatization is a common and serious problem in emergency rooms, healthcare settings, and when emergency responders are called in to assist in containing an emerging situation. The trauma cuts all ways and affects everyone on all levels. This includes emergency responders, service providers and service recipients. Sadly, much of this trauma is needless and avoidable.

Numerous alternatives to involuntary ‘treatment’, including medications, exist. Moreover, some psychiatric inpatient settings have reduced their use of involuntary interventions, including seclusion and restraint by over 99% after making a concerted effort at training, prevention, and non-violent implementation over a period of years.

Text of Legislation

Legislative intent:

• To protect citizens in healthcare situations from avoidable traumatization and/ or retraumatization associated with the mental healthcare intervention and treatment 
• To protect citizens in vulnerable mental states from being traumatized by the very intenventions that are intended for their benefit. 
• To make service recipients, the public, intervention teams, and health providers aware of the traumatic potential of the services that are being provided. 
• To reassure all citizens, regardless of status, that all possible steps are being taken to prevent systemic retraumatization in the name of care. 

Required Protections:

1. Staff training:

All staff whose job roles include interacting with service recipients must be trained in trauma-informed care and eCPR. Training must including annual refreshers for both modalities.

2. Person-centered Assistance:

All service recipients who are receiving involuntary care (or who could be reasonably foreseen to be at risk for receiving involuntary care) – where at the inpatient or outpatient level, must have:

A. 24 hour access to someone (whether staff or volunteer) who is:

• Trained in trauma informed care, Intentional Peer Support and communicating across alternate realities. 
• Trained in supporting and facilitating communication for both people in distress and for people who experience communication deficits. 
• Available within 15 minutes of a request to listen/ assist in person for at least 2 hours per day
• Available for the remaining 22 hours by phone, text, internet, or in person. 

Such services are deemed necessary upon request and are billable to insurance at reasonable healthcare rates.


B. Daily access to non-medication trauma-informed group learning experiences (whether offered by staff or volunteers), including a minimum of one of the following per day and four different modalities per week:

• Intentional Peer Support 
• Hearing Voices Network 
• Wellness Recovery Action Planning 
• Icarus Project Groups/ Activities 
• Harm Reduction for Coming off Psychiatric Mediations 
• NAMI Peer-to-Peer 
• Family Therapy 
• DBT 
• CBT 
• Art/ Creativity 
• Movement / Fitness 
• Stress-Reduction training (Yoga, Mindfulness, Meditation, etc) 

3. Mandatory review

Every instance of involuntary care or treatment will be considered as a system failure and a potential trauma risk for both staff and service recipients - whether involved as participants or vicariously affected as witnesses. In order to prevent further/ future personal distress or systemic re/traumatization, such persons must be offered access to:

• A safe, confidential, free avenue to process and make sense of their experience (within 1 hour). 
• Independent advocates (within 24 hours) to assist them to communicate their concerns and make recommendations for systemic changes, including the following: 

• coaching and in person communication assistance as requested to restore any relationships affected, whether in the healthcare setting or otherwise.
• an in-person incident debrief meeting with agency management within 1 week
• an in-person opportunity for facilitated resolution with others involved within 2 weeks

4. Penalties for non-compliance

Agencies are required to fully collaborate with these procedures and implement all reasonable remedial recommendations in good faith or face treble damages. 

Talking Differently About Suicide

Hi there!  Glad you found us!  Our group call format is in transition.  If you need peer support, want to offer it, or want to learn more about either or both, please contact us:

• peerlyhuman@gmail.com 
• call Sarah at 802-279-3876.

Our basic approach to people helping people ('peer support') is summarized below, as well as a flavor of what we've offered in the past:

 Talking About Suicide - Tuesdays 9-10 PM EST

The in place to be if you’re out of options or out of sorts. No pros, no cops, no 911. Just real people who have been there, are there, and get it. Call 331-205-7196 (no pin needed) or click: uberconference.com/peerlyhuman

Why We Are Talking Differently About Suicide

Modern society has created a world that many of us do not want to live in. Many of us are in pain and can't imagine this ever changing. We sincerely ask if life is worth the effort. 

