Power in the mental health system

A very simple and accurate way to identify the basic beliefs someone has about mental health is to find out where they stand on the issue of power.  Who should decide what???

In some ways this is the basic question of medicine.  Should people simply comply or should they have a choice. Obviously the knowledge of your medical professional is important but does that convey the authority that medical professionals sometimes seem to expect almost as a right? 

 The popular mythology is that people with mental health issues have a far greater problem with compliance than those struggling with physical health issues.  That supposed difference is laid at the feet of some neurological deficit that makes them not see their need for help.  The facts though simply dont support that.  As I pointed out in an earlier post:  “In her book, “Join the Club”, Tina Rosenberg makes the following observations, ” Poor patient adherence is a serious problem; dozens of studies have shown this.  Only a fourth of  people on blood pressure drugs in one study took their medication properly.  Only 13 percent of  diabetes patients taking certain drugs complied with their regimens for a year….50% of patients with chronic illnesses dropped out of treatment within  year….poor adherence is responsible for an increase in bacteria resistant to antibiotics, millions of hospitalizations, hundreds of billions of dollars in wasted health care and immeasurable patient suffering.”  These same facts have been pointed out by many other people.  People with mental health issues may not be any better than other people, but they are not any worse.  Whether or not the issue is simply people dont like to be told what to do or the issue has more to do with doctors perceived lack of credibility or some combination of several factors it is a human issue and not simply a mental health issue.

The problem is a huge double standard.  People who will not listen to what their own doctors tell them to do and see nothing wrong in that will blame those with mental health issues as having poor or even nonexistent judgement because they question the safety of medication prescribed, or question the message given about themselves by mental health professionals or simply wonder how relevant to them guidelines given to them are by people who never listened to them or sought their input in the development of those guidelines.  Given the lack of evidence for so many commonly accepted mental health facts you might wonder how anyone could take anything on face value, but to the “I can be noncompliant but you cant” people any evidence of doubt is evidence of an underlying deficit or sickness.

You either believe people have the right to choose or they dont.  And if you believe they dont then it would seem to me to be consistent to apply the same standards to those struggling with physical illnesses.  That is an extremely dangerous road to travel though and fraught with tremendous potential for abuse. 

A coercive system of medicine simply doesnt work.  To try to do it in any kind of consistent way would be prohibitively expensive.  Should medical care really be a legal matter???  In the end who judges and who judges the judges??  There is ample research evidence that says people tend to follow through with things they are emotionally invested in and without that investment you best have a 24/7 stick and it best be a big stick.  If you define away the issue of doctor credibility and trust between them and their patients have you really solved anything. 

The mental health system can either empower or disempower the people it serves.  Unless it finds a way to consistently empower the people it serves all the “medical knowledge” or therapeutic skill in the world is going to come up short.  The choice is to find a way to convince people there is something in all this for them or to turn mental health into a system of mental health cops looking for any evidence that someone is refusing “what is good for them.”

It is hard for me to understand how you can treat someone as important if you dont treat what is important to them as important.  Few things strike me as more important than the ability to make decisions about my own life.  The worst thing I can do I believe is not to keep people from making mistakes.  It is to tell them that because of their diagnosis, their label, their social status that they dont have the capacity to make decisions that are an unquestioned right of other people.