Tom Cruise and Scientology

This will be my shortest article in any media to date in a 25-year writing span. I write this in regard to the current controversy surrounding popular actor Tom Cruise, a Scientologist, and his public statements that Psychiatry is a "psuedo science."

Who cares?

Self-Determinology

The Consumer: Why are many people with mental illnesses calling themselves "consumers?"

There is a simple answer to this question. We are all consumers. We all buy or barter for goods and we use these goods for our own betterment whether that betterment is growth or sustenance.

People with mental illnesses are consumers of mental health products. These products may be medications, psychotherapy, the services of Psychiatrists, the services of Psychologists, and so on.

It matters not whether these products represent out of pocket expenses on the part of the consumer or whether they are funded by Medicaid or Medicare dollars. Even if consumption of these products is funded by government agencies, the consumer directs how the dollars are expended.

The identification of oneself as a consumer is of critical importance to the person with a mental illness. It marks an entirely new view of oneself within "the system." Rather than seeing oneself as a pawn pushed about on the board and with no control over the "game" and its outcome consumers may see themselves as having control over their treatment and, therefore, their lives.

The idea of being a consumer leads directly into that of Self-Determination. Self-determination, as the phrase indicates, is the process of a consumer determining what they want in life and allows them to see themselves as a person with a mental illness as opposed to "being" that illness. The consumers sets forth goals for their both their recovery and their lives and then begin setting forth paths to those goals.

Peer Support is also a powerful tool in the consumer arsenal. Many people with mental illnesses have come to realize the power of numbers through combining their strengths with those of other consumers. Peer support is not simply a matter of sharing things with others with similar problems. Peer support also embodies strength in numbers. Consumers meeting together can begin to see universal strong and weak points within "the system" and then to speak out against those points that are not satisfactory to their recovery.

Peer support may result in changes within local, state, and federal systems but, just as importantly, can begin removing the chains of stigma. When the public at large as well as government agencies begin to see that consumers are intelligent individuals who know what they want and what they do not want as well as showing the willingness to speak out, agencies begin to see that people with mental illnesses can participate in their own recovery. Agencies are then more inclined to listen to consumers and are less inclined to dictate to them.

Being dictated to applies not only to staff members within "the system" but to members of the support group itself. While leaders of support and self-advocacy groups will emerge to spearhead the efforts, these people are leaders only by common choice whether by being elected or by a common understanding and agreement among their peers that they have the strength to carry the effort forward. Consumer leaders should have no ability to coerce any individual consumer and generally strive only to move the effort forward to a certain point after which other leaders may emerge.

Once a person with a mental illness begins to grasp the ideas of "Consumerism," Self-Determination," and Peer Support" they come to be fully Empowered. They may then act much more effectively as advocates for both their own needs and those of the larger whole.

When these ideas are realized the whole embodies what is known as the "Consumer Movement."

An Innovative Idea

According to the Galveston County Daily News (March 21, 2005 - Article by Scott E. Williams) Galveston County Texas will be considering the idea of taking community mental health resources to the patient rather than having the patient come to the clinic.

Interestingly this idea reflects my previous post. It is the head of the mental health services division of the sheriff’s office who presenting it. Lt. Jaime Castro, lead deputy for the mental health services division of the sheriff’s office, said that he was preparing a pitch to county commissioners and other concerned county offices.

According to Castro, "The only two places in the county for urgent mental health treatment are the psychiatric beds at the University of Texas Medical Branch and the county jail."

The mobile unit idea started in nearby Harris County where funding has now been increased on the project after two years of mobile operations. I am not familiar with these areas and do not know anything about population density or whether the areas are mostly rural or urban but I know that similar services could be very valuable in rural areas.

As a former Job Coach and consumer advocate in a rural area of Georgia I know how difficult transportation can be. Trying to get our consumers to jobs they had secured with the help of county Supported Employment was a nightmare. Bringing consumers in for clinic appointments was a little easier since vans were allocated for this purpose and routes had been assigned. But this system caused undue stress to our consumers by forcing them to get up early no matter how they felt that day so that they could spend the rest of the day riding packed vans and sitting in clinic waiting rooms. Missing these appointments could result in a long waiting period during which the consumer may have no medications to help maintain stability.