No one should face these kinds of difficult decisions alone. These are difficult matters of conscience. We have not arrived at this place lightly. Almost invariably, there are overwhelming challenges, significant experiences of life to date and important competing values and needs. 

Nor should anyone facing such difficult matters of life and death be met with the modern crisis response.  We call crisis services sincerely needing help, wanting help, and, most importantly, hoping for something that feels like help.  Quite possibly, this is hardest choice we have ever tried to make. We want someone on our side, who believes in us and cares about us in ways that are clearly more than 'just a job.'

Ideally, we also want someone who can offer meaningful aid.  Someone who has access to resources that address the overwhelming real life needs we often have.  With regard to services that claim to offer 'professional help', we legitimately hope, long for, have a right to expect that there will be someone on the other end of the line who knows how to navigate the world that we - not just they - actually live in.  In a world that claims to offer meaningful reasons for staying alive, we legitimately hope, long for, have a right to expect that such people will know this well enough to meaningfully help us find our way through.

So, who ever thought, in a 'civilized' society, that 'help' would come to mean that armed militia show up at your door, drag you off in handcuffs, forcibly inject you with debilitating poisons, mistake your compliance for recovery, and then proceed to bill you for the insult. If you weren't 'really' suicidal before, you certainly have good reason to be now.

Suffice it to say the outcomes speak for themselves.  One of highest peaks for suicide is one week into hospitalization.  In other words, exactly when we discover the current system for the cold, hollow, empty shell that it is.  About that time, we put two and two together and our reasoning has never been more painfully rational or sane: 

I was already miserable and desperate before.  I knew I couldn't find the way on my own.  I did the right thing. I swallowed my pride and called for help. I put my known life at risk (home, job, family, community respect).  Against my better judgment, I did what I was told and turned my fate over to the 'true' experts.  Yet, I feel worse and more hopeless than ever before. If this is the best my community has to offer, then what hope is there...?

Nor is it any surprise that our other peak for suicide is one week after discharge.  At this point, the system has convinced us we are better off on our own. We may or may not still want to die.  But, we certainly know the answer is not to be found inside the institutional walls.  So, we paste a smile on our faces, start looking grateful, and do whatever it is we need to do to convince the powers in charge to release us.  

More often than not, we return to lives than have literally shattered in our absence.  Bills went unpaid, jobs were lost, partners left, kids were removed from the home.  Cherished pets starved to death.  Everyone around us treats us both as if nothing happened -- and as if we are irreparably broken. The ambulance bill arrives.  Then the hospital bill.  Then the bills from all the independent providers not covered by insurance.  

It's far worse than before.  Worse, in fact, than we imagined possible.  Yet, attempts at meaningful conversation are met with, Have you told that to your doctor?  The invariable response to legitimate feelings, Do you need to take your meds?  It's like conditioning the right to freedom of Jewish concentration camp survivors on the post-release assessment of their former Nazi guards. 

No pros, no cops, no 911.  

To counter this trauma, we abide by a simple rule:  No pros, no cops, no 911.  

Here, we meet each other as human beings.  We know what it's like to be there.  We know how overwhelming the challenges are, and how unbelievably painful and enduring the feelings have been. We know how slim the hope and possibilities seem.  We know how much we are asking each other to continue on in times like these.

That doesn't mean we disrespect human life.  To the contrary, we value it greatly.  We see it as far more valuable than just the rote matter of just going through the motions of staying alive.  We actually value the fundamental personhood of the human beings who are making that effort.

And we respect these human beings to choose wisely. 

Our method therefore is not coercion, but inspiration.  We think this is the far safer, wiser option under the circumstances.  The essence of our humanity is fallibility.  We all have incomplete vision and, as a result, imperfect judgment.  No one, therefore can know what another is experiencing.  No one, therefore can know what another should do.

Instead of trying to convince human beings who have given up to keep on trying, we invest our effort in a different direction.  We try to create the kind of community that offers hope.  We try to create relationships that are worthy of human effort and trust.  We try to open up a vision of a future that is worth someone staying alive for.  We try to clear the path to the resources needed to make what is possible actually attainable.  

