Saturday, February 21, 2009

Mental Health Treatment

I attended a conference yesterday on mental health issues in youth (which are applicable to adults as well), and thought I would share some of what I learned. Or my opinion on what was being said, at least.

Firstly, I found it refreshing to hear speakers from all different areas in mental health work including community based shelters (Covenant House), psychiatrists, and public relations, emphasising the need to recognise that individuals with a mental illness are not behaviourally dysfunctional or purposely defiant, but they are actually ill. The importance of this recognition comes in when anyone wants to help a person who is mentally ill as it requires a different approach than trying to reprimand or criticise atypical behaviours. Instead, one has to accept the difficulties of the illness, for both the helper and the helpee, in order to best structure a treatment plan. Specifically, the therapist needs to be tolerant of the patient’s relapses (substance use, self harm) and expressions of individuality (and I think this can be extended to separation behaviours that youth need to go through) such as non-compliance, rudeness, and missed appointments.

One point that was made at the conference regarding programs for the mentally ill, and which I think should and can be extended to include therapists (because let’s face it, they’re not all as understanding as they should be), is a certain amount of discrimination about who gets into the programs. The specific example was that many individuals who have substance use issues will not be accepted into a program until they have cleaned themselves up. The speaker’s opinion on this was that what we are saying is that we are not willing to treat you until you are better. So, those in most need of help are being neglected.

You see this in other areas as well. If anyone has tried to get a referral to see a psychiatrist, you know how difficult it can be. On the opposite end of the scale, when an individual is seeking help and they hear that they can’t get it and unless they are more sick, this might encourage the person to make themselves more unwell in order to get the attention and treatment they require. Even though depression is prevalent (23% of approved CPP disability claims in 2000 were attributable to "mental disorders" compared to 12% in 1990) and causes significant work loss (89% of people say stress related mental health issues have affected their work and an average of 40 days/year where they were unable to work) treatment is greatly under-resourced. Especially when you consider that almost ¾ of mental disorders begin before 24 years old, that suicide is the second leading cause of youth aged 10 – 24, and that depression is treatable.

For those who seek and find help, we are seeing that therapists and other helpers are discovering that validation and autonomy are practices that work best. While there are aspects of some disorders, especially for those who have had a chronic illness and never learned other behaviours, people generally know what they want and need to change in order to achieve their goals. So instead of pedagogically stating the obvious (‘you need to stop shooting heroin’), we need to accept the patient as an individual and let them come to the decision to stop on their own, because they will and they will feel more powerful for owing this decision and their recovery.

An aspect in treating substance use disorders which one psychiatrist applies to his practice is that he informs the patient that as long as they don’t use anymore than what they are currently using, the two of them can work together. And he seemed to find that even during the first week (though he didn’t state how people coped with the decrease of their addiction later), people would actually use less, and they did it on their own.

We can have programs with their associated mandates and protocols, but it is the people who are working with those with psychiatric conditions by their involvement with the individual (in a formal session or an informal session where the therapist buys them a sandwich) and meeting them at their level respecting the burden of the illness, who make the programs work. This is the major responsibility of the therapist.


If you are a youth in need of shelter or any other assistance.

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