Our discussion of the mentally ill population and their status in our society is a very relevant topic today! How did we end up with the same problem, which Dorothea Dix tried to "fix" decades ago? I would like to yet again pose the question, having seen the failure of a social policy (deinstitutionalization) gone completely wrong (for many reasons); how do we amend the damage and find a sustainable and pragmatic
Also, think about the work you are doing at your agencies. What solutions are they looking to achieve and how would you evaluate them? Are they treating the "symptoms" or digging deeper and addressing the larger problem at hand?
Thank you all for having participated during Thursdays class! I hope you enjoyed it as much as I did.
-Ana
13 comments:
Thanks for a great topic Anna! This really sparked some interesting ideas.
I actually left the classroom thinking about prof. Stein's point on lobbying. Lobbying has come to influence almost every aspect of our legislative process--our representatives are literally for sale. This means that the intentions behind common sense social justice approaches can have corrupt capitalistic motives. Now powerful lobbies influence the treatment options available to those who need it. Moreover, they can dictate what it means to be sick and what it means to "treat" an individual based all on what produces the best bottom line.
What does it even mean to really have a mental illness? As said in class, mental illness exists on a broad spectrum/continuum. Abnormality can change depending on the social context it exists. For example, funeral practices vary depending on the culture, so some types of grieving may considered normal in one society and be borderline depression in another. In our current system, these lobbies have strong influences on who and what can be considered abnormal/mental illness. The influence which exists in these corporations/institutions obviously can have adverse effects on public Heath, and, as prof. Stein suggests, changing our current lobbying system is key to improving our current method for treating mental illness.
Thanks for your post, Professor Ana.
We should sometimes be weary of pragmatism because of its emphasis on practical application. It could be the case that the-powers-that-be have decided that sending the mentally ill to prison is the pragmatic solution for society. From a pragmatic viewpoint, it appears impractical for Federal and State governments to provide the individual care that mentally ill persons desperately need—it’s too expensive! As Spencer also suggested in class, we like to systematize things because it is pragmatic to do so.
What might be the solution to the plight of the mentally ill in the United States? I do not know, but progress will certainly have to be incremental. What gains have been made since Dix’s era? How can we advance those gains? What losses have been conceded? How can we cut our losses short? Perhaps, we need to understand the historical context of where we currently are in this mental health struggle, so that we better understand the direction to approach.
In my agency, we are at the stage whereby our primary concern is understanding the problem of prescription drug abuse in the U.S. After gaining understanding, we then hope to recommend solutions based on the gaps observed.
Have a pleasant weekend, all.
Thank you for the very intriguing and controversial topic this week Ana!
My answer to Ana’s question in regards to finding a solution is that professional and individual attention needs to be given to mental health patients. As I touched on in class, systemizing a problem by applying the same solution to every case will not solve anything for an individual patient. Sure, mass incarceration of any group will remove their burden from site, but they as individuals will not be helped to better accommodate to society upon release (if ever released). The mental health institutions may not have offered substantial help by feeding patients medicines from invested pharmaceutical companies, but they did offer better mental health services than prisons. Also, the isolated conditions of prison do not help a mental health patient get acclimated to society any faster without therapeutic treatment either. This is of course is according to my already critical view of the ineffectiveness of the prison complex.
At my new agency, CASES, we look to provide the same necessary one on one counseling I referred to in the previous paragraph. Unfortunately, despite the great effort CASES makes, most departments are underfunded and cannot afford to hire more workers. The money issue at my site is the same issue that prevents more mental health patients from getting individual needs met from other non-profits as well. For that reason, the convenient mass incarceration option is being misused to incriminate patients who would otherwise receive the help they need.
Might one of the problems of "perspective" on the situation be buried in the language some seem to use so freely? What does it mean when we say, write, and repeat "the mentally ill" or "the mentally ill population"? What assumptions get erased, buried, and perpetuated that are actually part and parcel of the problem we are trying to discuss and address?
Thanks for starting us off Ana, and for doing such a great job!
