A Tale of Two Paradigms

Robert Nikkel, MSW
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I often wonder how to communicate more effectively with traditionally oriented colleagues who may have some beginning awareness of the shift taking place in paradigms of care in mental health and psychiatry. Some of them are closer than others to hearing the different perspective; certainly, some seem threatened by what they hear.

These are people who are not members of “the choir.” We have been pretty good at preaching to the audience already attuned to Mad in America and our continuing education project. But frankly, in my experience, we are not making enough progress in changing the way systems are working.

We need a platform for discussions and for increasing the understanding of diverging views—the tale of two paradigms. The purpose of this blog is to provide one such platform for that discussion. I will start by sharing two recent examples from Oregon and how the reports are shaped by the traditional “medical model.” Then, I will present the way in which the alternative model, the “social determinants model,” would critique them. Again, the idea here is to use this blog or parts of it in discussions with receptive colleagues.

It will be obvious that while I try to be as objective in my analysis as possible, I am an advocate for the “social determinants model” for reasons that I believe will become clear as this blog unfolds. I have included 10 talking points as an addendum to help with the discussions the blog is intended to stimulate with potential partners who are currently operating out of the “medical model.”

Before discussing the examples, I will lay out what I see as the primary characteristics of each paradigm. The “medical model” assumes mental health challenges are diseases. They are likely genetic in origin and result in chemical imbalances. They are there for the person’s entire life. Psychiatric medications restore the imbalances and reduce and keep symptoms of the disease under control. Often more than one medication at a time is necessary. Going off medications is very dangerous and usually results in relapse.  Access to care is paramount and based upon a foundation of regular medication checks appropriate to the disease diagnosis.

In the “medical model,” other services can be beneficial and include counseling and case management; ideal programs include housing, employment, educational, and family supports. Some programs are “trauma-informed” because stresses of all kinds aggravate the disease and lead to crisis services and hospitalization. Sometimes what is called “decompensation” causes threats of harm to self or others and can easily lead to severe confusion, paranoia, and even violence, which then lead to involuntary treatment. The most “chronically mentally ill” need residential treatment, often for life.

In contrast, the “social determinants model” assumes that mental health challenges are not diseases and avoids terms like “mental illness”, ”schizophrenia”, “chemical imbalances,” and “diagnoses.” People who are struggling should not be asked, “What’s wrong with you” but “What has happened?” Recovery is to be expected. Medications are used sparingly if at all and then for short duration.

In the “social determinants model,” treatment with drugs is seen as harmful, especially with mid- to long-term use. If a person has been on medications for any length of time, withdrawal is indicated but must be approached carefully and incrementally.  Peer supports like Individual Placement and Supports (IPS), Hearing Voices Network, “warmlines” staffed by “people with lived experience,” peer respite programs, Dual Diagnosis Anonymous (DDA), and complementary approaches like Soteria Houses are key elements.

In this model, the primary causes of mental health challenges are traumas of various kinds. The traditional mental health system is often a source of traumas. These often trigger reactions to earlier trauma experiences, especially psychiatric hospitalization and all forms of forced “treatment.” Professionals may be helpful in counseling and assistance in accessing safe, affordable housing but must be aware of all of the effects of subtle and not-so-subtle forms of power and control. Peers must be more than tokens in policy, program development, and evaluation. The model’s motto is “Nothing About Us Without Us.”

These two contradictory models and the assumptions behind them lead to very differing views of the two Oregon reports. The first example is a report issued in July 2020, “Better Health for Oregonians: Opportunities to Reduce Low-Value Care.”

The 50-page report was issued in July 2020 by the Oregon Health Authority on identifying “low value care” in the state’s health system. It was co-produced with the prestigious Oregon Health Leadership Council, a collaborative organization working “to develop practical solutions that reduce the rate of increase in health care costs and premiums.” The report had great potential—if it had it looked at the entire spectrum of health services through the lens of the “social determinants model.”

The overall goal of the council is to make health care and insurance more affordable to people and employers in the state. Formed in 2008, it brings together health plans, hospitals, and physicians to identify and act on cost-saving solutions that maximize efficiencies while delivering high-quality patient care. Of the 40 members of the board and council, there are no people with lived experience in mental health or addictions, nor are healthcare patients represented.

