Mental health in general in the US (and around the world) is poorly understood. Pop-psychology spreads myth, misinformation, and disinformation and Big Pharma preaches advancements in medication over advancements in therapy and counseling models. Money talks, and no one can argue with Big Pharma in this arena. Unless you are a professional in the field of mental health or a client or friend or family member of one, most people don’t care to know how the sausage gets made in terms of keeping ‘mentally ill’ people under control, and even fewer people care whether keeping them under control is an actual solution to the very real problems they face.
I’ve been living in a mental health institution for the last 2 years, and have been in the public mental health system practically from birth. We’re deemed scapegoats of the society, like criminals and often treated just as bad or worse. This society only knows itself by creating false dichotomies: classifying ‘these people’ as mentally ill, and ‘these people’ as not, based on a somewhat circular logic which allows for the unfair division of resources and diversion of those resources to those who are deemed ‘able’ to use them.
The way the authorities tell the difference between the 2 groups is way too often archaic and systemically discriminatory, and mental health has become so enmeshed with the criminal justice system so as to almost become indistinguishable from it at the Public level. Society needs people on the bottom so that others can be on top. Wish it were otherwise.
In some way we treat mental patients even worse then prisoners. Prisoners don’t get medicated against there will.
Being inside the system I expect you to understand it well. Given the suggestion in other comments that the problem might be due to a lack of obvious policy proposals it would be valuable to have easy to understand proposals. Do you have one? I think it would be valuable to have it spelled out.
Policy regarding research needs to be changed before making policy changes in distribution of care will make much of a difference overall IMHO. There is already a ton of infrastructure—human, physical and financial—in place to offer the services that are available; many types of policy changes to the offerings of care itself can be made. However there are serious areas of need not being met, and it still seems regardless of who’s in power at this point in time, strides in this regard are unlikely to be made without serious reconsideration of societies approach to it’s priorities.
Longer answer:
One of the main reasons has little to do with the Mental Health Care system per se, but rather how it is integrated (or not) into the broader society. The concept of Community Mental Health Care sounds good in theory, but in practice it still focuses primarily on individuals with ‘mental disorders’ as being the problem instead of understanding and making changes to how the community (or society) functions when it fails these people.
In my opinion Mental Disorder is a problem caused by something like a misaligned community and/or society, and people with mental health disorders are victims of neglectful or harmful aspects of their Communities or Society. Treating their symptoms does nothing to fix the underlying systemic issues causing the symptoms or problems in the first place. Without knowing where or how to make the changes, the problems are just shifted from one part of society to another.
Another aspect of this issue involves the distribution of goods and services both in this country and around the world, as Public Health Care becomes a reinvigorated topic of consideration domestically. Consider the fact there are serious differences between Public and Private Mental Health Care. Should Public Mental Health Care be as good as Private Mental Health Care even though it’s clients are poor and the government is paying for it? Or should Public care be less effective because it is provided ″for free” by the government? Or is it possible like many things in this country, we pay way more for goods and services than other countries do?
Pharmaceuticals are an easily accessible case in point. For example: If we can afford to give half a billion doses of COVID vaccine to poor countries, why can’t I as an American Citizen in the Public System, get the type of mental health care I need? The money to buy those doses going to other countries could fund the type of therapy I need to heal my severe PTSD, but instead I don’t receive appropriate care because the money isn’t available. Why is it the needs of poor people in other countries are often times prioritized over the needs of poor Americans?
This is the type of political reality many people with ill intentions latch onto, and weaponize in political discussions. Which makes having rational conversations about issues like that difficult and tends to have the effect of focusing on that one aspect to the detriment of the rest of the conversation that should be taking place. It can become a ‘can’t see the forest for the tree’ problem. So many people with good intentions avoid the conversations altogether in the belief it’s a Pandoras Box.
That doesn’t change the fact that there are a lot of conversations not happening at high levels I’m sure, that should, because they involve what would be considered unpopular opinions. These topics are ignored and backgrounded because they don’t test well with the audience, but this doesn’t change the fact that they are real issues. It just means it’s taboo to talk about them or attempt to find solutions to the problems they are associated with. Politics is the mind killer.
The fact is the Mental Health Care Cultureis in crisis because it is overloaded and under-equipped to deal with the overwhelming nature of the issues.
More workers won’t make a significant difference if they aren’t trained well and good training is hard to get because many of the old models don’t work like we were told they do; this is where too often things like over reliance on medication leaves clients/patients without access to any type of effective counseling, therapy or support. While medication can improve counseling and therapy, it is not a replacement for counseling and/or therapy, yet in an overwhelming number of cases this is the reality. The thinking goes along the lines “Something is better than nothing.” I’ve often found this results later on in “Too little too late.”
