If You Label Me, You Negate Me – A Dialogue On The Labels That Are Used About Mental Illnesses

Introduction

I consider myself to be very fortunate. I get to have dialogues with people on a wide range of topics. one of the topics that I am most passionate about his recovery from mental illness. To that effect, I participate in many discussion groups on the Internet. LinkedIn is one such resource for me. From time to time, I post my responses to others on my blog as articles.

The post that I responded to, unedited

"I haven't seen that particular documentary, Bill, but will check it out. Treatment models in other countries were noted throughout this thread. Some good DVDs to check out are "Healing Homes: An Alternative Swedish Model for Healing Psychosis", "Open Dialogue: An Alternative Finnish Approach to Healing Psychosis", "Crazy for Life" and "Take These Broken Wings". Working to Recovery offers 2 excellent DVDs, "How to Start and Run a Hearing Voices Group" and "Talking with Voices: An Introduction to Voice Dialogue". We hope to bring Ron Coleman and his wife, Wales, UK, who are now researchers in the field, to Wisconsin this coming spring to help teach voice dialoguing to people with lived experience and their clinicians about this effective model of healing for people with psychotic disorders.

Bi-Polar Bear (Photo credit: oxygeon)

I have found that the language we use also lends itself to supporting or dispelling the social stigma around mental illness/substance use disorders. If I may gently point out, you state "I am Bi-Polar". May I suggest that you are NOT your illness. You have Bi-Polar. As a NAMI Connections state trainer, we teach our facilitators that people are not their disorders and we no longer go around and identify each other by our disorders when opening Connection support group meetings. We are so much more than our disorders. I am joyous that you have found a recovery path that works for you. Each individual can do so and we need to foster and support that hope."

My response verbatim - Name Redacted

As always you are a great resource. I find it very interesting to hear the perspectives from other countries. I'll have to check these out.

I don't doubt the labels can and do reinforce social beliefs, including stigma. To reinforce this point, the Dutch theologian Kierkegaard says, "if you label me you negate me". I look at diagnoses is terms that are useful to describe a general predicament. Each pilgrim has there own path up the mountain. Everyone with the mental illness has to find their path to recovery. In my case, I'm grateful for my predicament. I have never encountered anything more instructive. It has led me to a greater understanding of compassion and hope. It has been beneficial in helping to support others. It's that lived experience that we talk about in peer support.

Words themselves have great limitations. For instance, the word moon, is not actually the moon. It is more like a finger pointing at the moon. As far as not being my illness, I suppose that means that I'm not a "graduate" of a masters program (2 of them actually), am not a father, or any other term that we might classify ourselves with. Again, these are merely labels.

The real substance of these labels does not encapsulate me or anyone else. It's interesting though when we

Veronica538 at work as truckdriver (Photo credit: Wikipedia)

ask people in our society what they do for a living they tend to make statements about their jobs as who they are. For instance, A person could drive a truck. How many hours a day are you a truck driver? Are you always a truck driver? At night when you lay in bed are you a sleeper as compared to a truck driver?

I am not disputing what you have to say in any way. As a matter fact I am a great believer that people should understand these terms as a general description of a circumstance. We still call people with cancer, cancer patients. But it is far from inclusive of their whole being.

I would encourage you to look at the body of my work on my blog. I try to be pretty clear in my writing and work with others that they are more than a diagnosis. These issues are more like facets on a diamond, part of the whole. I hope to continue to be able to grow in my ability to not use labels as time goes on.

When I sit next to the bed of someone who has tried to kill themselves I don't look at them as a diagnosis but instead as a human being. I don't try to tell them that I know better about their lives than they do. Most of the people that they've encountered in the mental health system have already tried that. Instead, I feel the most humane thing that can be done in these circumstances is to merely hold their hand and cry with them. In this context, I am a "friend".

So frankly, I am truly grateful for my predicament and could care less if you call me bipolar, Bill or any other label. I do realize though that for some people these terms are a great burden. So again, I would encourage you to read my work. It would be wonderful to get your feedback in areas that I can grow in. I think however that I support what you say entirely. It's just a shame that we do not have more elegant expressions.

I spend most of my life working with various professionals, doctors, lawyers, judges, and my peers (all labels by the way) to teach them to see beyond these terms. To everyone of them I suggest that a person is more than one aspect of their being. I encouraged them all to see people as people no matter the diagnosis.