The Oregon Health Authority claims to be “at the forefront of lowering and containing costs, improving quality and increasing access to health care in order to improve the lifelong health of Oregonians.” To bolster that assertion, the OHA is overseen by the nine-member citizen Oregon Health Policy Board “working toward comprehensive health reform in our state.” Again, there are no people with lived experience or health care patients.

Those associated with the “social determinants model” would point to the absence of service users, patients, and psychiatric survivors on the major policy councils and boards. They would also challenge the system to understand the ineffectiveness and high cost of services in programs based on the “medical model.” They would point to the glaring black hole surrounding the practice of prescribing psychiatric medications. It is almost certain that the not even one member of the prestigious Council and Authority has any knowledge of the carefully researched findings regarding psychiatric medications outlined by Robert Whitaker, Joanna Moncrieff, Martin Harrow, Jo Watson, Peter Gøtzsche, David Healy, Lex Wunderink, Jaakko Seikkula, and many others. All have consistently documented the poor outcomes associated with these drugs and risks of physical harm. It is unlikely they have any knowledge about the discouraging story of withdrawal from psychiatric medications, the risks of which are still being uncovered.

The report’s Appendix 3, “Low-value measures by type,” lists 48 of these. Buried down in #40 and #48 are the only psychiatric practices that are considered “low impact.” Otherwise, all of the low-value services are physical health care in nature. The mental health services are (40) prescribing antidepressants as “monotherapy” for people diagnosed with bipolar and (49) prescribing two or more antipsychotics.

Mental health professionals and advocates coming from the “social determinants model” would point out that the first has been recognized as dangerous for 30-40 years but is apparently still used or would not have been listed. As for the second, the research and analyses listed above clearly show that using even one antipsychotic results in poor outcomes for most people even in the short-term, much less after mid- to long-term treatment. Using two or more neuroleptics is even more unacceptable, but more commonplace than would likely be acknowledged.

Those in the “medical model” would likely be reassured that there are only two psychiatric interventions needing attention for change. They can continue their practice unfettered and unaware of all of the many truly low-value psychiatric services identified by careful, unbiased research and analyses.

Those who identify with the social determinant model would read the report very differently as giving traditional mental health care a free ride. They would point to the potential savings and improved outcomes that would come by prescribing fewer of these drugs. At least in Medicaid, the budget value of psychotropic drugs is not recognized.  In most state Medicaid budgets, these expenses are deliberately separated—thanks to lobbyists for the pharmaceutical corporations. However, they are not minor budget items and well within the range of values of other interventions listed in the report.

Psychiatric drugs, many of which are prescribed by primary care doctors and/or other non-psychiatrists, have very little unbiased, well-researched evidence of effectiveness, and most of them carry risks, some of which are quite serious. This is true for adults, and is even truer for children and adolescents.

This is all illustrated in the data which came from a public records request made last year for Medicaid expenditures for all psychiatric drugs. It showed many alarming results. For example, Oregon providers were prescribing many drugs to children and adolescents. A total of $8.7 million was spent for all medication to children and youth—$3 million for antipsychotics, $1.5 million for antidepressants, and $2.7 million ADHD drugs.

Adherents of the “social determinants model” would point out the extreme risks in using these medications, especially for antidepressants, which carry the Food and Drug Administration’s “black box” warning against using them.

Adults are prescribed $82.2 million worth of psychiatric drugs. These costs do not even include the expenses of psychiatric drugs used in the state hospitals, state prisons, juvenile facilities, and local jails. Nor does it include private insurance or Medicare. To make national estimates for the costs, one should multiply the figures by 100 since Oregon has only about 1% of the country’s population.

It is especially odd that psychiatric services would receive this free ride because of the second report, Mental Health America (MHA) 2020’s report, “The State of Mental Health in America.” It is considered a devastating analysis of Oregon’s mental health system and is frequently cited in the media and elsewhere. It claims that Oregon is the second lowest-ranked state for overall mental health care.

The data upon which all states are ranked comes from the Substance Abuse and Mental Health Administration (SAMHSA), The Centers for Disease Control and Prevention (CDC), the Department of Education (DoE), and state data. The rankings are supposedly based on “outcomes,” but they are not real outcomes. Instead they are almost entirely measures of access to various levels of care and estimates of prevalence of various problems like suicidal ideas, rather than measures of functional outcomes and satisfaction with services.