According to Lt. Castro, “It’s just cheaper to be able to deal with people at their homes than in a hospital or the jail. Almost every day, I answer a call because someone stopped taking his medication and is acting up to the point they’re a danger to themselves or to someone else. If we can treat them or provide the medication they need on the spot we’ll save a lot because, right now, jail and UTMB are our only options for those people.”

Diana Villareal, a psychiatrist with the Harris County program who used to work with the mentally ill in Galveston County said treatment that did not involve jail was also more effective.

“Once the legal system gets involved a patient is much more resistant to treatment because criminal law is much more adversarial than treatment,” she said. “This program has also allowed us to help people in a way that preserves their dignity which is important.”

Clearly, similar operations should be considered by other county mental health systems nationwide. Staff members should not feel inconvenienced as they would already be working for the day, they would travel in a van but it would not be packed with consumers, the consumer benefits by not going through a very stressful monthly ritual, less mentally ill consumers wind up in jail, and the county saves money.

It doesn't get much better than that.

Prisons, Mental Illness, and Politicians

Why do the politicians keep making promises? A better question would be "why we listen to them?"

Some politicians make promises that they know they can't keep just to get votes. Other politicians are simply deluded in their belief that their promises don't rely on a couple of hundred other politicians to have similar views.

The promises that really get me are the ones that rely on several subsequent elections to be realized. How can they possibly believe that other politicians 10, 20, or 30 years down the road will continue to carry their torch?

The policy changes that pop up as a result of this type of short-sightedness have nearly caused the collapse of our mental health system and have turned our already over-crowded prisons into mental hospitals. President John Kennedy began the process of "deinstitutionalization" 30 or so years ago and we have been very busy corrupting it ever since.

Kennedy believed that mental hospitals not only confined people who would have a better life in society, they also cost taxpayers a great deal of money. The idea was that hospital "inmates" would slowly be returned to the community as lower cost community mental health centers were phased in. Mental hospitals would only exist for immediate and temporary care of individuals who could be considered as presenting harm to themselves or others.

Unfortunately we failed to carry this out as it was originally planned. What actually happened is that we did finally bring long-term patients out of the hospitals (completed, I believe, in the 90s) but we never fully funded community mental health centers. As is usually the case much of this funding was funneled into other budgets. Community mental health budgets are continuously gouged nation-wide despite the promises of long, long ago. And we are now feeling the pains of this plan gone wrong.

While some people with mental illnesses simply refuse treatment, there are many others who simply cannot find adequate mental health resources in their communities. It is a given that a person with an untreated major mental illness is probably not the guy who is sitting in his penthouse with a wad of cash in his pocket. This is the person who is most likely to be out of a job and homeless.

What course do those with no money and no home usually take? In many cases they turn to alcohol, drugs, and theft. The next step is a series of arrests. It follows then that many people with untreated major mental illnesses wind up in prisons where they actually do find treatment. Wouldn't it be more expedient to put the cart before the horse and treat the mentally ill before these problems arise?

I saw the perfect phrase somewhere on the Internet last night: "Our prisons have become surrogate mental hospitals." The use of prisons as mental health treatment centers has become a major problem and a disgrace that is growing rapidly. Because of this now warped policy more and more resources must go into the prisons rather than into community mental health centers and the vicious catch-22 cycle continues to run and even thrive.

We have literally kicked our mentally ill out of state hospitals and into the communities where they cannot find adequate treatment. We avert our eyes as they turn to the alternative methods required to stay alive. Then we look on them with disgust and punish them further. We lock them up in our jails to “keep society safe” and continue to throw dollars into the system with the hope that we will not be dirtied by it all.

Ironically this pattern is ultimately costing us much more money than would have been spent had the funds been allocated to the community as they should have been in the beginning. Now, rather than paying for treatment and low-cost housing within the community, we are paying a much higher price to house and treat the mentally ill in prisons. A hidden loss in this mess is that community mental health systems can often find employment for their consumers. Employment brings dollars back into the community as well as providing an incentive to consumers to remain stable.

The only possible way to correct this plan gone awry is to funnel even more money into community mental health systems until mentally ill prisoners are released back into the community and the balance of funding levels out as prison costs go down. At this point any additional funding of community mental health systems may be reduced until it reaches the proper level to sustain these activities. Rather than doing the usual "take it from there and put it here" funding, tax dollars would be saved and some eventually re-allocated.

It is in everyone's best interest that this happen and happen soon.