By Marvin Ross
In my recent blog on social work, I concentrated on the bad and the ugly by outlining the absurdity of the mental health course in the social work program at McMaster University. This is a course that ignores the advances that have been made in the understanding of mental illness and the treatments and strategies that are available today – medication, community treatment orders or assisted out patient treatment.
I did mention that good social workers have a key place in helping those with illnesses to improve when working with psychiatrists, nurses and other professionals. Lynn Nanos, an emergency psychiatric social worker in Massachusetts has just published a book called Breakdown A Clinician’s Experience in A Broken System of Emergency Psychiatry. Ms Nanos uses her experiences with the many patients she has dealt with over the years to illustrate the extent that when hospitals release seriously mentally ill patients too soon without outpatient follow-up, the patients can end up homeless, jailed, harming others, or even dead. And when patients are deemed suitable for inpatient care, they can languish for weeks in hospital emergency departments before placements become available.
She points out that mental health services have cycled back to the 19th Century when the reformer, Dorothy Dix, was appalled at what she witnessed in Massachusetts. “She would be shocked, bewildered, terrified, and unimpressed with both the Massachusetts and United States systems if she were alive today.” And I might add that other industrialized nations are no better in dealing with mental illness than the United States.
In her chapter on stigma and psychiatry, she lists about 17 reasons why psychotic people do not accept treatment. Only two are exclusive to the US – size of copay and lack of health insurance coverage. All the other reasons apply to countries with universal health care. She also points out correctly that stigma is not a major problem as a barrier to treatment. She states that “Although stigma associated with mental illness exists, it is not the greatest barrier to accessing treatment. No patient with psychosis ever reported to me that this was her reason for not seeking help.”
Having said that, she turns her attention to the problems with peer support programs and the hearing voices movement in Massachusetts. “Anosognosia is real and a common barrier to treatment. But, they (the anti-psychiatry groups) either minimize anosognosia or delegitimize it.” And “people who are not authorized to prescribe medication should not teach people how to reduce or stop taking medication, especially in a formal setting.”
Of the many anti-psychiatry groups that I’ve battled with on the internet are those who joined the Boston Globe Spotlight on Mental Health group that was set up on Facebook after their excellent series on mental health in Massachusetts. Sadly, these advocates are not just limited to the state that Ms Nanos works in but they are all over.
Anyone interested in reform will find the real life stories that illustrate the author’s points fascinating reading. Her list of endorsements include family, police, academics, clinicians and advocates and names that many will recognize like Dr E fuller Torrey, Pete Early, Ronald Pies and others.
Mind You Reflections on mental illness, mental health and life 