This report has been eagerly employed by traditionally-oriented “medical model” advocates. They see it as a way of advocating for increasing the current types of services. However, in the absence of functional outcomes, those from a “social determinants model” would question whether access to “medical model” services is necessarily a good thing.

Critical thinkers from the “social determinants model” would ask several more questions: Who sponsored the report and how might sponsorship end up shaping the recommendations? The answer to sponsorship can be easily overlooked because the information shows up at the bottom of introduction section with the names and logos of 2 organizations, Otsuka and Alkermes. It states, “This publication was made possible by the generous support of Otsuka America Pharmaceutical Companies and Alkermes.”

However, it does not reveal that Otsuka is the maker of Abilify and that it is also “developing the ADHD drug centanafadine.” The second, Alkermes, has “more than 20 commercial drug products and candidates that address serious and chronic diseases, such as addiction, schizophrenia, diabetes and depression.” Among these products, “five are primary to the company: risperidone long-acting Injection (generic for Risperdal Consta) for schizophrenia and bipolar 1 disorder, paliperidone palmitate (generic for Invega Sustenna in the U.S., Xeplion in Europe) for schizophrenia.” There is no statement of the conflict of interest in having pharmaceutical corporations sponsor the report.

Perhaps because of this conflict of interest, the outcomes of the report reflect the interests of the pharmaceutical industry. Instead of measuring outcomes like increased functioning, recovering a full and complete life, decreased suicides, improved relationships, and affordable, safe housing, the report measures only how well people can access psychiatric drugs.

Both reports are highly flawed from the “social determinants” perspective and very reassuring to “medical model” adherents.

A major challenge for advocates will be to help the adherents of the “medical model” understand the differences between the paradigms. As system changes based on the “social determinants model” begin to pick up steam, another challenge will be to counter the inertia and resistance of providers. This resistance will be strongly supported by advocates for the existing systems of care. Certainly, as programs rely less on medications, the pharmaceutical companies will resist with all their might.

This blog should be used as diplomatically as possible with receptive providers, advocates, legislators, county mental health officials, and any other interested organizations to stimulate changes from the “medical model” to the “social determinants model.” The Addendum: Talking Points may be of assistance in organizing discussions that can be arranged by sharing this blog.

ADDENDUM: TALKING POINTS
  1. There are two conflicting models for the design of mental health programs—the “medical model” and the “social determinants model.”
  2. The key conceptual difference is that the “medical model” asserts that mental health problems are diseases that respond well to medications, while the “social determinants model” asserts that the problems are trauma-related and respond best to support and relationships.
  3. Two recent reports from Oregon illustrate the ways in which the two models result in significantly different conclusions.
  4. A problem with both reports is the absence of input from persons with lived experience.
  5. The Oregon Health Authority report avoids identifying the major ‘low impact” psychiatric interventions, namely psychiatric drugs, ignoring decades of outcome research.
  6. The costs of psychiatric drugs in public and private health insurance budgets are higher than is commonly understood and clearly within the range of all the other “low impact” services identified in the report.
  7. The Mental Health America 2020 reports focuses on data related to access to care rather than the quality of that care and improvements in life that result from the different models.
  8. This emphasis on access to care is driven by the financial sponsors of the report, two major corporations that create and sell psychiatric medications.
  9. Functional outcomes, (i.e. people recovering full and rewarding lives) associated with the “social determinants model” far exceed those same kinds of outcomes associated with the “medical model.”
  10. This blog should be used diplomatically with receptive mental health practitioners and program developers to assist them in reformulating their services and supports.

***

Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

31 COMMENTS

  1. Thanks Robert N.
    Well written.
    I think what you are proposing is a “reformed psychiatry”.
    If some politicians suggest to Brazil’s president that perhaps he and his cohorts adopt
    a kinder, more conscious leadership, I’m sure that won’t happen.
    People do not leave positions of power voluntarily. It just messes up their
    system. Within their system are a whole bunch who operate despite knowing the harm
    they cause, despite knowing what garbage they subject their subjects to.
    Everyone becomes guilty by association.

    “People who are struggling should not be asked, “What’s wrong with you” but “What has happened?”

    Which begs the question, What is wrong with psychiatry and what happened to the practitioners in their early years to become part of an abusive cog in an abusive power driven wheel.