I was a founding member of the Painting Pathways Clubhouse. I love the term that we use, "colleagues". But again it still a label. It just happens to be a more palatable label than mentally ill. At the clubhouse I have seen many miracles. For a group of people who were supposedly dysfunctional, I have seen us come together as a community and do things that supposedly other "normal people" can't do. Thank you for your continued work. I appreciate you.

With A Little Help From Your Friends - Peer Supported Respite

Institute of Mental Health 6, Nov 06 (Photo credit: Wikipedia)

 Introduction

"What is clear from the results is that these patients could do as well or better in a less restrictive environment," said Tom Greenfield

There is an increasing mental health crisis around the entire world. With worldwide financial resources quickly eroding many countries are running out of the ability to care for those with a mental illness. Due to this, we need to re-evaluate our practices and systems of treatment. Hospitalization, medications, and cognitive therapy may not be enough to promote psychological growth.

Logo of the National Institute of Mental Health. (Photo credit: Wikipedia)

From research done by the State Of Massachusetts, the National Institute of Mental Health, the Substance Abuse and Mental Health Services Administration shows that there is hope for increasing mental health and reduce many of the higher costs of services and treatment. Further there are articles in the American Journal of Community Psychology that cover this research extensively.

The goal is to provide a more prophylactic treatment protocol through the use of services such as peer supported respite centers. Peer supported respite centers are residential, pre-crisis and crisis facilities that are staffed by certified professional peer support specialists. According to one study from Massachusetts peer supported respite is not only cost effective but is more likely to lead to psychological growth.

Institute of Mental Health 4, Nov 06 (Photo credit: Wikipedia)

A different and less threatening environment

Respite care is different from traditional inpatient hospitalization. Most respite centers are not locked down wards. The average stay at a peer supported respite center may be longer in duration than hospitalization. This is largely possible due to lower total cost of care that consumers receive.  

The longer duration of inpatient care offers opportunities to build skills in self-advocacy, establishing good support networks, and how to deal with crisis in a safe and effective manner. These centers also allow for more time to adjust to changes in medication. This significantly helps with the side effects and allows for emotional support until therapeutic benefits are realized.

Experienced staffing

These facilities are generally staffed by professionals who have been diagnosed with mental illnesses. These people have very practical experience dealing with mental illness and recovery. They have what is referred to as, “lived experience” and have reached a meaningful level of recovery themselves. This enables them to provide very individualized care and treatment plans. Often these practitioners work closely with human service organizations and other peer supported services in the community. These relationships help to establish long term stability and to overcome problems like housing which can be a significant problem.

Respite care and the criminal justice system
Peer supported care is being looked at more often as a resource for alternative sentencing agreements for those who are involved in the criminal court process. The desired outcomes of this would be to reduce re-entry into the system, increase compliance, and reduce the cost of administering these cases. According to the federal government 61% of inmates have a significant mental illness. Often these people are not receiving adequate care even within traditional systems of mental health. It would seem that financial resources are a major contributing factor. One department of corrections director told me that to get any real change in caring for those with mental illness is to sue them. They have repeatedly asked for money to deal with the increased populations that they are mandated to treat. This problem is extended when inmates are released under community supervision.

If you consider the benefits and outcomes from peer supported respite, it is easy to come to the conclusion that a community based respite center can bring both financial and emotional relief. I encourage the leaders of our communities, counties, and states to take a serious look at this option. If we build stronger Americans, we build a stronger America. Respite centers may offer a significant resource in accomplishing that goal.

Chiropractic & Mental Illness

@chiropractic I Voted (Photo credit: planetc1)

Introduction

Chiropractic care has a broad influence on the nervous system. Although most practitioners focus on physical disorders, it is clear that good nervous system health effects emotional and psychological health. According to B.J. Palmer, the son of the man credited with the discovery of chiropractic care, dislocated cervical vertebrae has a real impact on mental health. According to my Chiropractor Ron Ziolkowoski, D.C. of the Ziolkowski Chiropractic Clinic, only 10% of the capacity of our nervous system is taken up by pain messages. The rest of the bandwidth is dedicated to healing and maintaining the body. When organs can work at their best potential which has a natural effect on the mind.

