Too Mentally Healthy

Mentally Too Healthy  083111

In its discussion of Health and Human Services the Sierra County Board of Supervisors have hit on a new idea: there is such a thing as too much.  
Most recently the discussion centered on mental health services in the schools.  The issues were two: First, how much government involvement with children without parental consent is too much?  Second, how much mental health “help” is too much?

The Problem of Thresholds
Thresholds for both issues are driven by expert opinion, community values, and funding.  California law spiders the issue, with some laws applying to people under 18, some applying to the provision of mental health services, some governing how mental health dollars will be spent.  Professionals in psychology and social work, in particular, parse out data to make inferences, and those inferences become practice, nearly always there is found to be the need for greater “helping” and more funding.  

The public is driven by terrible tales in the news, about how this little kid experienced this, or that little kid died.  These stories add nothing to the knowledge the public has about state intervention, and they almost never discuss the negative effects of interference in families, but instead stimulate the public’s emotional response, creating an environment of acceptance for state intrusion in the family.  

As a result of a strong and influential expert class, and an emotionally reactive public environment, thresholds are driven by an unreasonable expectation.  “Every child in California” should have a safe and stable home.  While as a society we should agree to the sentiment, as public policy it leads to helping too much.

Freedom isn’t free.
There are risks to everything in life. As a society, we should be honest about the nature of real life, which is often very difficult.  There should be a reasonable threshold of interference in a family, and that threshold in practice needs to be sufficiently high that, of a necessity, not every child will live an ideal life.  There is a risk to liberty and freedom.  The psychological sciences try to draw conclusions based on a middle class culture, those are the mores against which a diagnosis is determined, not the values of liberty.  Some folks are odd; being odd or unintelligent has social costs.  When the odd person is a kid is school, the belief goes, she or he is still being formed, they can be healed, and since they have their whole lives ahead, the investment pays of in the long run.

But, people have the right to fail, indeed, society has slots that can only be filled by those who fail at making money.  Social work can do nothing about the poor economy, or the diving standard of living which hurts the poor and working class the most, it can only act on the individual, find fault and blame there, make corrections there to raise just that person up in the economic game of musical chairs.

Children are most vulnerable to the pressure to look, act and speak a certain way to be considered “healthy.”  The state claims to act for the Constitutional rights of the child, the legal rationale for CWS power over the family, but that claim is simply false.  If it were true, then the child would be a free agent; no child is.  Instead, they are children of the state.  Give the child the authority to say, “enough help from you, leave me and my family alone” and the claim will be more authentic.  The current rationale is simply an excuse for the state to do what it pleases.  In the worst case, families have to deal with a pit bull agency, single minded in its intentions.

The school itself has broad powers over the child, which exist, it is claimed, for the safety of the child and the other students.  Liberty is dangerous, but most of all, it is troublesome, it disturbs the flow.  The school is a non-profit business that makes money by getting children to fill seats and pass tests.  If a child fails to fill a seat, the parent must explain why.  

If the child is problematic in the class, it disrupts the flow, in theory denying other students the chance to learn, but more often simply being a problem for the teacher.  The school will typically consider a problematic child to have a troubled life at home; teachers and counselors often gossip among themselves, driving the rationale for a kid’s acting out to be his fault, or the family’s fault, and not the poor job the school is doing engaging the kid, or the unrealistic pressure school puts on some kids.  The prudent thing to do is to hand the kid over to a counselor.  The school has somewhat less power over the parent, but they can, and indeed must, call CWS if something seems wrong in the family.  They can also call the family on the carpet and make various threats for action.  

The intersection of the school and mental health/social services can be a dangerous place for a kid or family to linger.

From Here 

The Disappearance of Informal Services
Do we need some kind of services in the schools for kids who have problems?  Certainly, we do, but there was once an array of humans at the school a kid could confide in.  Many of those have been disempowered, primarily because the librarian and Lunch Lady Doris are now mandated reporters and don’t want to have kids confide in them, but also partly because of the rise of the specialist in the school, and partly because of teacher time constraints and burnout.  Instead of increasing the importance of standardized tests for children and for schools, the school environment might be healthier for children if some of the pressure were taken off teachers and administrators.  Some of the legal liability for talking to kids might be reduced as a way of restoring the natural mentor relationship adults working with kids used to have.

For children who really do need mental health services, the school can always make a referral to mental health for the family.