    Psychiatry however, despite keeping an economy going, is also a huge drain, monetarily, and medically, since their chemicals result in subjects needing extra medical observation. They are a huge drain on morale within the public, ruining families and possible support structures. Disabling subjects.

    Politicians are aware, but they need to act on all the human abuse going on and being agreed to by themselves.
    I doubt anything but a coup will remove the dictators.

    • “Politicians are aware, but they need to act on all the human abuse going on and being agreed to by themselves.”

      Yes. There is currently some social/political focus on this in the context of George Floyd’s death. Primarily peaceful advocates are joined in the streets of Portland by people with other agendas, wanting revolution. Those in power, on either side, seem unwilling to yield, to consider other points of view.

      What may come of all this — and how – remains to be determined.

      Nevertheless, it seems a positive thing, Robert, that you have articulated your view so well here in this public space. It may not be “ruling” yet, or ever – it may have difficulties of its own, to be determined if/when the paradigm shifts.

      The “social determinants” model of mental health care is an important contribution to ideas about overall shifts in how our society may operate – which, then, affect the social determinants of people’s distress. I wonder if relating your focus on mental health care to the more overall questions of possible paradigm shifts in our society might make it easier to talk with some of your colleagues? Especially in Portland, and maybe in Salem and other places in Oregon as well.

    • How about a revolution — a coup would be too authoritarian.

      the “social determinants model” assumes that mental health challenges are not diseases and avoids terms like “mental illness”, ”schizophrenia”, “chemical imbalances,” and “diagnoses.

      When people speak of “models” you need to ask “models” of what?

      If what someone calls “mental health challenges” are not diseases, neither do they constitute “health” challenges. It is contradictory to criticize the “medical model of mental illness”; if you use the terms “mental illness” OR “mental health” you are embracing the medical model.

      • “if you use the terms “mental illness” OR “mental health” you are embracing the medical model.”

        Glad to see you brought that up, bears repeating. As far as models go, I’m not interested even in “non-medical” ones, that gaze onto a subject and deem them substandard as far as “function” or “normality” go.
        These “ass-essments of subjects can be done in private settings, one need not make careers out of defaming, harming and socially controlling people and YET, pretend it was about “health”

      • Hidden at the top of this article is a key concept: These are “paradigms of care.”

        The “medical model” is a treatment model based on how medical doctors treat the things they are asked to treat – wounds from accidents, acute illnesses, chronic illnesses.

        The “social determinants model” is more of a social work approach to treatment.

        Neither of these models really address root cause (etiology). I think this confusion is rampant and is worth clarifying. Both models have problems with etiology. Both do! They are treatments models.

    • I absolutely agree, we have yet to change “the way systems are working.” Despite the fact that the entire “bible” of the mental health system was debunked as “invalid,” by the head of NIMH, seven years ago.

      The DSM “bible” describes the theology of, and was written by, advocates of the “medical model.” Who have subsequently confessed it all to be “bullshit,” and who do have unethical ties to the pharmaceutical industry.

      I have to agree with Sam, I don’t think the “medical model” will go away with mere talking points. The “dictators”/psychiatrists within the “medical model” system need to be shocked to awaken them. Either by totally eliminating use of their “invalid” DSM billing code “bible,” or by taking away their power to involuntarily force drug people, or preferably both.

      “Power tends to corrupt, and absolute power corrupts absolutely.” The psychiatric industry has corrupted itself absolutely. Largely because psychiatrists were given the power to play judge, jury, and executioner to anyone they please, for any reason that financially benefit themselves – power neither the psychiatrists, nor anyone else, deserves. And they’ve turned the “mental health” industry into a multibillion dollar, primarily child abuse covering up, industry. Despite the fact that covering up child abuse is illegal.

      Those of us here have already found the iatrogenic – NOT “genetic” – etiology of their two “most serious DSM disorders.” The ADHD drugs and antidepressants can create the “bipolar” symptoms. And the antipsychotics/neuroleptics can create both the negative and positive symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome and anticholinergic toxidrome.

      Power and credibility needs to be taken away from the absolutely corrupted psychiatric system, and it’s “medical model” adherents. “Dictators” don’t give up their power voluntarily. We’ve destroyed their scientific credibility with our medical research findings.

      Now the psychiatrists’ power needs to be taken away. And most of the psychiatrists and psychologists should likely be arrested for their systemic child abuse covering up – and pedophile aiding, abetting, and empowering – crimes.