Some old models work but need updated or potentially rolled back; this is where I believe alcohol and drug addiction treatment needs to be separated from mental health care treatment, as they are both 2 very different treatment modalities (or should be) yet in the name of government ‘efficiency’ they were collapsed into one department within many state governments a few decades back. What used to be treated as 2 separate issues by 2 different departments with 2 different treatment modalities became 1 badly integrated governmental department with a ‘1 size fits all’ approach to whatever ails you. Add in the further unskillfull integration of the Criminal Justice and Public Legal Systems into this community which is in constant crisis, and what we have is a horrific tragedy which keeps unfolding over time which no one takes responsibility for or is able to effectively influence in a positive way.
Additionally, some models of treatment need to be dropped entirely while others need to be created to repair the damage done by the models which did more harm than good. Gay conversion therapy is an example of what I’m talking about here; programs like these functioned with government oversight and federal funding and the amount of damage caused was and is tremendous. Treating the victims of treatment like this is a specialty service that didn’t exist until there was a recognized need for it.
There are still programs in this vein that need to be terminated and replaced with effective treatments, and there are many victims who still suffer because their suffering isn’t yet recognized. Quite often these are men and boys, and in a Schizophrenic society like the US, society can’t figure out whether they are victims or perpetrators. If we try to consider them both, and even think about affording them the care and support they need to heal from their victimization, we’re afraid our heads will explode because we’re also trying to punish them for being perpetrators at the same time. Our system is a punitive system, and is the major underlying flaw of Western Tradition from my current perspective. Still trying to write about this.
Given the pace of change across the board, from changing peoples minds, to changing their habits, to changing the physical environment they inhabit, making bad calls in policy changes has the result of wasting massive amounts of resources and causing massive amounts of suffering. I won’t go into why now, but, comprehensive re-examination of the research done in the decades leading up to our current time needs to be done using better tools and methods with our newer understandings before things will change much for the better. I’m not offering quick solutions, just more comprehensive and potentially effective ones.
This process would be complicated and multi layered, but necessary to re-frame and re-integrate new understandings into older but correct models and scientific frameworks, and to create new frameworks based on better understanding of the consequences of the mistakes of the past. Outdated, polluted and biased data can lead to polluted information, polluted information can lead to polluted knowledge bases, these in turn lead to polluted decisions regarding policy changes which muddy the waters instead of clearing them up.
We’re at a cross roads in Western Society; we are laying a new technologically advanced foundation for the future on a shaky foundation of pre-digital knowledge, wisdom and understanding. I’m suggesting we shore up the foundations of Western Society culturally before we attempt to keep building upwards. The Psycho-Socio-Econo-Tectonic plate system of the world wide cultural subconscious is full of faults, and the if we don’t understand them well, they’ll be our downfall whether we do it ourselves or engineer AGI to do it for us intentionally or unintentionally.
This is why my money is on better research being the key. Getting politicians to pay attention to these concerns is another matter, and as we’ve seen with the public response to the COVID Pandemic, even when the research is done, and the majority of the government is on board, disseminating and assimilating good solutions into society in a positive way is often a huge struggle. This issue of Cultural Lag is a constant thread that runs throughout any type of positive change in society. Which is why I’m still working on a model of Social Physics.
For example: If we can afford to give half a billion doses of COVID vaccine to poor countries, why can’t I as an American Citizen in the Public System, get the type of mental health care I need? The money to buy those doses going to other countries could fund the type of therapy I need to heal my severe PTSD, but instead I don’t receive appropriate care because the money isn’t available.
Developed nations can’t afford not to give a lot of COVID vaccine doses to poor countries. Not giving poor countries vaccines means giving COVID-19 more opportunity to mutate and cause a new wave in developed countries.
The cost of a new wave in a country like the US is so high that it makes a lot of sense to prevent it buy giving poor countries vaccines.
Why is it the needs of poor people in other countries are often times prioritized over the needs of poor Americans?
Americans whether poor or rich need poor people in developed countries to take vaccines. Pandemic prevention doesn’t work if you don’t think globally and fight viruses where ever they are. Fighting viruses while they are in foreign lands with vaccines is similar to send the military to foreign lands to prevent people from attacking your homeland and generally there’s much more money wasted in military for preventing foreign threads then in public health.
In general the US spends a lot less on foreign aid that most people assume and a lot of the money it does spend gets spend for geopolitical aims such as paying off the Egyptian millitary for accepting Israel as a state.
Josh is unable to post at this point, but here’s his response:
Developed nations can’t afford not to give a lot of COVID vaccine doses to poor countries. Not giving poor countries vaccines means giving COVID-19 more opportunity to mutate and cause a new wave in developed countries.