Several impatient patient programs have implemented Chiropractic adjustments for mental health care. In some of these programs Chiropractic was the primary clinical service. In 1922, The Chiropractic Psychopathic Sanitarium was one of the first in the field. Later the name of the facility was changed to Forest Park Sanitarium.

Early results were promising

English: A diagram of the Human Nervous system. Français : Schéma du système nerveux humain. (Photo credit: Wikipedia)

Early on it became quiet clear that mental health patients got better with out successive re-entry to hospitals for psychiatric  care. North Dakota Judge A. W. Ponath showed that at the North Dakota state mental hospital, the positive outcomes ranged from 18‑27%, compared to 65% at Forest Park.

In 1951, Clear View Sanitarium was purchased by the Palmer School of Chiropractic. Each day the patient was examined using a device called a “neurocalometer” (NCM). From there the chiropractic doctors looked at the results and any nerve impingement was adjusted. In addition to this there was an enhanced focus on proper patient nutrition. They often served vegetables from the garden that was grown on-site.

Impact of insurance companies on research

Both of these early organizations closed by 1961. The insurance companies of the time did not recognize Chiropractic as an evidence based treatment for mental illness. Without on-going funding was not possible to continue these institutions . In 1973, Dr. Schwartz published a report on 350 patients afflicted with mental illness.  It indicates that people with mental illness got better in a measurable way . He wrote a book, "Mental Health and Chiropractic: A Multidisciplinary Approach."  Since this time there has been Interest in this approach to helping in the physical and mental health of all patients.

If you have a mental illness it may be good practice to see your local chiropractor. Mental Illness is a disease that you can have meaningful recovery from. For all of us there is a unique path to healing. I encourage you to look at chiropractic as one tool in your arsenal.  

Mental Health "Injustice System" - Failures Criminal Rights & Just Dispositions

Introduction

If we are to temper justice with mercy,  we have to consider the individual and societal needs of forgiveness in order to soften (temper) our need for justice. This helps us assure that the punishment, if warranted, fits the crime. Today, we have systems where those with mental illnesses are charged for crimes or wrongdoings and are met with such incredibly harsh and seemingly disproportionate punishments. We do immense harm to a person's spirit and ability to overcome, repent, develop and grow from mistakes and recover. Further, we do specific harm to the basic civil and human rights of all. - paraphrased, author unknown.

As a part of the advocacy work that I do, the mentoring, and peer support, I run into a lot of people who have criminal issues. So far my experience in dealing with the criminal court systems have brought up both challenges and opportunities. One thing I can say with certainty is that it has at times been a huge disappointment.

I live in a County where there are five full-time attorneys in the District Attorney’s Office. Between them they deal with 2,500 cases a year. They’re good people who work hard for our community. Unfortunately this is one of the areas where I found some disappointment. In a meeting with the district attorney, he laid out all the things that he would not consider as being partially or wholly mitigating circumstances. The case I was involved with was abstracted and given to him so we could discuss some of the very real problems with cases like this. I’m not sure he actually read it. He is after all a very busy guy. So we never really got to the heart of the conversation.

Are we seeing these cases clearly and early?

One of the first factors that I saw in this case is that early identification and careful evaluation of the arresting officers reports should have raised a flag that this was not a criminal matter. Apparently the attorney presenting the charges to the court did not read the full statement of the arresting officer. I think in any reasonable level the probable cause that a crime had been committed was seriously in question. In fact, it may have been more appropriate to refer the matter to the adult protective service agency and/or medical professionals.

The second factor that I saw in this case is based on my experience in dealing with people who have mental illnesses. I have practical day-to-day experience with people on all levels of the spectrum and have seen major improvement in the quality of their lives and their ability to reach meaningful recovery. Facilitating this recovery is a large part of what I do. I know many the mechanics from practical experience. I feel qualified enough to say; that based on this lady’s diagnoses and my observations of her leads me to believe that her low day-to-day functioning puts her at risk. I did however feel that with the support of halfway house services, medical stabilization, helping her to build healthy support networks, she would be very likely able to stop having interactions with law enforcement. Actually, with this individual, I know I had a significant impact on the outcome of the case. I appeared in the case as a friend to the court to facilitate communications between the court and the defendant because of her significant mental illness. The significant portion of this mental illness was demonstrated by her largely disorganized thinking and varying functionality from day-to-day.

