SUBJECT: MENTAL ILLNESS
PURPOSE: This briefing note is a recommendation for changes in policy pertaining to mental illness.
ISSUE: There is not enough action to absolve those who recover from mental illness.
Background:
Mental illness is an issue of contention in the modern society. Mental illness occurs because of a variety of factors, it could be trauma- psychological, it could be predisposed via genetics- biological, or it could even be a result of the environment. Regardless of whatever the causation of such illness, these people are stigmatized by the society as a result of their diagnosis. Such labelling causes much pain and alters the trajectory of their life. People with mental illness, live on a day-to-day basis where they are constantly under scrutiny for their behaviors and actions. It is such scrutiny that causes the pain and suffering that these people experience. Although they experience this, it is necessary to understand that these peoples experience can be valuable, and their insight can certainly help the society understand how to mitigate and manage the illness and the recovery from the illness. Specifically, what is concerning for people that live with mental illness, is the fact that modern Medicine keeps these people in medicated therapy their entire life after the initial onset of the illness. In a bid to prevent relapse, Medicine aims to continue the therapy long after signs and symptoms are addressed. This results in a tort. A tort can be defined as an injury or harm to another person. Although many of the cases of mental illness are likely not reversable, there are some mental illnesses that people recover from. It is the mental illness that is caused by trauma or stress from a situation, circumstance or scenario that can be reversable. Once the stimuli for trauma has been removed, and the individual is treated by the medical practitioner, some people recover from the illness. However, the Ministry continues to label these people with an active diagnosis of mental illness regardless. This is a form of false imprisonment. False imprisonment can be defined as a state of being imprisoned without legal authority. It is true that the medical community has legal authority however, the flaw in it is the fact that some people want to get off of therapy, some people have recovered and are able to prove their recovery, prolonged use of the therapy causes residual effects as Diabetes (prescriptions of Seroquel or Olanzapine) or Parkinson’s (Risperidone), some therapy causes side effects such as obesity, drowsiness and sedation, some therapy serve as a method to subordinate another and some therapy serve as an emotional reminder of the stigma annotated to the diagnosis thus causing more stress and people that are diagnosed experience character degradation. From Medicines perspective, these are all forgone in an effort to avoid relapse. However, what is clear here is that the mentioned are legal flaws by which undermines the individual capacity of the person diagnosed in their bid to make their own decision about directing their own medical care. What Medicine says is that as long as the individual is not a harm to himself or others, he or she can be in a position that is not restrained by the medical system.
Considerations:
The issue with mental illness is stigmatization and the lack of a proactive method by which those that want to be taken off of therapy can undertake. Most practitioners advise against discontinuing therapy as they feel that it is in the best interest of the patient to do so. They act according to what they have been educated and what they have observed and treated in people who have experienced mental illness in their practice. They act in a scientific way to prevent their patients from an exacerbation of the signs and symptoms. However, science used does not always explain the actual phenomena. They act based on demographic data that they have obtained in medical literature and statistics. It is these statistics and data that speculate and create normativity which serve as a standard in the medical community for treatment. A person experiencing a mental illness is reduced to a statistic, a representation of what has been observed in the society and not an individual with a unique problem and causation for their illness. Physicians attempt to understand based on their observations at the time of an appointment however, what they do not understand is the fact that they are acting in a manner that lacks the actual and real experience of the illness if any and thus in lieu of that they attempt to use statistics and theories to explain a potential health problem the individual is experiencing which then results in a lack of empathy or actual concern for the real problem of the individual. This then results in misdiagnosis or a treatment which is not suitable or a prognosis which does not reflect the actual recovery period of the individual. The problem that Medicine has is the fact that they diagnose these mental illness based on probability and speculation and not the actual experience of the individual. Oftentimes the individual getting diagnosed gets discredited in the attempt to scrutinize the health and wellbeing. Practitioners often tell their patients that he or she won’t be able to explain or observe their own “illness” so they can proceed with treatment. They do this to act on the individual bias of the individual which they see as an implication to impartiality. They also do this so they can obtain observations from others to get a clear picture of phenomena. These "witnesses" also are unaware of the actual problem of the individual and attempt to use their experience of what they observed in their lives to explain the signs and symptoms of the person being diagnosed. Sometimes said observations have no clinical basis other times these observations are a result of ignorance. As a matter of fact, perception and memory is not always accurate, there are studies (National Public Radio) which say that memory “[is] an act of reconstruction, or what [may be called] "mental paleontology."” The fact that the patient is being scrutinized by the physician creates a preconceived notion within the witnesses and thus it results in an injustice to the patient. Therefore, the only people that can actually determine matter of fact is the physician and the patient in question. Physicians in their effort to address the presenting signs and symptoms proceed with interventions