      There is a reason we all now live in a “pedophile empire.” We have a multibillion dollar medical/religious, primarily child abuse covering up, scientific fraud based, “mental health system,” not to mention seemingly a pedophilia controlled government.

    • Great comment sam.

      “Which begs the question, What is wrong with psychiatry and what happened to the practitioners in their early years to become part of an abusive cog in an abusive power driven wheel. ”

      Really good point here too, maybe if they used just a fraction of the money used to research “mental illness” we might have a solution to the problem that is psychiatry by now.

  2. “It is almost certain that the not even one member of the prestigious Council and Authority has any knowledge of the carefully researched findings regarding psychiatric medications outlined by Robert Whitaker, Joanna Moncrieff, Martin Harrow, Jo Watson, Peter Gøtzsche, David Healy, Lex Wunderink, Jaakko Seikkula, and many others.”

    What about US – what about the people psych drug killed, who haved bravely put comments on here?

    Psychiatry is evil, this is clearly stated in it’s history and the fact that it wasn’t abolished and outlawed due to American eugenics after WWII, means that it is now rampant and doing very well in it’s closed cultures of abuse outside and inside the body.

    Psychiatry has to be abolished – that’s for all the people who are no longer here and the people who have no idea of all this, yet will be destroyed by this monster just by doing what they feel is normal and right – going to their doctor for anxiety/insomnia/depression.

    For those of you who are new to all this, listen to what these monsters did if you think I’m way over the top:

    https://www.youtube.com/watch?v=4YU6CHaTWb0

  3. I worked at a youth agency serving homeless and foster kids. We had a resident in our transitional living program who abused ADHD medication in order to pull a midnight shift. I posted what I observed in the log but got no guidance from the case manager or the supervisor. At one point, the youth was walking around on the roof of the agency. I no longer work at the agency. The agency publicizing on its website that it offers psycho-pharmacological services at its agency. How best to educate the community at large with regards to this situation.

  4. Julie Greene , MFA ( Of Blessed Memory ) wrote this comment Sept. 21, 2019 to the blog (Is Remaking Psychiatric Care Possible ? ) by Robert Whitaker . The following is an excerpt of Julie’s comment .

    “Psychiatry is a dark shadow in our history , an abomination, an embarrassment.
    People wonder why, when the Nazis were rising in power in Germany , the story never reached most of the North American public. The reason is that the media did not publish these stories , or when they did, it was some tiny article in a remote corner of the newspapers. There was growing anti – Semitic sentiment shared among the most powerful and richest influences of the day . Their companies funded the papers through advertising.
    This is exactly what is happening now . They squelch our stories . They silence us in every way possible , even using illegal means to keep us out of the mainstream media . We continue to grow in numbers and are more successful at shouting loudly , but are dismissed as nutcases. When I explain to people that I “got better” because I got all MH “care” out of my life, they say ” Oh but you’re an exception.” I’m honestly tired of hearing that. I have known others who have done the same, ditched them all, and what’s cool is that EVENTUALLY, these folks flourish. It takes time to get through the grieving and financial wreckage.

    Psychiatry should be abolished. The drugs are only a side issue. Psychiatry is guilty of heavily influencing society on all levels, encouraging eugenics, that is , the separation of the supposedly sane and the supposedly insane . The media supports this idea , that we should be given “care” which might include incarceration . That we should be put out of work and then, handed an embarrassment of an income from the State. That we should become property of the State, which now controls and monitors our finances and our living situation . We are rounded up and put in ghettos or prisons.

    Their “care” should be exposed for what it truly is. The Nazis lied about the showers and psychiatry , is lying about what it does , too . We need to inform and enlighten the public so that psychiatric “care” can be stopped. Ended . We need to save our people from the fate we ourselves befell.

    A new era should begin not based on hatred and fear of “other” but based on love.”

    • Beautiful quote Fred. I miss Julie more than I ever imagined I might while she was here. And I’m glad we got to understanding & respecting one another more as time passed, and before it was too late.

      Psychiatry should be abolished. The drugs are only a side issue. Psychiatry is guilty of heavily influencing society on all levels, encouraging eugenics…”

      This is so key. MIA tends to focus almost exclusively on drugs drugs drugs. But drugs are just one tool in psychiatry’s arsenal, albeit a very effective one in pursuing its goal of social control.

