For some time now, there has been much written about and even more talk concerning the “restructuring” supposedly happening in various mental health systems. So far, everything I have read or heard of, indicates to me that all this “restructuring” is nothing more than an attempt to find new ways to do much of the same old thing within these systems and within the societies which foster and embrace them.
The use of force within these mental health systems needs to be completely done away with before these systems can truly become ones of “empowerment” for everyone involved. This would be real change, because it is what is needed and because it is also very long overdue.
Whether on an inpatient, outpatient, or “community” basis, the use of force or coercion in mental health treatment is clearly wrong. Force and treatment do not go or work together. In fact, each works in opposition to the other. Force fosters dependency, victimization, anger, violence, helplessness, and irresponsibility. However, treatment which is free from the use of force or coercion embodies what is essential to what often becomes termed as “recovery”: personhood, self-determination, hope, faith, responsibility, and independence, as well as interdependence. Force does not ensure safety or security; rather, it is the use of force that destroys them.
Using force is easy. Choosing alternatives to force may be difficult, or seem so, but it need not be impossible. Many options are available which are not possible when force is the governing paradigm.
If the force/coercion paradigm were no longer in place, the power imbalance that currently exists would cease, or at least its base would lose its authority. Resources which are currently being employed to bolster the force paradigm could be used instead, to meet the basic needs of individuals-needs now not met in a way of their choosing, or not met at all. These needs include: non-segregated, non-congregate housing, home ownership programs (designed by persons they are meant to assist and packaged to assist persons living on very low incomes), tenant-based rental assistance programs, income, food, support, training, employment, healthcare and transportation.
Meals on Wheels, personal assistance services, and Part B-Independent Living Services can play meaningful and vital roles in supporting individuals labeled with psychiatric disabilities to live independently. However, it would take a major shift in resources to fund these much- needed programs. In Vermont, information regarding these programs and access to them, can be gained through the Vermont Center for Independent Living (V.C.I.L.).
We must do several things, including these:
- End civil commitment and abolish the insanity defense for persons labeled with psychiatric (or emotional) disabilities.
- Hold people fully accountable for their actions if a crime is committed and then proven within the criminal justice and correctional systems, regardless of whether or not an individual is labeled with a psychiatric disability.
- Shift resources to fund a system that helps to meet the needs of individuals labeled with psychiatric disabilities in a way of their choosing and make mental health systems completely voluntary.
- Use vouchers to allow people real choices both in selecting care and/or service providers and the actual care and/or service that they may choose to receive.
- End the preferred-provider status, sponsored by state statutes, currently in place within community mental health systems across the United States.
Often, there are concerns raised about what should be done if someone is “out of control” or “troubled” or “in need of treatment” when their state of mind and/or behavior is being questioned. While the issue appears to be complicated by several factors, including current constitutional law regarding an individual’s rights in criminal proceedings, it is my belief that people can be held more accountable by changing how they are treated, by abolishing the insanity defense, and by ending civil commitment of individuals labeled with psychiatric disabilities.
Being “out of control” or labeled with a psychiatric disability should not be an excuse and should not be tolerated if a person is proven to have committed a crime.
If no crime is committed, but the person appears to be “out of control” or “troubled,” they should be offered voluntary assistance only or otherwise be left alone. More tolerance in this manner is actually needed, not less of it. If an individual is not committing a crime, but her or his actions are annoying others, then they should not be detained or interfered with-just like anyone else. Being annoying, a jerk, or “out of control,” or being labeled with a psychiatric disability in itself should not be grounds for imposing society’s will.
We shouldn’t be able to hold people accountable for actions that we think that they might do. People should, however, be fully accountable for proven criminal violations of the law.
I do believe that it is possible for us to finally rid ourselves of the terrible burden of force and coercion within mental health systems.
One of my favorite quotes which I need to constantly remind myself of and which I use often in this charge of work is this one: “Some men see things as they are, and ask, Why? I dream of things that never were and ask, Why not?”-Robert F. Kennedy. These words help carry me through many tough times-both personal and political. I encourage everyone to dream and then to ask, “Why not?” This can be very liberating to one’s mind, body and soul, especially when sharing with and supporting each other-as we journey into the unknown together.