that are theory based. A theory is a system of ideas intended to explain something, in this case a mental illness. In fact, the APA American Psychological Association says, “professional mental health practitioners’ reasoning about mental disorders appears to be theory-based” and that their study claims that “clinicians’ concepts of mental disorders are actually quite theory-based rather than theory-neutral.” This means that the diagnosis of mental illness is based on theories observed within a population wherein a generalized theory was conceived to explain the phenomena thus, the APA in their study says, “clinicians’ concepts of mental disorders are not merely statistical correlations of symptoms.” Therefore, what a mental illness is with respect to the foregoing is that it is a theory and a statistic. The flaw here then is the fact that an individual is unique, and his or her experience could potentially be contrasted from the statistic. Medicine justifies their diagnosis based on their scientific observations within the population in combination with the clinical presentation of the person in question where then they attempt to categorize the person according to theories. What happens when an individual presents himself to a practitioner in a doctors appointment is the fact that he or she is observed and he or she is prompted to divulge his or her health issues. It is true that doctors attempt to individualize the illness during such appointment however, there are more factors that involve mental illness. A person during an appointment provides a fractional representation of the cumulative experience of their life. Mental illness is caused by many factors and through such appointment, all considerations cannot be possibly conveyed, which is why another approach to diagnosis should be considered. The fact that not all considerations are examined, results in a misdiagnosis and a prognosis that does not reflect the actual recovery period thus keeping the individual at a state by which he or she is compelled to take therapy indefinitely. A person is a representation of holistic health. A person’s wellbeing is based on physiological, psychological, economical, social and environmental factors. These should be considered when treating an individual.
For example, a person presenting with what seems to be psychosis goes for an appointment to a doctor. The doctor conducts his assessment with the patient and the witnesses who have a preconceived notion and bias of illness. The physician than verifies that it is psychosis and he or she proceeds to treat the individual with therapy. What is clearly a violation of the individuals rights is the fact that the physician didn’t do his due diligence by investigating the actual cause of the illness. With the consideration that if such stress inducting stimulus is removed, the individual can recover. In this case the stress inducing stimulus was the fact of poverty. And such poverty caused the individuals self-worth to be drastically reduced resulting in being mistreated and an eventual assault and battery. There are two potential causes here, the poverty and the assault/ battery. It is clear that people receiving support from the Ministry of Social Development and Poverty Reduction are prone and at risk for mental illness. It is also evident that an assault/ battery can result with an individual experiencing low self worth. The main factor here is the stimulus of stress. The Ministry provides higher rates in the form of disability to avoid further deterioration. Hospitals provide care to treat the assault/ battery. There are also programs which aim to give victims support, such is the case with the Crime Victim Assistance Program. However, these supports only aim to address a “real and substantial risk to danger”. Which essentially means a direct risk to your person. Therefore, intervention does not look at other factors such as economics, social and the environment. By providing people with post-secondary options rather than just focus groups which serve as a constant reminder of trauma, such program as the Crime Victim Assistance Program can alleviate this. It would remove the stimulus but would also place the individual in a new environment wherein he or she can make new social relations and improve economic standing for the future. Perhaps there should be integration of the Student Aid Program with such programs as the CVAP program and the Income Assistance and Disability Assistance Program. The point here is that the individual is holistic, and causation should be determined by the physician. Such method of not determining causation is negligent and causes a recurring harm to the patient.
According to data collected by the National Alliance on Mental Illness “20.6% of U.S. adults experienced mental illness in 2019 (51.5 million people).” According to the National Institute of Mental Health 1 in 5 adults experienced mental illness in 2019. Specifically the annual prevalence of such mental illness are as follows: “Major Depressive Episode: 7.8% (19.4 million people); Schizophrenia: <1% (estimated 1.5 million people); Bipolar Disorder: 2.8% (estimated 7 million people); Anxiety Disorders: 19.1% (estimated 48 million people); Posttraumatic Stress Disorder: 3.6% (estimated 9 million people); Obsessive Compulsive Disorder: 1.2% (estimated 3 million people);Borderline Personality Disorder: 1.4% (estimated 3.5 million people).” Mental illness has a ripple effect such that those that experience it are prone to other situations or conditions by which exacerbate their signs and symptoms. Individuals with depression have a 40% higher risk of developing a cardiovascular and metabolic diseases; people with mental illness are likely to have a dual diagnosis; people with mental illness are likely to experience addiction; people with mental illness experience unemployment and the rate is higher amongst this population; high school students with depression are twice as likely to drop out and; students aged 6 – 17 with mental illness are three times more likely to repeat a grade. It becomes clear that the data provided by the National Alliance on Mental Illness provides insight on the situation, circumstance, or scenario’s of those experiencing mental illness. What needs to occur here are affirmative program changes and government reform to be able to address such matters as actual causation and interventions and the labelling of the mental illness from “active” to “inactive.”