When we fail to do that, we try to be honest with ourselves. We recognize that we have failed another. We were not able to create relationships meaningful enough - or a community life rich enough or accessible enough - to inspire our comrade to stay alive.

We also consider long and hard what message someone may have been trying to tell us.  We consider long and hard what - consistent with our own needs for self-preservation - we could have done differently.  We consider, long and hard how, not just the person, not just us, but also the society we live in might need to fundamentally change.  

Our Commitment to Each Other

Here is the basic commitment we make, one human being to another, to the best of our ability: 

1. Offer a human rights-informed, coercion free space
2. Share from the heart & make space for others to do the same
3. Hold each other’s truths with dignity, respect, interest and willingness to learn
4. Maintain a heavy dose of humility for the things we don't yet know or understand
5. Respect each person’s conscience and right to decide for themselves
6. Create a community, rather than a support group
7. Change the world in ways that make it livable for all human beings
8. Support each other’s human rights, including the right to be left alone

To Join Us - Tuesday Nights 9 -12 EST:

• Call 331-205-7196 No Pin Needed

          or

• Web in: https://www.uberconference.com/peerlyhuman

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About Us: 

This call is part of the Virtual Drop In/ Crisis Respite.  We are an all-volunteer, peer-run drop-in community. Our mission (in progress) is to create a 24/7 community-on-call that feels like human family and advances human rights.  We are entirely self-funded, with a total budget of $22/ month.  For a current schedule of calls, look here:  http://right2bu.blogspot.com/2015/11/virtual-drop-in-crisis-respite-weekly.html

The Virtual Drop In/ Crisis Respite is  a project of the Wellness & Recovery Human Rights Campaign.  Our campaign advances respectful, dignified, non-pathological approaches to human challenges that get labeled, sanctioned or treated in the world of 'behavioral health.'  The campaign is entirely volunteer and peer-run, with no added budget.  To read more about our approach and our vision of a better world, see:  http://right2bu.blogspot.com/  or contact us on facebook at https://www.facebook.com/groups/WellnessRecoveryRights. 

Disordered Thinking – STOP IT!

There’s a Bob Newhart clip.  The client worries about being buried alive.  The clinician’s solution: “STOP IT!” https://www.youtube.com/watch?v=Ow0lr63y4Mw

What if it were that simple? You only had to change your mind. Exercise your option to do something different.  This is the second of a series of articles that makes the case for a 100% voluntary approach to mental health. If you want to start at the beginning, you can do that here:  Rethinking Public Safety – The Case for 100% Voluntary, http://www.madinamerica.com/2016/02/rethinking-public-safety-the-case-for-100-voluntary/

In this second essay, we take a look at trauma, and propose an end to ‘disordered’ thinking.  By the end of this article, we will be asking everyone – clinicians, politicians, law enforcement, emergency responders, families, friends, the general public – even those of us with labels – to ‘STOP IT!’ 

1.    Human needs are not disorders

For years now, the behavioral health community has maintained a ‘disordered’ perspective.  The idea is that people have pre-existing genetic, biochemical, mental or behavioral abnormalities. Those affected are irrational and susceptible to acting without regard to personal welfare or that of others. Aggressive treatment is required to correct or mitigate deficiencies, including psychoactive drugging and psychotherapy.

In 2011, however, the National Council for Behavioral Health blew the lid off this theory. In a special publication - nearly 100 pages in all – they ‘broke the silence’ on the impact of trauma in behavioral health.  They called on behavioral health professionals nationwide to recognize and address the prevalence of trauma in mental health, substance use, criminal justice and shelter settings.  They called attention to the fact that ninety (90!) percent or more of service users across these domains are ‘trauma’ survivors. Notably, A. Kathryn Power, then-Director of the Center for Mental Health Services (a division of SAMHSA) wrote: “Interpersonal violence … is widely accepted to be a near universal experience of individuals with mental and substance use disorders and those involved in the criminal justice system.” Other kinds of ‘trauma’ including lack of access to basic human needs, widespread poverty and social marginalization were also noted.  