It was pretty clear to me

It didn’t take a lot of investigation to figure this out. In the arresting officer’s report, he noted some issues that clearly illustrate that mental illness may have been a mitigating factor in the crime. The arresting officer says several things specifically; that she was unable to and not unwilling to follow simple commands, that she was incoherent, and that there were large amounts of psychotropic medications visible to him. He does not mention specifically but I assume all of the medications were properly labeled and prescribed to her.

The judge asked me about my general opinion about the case. I pointed out to him that on the face of the arresting officer’s report that it was a lot more likely to be a psychological crisis than it was a crime. Apparently he agreed with me. Once back in session, the judge asked both attorneys to appear in chambers. I know basically what was said in that meeting. The judge simply asked why we were not thinking of a civil solution in this case. It would seem that both the defense counsel and the prosecuting attorney agreed immediately. The terms for a deferred prosecution agreement were discussed and settled upon.

How can someone consent to an agreement with the court if they clearly do not understand it?

English: Justice and Law Suomi: Oikeutta ja lakia (Photo credit: Wikipedia)

In the presence of the defense counsel I participated in the discussion about the deferred prosecution agreement and what it meant to her. I started to grow concerned after about 45 minutes of conversation with her. In that time she was never once able to clearly articulate and/or paraphrase what a deferred prosecution meant to her and what would be expected of her. I am not sure she understood that the prosecution of the crime would only happen if she did not follow along with the civil requirements. As a recall, she was still asking about how much jail time she was going to receive. It didn’t seem to sink in that jail time was not an issue. I think it was at this moment that her civil liberties started to erode. If she could not understand what the agreement meant she could have never consented to it. I did mention this to several parties. I also advised various parties that to reduce the likelihood of seeing her before the court again she would need more comprehensive services than were being discussed.

This is where my conversation with the judge may have had in negative impact. Since it was so easy to put a deal on the table, she was not evaluated for competency. For various reasons she was ordered to comply with state law that did not suit her needs. Because the civil solution came up so fast, any real understanding of her competency was not investigated. Due to this, I felt that the civil solution on the table was a failed solution. She perhaps did not get the care she needed to avoid re-entry into the system. Approximately one year after the first case I got a phone call from her. She had been arrested again and the circumstances were almost the same as the previous case.

If you want changes in our department sue us

There are people who complain about costs in our system. In talking with agencies like the Department of Corrections they realize this is a problem also. They are the ones having to deal with inmates with mental illness in high numbers. I had a director of one such department that flat out told me the only way to affect changes in our organization is to sue us. This is because they lacked funds and resources for treatment.

There are evidence-based solutions that are highly effective. The use of peer support can contribute as part of the answer. Peer support specialists are much more cost-effective and have better percentages of reimbursement rates for their services. Along with this more intermediary respite care facilities are required. Current admission standards for mental illness generally requires that a person say that they have a plan and intention to kill themselves. I think more investigation and research by the criminal justice system needs to be done in this area as viable methods to reduce re-entry are available and these programs are financially prudent.

Training is an important issue also. The need for more training for officers in crisis intervention may help to resolve issues without arrest. It might help identify mental health crisis as compared to criminal intent. I believe that lawyers need better education about evaluating competency. Traditionally, not guilty by reason of mental defect or insanity is almost impossible to make a case for. Competency to assist in defence should be clear if the person can’t understand what they are agreeing to. Lawyers could have a better understanding of what a successful disposition looks like given the balance between justice and civil liberties. Hopefully  this will broaden the defenses that are available.

Change is needed and can be done

An American judge talking to a lawyer. (Photo credit: Wikipedia)

It would seem that the civil and criminal liberties that we all enjoy as citizens are desaturated for those with significant mental illnesses. Insight on this factor comes not only from this case, it also comes to us right from the jails and prisons themselves. The Bureau of Justice statistics reports that says 61% of state prisoners have a mental illness, jails have a rate of 41% of inmates with mental illness. In general our population has about 5% of people who have diagnosable severe mental illnesses in any given year. As an example, our County has around 80,000 people. This suggests that 4000 people in our community have major psychological problems. Considering the high numbers of people with mental illness in the justice system, how many of these cases are being misidentified? How many cases are we missing? Also, what can we do with these people anyway? For many states and counties the resources are very restricted. There are cost-effective and effective recovery methods and resources that can be developed and tend to reduce re-entry into the system. With some willingness, people with mental illnesses can receive the benefit of justice tempered by mercy.