How Much Help
The “CONNECT” program was, compared to other mental health programs, considered to be “informal”.  The counselor doesn’t, we guess, keep formal records.  If that were true, it would be extremely odd.  Any counselor knows they are legally liable for a number of reporting and other requirements.  Their profession, and their paychecks, are at stake.  Any good counselor keeps notes, and good notes contain the time and place of the interaction, the kid’s name, something of the complaint or discussion, and some small conclusion, usually related to progress if the problem is on-going.  A counselor might need those notes if they were called to court, or simply to prove they’ve been earning their pay.  These notes are technically the property of the counselor, and are “informal” but they are written reports none the less, and if the counselor fears, for example, that a child is being badly treated at home, or if the counselor fears the child will hurt themselves or someone else, they will turn their notes in some form into a formal report.  There is almost no way to competently do the job without creating a paper trail.  It’s simply common cover-your-ass wisdom.  

Further, for a kid to get government funding for treatment, someone has to act as an intake worker.  Typically, that’s the first mental health worker they meet.  Driving everything is the diagnosis.

Diagnosis is Destiny
Supervisor Goicoechea made a remark in a recent Board meeting about youths rebelling against authority without being labeled “crazy”.   The problem isn’t quite so simple, but the results are very much the same.

Psychology has become very scientifical over time; not “scientific” because that is the realm of psychiatry, which requires a medical degree, but scientifical, meaning the tropes and themes of scientific inquiry are used to discover what are hoped and assumed to be cause and effect relationships between certain behaviors and social success, and between treatment methodologies and treatment success.  

What research does show, and this has been relatively constant over the years, is that three quarters of people suffering from “neurosis” ailments get over them on their own without any help from organized mental health.  Research on the relationship between behaviors and social success has the odd problem of clear data, but biased data interpretation.  That is, the researchers can count all right, but typically fail at interpreting the data because they ascribe causality.  

For example, it has been shown that high school students who expect to go to college are less likely to use tobacco.  This might be because people who value education typically smoke at a much lower rate than working class people.  People with degrees tend to enjoy better health and longer life than working class people and typically assume a longer life.  Do people with college degrees smoke cigarettes and drink too much?  Certainly, but the rate is lower, and that’s all the data says.  In short, will enrolling a kid in college ensure he won’t smoke?  Of course not.  Will smoking mean a kid is less likely to succeed in college?  No.  The data simply measures a complex relationship between the assumption of a college degree and tobacco smoking; there’s not too much use for a helping expert to make of that data, but they do!  They then disregard the reality of college education by dislodging one student from a seat and replacing them with another.  There has been, at best, a localized trade, but no net gain on the system.  This is because they start not from a place of objectivity, but from an assumption of social relationships.

At the Level of the Kid

It’s not very different at the level of the counselor.  A diagnosis makes a treatment plan possible, a treatment plan makes treatment possible, treatment makes counseling possible.  It all makes billing possible.  Once a diagnosis is made and entered in to the record, as long as the therapist uses an approved treatment plan, they are pretty much bulletproof legally and administratively.  Who wouldn’t get clients into a case with an identifiable diagnosis as soon as possible?

The diagnosis has power with the client, too.  It gives them something to know about themselves, something to treat, to act positively towards.  Treatment involves learning new things, looking at the world in new ways, looking on one’s shortcomings as surmountable.  Some clients come to love treatment, because it is time to talk to someone who, for money, cares about them and their wellbeing.  It’s not perfect love, but it’s a kind of love, as some say of such services.  

What Kind of Parent

Kids who have “behavioral” problems are tough for parents, who often have to balance the kid’s need with the needs of other kids, a job, a partner, sometimes health or mental health problems.  When the state takes a child and makes her its own, one might think the kid was in excellent hands, after all, they have access to helping professionals, they then have paid professional parents.  Certainly they must snap right out of their problems.  Sometimes they do; sometimes they were going to anyway.  Sometimes they don’t, not fast enough to suit the treatment plan.  Then, instead of being a spanking parent, it becomes a chemical parent.

Kids and adults with behavioral problems which are intractable to counseling alone are dosed with drugs first, then counseled.  Got a drug problem?  We’ll get you off drugs by getting you drugs for your depression, anxiety, affect disorder or obsessive defiant disorder.  Still on drugs, but magically no longer a problem!

 Strattera may cause serious mental health problems including suicidal thoughts and psychosis (seeing or hearing things that are not real) in children and teenagers.

Do Not Use Strattera If

  • you have or had suicide thoughts or actions
  • you have heart problems, heart defects, irregular heart beat, high blood pressure, or low blood pressure
  • you have mental problems, psychosis, mania, bipolar illness, or depression
  • you have liver problems
  • you are pregnant, planning to become pregnant, or breastfeeding
  • you have an eye problem called narrow angle glaucoma
  • do not combine with a monoamine oxidase inhibitor

Warning from Strattera, (atomoxetine) given for ADHD and to boost antidepressants.