You can read the entire National Council publication here:  Breaking the Silence: Trauma-Informed Behavioral Healthcare (National Council Magazine: 2011:2), http://www.thenationalcouncil.org/wp-content/uploads/2012/11/NC-Mag-Trauma-Web-Email.pdf.  Another excellent resources is the 2014 TED Talk by Nadine Harris, MD: ‘How Childhood Trauma Affects Health Across a Lifetime,’ https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?language=en

2.    This is a social justice issue.

You may wonder why the word ‘trauma’ was put in quotes.  In recent times, the idea of trauma has been medicalized. It is now seen as a disorder -  something to be treated, even medicated away.  In actual fact, however, trauma is a social justice issue, not a medical one.  Vast numbers of behavioral health clients grow up without a way to meet basic human needs. Things like:

• reliable access to food and habitable shelter
• safety of person and property
• dignity, respect and fair treatment
• meaningful participation and voice
• the family means to make a living
• opportunities for development across major life domains
• human support to make sense of experience in their own way

These are people’s actual, life circumstances.  They would be matters of concern for anyone.  They represent core dimensions of existence.  Universal Declaration of Human Rights, http://www.un.org/en/documents/udhr/  Yet, many, many people feel insecure, ignored or even totally trampled on  - and with good reason - physically, emotionally, socially, economically, existentially.

Labeling trauma a ‘disorder’ in these circumstances is problematic to say the least.  Any conscious, reality-based human being should be distressed by these conditions.  The distress is a message.  It is like your hand burning on a hot stove.  The feeling of pain tells you to move your hand.  This prevents further damage.  If you just rationalize or drug that sensation away, there is no telling how bad you’ll end up.  

The painful thing is that we live in a society where many hands are currently burning.  The stove is on high, so to speak, on a massive scale.  The medical model solution is to blame and ‘treat’ (drugs, CBT, electroshock), the victims when they cry out too loud and make others uncomfortable.  We lock them up, silo them away – and not for their own sake I would argue.  Speaking for myself, there is nothing quite as devastating as realizing that you live in a world that – despite many good intentions – has somehow gone drastically off course.  Frankly, it can be a relief to know that crisis is someone else’s job and to not have to feel so unbearably helpless. 

3.    FFamilies are not the problem here

Families have been given a bad rap in popular psychology.  For many, families are our most valued allies and supports. Even where that is not the case, the social injustices of the modern world affect families just as much as anyone. 

The fact of the matter is that life is hard on its own.  There is trauma-a-plenty to go around.  Opportunities abound for poverty, discrimination, bullying, bad grades, bad judgment, job or home loss, failure, rejection, break ups, tragedy, bankruptcy, grief, regrets, humiliation, sickness, injury, accidents, threats, rape, harassment, stalking, deception, scandal, swindles, slander, targeting, insecurity, crime, worries, disaster – it’s an endless list.  

4.   A closer look at human needs and ‘trauma’

The implications of the trauma/ human needs perspective are pressing and are vast.   They provide a widely applicable, independent framework for understanding human behavior. No pathology, no chemical imbalances, no genetic markers are needed. 

Sound unbelievable?  It’s not.  All you need is an integrated understanding of the human stress response and then to connect the dots from there.

The two nervous systems

We have two basic nervous systems:

(1)    ‘All-is-well’ (parasympathetic) for everyday routines.  This is for stuff like eating, sleeping, relaxing, small talk, hobbies, tinkering around…

and

(2)    ‘High-stakes’ (sympathetic/ ‘survival response’/ fight-flight-freeze)  This is our ‘get your butt in gear’ system.  It’s our rapid response system for things that are a big deal – essentially threats or opportunities.  This includes all kinds of stuff - both ‘good’ and ‘bad’ – where the stakes are high: 

·         Discovering a new friend, new gossip, twenty dollars or your toddler in the road

·         Taking tests, exams, someone’s wallet or advantage of a child

·         Scoring a point, contract, victory or high

·         Getting laid, married, yelled at, ripped off, assaulted or stopped by police

