Insane Consequences Review – Mandatory Reading for Students, Politicians and Health Care Bureaucrats

By Marvin Ross

Insane Consequences How the Mental Health Industry Fails the Mentally Ill by US advocate, DJ Jaffe is a tremendous resource for anyone wishing to understand the industry that has developed around mental illness. And that is an industry that ignores the most seriously ill in favour of promulgating programs that are not evidence based, that are grounded in social theory rather than scientific theory, and generate jobs for the professional carers.

I am absolutely amazed at the amount of work that has gone into this volume. If anyone doubts Jaffe’s conclusions or statements, his sources are well laid out so you can check on them for yourself. A great deal of the problems with mental illness treatment in the US is its totally absurd health care system which baffles those of us who live in countries with universal single payer health care.

A few years ago, the Bridgeross author, Erin Hawkes (When Quietness Came: A Neuroscientist’s Personal Journey with Schizophrenia), appeared on an NPR radio show in Ohio to talk about her book. The interviewer was amazed at how much care and treatment she received in both Halifax and then Vancouver. How much did it all cost, she was asked. She thought for quite  awhile and said, “I think I once paid for an ambulance ride”. The interviewer was stunned.

But then, we don’t have absurd rules like the Institute for Mental Disease (IMD) exclusion. Because of this rule, Jaffe points out, Medicaid will not reimburse states for psychiatric beds. When the states cannot get reimbursed, they close the hospitals.

However, despite the difference in how health care is funded, most of what Jaffe talks about is relevant for Canada and, I suspect, other western countries. The seriously mentally ill are ignored for the most part, make up a huge proportion of the homeless and of the prison population. The focus, as Jaffe discusses, in the US and in other countries is on stigma which helps no one, on denying the connection with violence for those who are untreated, and on the misguided concept that people are free to decide their own fate when they lack the capacity to do so and are thus left to fend for themselves when they need to be hospitalized.

While medication is the cornerstone of proper treatment, there are still non evidence based theories being flogged as replacements for the medications. We have Open Dialogue from Finland that lacks any proper evidence, Mental Health First Aid, prevention programs to prevent illnesses where the cause is not known, and to foster peers with so called lived experience to replace trained medical staff. All discussed in this book.

I should also mention that Jaffe talks about the problems that caregivers have dealing with the system because of privacy laws. I quoted him in my Huffington Post blog on the problems that caregivers have with a suggestion that we all deserve a hug.

All of the book is valuable as a resource but what I found most helpful was his Appendix on the studies of Assisted Outpatient Treatment (AOT). These orders compel a mentally ill individual to accept treatment in the community. If they refuse, then they can be hospitalized. Jaffe cites about 20 studies that demonstrate the effectiveness of this program to reduce homelessness, incarceration, violence, reduced hospitalizations, and emergency department visits to name a few.

This book should be mandatory reading for all students in mental health counselling programs, nursing, social work and medicine. It also needs to be read by government policy makers. Money can be thrown at a problem but unless that money is spent wisely on evidence based programs, it is wasted. And that is what happens today.

Finally, because Jaffe is donating all his royalties to  the Treatment Advocacy Center and to Mental Illness Policy Org, purchasing the book will help those groups better advocate for the seriously mentally ill.

5 thoughts on “Insane Consequences Review – Mandatory Reading for Students, Politicians and Health Care Bureaucrats

  1. I will certainly purchase the book. Jaffe’s advocacy is needed more than ever given the ludicrous stuff that goes on. It is mind boggling to watch the diversions of money that go into stuff that does not do anything for patient care/ treatment for those who are truly afflicted with an illness. . Instead we watch amateurs or those with suspect agendas call the shots. Properly trained heath care professionals with the skills to stabilize serious illness must be there in order to restore a life to worth living .


  2. I think we might have something like the Institute for Mental Disease exclusion in Canada. It was once cited to me as a basic economic fact behind wholesale closure of our provincial hospitals – i.e., no available federal funding. Anyway – thanks for great review. I’ve bought DJ Jaffe’s book and Erin’s book, and recommend both to all family members, non-profit organizations and professionals trying to help people with schizophrenia and other psychotic illnesses. It’s time to get angry, get organized, and advocate LOUDLY for appropriate medical care and services for our folks!


  3. Got mine yesterday, it was nice to see that the Canadian price is only $1 more than the U.S, Piice, I was sorry to find that Portico the only place where you can talk to CAMH was not available any more… It saddens me to endure the isolation and the “Wall” this worhty organisation builds around itself !!!
    Time for me to look for fresh air, in Paris…be back at the end of June


  4. I have now read almost all of this book. I only got it yesterday afternoon. Obviously I could not put it down because it echoes very succinctly what I have long thought and could barely articulate. It is so pertinent to the faulty road Canada embarked upon with its useless Commission and its embracing of ill thought out prevention programmes. Funding stuff that does not make any difference for those who are truly afflicted by a very serious biologically based mental illness is really a crime. And clearly it provides jobs for those who do not or want to serve those with really serious illnesses. Our streets reflect the neglect Our University wallow in stigma programmes, suicide prevention programmes,whereas real treatment would ease the patient and be more proactive in terms of suicide and decreasing stigma.

    The whole industry is just that , it has little to do with healthcare. Imagine funding talking about stigma when a patient is suffering from blood cancer. Treatment comes first I have been sickened by some of the campus activities here at Queens which divert funds from things that would really make a difference i.e professional care and timely treatment. But they continue with a “bull horn”, peddling propaganda which is not evidenced based. Mental health first Aid ! ETC ETC when our streets are filled with begging people who are often very psychotically ill. They are in need of treatment housing and hospital beds. Timely treatment would do more for stigma busting than any of this constant babble and misguided talk about stigma.

    Discrimination is the only apt word to describe what really happens to most of those who are felled by a serious mental illness. They mostly do not get professional healthcare. Anyhow i go on read the book and you will see that Jaffe has tacked every aspect of what went and continues to go wrong


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