Human Rights and Mental Health Care: Managing the Intersection

1. Human Rights and Mental Health Care:  Managing the Intersection Ron Unger LCSW 4ronunger@gmail.com

2. My story • “Stormy search for self” as a young man • Sometimes “mad” but it was also a positive emotional and spiritual journey • Multiple family members pulled into mental health system due to similar crisis • Became an activist for change in the mental health system • Then became a professional • To develop alternatives • Then became an educator • To increase availability of alternatives • See my blog http://recoveryfromschizophrenia.org/

3. Conflict at the Intersection • People in mental health crisis are frequently dangerous to self, sometimes to others • “Too much” respect for their rights has been criticized as possibly leading to people “dying with their rights on” • But too little respect for the human rights of people in crisis can lead to very serious problems that are too often ignored • By looking at both sides of the issue in a balanced way, we can find better solutions

4. Coercive mental health treatment leads to trauma & more problems • Between 44 and 51% were found to have PTSD induced by psychiatric admission and treatment • (Priebe, Broker, & Gunkel, 1998; Morrison, Bowe, Larkin, & Northard, 1999) • Forced drugging, restraint, and seclusion have been identified as inducing fear, victimization and helplessness • Also a factor: Loss of control over identity as one is forced into the role of a “mental patient”

5. Other Risks from Coercive Treatment • Damaging person’s relationship with mental health system • Creating either • Too much rebellion & disengagement, or • Too much compliance • Possibly imposing a treatment which is actually more harmful than helpful • Because of failure to listen to feedback from person receiving treatment • In General, unjustified infringements on liberty

6. Reducing Coercive “Treatment” • Often mental health goals can be accomplished without coercion • Seclusion & Restraint can usually be mostly eliminated by facilities which make that a goal • Research shows making voluntary treatment easily available works as well as involuntary outpatient commitment in reducing mental health problems • Greater appreciation of the damage done by coercive treatment, and appreciation for the very limited ability of psychiatrists etc. to predict violence, could lead to much less use of coercion • And ending it sooner, when it is used at all

7. Rights Violations by Misinformation • Mental Health system has pretended to know that there exist “real illnesses” like “schizophrenia” that are definitely not understandable reactions to difficult events • Despite large amounts of evidence to the contrary • Has a “bible” (the DSM) of ever expanding “disorders” invented by committees • Human distress and confusion is real • and sometimes overwhelming or even deadly • But is not adequately addressed by applying labels and then treating the person just based on that label

8. Lies and “mental health” • Much of the public is convinced that mental health problems are due to “biochemical imbalances” that can be corrected by medications • Despite the fact that no one has provided good evidence of anything that simple! • And despite the fact that psychiatric drugs create abnormal biochemical states in the brain • In 2003, MindFreedom did a hunger strike to challenge the APA to provide evidence of a biochemical imbalance • More recently, psychiatry is backing off from any such claims

9. This book documents a large body of evidence suggesting that while psychiatric drugs often appear to help in the short term, • The long term effect on average is to make the problems worse

10. MT = Maintenance Therapy GD = Guided Discontinuation See Wunderink, L., Nieboer, R. M., Wiersma, D., Sytema, S., & Nienhuis, F. J. (2013). Recovery in Remitted First-Episode Psychosis at 7 Years of Follow-up of an Early Dose Reduction/Discontinuation or Maintenance Treatment Strategy: Long-term Follow-up of a 2-Year Randomized Clinical Trial. JAMA Psychiatry, 70(9), 913-920. doi: 10.1001/jamapsychiatry.2013.19

11. An overview of what people should know about psychiatric drugs: • The drug will not simply correct a specific “biochemical imbalance” • It will create what could be called a “drugged state” • and then either this drugged state or the placebo effect may be give some relief in the short term • In the long term, there is substantial risk that use of the drug will interfere with resolving the issue • And there is risk of various side effects, • including possibly permanent neurological changes, and dependency problems.

12. One Choice is No Choice • There is no adequate “informed choice” when people are given only one treatment option • Options that should exist: • Psychological approaches that address trauma and life stresses • Even for “serious disorders” • Holistic options that integrate mind, body, and spirit • Social causes of mental health issues should be appreciated as a public health issue • Like inequality

13. A common [should be horrifying] complaint made by many who have recovered: • “In order to recover, • I had to believe the opposite of what the mental health system told me to believe, • and I had to do the opposite of what it told me to do.”

14. Speak out! • We all have an ethical obligation to speak out when human rights of people receiving treatment are being disrespected • And when treatment guided by narrow ideology and/or profit seeking is leading to more harm than good • Joining an advocacy group like MindFreedom is one way to help make sure these issues get addressed!