The demonstrated need for more coercion 

Some people see in everything a demonstrated need for more coercion in the mental health system.   They talk about 325,000 people with serious mental illness in our jails and prisons and say we could have avoided that.   They ignore the fact that many of the people they talk about are disproportionately black, disproportionately poor and say that if they just got the mental health treatment they need everything would be okay.  It won’t.  

 I  don’t know anyone who actually works in the mental health system who believes it is a magic elixir.  And I don’t know anyone who believes that the larger ills of this society are a reflection of a defiency in psychiatric hospitalization or AOT or some other “service for the seriously mentally ill.” 

When Rep. Murphy first starting touting his bill it would cure everything.   He talked about the mentally ill in the jails and the homeless and said his bill was just  what they need.   He told us after the tragedy of each mass shooting that the blame was on Congress for not passing his bill and on those who would argue against him. 

He would trot out huge numbers of people he was going to help,  that had serious mental illness,  that had basically been left in the cracks, but much he said just left me confused.   He would talk about how the mental health system sucked and then sing the glories of AOT which was committing people to the services he said sucked. I  never understood that.   He would talk about the need for evidence based practices and then extol psychiatric hospitalization which to my knowledge no one has ever accused of being an evidence based practice.   I didn’t understand that.  He talked about the need to provide services for people that had no access to them then voted countless times to repeal the legislation that would give them access to that care.   I didn’t understand that.   He talked about the mess the federal government had made of mental health and how states needed to have control over what happened in those states and then tried to institute a national law that said states could only get federal money if they agreed with what he thought was important.   I didn’t understand that.   He said,  in effect,  that we lacked the effort to do better and that more money needed to be put into services for the seriously mentally ill (psychiatric hospitals?).   He left those people at the state level who struggle each year with trying to avoid cuts to their budgets hanging in the air trying to figure how they would pay for his  moral imperative.  I don’t understand that.   If we plunder the community budgets to build more hospitals then what happens to the services he is so eager to AOT people to?  I don’t understand that. 

On more than one occasion I have wondered if his biggest problem is not with the services we fund but with the amount of people we allow access to them.   He chatters endlessly about the “worried well” and about the danger they pose.   He seems to see them as the biggest impediment to building his beloved psychiatric hospitals.   I wonder,  really wonder if he really thinks the answer to the whole mess is not to deny services to those he thinks undeserving of help and I wonder how he even begins to think such a thing is right,  legal or even vaguely possible. 

He talks about big problems but his solutions are not big solutions.   I think New York may have the biggest and most well financed AOT program in the country.  The last time I did the math they served 1/3 of 1% of the people served in the New York mental health system.   In the state it is the biggest deal it is not a big deal.   Psychiatric hospitals are in most places I know what they are going to be.   I  think that ship has sailed. 

Many people don’t care about any of this. They don’t care about big answers.   They care about answers for their son or their daughter.   The debate has become a war of anecdotes and I believe in a war of anecdotes everyone loses.   All it does is polarize people farther and make common ground impossible.   I  can tell you about my friend Jesse who survived 24 years in the snake pit that is the Florida Hospital System.   He saw things neither you or I will ever know.   He doesn’t talk about treatment or even recovery.   He talks about being free.   I can tell you about another friend who spent 17 years in a psychiatric hospital in Ohio.   Her stepfather raped her when she was 16 and when she tried to complain her family decided to shut her up.   I can tell you about my sister in law who committed suicide after the mental health system drove her “crazy.”   But none of these things help you to feel better about your tragedy,  about your fears. 

The discussion has become either /or.   The affirmation of one person’s experience is based on the denial of another’s experience.   As long as you can only win if I lose or vice versa there will never be any victory.   The experience of those who have been injured by the system are very real.   The injury of those who feel like they will be injured by the absence of the system are real.  We live in the same cracks. 

Many people with mental health challenges,  with mental health diagnoses have found and built a better life.   People who never thought they would make it or who others thought would never make it have.  BUT…. for  many the system sucks and unless we find a way for us all to win  then none of us will.   Either /or offers no hope.  We must find a both/and. 

Reform should be about finding better ways to help people.   It should be about honesty.   But reform should also be about treating people better,  about treating people more humanely.   It is not just about what we do for mental health but how we do mental health.  Perhaps I am naive.   Perhaps I am stupid but I don’t see why they have to be mutually exclusive.   We can do better but it starts with even admitting the possibility there can be a we. 

A better system is one that is honest about the needs about the needs of all the people it serves and realizes ever person it serves is,  regardless of the issues he faces,  still a person. 

Is that just a silly way to view things?  Is it even possible? 

For all our sakes I hope not. 


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