New Project Takes Center Stage

John M. Hood III

As Public Policy Coordinator of the California Network of Mental Health Clients, I have become acutely aware of the lack of client perspectives concerning controversial issues within our own ranks. Legislation moves quickly, so I don’t have the time or the money to have a TELECONFERENCE for every bill on which a NETWORK designee must take a stand during State government proceedings. Currently, client consensus on their dislike of “involuntary commitment,” the need for financial enhancement of the client population, and a desire for user friendly treatment options have been some of my best resources for action. To help solve this problem of not having a wide range of clear objectives which represent client views, the Public Policy Program in conjunction with Self-Help, Minority Issues, and the CNMHC Board of Directors has begun a several year project to put together a book of Position Papers. To be truly useful, this huge undertaking will need the participation and input from hundreds of clients throughout California.

The first two topics, which seemed good places for clarification to begin, are:

1. “Do clients believe mental disorders are neurobiological diseases” and
2. “In the context of crime, how are law and mental health diagnosing and treatment to be separated? Or should they?”

With Question (A), I personally know of many clients who are very offended by the notion that they have a “broken brain.” They feel that environmental factors played the key role in any psychological difficulties that may have led to treatment or disability. I continually hear complaints from people receiving psychiatric “care” in the mental health system that there is nothing wrong with them and that are they being abused. At the same time, others run to the nearest neurologist looking for a reason for their problems. Large amounts of scientific research statistically finds some genuine correlation to heredity, pre-natal viral infection, and brain chemistry as possibly accounting for many types of differences between so-called mentally disordered people and “normal” people other than tumors and lesions in the brain. This gives the medical model real credence which can’t be ignored. Today, this latter perspective is so dominant that government documents are actually using terms like “neuropsychosocial” instead of “psychosocial,” which some clients may feel treads on sacred ground. Question A opens a “whole can of worms” for family members who want anything to be the cause of “mental illnesses” but parenting.

As soon as politics enters the picture the position taken by clients becomes very problematic. A bill was introduced this year in the California State Legislature which would have not paid for some psychiatric treatment unless it was “identified ... as severe, biologically based mental illness.” Supporting the medical model in this case leaves the door open for two people with identical symptoms and behaviors to potentially have “fail proof” DNA tests administered to them with one ending up having medical coverage and other homeless without any benefits. Considerable objection could easily be raised against allowing some future, routine blood-work be the defining feature of mental illness which decides who gets help and who doesn’t. Even clients who abhor the notion of linking biology and mental health laws might consider it politically expedient to do so when they consider how our society feels about people growing up in the clearly terrible living conditions. We see this publicly sanctioned callousness towards people with environmentally traumatic life situations being shown no favors in courtrooms, welfare offices, and on television continually. A genuine client perspective on neurobiological diseases is very important if as a group we want laws and language usage to represent how we feel about ourselves and still be realistic.

This leads to Question B where the criminal justice system is directly involved or tragedy with very serious repercussions could have been averted through intervention. Suppose, a person gets so delusional that he or she kills someone because the radio tapped into their brain so the world would be saved. This leads to Question B where the criminal justice system is directly involved or tragedy with very serious repercussions could have been averted through intervention. Suppose, a person gets so delusional that he or she kills someone because “the radio tapped into their brain so the world would be saved.” Do clients feel prison or a psychiatric hospital is the proper place for the murderer? Some clients who are merely suicidal risks because they’re depressed may object to sharing the same room with a murderer, even if it’s two years after the act and he or she has been stabilized on medication and doing well. “Legal Insanity” as a defense is not applied in all 50 states of the U.S. and jails are being used more and more as “Insane Asylums” where much forced drugging occurs.

In the example just given of the “radio telling” a person to kill: What if you were informed of their plan to murder, knew he or she had just quit taking their medication, and that the individual was clearly “flipping-out.” Even if after all your efforts to personally give support and encourage a psychiatric appointment didn’t work, you didn’t tell anyone who would intervene due to your desire not to participate in “involuntary commitment,” would you partially be to blame when the murder occurs. Should someone who has lost touch with reality and has no idea of right and wrong be held fully responsible? Many Americans feel that if people with psychological problems are informed that they will be held fully accountable for any illegal act they do, they will seek mental health treatment and crime will decrease. This is a very difficult question for clients, since the Client Self-Help Movement stresses high morals, not going behind the backs of their peers, and limiting involvement with formal psychiatry. The betrayal of trust among clients and survivors is considered about the “greatest heresy.”

Voluntary “Diversion” into the mental health system for minor crimes is becoming a big topic in current legislation but could elicit mixed feelings. On the surface this type of handling of clients seems attractive and has many supporters, since prison is not a very conducive place for personal growth. The downside is that someone could get caught urinating in public by the police, be found mentally ill, and instead of spending a few days in jail end up spending the rest of their life in the mental health system. Frequently, judicial dollars don’t follow the petty criminal into the mental health system, so services are reduced to people who really do want help. Since it is so easy to find someone mentally ill, there are many people who fear that huge numbers of law-breakers will take the “easy way out” and choose psychiatric treatment and entitlements over jail. The entire issue asked in Question B is much more complex and diverse than the points I’ve mentioned. As clients, we definitely need as many ideas as we can get on how to approach the interface between the mental health system and the criminal justice system. Our views on this matter are currently of extreme value with our State Hospitals practically empty and the prison populations mushrooming in size. I hope clients will give some deep thought to Question (B) and share their insights into the problems.

Please begin outreaching to client groups everywhere in California by xeroxing this article and encouraging participation. We need a wide range of material and a large sample to make the Position Papers book of true relevance. True consensus on such controversial topics among a group as diverse as the client/survivor community will probably be impossible, but getting areas of discord defined will be of great help. In the final product there will be mostly a quoting of the responses received (in some edited way which doesn’t alter meaning) and a client’s name will be used only if that is his or her wish. Don’t send huge amounts of material to me at once, because I will have enough trouble going through the responses and attempting to put together something coherent. Even for those people who want to remain anonymous, a name, address and phone number would be appreciated far further contact as the project continues. Other questions will be disseminated soon, so begin sending me your ideas now on the two issues raised in this article. Don’t call me on the phone with your opinions, because that will be of no use for a book project. I want the Position Papers book to be a success, so begin getting California’s “direct consumers” sending me their thoughts to: