A police car, alternating red and blue lights parked behind me, blocked my car in perpendicularly and made it impossible for me to go anywhere. This officer was looking for my best friend, who had gone into the restaurant before me, to escort him by handcuffs, ambulance, and a flashing police car to the specialty hospital located on South Street. His brother and I visited him as soon as the general intake was over and the trauma was already induced marked clearly in his flat affect. We sat quietly while nurses distrustfully checked in on us periodically. He looked more wounded than he had previously; empty of feeling, barely cognizant enough to comprehend the lack of ethics in the transition from restaurant to hospital. To watch a series of events unfold many times in the same cold, procedural pattern was not only discouraging in my interest in helping those struggling with mental health difficulties, but also a distortion of what the intent of mental health treatment is supposed to do.
In being mentally well, it is expected for those struggling to seek out mental health professionals to aid in their recovery. Yet a study in 2003 of Psychiatric Hospital settings indicates that 82% of patients reported that institutional events and procedures caused trauma and harm (Trauma Within the Psychiatric Setting, 2003). This issue should raise red flags all over the mental health sector and should cause all providers, parents, and those involved with somebody dealing with issues of mental health to rethink their perceptions of how to best help. I believe that the mental health sector needs to rethink their general guidelines in deciding how someone should be helped, focusing on their history and needs rather than following a “tried and true,” model of forced aid.
The best explanation for such forced hospitalizations and treatments is the claim that these measures are a necessary evil. A study done in Norway justifies the use of coercion of a patient through three main claims, does the patient have a mental disorder, did the physician attempt to have the patient admit voluntarily, and is it in their best interest, since the greatest worry is whether they may cause harm to themselves or others. Within those claims there are good intentions. When there is discussion about whether or not treatment is in the patient’s best interest it is usually because the case has reached such a high level of severity that they believe the patient will commit suicide or cause harm to more than just themselves (Ugstad, 2014). I do think that the idea at heart is protection, but protection is lost as soon as mental health professionals lose sight of the specific patient or case they are meant to focus on.
Although forced hospitalization is meant to be a last resort it often isn’t especially because of the process of evaluation. The first step upon arriving at a psychiatric hospital is this evaluation. The evaluation comes with violations that cause the person arriving to the hospital to feel a loss of autonomy and subjective distress. Belongings are searched, questions upon questions are asked, and once admitted the patient waits in a locked room. I have been present during a hospitalized intake. The man’s items were taken from him, he was questioned, convinced to commit to voluntary hospitalization, almost immediately regretting it, regarded suspiciously and had to remain in a locked room until transferred to the general ward. What I am getting at is the idea that necessary evil reinforces. Necessary evil reinforces the dismissal of patient’s opinions because it sets a precedence that they don’t know what is good for them and at that point it stops becoming about the patient’s well-being. Instead it starts to become a process that follows general guidelines and is not functioning on a case-by-case basis. The problem with the idea of a necessary evil is that it makes the entire procedure less about the wellness of the patient and more about the general wellness of those around the patient. It makes trauma a more likely outcome and trust and safety become lost feelings.
One of the most famous cases of psychiatric hospitalization causing trauma is the case of Anna. The trauma she had experienced prior to being put into psychiatric units was further progressed by “her perception of herself as “bad,” “defective,” a “bad seed,” or an evil influence on the world,” this idea became concrete in her mind because of her psychiatric homes, her feelings were “reinforced by a focus on her pathologies, a view of her as having a diseased brain, heavy reliance on psychotropic drugs and forced control, and the silence surrounding her disclosures of abuse (Jennings 1994).”
Most people who come to a mental health professional struggling to find themselves amidst the abyss of their own mental battle feel what Anna has described. There is an inadequacy associated with many mental health disorders that the patient is struggling to let go of or hopefully recover from. Another study of trauma within a psychiatric setting support the thought that hospitals can cause regression rather than progression, “In general, the results of this study indicate that mental health consumers have experienced a number of traumatic, humiliating, or distressing events during their hospitalization (Trauma Within the Psychiatric Setting 2003).” Trauma, humiliation, and distress are not the ways a person that is seeking help should feel within an environment that’s mission is supposed to be promoting wellness.
If you haven’t yet noticed, there is a theme and it is the paradoxical nature of the help that some mental health advocates claim to provide. This help causes significant setbacks and can produce further mental health issues. The thought of future mental health issues leads me to my next point, the case of a patient that has left a mental treatment facility but once again must seek help. This patient has an intense fear of the mental health sector, and cannot seek help from the socially accepted solutions, which all land in the sector they fear most. The reaction they have is a DSM-V classified diagnosis, PTSD. Post-traumatic stress disorder can significantly impair functioning through intense anxiety that can manifest in many forms as a reaction to an event defined as terrifying in one’s past, experienced or witnessed. Now the effects of trauma are very clear and reflect poorly on forced methods of aid. Instead of these methods, there could be a more patient focused ideal in which the evaluation is based on functionality of the client, severity, and their own voices.
Other means could be used to accomplish the same ends. No suicide contracts are an effective measure in preventing harm to oneself. Outpatient programs and support groups would harvest feelings of community rather than feelings of shame as produced by psychiatric environments. It is important for those in the mental health field to constantly be thinking about trauma-informed care. Take for instance the study I mentioned earlier, Trauma Within the Psychiatric Setting, the report states a very important measure they take to ensure that trauma is avoided, “interviewers were trained to monitor the subject for any signs of distress…if any subject appeared to be significantly upset, they were to have the subject either take a break or abandon the study (Trauma Within the Psychiatric Setting 2003).” Trauma-informed care does exactly what it says; it takes into consideration how the action may affect a person in terms of their previous, present, and future trauma. Mental health should focus on generating positive change rather than the negative change that is often a result of events within psychiatric units.
Now to acknowledge my most important point; throughout the paper I have explained how the attitudes of mental health have caused adverse effects on those they are meant to help. I have to stress the importance of this issue because there are so many people in the modern era that are struggling with mental health. The seriousness in which mental health can affect a person often leads to decisions between life and death. Mental health can sometimes be completely debilitating and even the chance that someone may be suffering should be enough to call upon a further look at the ethics of the mental health sector. With that knowledge, it is vital to understand that mental wellness isn’t just applicable to those who are characterized with a mental health disorder. As a population positive growth in the mental health arena would help all sorts of people gain functionality and promote a healthier environment for all. Wellness is a movement that has begun and cannot be ignored. Being able to access this wellness could create a way to thrive even in times of negativity with the use of positive coping skills and increased awareness. This movement applies and, as I mentioned, can benefit all people because everyone deserves to feel well or at the very least be given the chance to feel well.
Jennings, A. (1994). On Being Invisible in the Mental Health System. Retrieved February 28, 2015, from http://www.theannainstitute.org/obi.html
KS, L., & Shankar BG, R. (2011). Hospital Related Stress Among Patients Admitted to a Psychiatric In-patient Unit in India. Online Journal of Health and Allied Services, 10(1), 1-6. Retrieved February 28, 2015, from http://cogprints.org/7790/1/2011-1-5.pdf
TRAUMA WITHIN THE PSYCHIATRIC SETTING: A PRELIMINARY EMPIRICAL REPORT. (2003). Adminstration and Policy in Mental Health, 30(5), 453-460. Retrieved February 28, 2015, from http://www.psychrights.org/Articles/PsychiatricTrauma.pdf
Ugstad, K. (2014). Interpretations of legal criteria for involuntary psychiatric admission: A qualitative analysis. BMC Health Services Research. Retrieved February 28, 2015, from http://www.biomedcentral.com/1472-6963/14/500