Short answer:
I’m in agreement with the intention of this thinking 100%; being a responsible world leader includes taking responsibility for helping poorer countries in instances like this. I disagree with how those intentions are realized at times however. America has limited resources despite acting like we don’t. When we still struggle as much as we do with poverty, hunger, and poor health care domestically, I believe it’s ethical to question spending on health initiatives in other countries.
Mental health in general in the US (and around the world) is poorly understood. Pop-psychology spreads myth, misinformation, and disinformation and Big Pharma preaches advancements in medication over advancements in therapy and counseling models. Money talks, and no one can argue with Big Pharma in this arena. Unless you are a professional in the field of mental health or a client or friend or family member of one, most people don’t care to know how the sausage gets made in terms of keeping ‘mentally ill’ people under control, and even fewer people care whether keeping them under control is an actual solution to the very real problems they face.
I’ve been living in a mental health institution for the last 2 years, and have been in the public mental health system practically from birth. We’re deemed scapegoats of the society, like criminals and often treated just as bad or worse. This society only knows itself by creating false dichotomies: classifying ‘these people’ as mentally ill, and ‘these people’ as not, based on a somewhat circular logic which allows for the unfair division of resources and diversion of those resources to those who are deemed ‘able’ to use them.
The way the authorities tell the difference between the 2 groups is way too often archaic and systemically discriminatory, and mental health has become so enmeshed with the criminal justice system so as to almost become indistinguishable from it at the Public level. Society needs people on the bottom so that others can be on top. Wish it were otherwise.
In some way we treat mental patients even worse then prisoners. Prisoners don’t get medicated against there will.
Being inside the system I expect you to understand it well. Given the suggestion in other comments that the problem might be due to a lack of obvious policy proposals it would be valuable to have easy to understand proposals. Do you have one? I think it would be valuable to have it spelled out.
Short answer:
Policy regarding research needs to be changed before making policy changes in distribution of care will make much of a difference overall IMHO. There is already a ton of infrastructure—human, physical and financial—in place to offer the services that are available; many types of policy changes to the offerings of care itself can be made. However there are serious areas of need not being met, and it still seems regardless of who’s in power at this point in time, strides in this regard are unlikely to be made without serious reconsideration of societies approach to it’s priorities.
Longer answer:
One of the main reasons has little to do with the Mental Health Care system per se, but rather how it is integrated (or not) into the broader society. The concept of Community Mental Health Care sounds good in theory, but in practice it still focuses primarily on individuals with ‘mental disorders’ as being the problem instead of understanding and making changes to how the community (or society) functions when it fails these people.
In my opinion Mental Disorder is a problem caused by something like a misaligned community and/or society, and people with mental health disorders are victims of neglectful or harmful aspects of their Communities or Society. Treating their symptoms does nothing to fix the underlying systemic issues causing the symptoms or problems in the first place. Without knowing where or how to make the changes, the problems are just shifted from one part of society to another.
Another aspect of this issue involves the distribution of goods and services both in this country and around the world, as Public Health Care becomes a reinvigorated topic of consideration domestically. Consider the fact there are serious differences between Public and Private Mental Health Care. Should Public Mental Health Care be as good as Private Mental Health Care even though it’s clients are poor and the government is paying for it? Or should Public care be less effective because it is provided ″for free” by the government? Or is it possible like many things in this country, we pay way more for goods and services than other countries do?
Pharmaceuticals are an easily accessible case in point. For example: If we can afford to give half a billion doses of COVID vaccine to poor countries, why can’t I as an American Citizen in the Public System, get the type of mental health care I need? The money to buy those doses going to other countries could fund the type of therapy I need to heal my severe PTSD, but instead I don’t receive appropriate care because the money isn’t available. Why is it the needs of poor people in other countries are often times prioritized over the needs of poor Americans?
This is the type of political reality many people with ill intentions latch onto, and weaponize in political discussions. Which makes having rational conversations about issues like that difficult and tends to have the effect of focusing on that one aspect to the detriment of the rest of the conversation that should be taking place. It can become a ‘can’t see the forest for the tree’ problem. So many people with good intentions avoid the conversations altogether in the belief it’s a Pandoras Box.
That doesn’t change the fact that there are a lot of conversations not happening at high levels I’m sure, that should, because they involve what would be considered unpopular opinions. These topics are ignored and backgrounded because they don’t test well with the audience, but this doesn’t change the fact that they are real issues. It just means it’s taboo to talk about them or attempt to find solutions to the problems they are associated with. Politics is the mind killer.
The fact is the Mental Health Care Culture is in crisis because it is overloaded and under-equipped to deal with the overwhelming nature of the issues.
