I know someone who once told me he would rather die than go to a mental health center and “get help.” He had seen a family member hurt as badly by the mental system she sought help in as by the very real issues she struggled with. He swore he would never let what happened to her happen to him.
A few years later he committed suicide. He never sought the help he was so sure was going to hurt so bad.
We spend a lot of time talking about the content of the mental health system and little time talking about the process. We assume the benign intent of how we do mental health. Anyone who says the biggest issue is not simply how we treat mental illness but how we treat people is dismissed as someone denying the needs of the mentally ill or someone showing symptoms of their own pathology.
By not considering the process of how mental health is done, by not treating the how as important as the what, much of what is most important to the people who actually use the system is either denied or minimized.
We spend much time trying to put gas in a car with flat tires.
The central argument of Rep. Murphy in many ways is that it doesn’t matter how you treat people and getting too concerned with that gets in the way of treating their illness. I know of no other field of medicine that would seriously make the same argument.
The most impressive statistic I know in the argument for mental health reform is simply how many people don’t come. How many people who according to some estimate struggle with issues or problems that might be helped in some way by the system, how many people who might meet the criteria for some kind of diagnosis simply don’t buy it and either never seek that help or if they do soon leave feeling like the experience is either useless or harmful. Depending on what studies you read I have seen numbers ranging from 50-75%.
There is no one explanation for that. Access to service is part of the problem without question. Many people either don’t have insurance or live somewhere where not much help exists. Some people deny they need help when they do. Some people need other kinds of help more and see people trying to them treatment as irrelevant to their lives. No counselor had ever “cured” homelessness or hunger as far as I know.
But I don’t think any of this begins to account for a 50-75% number. Some people talk about stigma, but even that word does not really capture the experience of what it means to be “mentally ill” in this culture and in the mental health system. It is prejudice and it is discrimination but it is so much more and that so much more has a lot to do with why the mental health sytem is not what it could be.
I found the quote below in something I wrote originally 5 years ago. I would probably change the way some of it is worded but it substantially describes still what I think the real problem is.
“Many people find the mental health system intolerable or even useless because of what they believe it says about the kind of people they are. The mental health system makes sense of mental health issues in such a way that it speaks predominantly about the “judgement of mental illness.” It tells them the most they can expect is a diminished life dealing with a life long affliction that will probably only get worse. It tells them they will be forever dependent on professional treatment and often that they will have to take medication for the rest of their life. The medication helps many, but for many others doesnt work nearly as well as advertised and in fact has side effects that are dangerous and drastically affect the quality of daily life. The disease concept is justified as a way to tell people it isnt their fault, but fault or not, leaves many feeling that their lot in life is to be forever left out of good things and marked as somehow deficient and not as really human as other people. If they accept this “judgement” for many it also means they are in danger of being treated with prejudice by those around them and perhaps excluded from relationships and groups they formally were part of. They also find that many of the people who try to help them are suspicious of their commitment to making a better life. They tend to believe that “mental patients” cant be trusted and really dont want to change. They talk about some people as “frequent flyers” and often dont believe the people they are trying to tell to change are likely in the end to do the things necessary to change.
Many of the people I know tell me that the mental health system uses a cookie cutter “one size fits all approach.” They object to being told the most fundamental thing about them is their diagnosis and that because of that diagnosis the things they value and care about are not quite as real or relevant as they are to people without a mental health diagnosis. They are astounded that their diagnosis is often more an artifact of the particular doctor they see than anything else. They see doctors who assure them that medications are necessary and safe, but yet read the constant reports of pharmaceutical companies who lie, cheat and manipulate to sell these “necessary and safe” medications. And they wonder who and what they can believe.
Many people decide they are not the kind of people the mental health sytem tells them they are and that their life need not be limited to the experience the mental health system provides. They opt out of the system or never enter.”