The Mental Health System:
Recovery Should be the Goal
by Jim Gottstein

One of the great disservices of the Mental Health System ("The System") is that convincing their patients that they will never get better or back to "normal" seems to be the number one goal.   This is termed "acceptance" or, if the patient doesn't accept it, "denial."    Of course patients are going to resist the notion that they will never get better.  Not only should they, but it is the only way that anyone will recover.   Until recently, it was not even acknowledged that people suffering from serious mental illness can recover.  In Alaska, as elsewhere, there have been pioneers, such as Andrea Hercha Schmook, who without any role models, managed to fully recover from years of severe mental illness.  Andrea is now the Chief of consumer affairs for the Illinois Department of Mental Health and has developed very successful trainings on recovery from mental illness.  Because of Andrea and others,  it is now recognized that  people can and do recover.  However, the vast majority of people in The System do not know this and continue to believe that their number one job is to convince their patients that they will not get better. 

Thus, for example, we believe that while recovery for a much larger percentage of mental health consumers is possible, we also believe that consumers must take responsibility for their own recovery, mental health and behavior.   For many, this will mean finding a medication regime that works and following it.   For almost everyone, it will mean learning how to recognize the warning signs and what needs to be done for that person to prevent a relapse.   Relapses are not only inevitable, but they are necessary in order for learning to occur.

Many people in The System believe that their patients should just "comply" with the medications that have been prescribed for them.  But think about it -- why is "compliance" such a problem?  Certainly the consumer wants to be free of mental illness (in virtually all cases), but the prescribed medication regime is so unpleasant that the consumer doesn't want to continue.  In many cases, medication is nothing more than a "chemical straight-jacket" that leaves the consumer a zombie.  It is no wonder that this is not considered an acceptable outcome to the consumer.  This may be in marked contrast to the consumer's family member for which safety is the most important thing.  The same is true for the mental health professional.  But a person who is suffering from mental illness wants more than a zombie existence.   If the consumer is allowed to participate in the medication decision-making, a medication regime that really helps from the consumer's perspective is much more likely to be achieved.  The consumer can try different medications to find out what really works with acceptable side effects.  Of course the mental health professional has the professional training about the medications, but the consumer knows how it is affecting him or her and more importantly has to be satisfied with the choice or "compliance" will be an issue.  It should be collaberative to work.

Another truly amazing thing about The System is that that the patient doesn't have anything worthwhile to say about what does or doesn't work.  Thus, a psychiatrist may prescribe a medication that the consumer adamantly opposes rather than the one the consumer wants because the psychiatrist "has had success" with the prescribed medication.  But often, the consumer knows very well that the medication doesn't work that well for him or her or that the side-effects are so bad that the medication is unacceptable.  In such circumstances is it any wonder that there are "compliance" problems?  When the consumer gets a medication that helps with an acceptable level of side-effects, then there will be no "compliance" problems.  There may be experimentation on what is really necessary, but "compliance" will not be the issue.

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                Copyright 1998 Jim Gottstein.  All rights reserved
last modified 10/23/1998