This topic is particularly interesting because there are so many facets to the issue and to the solution. First, the mentally ill have rights to be free from institutionalization and from medication, yet they dont yet have the right *to* be institutionalized and medicated, unconditionally, if they choose to do so. Therefore, I think the first step to finding an individualized solution is giving this population both rights, and giving them and their families the freedom to choose which they will practice.
As many of us have already discussed, money is the biggest barrier in the way of justice. Unfortunately, this is not just the case for the mental health field. At Safe Horizon, a big setback to holding traffickers accountable is the lack of resources. There is only one small department,ICE, in the NYPD responsible for investigating and prosecuting these crimes. Because they have such a lack of resources and manpower, they strategically use them to investigate the cases with multiple victims. Where does this leave the thousands of other men and women who are victims of equally horrific crimes and whose lives are completely shattered? It's extremely unfair that these people have to suffer for the rest of their lives with no justice to the perpetrators.
I really hope for a future one day where money is invested into the systems that desperately need it.
Great class and discussion Ana. Although the agency I intern at, URI, provides support for victims/survivors of domestic violence, one of my supervisors, Ms. Centeno, has a "passion" for mental illness which has caused me to be more aware of the topic so this was a very exciting discussion as I was open-minded/aware of the issue. Before my internship at URI and exposure to Ms. Centeno, I was ignorant of the issues and wasn't particularly interested to know about it nor be sensitive. I grew up in a culture where people with mental illness were shunned and spoken of in hushed tones or even laughed at.
The entire system we live in seems to be influenced by the "almighty dollar". It is extremely frustrating. There seems to be no real solution to anything. Those that have the money, only seem to look at the bottom line. Those that sincerely want to address social issues, do not have the finances to do so. A seamstress or tailor does not want to alter a garment that was made by someone else as it is more tedious, time consuming and frustrating than to make a new garment from scratch. I use this analogy because I think the best solution would be to start all over. Start at the very beginning. But I think that the problem will just repeat itself, probably in another form, but it will repeat itself. The solution lies with the intentions of people over which we have no control. As Lord Acton said, "power corrupts and absolute power corrupts absolutely." Money gives the holder of it, power.
At URI, they provide housing and other services to survivors of domestic violence. They are very understanding about the trauma that the victims go through and the many ways it can affect them. (On a side note, I was very surprised to learn the effect that domestic violence can have on babies or toddlers. I learned that it can cause them to be fussy and irritable, something I used to take as just "bad behavior" or being spoiled.) There are times though, that I feel the residents are being pampered a bit because they get certain courtesies that are not acceptable in the "real world", for example, being very late for or keeping an appointment with a worker right inside the facility and not having the courtesy to reschedule or at least say that hey will be late. However, I am understanding a lot more about what the clients have to endure and I get frustrated for them so I understand that at times they may not remember or may not want to be bothered because they are dealing with a lot. I maintain that the "system", the government social service system, is designed to keep recipients dependent on it. Their hands seem to be tied. Some people need the "system"to transition but there are a lot of hoops to jump through. Some of the expectations are unbelievable and unreasonable. Again, it comes down to money and those that have it, wields its power to increase their bottom line. There's an old saying, who's in the kitchen, feels the heat. Sadly, unless one is in the situation (in the kitchen), one doesn't really understand what is needed etc. (feel the heat). As Leena said, "I really hope for a future one day where money is invested into the systems that desperately need it."
Thanks, Ana. And here's an indication that maybe you should be a New York Times columnist (since you scooped Nicholas Kristoff's editorial on this very topic by a few days!). You can cut and paste this or find a link to it on our "Check It Out" section of the blog.
http://www.nytimes.com/2014/02/09/opinion/sunday/inside-a-mental-hospital-called-jail.html?_r=0
Thank you Ana for a great blog post and a fantastic class this week!