More workers won’t make a significant difference if they aren’t trained well and good training is hard to get because many of the old models don’t work like we were told they do; this is where too often things like over reliance on medication leaves clients/patients without access to any type of effective counseling, therapy or support. While medication can improve counseling and therapy, it is not a replacement for counseling and/or therapy, yet in an overwhelming number of cases this is the reality. The thinking goes along the lines “Something is better than nothing.” I’ve often found this results later on in “Too little too late.”
Some old models work but need updated or potentially rolled back; this is where I believe alcohol and drug addiction treatment needs to be separated from mental health care treatment, as they are both 2 very different treatment modalities (or should be) yet in the name of government ‘efficiency’ they were collapsed into one department within many state governments a few decades back. What used to be treated as 2 separate issues by 2 different departments with 2 different treatment modalities became 1 badly integrated governmental department with a ‘1 size fits all’ approach to whatever ails you. Add in the further unskillfull integration of the Criminal Justice and Public Legal Systems into this community which is in constant crisis, and what we have is a horrific tragedy which keeps unfolding over time which no one takes responsibility for or is able to effectively influence in a positive way.
Additionally, some models of treatment need to be dropped entirely while others need to be created to repair the damage done by the models which did more harm than good. Gay conversion therapy is an example of what I’m talking about here; programs like these functioned with government oversight and federal funding and the amount of damage caused was and is tremendous. Treating the victims of treatment like this is a specialty service that didn’t exist until there was a recognized need for it.
There are still programs in this vein that need to be terminated and replaced with effective treatments, and there are many victims who still suffer because their suffering isn’t yet recognized. Quite often these are men and boys, and in a Schizophrenic society like the US, society can’t figure out whether they are victims or perpetrators. If we try to consider them both, and even think about affording them the care and support they need to heal from their victimization, we’re afraid our heads will explode because we’re also trying to punish them for being perpetrators at the same time. Our system is a punitive system, and is the major underlying flaw of Western Tradition from my current perspective. Still trying to write about this.
Given the pace of change across the board, from changing peoples minds, to changing their habits, to changing the physical environment they inhabit, making bad calls in policy changes has the result of wasting massive amounts of resources and causing massive amounts of suffering. I won’t go into why now, but, comprehensive re-examination of the research done in the decades leading up to our current time needs to be done using better tools and methods with our newer understandings before things will change much for the better. I’m not offering quick solutions, just more comprehensive and potentially effective ones.
This process would be complicated and multi layered, but necessary to re-frame and re-integrate new understandings into older but correct models and scientific frameworks, and to create new frameworks based on better understanding of the consequences of the mistakes of the past. Outdated, polluted and biased data can lead to polluted information, polluted information can lead to polluted knowledge bases, these in turn lead to polluted decisions regarding policy changes which muddy the waters instead of clearing them up.
We’re at a cross roads in Western Society; we are laying a new technologically advanced foundation for the future on a shaky foundation of pre-digital knowledge, wisdom and understanding. I’m suggesting we shore up the foundations of Western Society culturally before we attempt to keep building upwards. The Psycho-Socio-Econo-Tectonic plate system of the world wide cultural subconscious is full of faults, and the if we don’t understand them well, they’ll be our downfall whether we do it ourselves or engineer AGI to do it for us intentionally or unintentionally.
This is why my money is on better research being the key. Getting politicians to pay attention to these concerns is another matter, and as we’ve seen with the public response to the COVID Pandemic, even when the research is done, and the majority of the government is on board, disseminating and assimilating good solutions into society in a positive way is often a huge struggle. This issue of Cultural Lag is a constant thread that runs throughout any type of positive change in society. Which is why I’m still working on a model of Social Physics.
Developed nations can’t afford not to give a lot of COVID vaccine doses to poor countries. Not giving poor countries vaccines means giving COVID-19 more opportunity to mutate and cause a new wave in developed countries.
The cost of a new wave in a country like the US is so high that it makes a lot of sense to prevent it buy giving poor countries vaccines.
Americans whether poor or rich need poor people in developed countries to take vaccines. Pandemic prevention doesn’t work if you don’t think globally and fight viruses where ever they are. Fighting viruses while they are in foreign lands with vaccines is similar to send the military to foreign lands to prevent people from attacking your homeland and generally there’s much more money wasted in military for preventing foreign threads then in public health.
In general the US spends a lot less on foreign aid that most people assume and a lot of the money it does spend gets spend for geopolitical aims such as paying off the Egyptian millitary for accepting Israel as a state.
Josh is unable to post at this point, but here’s his response:
Short answer:
I’m in agreement with the intention of this thinking 100%; being a responsible world leader includes taking responsibility for helping poorer countries in instances like this. I disagree with how those intentions are realized at times however. America has limited resources despite acting like we don’t. When we still struggle as much as we do with poverty, hunger, and poor health care domestically, I believe it’s ethical to question spending on health initiatives in other countries.