·         Going on first dates, adventures, job interviews or a rampage with your partner

·         Getting through performance reviews, competitions, college, police interrogations or psychiatric exams

·         Resisting temptation, peer pressure, arrest or psychiatric drugs

The high stakes system is the key

If you want to make sense of so-called ‘psychopathology’, the high stakes system is the key.  If you know what to look for, you potentially can explain all the so-called major disorders - anxiety, depression, bipolar, OCD, borderline, substance use, anti-social, addictions, dependency, paraphilias, etc.  You just need to know the person’s story, their perceived needs, and their default responses when the ‘stakes are high’. 

How the high stakes system works

The high stakes system spurs the body to initiate dramatic physical and mental changes.

On a physical level:

• Blood and resources go to the muscles (tense, achy, shaky, trembling, agitated), heart (pounding), and lungs (heavy breathing, hyperventilating, out of breath).
• Energy production (digestion, swallowing, bladder, bowel) are triaged or shut down.  This leads to things like nausea, vomiting, lump in throat, urge to urinate, incontinence, cramping, diarrhea, light-headedness.

On a mental level:

• Focus narrows to the source of concern (tunnel vision, hyperfocus, losing the forest for the trees)
• Rapid response feels urgent (hair trigger, impulsive, reactive)
• High-level thinking is largely triaged out (stammering, stuttering, losing words, mind going blank). 
• Gone are the capacities needed to think ahead, remember consequences, learn new information, weigh costs and benefits, assess impact on others, defer gratification and solve complex issues.

How high-stakes and all-is-well interact

Here is how these two systems interact:

Phase 1: Initial activation (High-stakes revs up)

1. We see (perceive, experience) a threat or opportunity

2. The high-stakes response kicks in
3. Resources shift automatically from brain (rational thought) to brawn (taking action)
4. Strong effects (fight, flight, freeze) occur.

It’s important to note that fight, flight and freeze are more like tendencies than fixed forms of expression. The effects are unique to individuals.  They represent an amalgam of personal strengths, past experiences and familiar ‘tried and true’ behaviors.  Thus, different people ‘fight, flight. freeze’ on different levels and in very different ways.

Here are some things I have done:

·      

• Physical (strike out, yell, swear, damage property, run, drink or take drugs, go limp, hide in bed)
• Emotional (rage, seethe, envy, hate, worry, dread, cower, cry, space out)
• Social (complain, humiliate, beg, apologize, withdraw),
• Intellectual (argue, distract, forget, go blank)
• Spiritually (pray, leave body, become a deity, feel empty or dead,).      

   

Phase 2: Prolonged activation (If high-stakes stays turned on)

Sometimes the high stakes circumstances go on and on…. When things stay unresolved, the high-stakes system keeps at it, with the following effects:

·         

•  Resources keep going to brawn not brain
•  Mental capabilities progressively break down
•  Bodies break down too

If concerns stay unresolved for weeks, months or even years, this can take a heavy toll.  Our brains and bodies need sleep and resources to repair, restore and learn.  If they don’t get that, we might end up:

·      

•         Physically sick, injured, exhausted, attacking
•          Emotionally despondent, erratic, raging, burned out
•       Socially withdrawing, ranting, verbally attacking, totally depending on others
•       Intellectually zoning out, disorganized, losing time or memories, missing the forest for the trees
•       Spiritually visiting other realms, hearing or seeing things, feeling worthless or empty, wanting to die. 

The possibilities are endless.  That’s just some of what has happened for me.

Phase 3: Resolution (Return to ‘all-is-well’ baseline)

To stop decline, we need to feel some resolution. We need to be able to trust that things will be ok.  Otherwise, the high-stakes system will keep doing its job – which is to stay on alert and protect us from potential danger.    

The moment things start to feel resolved, however, something magical happens.  The effect is dramatic:

•       The high-stakes response turns off
•       The all-is-well system takes over automatically
•       We are able to rest, relax, digest food, sleep
•       Our bodies replenish, our brains repair and heal
•       Extremes and intensity tend to quiet down

5.    Threatening people is dangerous

The high-stakes system it is binary and reactive.  You are either friend or foe, for me or against me.  This is not a disorder, it’s basic survival.