I feel as though it is very possible to find a sustainable and pragmatic solution to this interesting problem. First of all, we definitely need to find a way to balance the rights of the mentally ill to maintain their freedom from institutionalization and medication and for them to have access to institutionalization and medication. In regards to finding this balance, I completely agree with Leena that the first step is to sufficiently provide the medically ill the right to be institutionalized and medicated and then allow the individuals and their families to decide how to move forward. Keeping this in mind, the question that inevitably arises is how do we grant them this right?
The right to institutionalization used to be much more widespread until deinstitutionalization ruined it all. Due to the fact that deinstitutionalization was such a major contributor to the problems we are facing today regarding this issue, I believe the ironic reinstitutionalization of mental health facilities is necessary. As I proposed in class, I legitimately believe some prisons can be altered to sufficiently address the needs of the mentally ill. The utilization of preexisting buildings for new purposes is not something new to this country (see New York City’s transformation of an old shoe factory into a CUNY school as an example). The next problem that must be faced is regarding those individuals who choose to exercise their right to not be institutionalized and medicated. How do we keep these individuals from falling into the criminal justice system as they have already been for years?
It is important hear to note that it may not be possible to completely stop the mentally ill from committing crimes, which thus makes it essential that we modify the way we deal with these individuals when an offence does take place. First, the problems surrounding the insanity claim that we discussed in class must be addressed, whether it means altering the term to be broader, or completely eliminating it is irrelevant, what is important is that change occurs. Next, I believe the article’s suggestion of specialized courts is extremely important to take into consideration. If developing separate courts is not feasible, specialized procedures must be put in place when dealing with an offender who committed their offence due to mental illness. In the event that a mental illness does influence an individual to commit a crime, I would suggest that penalties based on the severity of the offence be instituted, including mandated medication or institutionalization for an allotted period of time. Although this would essentially remove their rights to be free from institutionalization and medication, it is not logically different from how we take away certain rights from other offenders who are sent to prison. Of course, I do recognize there would be difficulty in arguing a mental health issue influenced an individual to commit a crime, but if the right measures for implementing this solution are taken, these types of pitfalls can easily be avoided.
In regards to my agency, I believe CEO is honestly doing a little bit of both. As you may already know, one of the ultimate goals of CEO’s work is to decrease recidivism by helping individuals with recent convictions find full-time work. It can be argued that recidivism is not caused by a lack of employment, and is thus a symptom of even greater institutional problems. Along with helping individuals find full-time employment, CEO is also pushing for changes in legislation by supporting the Ban the Box initiative so that formerly incarcerated individuals are not discriminated against on the basis of their criminal history. By doing these two things in conjunction I believe CEO is both addressing root cause problems as well as those problems’ symptoms.
Excellent class Ana.
For FedCap, we really try to create opportunities for people with barriers to move toward economic independence as valued and contributing members of society. One of these opportunities is to help the unemployed find jobs. As many of these customers are actually not coming to FedCap out of their own choice but more because it is court ordered to them. Many of these customers do have a negative attitude because they instantly view FedCap to the welfare system…something set up to fail them. We not only want to help customers find jobs but also housing, counseling services, and even a babysitter. We do all of this because we understand the core of these necessities can help them overcome obstacles, rebuild their lives, and find and keep meaningful employment
It's frustrating to live in a system in which green is the most important color and worth more than individual lives. As we discuss the issue of mental illness and the system in which allows it to flourish without intervention (be it medical or otherwise), it becomes hard to envision a system in which this wouldn't be the case. One of the major issues in this topic is how we finance our health care system, and where all of the money is allocated. Which issues are more important than others?
Due to the stigmatization of mental illness, the general public don't care about what happens to people with mental illnesses, especially once they are criminalized. It is much easier to resort to the "out of sight, out of mind" mentality.
I think one of the key components in changing the system and changing our society within this system is through de-stigmatizing mental illness as a whole. Education and exposure to what mental illness is, what it isn't, and moving away from it being the definition of an individual. This won't happen, of course, without money and power, and money and power are hard things to obtain. I know this was said in class as a joke, but it would literally require a revolution of some sort in order to initiate some sort of change in our system. Like Simonne said: "the best solution would be to start all over. Start at the very beginning." If we knew then, what we know now, how would things be different if we just started all over?