      It took some transcendent thinking on Julie’s part, given that she ultimately was killed by lithium, to understand that the deadliest aspects of psychiatry go beyond even the lethal effects of drugs and ECT. Psychiatric ideology and practice is a psychic straitjacket that has conditioned vast segments of the population into believing that their inner suffering is not a reaction to a toxic culture, but a symptom of a “mental” disease — a brain disease at that. So any anger, rage or resistance someone who knows they are oppressed might understandably direct at the external oppressor is directed inwardly in terms of worry, shame, and self-limiting behavior.

      Julie got this, as can be seen from her above quote, which I’m glad Fred has archived.

      • Yes OH, I’m grateful Fred posted that piece. It really says it all. Perhaps the consciousness comes with age, just to fully understand the damage of psychiatry which started long before any “treatment” was engaged. And it might be the maturing, which eventually has some shrinks “come out” after or close to retirement. When the full realization hits them as to WHAT they were involved in, how many people they hurt. They never hurt just the subject, it involves everyone, in the same way that the thing that led a person to become the subject, was not located only in that person.
        It is why I cannot understand someone if they are against only this or that part of psychiatry. RIP Julie

    • In viewing Julie’s youtube describing her wish to write a book about Lithium while “not needing to make a whole lot of money”, how do We create a whole lot of social justice? In the aggregation of cases and the subsequent volumes of treatment gone awry, there would seem to be a line of “Enough is Enough”. What type of attorney or Law Firm could win the case to improve justice and our civil rights? Or individual rights? (Does “Our” civil rights become diluted in the language of the whole We, the People? or are We, a people, a tribe within the larger group?)

    • Thanks for republishing this Fred. I haven’t had time to read the above article so am for the moment commenting only about Julies comment.

      “They silence us in every way possible , even using illegal means to keep us out of the mainstream media”

      While I can’t say I have been totally silenced since the attempt to unintentionally negatively outcome me failed, I have been astounded by what can be achieved with negligence, fraud and slander by those charged with a duty to enforce the rather flimsy protections afforded the public by our laws.

      Imagine, I have a letter here from our Chief Psychiatrist to the Mental Heath Law Centre (public advocates) stating that the protections afforded citizens from arbitrary detentions do not exist (not unlike our Police stations not having a copy of our Criminal Code and referring citizens with proof of public sector misconduct to a hospital for ‘treatments’), and that they can be snatched from their beds and force drugged under the guise of a ‘chemical restraint’ BEFORE even being assessed by a psychiatrist. Of course this letter exposes the fact that the person who is, by his own words, providing “expert legal advice to the Minister” doesn’t even understand the protection of “suspect on reasonable grounds” from arbitrary detentions, and thus no only are ‘suss laws’ being enabled by his negligence, but the consequences are not simpy a ‘stop and frisk’ but forced drugging with large amounts of anti psychotics and benzos (which will then provide a psychiatrist with every justification to make one a “patient”) And further, the Minister (also the leader of the Government in the Upper House) confirms the rewriting of the law by our ‘protector’ (Chief Psychiatrist).

      Might sound unbelievable, might sound insane……. but has anyone checked? Not a soul prepared to take the matter up with the C.P., or should I say when they did (thanks Council of Official Visitors) they were told to ‘back off’ while they sorted the matters out and manipulated the outcome.

      ‘My’ government pointing the finger at China whilst they are enabling torture, kidnappings and then killing anyone who has the misfortune of being able to prove what I’m saying. I’m sure they are ‘on to it’ now. But the major concern has been the manner in which they can silence any and all persons who are charged with a duty to protect the “consumers, carers and the community”. Why on earth would remaining silent about organised criminals within our hospitals be a good thing? Would they remain silent about other areas where ‘scammers’ are operating? Do Rolex confirm the validity of ‘fakes’ to protect their reputation? Because that is what is being done in my State. They are even denying me access to legal representation and the courts now they have been informed that they failed to retrieve the proof of the torture and kidnapping, and thus that my claim that they attempted to murder me is a real possibility with a ‘motive’.