Imagine you are in the wild.  You catch a glimpse of something out of the corner of your eye.  Is it a bear or just a tree?  Is there a stick or a rattlesnake in the path?  The high-stakes system does not take chances.  It reacts and asks questions later. 

Whether you are police, clinician, psych tech, family member, friend or the person of concern, this is the frame of mind that leads to everyone’s worst nightmare.  But, once you understand how high-stakes works, it’s pretty clear what to do.

In high-stakes times, people trust their guts (that’s where the resources are).  Talk is cheap, roles are cheap.  It’s all in how you come across.  If the right feeling happens (respect, dignity, shared humanity, genuine caring about my concerns), then the stakes go down and all-is-well kicks in. Blood returns to the brain, along with the ability to think, communicate and heal.  We all go home tonight.

It’s also relatively easy to see the problem with coercive, confrontational approaches. A show of force tends to destroy the very rapport that could be life-saving. To be sure, risk is ever present.  But, in a very real way, the odds shift with how you play your hand. (For a sterling example of this, listen to the 911 recording involving Michael Hill, a would-be school shooter and school office worker, Antoinette Tuff, https://www.youtube.com/watch?v=1kVpipSXRKA.)

It’s also easy to see why reasoning and logic don’t usually work.  This is not a reasoning frame of mind.  Literally, the brain capacity is not there.  That doesn’t mean rational capacity is gone forever.  It just means the stakes are too high for now. 

This is good news.  It is often a solvable problem. It means that we both can get to a reasoning place if one of us can make the stakes go down. 

How to do this is the million-dollar question.  But, at core, it’s really simple.  There’s a golden rule that cuts all ways:

                            If you want to make things safer,                        start looking safer to those you want to reach. 

When you scare someone, the high-stakes nervous system literally starts pumping the blood away from their brain. The more you threaten them, the less their brain has to work with.  Thus, the less rational they physically are able to become. This is dangerous for everyone!

6.    A better nosology for behavioral health…?

So where does all this leave us?

The DSM (psychiatric) model of ‘mental disorders’

On the one hand, the DSM (Diagnostic and Statistical Manual published by American Psychiatric Association) is quite frank.  It has no opinion about the root causes of ‘disorders’; it is simply a system of classification and labels. In no small part, the DSM is also the product of insider turf wars, political compromise, industry needs and billing concerns.  Caplan, PJ (1995) They Say You're Crazy: How The World's Most Powerful Psychiatrists Decide Who's Normal  (Perseus Books: www.aw.com/gb)

One noteworthy consideration for our purposes is that insurance companies pay for ‘mental disorders’ – but not to help normal people who are struggling with a difficult life.  The result is a ‘don’t ask, don’t tell’ (garbage in – garbage out) approach to assessment. Rote symptom checklists determine whether your anxiety, mood, grief, trauma, substance use, sexuality is ‘normal’ or ‘disordered.’  Real life facts, like a growing up in shelter housing getting routinely abused in the group showers, are frequently ignored as irrelevant, or not even asked about. It’s like your teacher pronouncing you ‘learning disordered’ without ever considering whether you study. 

Beyond that, even the categories themselves are questionable. Experienced clinicians disagree frequently.  Individual suicide and violence aren’t predicted much better than flipping a coin.  In 2012, concerns like these led whistleblower Paula Caplan, Ph.D., to report to the Washington Post:  "Psychiatry’s bible, the DSM, is doing more harm than good." https://www.washingtonpost.com/opinions/psychiatrys-bible-the-dsm-is-doing-more-harm-than-good/2012/04/27/gIQAqy0WlT_story.html  A year later, the National Institute of Mental Health literally threw out the DSM and decided to start over.  Insel, T (Apr. 29, 2013) Transforming Diagnosis, Director’s Blog (CMS), http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml

The Medical Model of ‘mental illness’