Options:
Option 1: Obtain post-secondary education and integrate the Student Aid program to CVAP and Ministry of Social Development and Poverty Reduction.
The feasibility of this option is very high. However, changes to the legislation pertaining to the provisions of programs such as crime victim support and income/ disability assistance must occur. Post-secondary education acts as a social leveler allowing people to be able to change their situation in the distant future. By promoting post-secondary education, it directly affects the scenarios the individual experience by bringing them to a new environment in which he or she can participate in new social relations. Further, the circumstance changes through changes in action, rather than being out in the community and being vulnerable as a result of potential causations such as poverty, the student can act to rectify such vulnerability through studying rather than participating in risk activity. By working to address the vulnerability of these people, they can begin to work on their self-worth which would essentially bring them to better scenarios for support. This option gives people equity, as it serves to improve the overall situation of the citizen. It gives them the tools needed to attain success within any conventional society. This is the least sustainable option because it would require a lot of changes to existing programs however, it is the option that is the most beneficial for people. This option is accountable as it addresses the situation, circumstance or scenario through the theory of holistic health thus providing the citizen with safety by addressing risks and vulnerabilities directly. This option is the most sustainable, as these people have valuable insight which can result in government services that are more efficient and resilient.
Option 2: Reassess after five years and then as necessary from the onset for change of status of “active diagnosis”.
This is very feasible; however, it would require cooperation with the Ministry of Health. By labelling mental illness as “active” or “inactive” it allows people to continue to live their lives and it places them in a situation whereby they can operate unhindered by the stigma. In addition to this option however, a protocol for the management of the stigma must be created. If the medical industry knows how to give such label to its patients, don’t you think that it is also their responsibility to find the solution to their labeling as to prevent the pain and suffering caused by a constant vilification of the person’s being as a result of the stigma an effect of the diagnosis? The stigma of mental illness can be rectified and recovery is a method by which interventions can be implemented to adjust the negative public perception that the individual is constantly experiencing. This option would give the person whom is labeled, equity as they adjust to returning to a “normal life.” From the perspective of security, this choice promotes a reassessment after five years from the onset. This option thus is accountable as it continues to monitor the patient for a duration in which provides concern.
Option 3: Promote client – doctor communication and consider possibility of discontinuing therapy.
This option is the least feasible as doctors are not inclined to discontinue therapy. However, a method should be devised to safely discontinue therapy for those that have gone through the proper channels to prove their recovery. This is where the therapeutic use of alcohol such as wine can benefit the discontinuation of psychotropic drugs. By using alcohol as a complementary medicine, it would give alcohol a new role in the medical field. Alcohol serves as a method by which the side effects of discontinuation can be reduced. Such side effects are not limited to insomnia, reduced appetite and feelings of worry (i.e.. what if discontinuation results in relapse). It serves as a bridge by which patients can return to some form of normalcy. However, it is also a concern that mental illness can be tied to addiction, therefore practicians must heed caution. This gives those eligible for discontinuation of therapy equity as it would prevent the above noted legal flaws from causing further harm. It would also give these individuals the ability to manage their health. This is the most inclusive option as it serves to reintegrate people into society.
Option 4: Permit physician access with the direction of a Social Worker to such relevant programs as CVAP and Ministry of Social Development and Poverty Reduction by amending the legislation of Freedom of Information and Protection of Privacy Act and Privacy Act.
This is not very feasibility however it would require cooperation with various agencies of the government. This option would require systemic amendments to the above noted legislation which would require support from various political parties. The public acceptability for this option is very low. People do not want changes to privacy and there is massive pushback as was evident when the Liberals attempted to change privacy laws related to electronics. This option however, is very accountable to the patient as it serves as a method by which the causation of the mental illness can be explored in great detail ,through looking at the individuals situation, circumstance and scenario via the holistic lens, all of which are considerations to factors resulting in mental illness.
Option 5: Status quo.
This option is the most feasible however, it would result in the continual injustice to those that are eligible for recovery. This option however, would result in minimized risks and vulnerabilities to the society and to the individual. Selecting this option keeps a large part of the community marginalized however, and it serves to continue a health care system that is not in the interest of the patient diagnosed with a mental illness by keeping them in a state of false imprisonment.
Recommendation:
Option one and option two are recommended.
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