In regards to my agency, there are issues that intersect with this idea of stigmatization when talking about the Deaf community and with people with disabilities and domestic and sexual violence. There are different levels there that contribute to subpar treatment of those affected by DV/SV as well as the general public's perceptions of Deafness and disability. I always resort to saying that the only way-- or really, the most effective way of changing ideas and perceptions around issues that people don't understand or face often is through education and exposure. People are afraid of what they don't understand, so it is much easier to deal with issues by throwing people into hospitals or into jails, and sometimes both.
Thanks Ana for such a thought provoking class!
Hi again, and many thanks to all your contributions to the blog, and to Ana, of course, for leading a great class and blog.
I know you are all busy and that you have plenty to read, but I'd like to suggest/ask you to take a look at the prologue to my book Love, Sorrow and Rage, which is short and which is already on our e-reserve. I believe it may offer some additional insight and nuance to the topic. I have two pieces on e-reserve. The one I am recommending now is listed as
Waterston,A."An Urban Ethnography for Our Times." Love, Sorrow and Rage.Philadelphia:Temple University Press. Pp1-21.
Thank you for considering taking a look.
I know this was a good class and blog because I am more frustrated and confused now than I was at the beginning. Moreover, I feel the need to problematize even further. I am buoyed by the evidence that the class is looking upwards to the powerbrokers (e.g. those in charge of resource allocation, corporate lobbyists, etc.) not just the mentally ill themselves. I'm glad you are questioning the very definition of mental illness and looking to see who does the defining (insurance companies; lawyers, Hollywood?). Thanks to Ana, we have a better grasp of the complexities of the issue. But even this wider perspective does not begin to address certain problems which, I feel, are insoluble. So I would not feel comfortable leaving you with the idea that if only people were given appropriate treatment, and if only their living needs were met, and if only fill-in-the-blank, the problem of either mental illness or its criminalization would disappear. We like to say these things but, like the Miss America contestant angling for world peace, it rings somewhat hollow.
There is no good treatment for mental illness. You might be surprised to hear that there is actually no empirical evidence at all that various mental illnesses are caused by imbalances in neurotransmitters. Thus, the drugs given to correct imbalances have no reason to work. In fact, evidence is mounting that the drugs actual may cause mental illness. Certainly, being kind to people and trying to help them is better than locking them away in one form or another just on humanitarian grounds. But, it is also true that in the grip of severe illness many people will not be able to take advantage of kindnesses or any kind of treatment, including talk therapy, CBT, or drugs to calm them down (by the way, we do have very effective sedating drugs but they have horrific side effects). And, given that we really have no proof that treatments work, on what legal basis should we force their compliance? On the other hand, if we don't and the person becomes agitated and either a public danger or, more likely, a public nuisance, what next?
No one belongs in prison, including the mentally ill, as far as I am concerned. And, for humanitarian reasons, I just think we should be as kind and helpful to people as we can. But I have come to believe that this is an area where we need to be most concerned with avoiding causing grievous harm. I am just not sure there is much that we can do to help. Indeed, the older I get, the more I think there is to be said for just not making things worse...
This is hard for those with a passion for justice and advocacy to hear but I hope you can sit with it for a bit.
Hello All,
Great class Ana you rock!!!! I believe that there are many avenues to achieve a sustainable and pragmatic solution. The health professionals need to find a way that will keep the “mentally ill” safe but also find a way to understand their patients individually. The solution is a mesh between treating the patients as people and applying treatments that are specific to them. The evaluation of such a system has to thrive on the health professional being aware of the patient as a human being and not a number.
At Cases, I believe the focus is to educate the students to help them succeed in the future. The purpose is for the students to reach goals that can help combat the factors of the world. I have faith that these programs, which we all work with, can achieve the goals that they set out in their missions.
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