The medical model hasn’t fared much better.  Despite billions of research dollars, there is no demonstrable ‘chemical imbalance’ and no compelling genetic or biological markers.  During the past several decades of increasing ‘drug therapy’, disability rates have sky-rocketed.  Long-term outcomes and relapse rates have worsened overall. There are countless reports of drugs increasing or even creating urges to violence or suicide.  Due at least in part to treatment effects, the ‘mentally ill’ lose 15-25 years (on average!) off the normal life span.  Whitaker, RH (2010).  Anatomy of an Epidemic.  New York: Random House

The social justice model of trauma and human needs

On the other hand, when you look at trauma and its effects, a different picture arises.  Much of what has been baffling about human behavior and symptoms becomes understandable:

• Resources are seemingly scarce
• People have basic needs
• They see a threat or opportunity
• The high stakes system kicks in
• Predictable physical, mental and social effects occur.

Equally important, this is not a disorder.  High-stakes reactivity is supposed to happen in high-stakes situations.  The problem is not that people are maladaptive.  The problem is that some 90% of behavioral health service users are going without basic life necessities – things that everyone needs to live and be well. 

The impact of diversity

When you put the above factors together in varying combinations, you can pretty much cover the DSM. If you factor in the survival function of high-stakes responses, it gets even more convincing.

The wide variability of high stakes responses is not an accident.  To the contrary, our natural human diversity in times of need is a tremendous asset to our species.  When an entire community is facing a threat, this ensures that people will respond in numerous rich and creative ways. 

This promotes community resilience and survival overall.  If we all responded the same way to danger or opportunity, a single threat (predator, disease, disaster) could wipe us out.  We actually need the creative solutions that people come up with under duress to ensure our collective survival.       

On the other hand, when the stakes are more individual, the virtue of diversity can get obscured.  Only one of us – not the whole group - appears to be affected.  So, the way a person responds can look pretty strange to everyone around them.   

This explains why so-called 'mental illness' is so hard to diagnose and categorize.  We're not seeing an actual 'thing' in and of itself (e.g., depression, bipolar, panic disorder).  We're seeing the response to an actual thing – for example, feeling sick to your stomach before an important test at school. 

 At this point, you can also see the futility of trying to classify so-called ‘mental disorders.’ Just look at a group of kids before a high school math test.  They are all facing the same core stressor, but there are almost as many responses as students.  (This same scenario highlights the problem with adrugs-first approach.  Very few students will do better on the test, if say, the moment someone sees you puking, the school injects you with Zyprexa.)

So let’s take this one step further.  Imagine you are having the worst day of your life.  You have been waiting for hours, naked, hungry, cold and alone, in a barely furnished room. You have never met the doctor who shows up and claims to be here to help you. After five minutes, the doctor cuts you off, then proceeds to tell you what your problem is and what you need to do about it.  A prescription is written, given to a nurse.  Your entire fate from that point on depends on what you do next.   

There is hardly a better way to exacerbate, instead of lessen, high-stakes responses.  This is true even if you come into the system as a lucky one-in-ten with no prior trauma.  On its face, such arbitrary exercise of authority is traumatizing in and of itself.  It is unilateral, frightening, insensitive, confusing and grossly uninformed.  There is no meaningful discussion, no apparent recourse, no one on your side.  Experientially, it’s much more like being a prisoner of war than a recipient of actual care. 

This kind of ‘treatment’ causes the very ‘illnesses’ that experts claim to see.  High-stakes responses are unique and extreme by design. They make look strange to onlookers, but this is a good thing overall.  Predators/ competitors are unable to anticipate or plan for what we’ll do – which promotes both individual and species survival.

On the other hand, it’s not hard to connect the dots with common ER ‘outcomes.’  People are seen at their worst, treated badly, diagnosed based on their worst possible performance and then detained and drugged accordingly.  Needless to say, this is not a particularly fair or ‘professional’ way to assess someone’s capacity to survive safely in freedom. 

The moral of the story:

            If you want to be as safe, rational and helpful               as possible, but you’re still hanging on to disordered thinking…

STOP IT!