Sunday, April 9, 2017

Destigmatizing mental health--who benefits?

There is a bill in Congress that has passed the House, and I wonder how many of you have heard of it.  It's called the Helping Families in Mental Health Crisis Act of 2016, affectionately nicknamed the "Murphy Bill" after Rep. Tim Murphy of Pennsylvania.  Among its provisions is the "Compassionate Communication on HIPAA"--which basically means if you have a mental illness, and a family member--or your doctor--decides that you are "in crisis," your right to privacy goes out the window.
Meanwhile, after Carrie Fisher's death, we learn that she was a tireless advocate for destigmatizing mental illness.  A number of people started coming out last year as "mentally ill."  Destigmatization for the win!
But who wins?
The juxtaposition of these two events shows that we have not destigmatized mental illness at all.  What we have done is destigmatize mental illness treatment.  Specifically, we have destigmatized one particular treatment model--behavioral therapy and psychotropic medication.  But, as the above bill shows, we still see the mentally ill as unstable and incompetent.
Mental illness is not simple.  It's a festering, bubbling cauldron of trauma, loneliness, financial stressors, chemical dependency, marginalized identity, and living in a society that does not handle pain well.  Because it is so complicated, there cannot be a simple, quick, "one-size-fits-all" solution.  Unfortunately, the limitations of insurance, our culture's need for the "quick fix," and the idea that "doctor knows best" lead us to pushing the above model.  When it works, it works.  When it doesn't--then a complicated problem can become very bad very quickly. 
We know that this model works for the provider.  They have a steady stream of patients.  And we know it works for the various social service agencies who can pat themselves on the back and say that they are doing something.  But what of the patient?  What can the patient do when a medication doesn't work, or the behavioral model of therapy is a poor fit?  If they go with the program, they are wasting time and resources on a treatment that doesn't work.  If they don't--then their doctor can say they are "in crisis."  And the stakes are high.  So much rides on keeping a provider happy.  Those determined to be "mentally ill" can potentially lose their children, their jobs, their access to schooling, and their freedom.  And now, they can take away your right to privacy as well.

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