A History of Mental Illness
Michel Foucault, French social theorist, did an examination of “madness” through European history from the 15th Century.  He realized that the mad were treated just like everyone else for much of history, but as leprosy as a reason for exclusion declined, madness took its place.  

Bosch’s Ship of Fools

In the 17th Century, the mad began to be identified and segregated; it only required a resistance to social (or Church) doctrine to be classified as mad.  By the 18th Century it was defined as the opposite of reason; by the 19th Century, a medical illness of thought, or the brain, or both.  

As madness as a concept worked its way through history, its definitions changed.  In the 19th and early 20th centuries, practitioners began to systematically describe and classify mental illnesses. The Diagnostic and Statistical Manual of Mental Disorders, for example, emerged in the 1950s and has been revised, partly due to changes in technology and practice, partly due to social changes.  Often, during that time, mental illness, that is, the diagnosis, continued to be a social justification for certain kinds of treatment.  In Russia, it could get you recuperative time in the gulag.  Indeed, sociologists have repeatedly demonstrated that, to a very large degree, mental illness is a social disorder, arising from the individual and society in concert.  Dysfunction occurs when the individual and society are not in harmony.  

In the early 21st Century, treatment has changed.  We no longer allow the mentally ill to be housed like cattle in conditions that would make a sane person howling mad, and we can’t afford to house them properly, so we treat them with drugs and give them outpatient support.  If they’re significantly mentally ill, meaning they can’t function normally even when dosed to the gills with drugs (hey, wait a minute….) then we keep them in homes in scattered neighborhoods.  Very few people would disagree that things are getting better for the mad, since they are once again treated, at least technically, like regular people.

Indeed, treating some forms of mental illness as medical diseases has lead to improved, more nearly normal lives for people who are significantly mentally ill.  In fact, dosing people worked so well that practitioners in the 1960s began dosing people, even middle class housewives, for a variety of complaints which, a generation before, would have been treated with hard work and a firm talking to.  It was, and still is, popular to prop people up with drugs so they can live what has become the expected life for a producer-consumer in the neo-capitalist age.  As drugs proliferated, so did ailments for them to cure, in other words, ailments with the proper diagnosis.  

 RESULTS. Of the foster children who had been dispensed psychotropic medication, 41.3% received 3 or more different classes of these drugs during July 2004, and 15.9% received 4 or more different classes. The most frequently used medications were antidepressants (56.8%), attention-deficit/hyperactivity disorder drugs (55.9%), and antipsychotic agents (53.2%). The use of specific psychotropic medication classes varied little by diagnostic grouping. Psychiatrists prescribed 93% of the psychotropic medication dispensed to youth in foster care. The use of 2 or more drugs within the same psychotropic medication class was noted in 22.2% of those who were given prescribed drugs concomitantly (along with counseling).
From HERE 

When are problems simply troubles?
It’s all a matter of threshold, of degree.  There is every reason to accept the idea that surviving the inevitable problems of life causes wisdom, it’s what helps us form ourselves as adults.  School age kids have the problems kids have always faced: hazing, hardship at home, sexual exploitation, social rejection, dissatisfaction with life.  Some might require professional help; others might just need some good advice and some time.  How do we know where we want the government to insert its funding and authority?    

Help from the Government
For county residents of all kinds, from ranchers to business operators to timberland owners, help from the government is necessary to life, but still not pleasant.  

Still, significant mental illness is a burden on life.  Many people are “dual diagnosis” meaning they abuse drugs and have a mental health diagnosis.  Without help, these folks will spend some or most of their lives in jail.  They’ll often lose relationships, careers, property, and time.  They statistically live less long and tend to die in newsworthy ways.  Anyone of any age who needs mental health or drug and alcohol services deserves to have them; it’s in the county’s interest to provide them.

Who Decides how much is too much?

But, how many of our 3200 county residents need these services?  How many of our 410 children need them?  How many of us can find mental health the old fashioned way, by talking to someone older and wiser?  How much mental health service do we, individually and as a community, really need?

The Board of Supervisors is the closest elected body most of us have access to.  Their power over the situation isn’t great: they can’t tell the Director of HHS how to run most services.  The only power they have is to refuse to accept funds, refuse to authorize a program.  At a time when jobs seem to matter more than anything, and bringing government dollars into the county seems like our only hope, it’s important that someone ask the larger questions which impact the kids and families in the county.  How much HHS access to kids is too much, and how much mental health help do we really need?
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