      There is something Julie had that most of these so called ‘advocates’ lack, a spine, a backbone to speak out despite the personal risk to her safety. Yes they are silencing us, and like the National Socialists they will do so for so long with the support of the government of the day. We are happy while we are all making money, but things are changing and rapidly. These laws they have ignored and now dismantled that used to protect us, can now be weaponinsed to ensure the maintenance of profits for the select few (i’m sure their genetic makeup is being checked before admission to such an elite class. I know the clinic psychologist and her psychiatrist husband were having lots of tests run on their children.)

      What I can say as a result of my experience is that the ‘community’ is gradually losing their rights and even when they have those rights written into black letter law, they will allow the Chief Psychiatrist to violate those laws with his negligence and will not even challenge that violation. THAT is how the National Socialists got control, they realised that the jack boot in the face was a great coercive method.

      Anyone care to look at this letter from the Law Centre to the Chief Psychiatrist and his response? “suspect on reasonable grounds” (criteria set out in s. 26 of the MHA) becomes “‘suspect’ on grounds they believe to be reasonable” (no criteria and thus arbitrary detentions of anyone the Community Nurse wishes to kidnap). Druggings before police interrogations with date rape drugs and a prescription signed 12 hours after the ‘target’ was spiked, by a doctor who didn’t even know of the existence of the person who was “intoxicated by deception”?

      Or is it the claim that we need to go ‘softly softly’ in such cases? I think not, I am still being slandered by our current Minister for Health, and my questions of law to our Attorney General (Where do I make complaint about being tortured by Public Officers?) are still being referred to the Minister for Health, who simply slanders the victim as ‘mentally ill’ and refers to the torturers for ‘treatment’ (which seems to result in unintended negative outcomes). They don’t think they’re being watched which is the good news among all of this.

      Do not conceal the truth when ye know what it is. Why would the State wish to conceal such vile acts from the public. surely they would have confidence if they knew such evil was being dealt with? Or is their conflict of interest getting in the way, and like the abuses of the churches on children they find it so much easier to call these abuses “character flaws” rather than what they are, criminal offences? And our Attorney General refuses to acknowledge the law and hands the issues sideways to be dealt with via ‘medicine’. And with a Euthanasia Act that makes killing a medical procedure? Why wouldn’t you?

      Yes, Chinas laws may actually allow for arbitrary detentions, but there seems to be a lack of proof that it is being done. Our laws allow for arbitrary detentions though they are disguised from the public as ‘welfare checks’, and the acts of torture called mental health treatment. Plenty of proof that it is being done, though like the Jews, the victims are considered sub human and labelled “patients” to enable the acts to be concealed.

      • “There are two conflicting models for the design of mental health programs—the “medical model” and the “social determinants model.””

        This from the “Talking Points”

        There are two kinds of people in this world, those that think there are two kinds of people, and those that don’t.

        Is this statement correct? Or is there also an ‘abolitionist’ model which poses that if we stop these “medical” and “social” determinists from doing harm to people then we have “designed” a model that works for peoples mental health?

        Maybe there are three kinds of people in the world? Your failure to recognise them as people being the problem, not the models your designing to bring them under one or the other model.

          • Or at least the lets not treat people so badly that they say “She stopped at the curb and she turned around to look at us, and she smiled, and she leapt in front of a car, and she hasn’t woken up since,” and then later claim we just need to intervene earlier model.

            A 13 year old child (I do hope the consent forms were signed, or is this something that can be done post hoc, like the prescription for the drugs I was ‘spiked’ with?)

            Minister.

            “this recent case has highlighted that the current system does not cater for all”

            “It’s important we support our young people to address mental health issues early, before they become worse.”

            [note the use of the word "they" in this sentence. Should it not read "before WE make them worse" at least in some instances given the admission the system does not cater for all?]

            And we know that it wasn’t the ‘treatment’ that she received that resulted in such a ‘goodbye’ how? Oh that’s right, that has already been decided. Medical model people blame the social determinants people, the social determinants people blame the medical model people and ……… the wheels on the bus go around and around.

            Our Chief Psychiatrist is doing a targeted review of the matter which ….. well I’d like to share the way these ‘investigations’ are done via the letter of complaint and the response from our Chief Psychiatrist I have here, where the law has been rewritten to allow what is criminal to be seen as ‘nothing to see here’, but it seems no one cares (if you do I’m more than happy to share the letters with you all, especially someone who will assist in publishing them with redcations to protect the innocent). He looked, he saw what he didn’t want to see, and then ensured no one else saw what he didn’t want to see. I assume that no one will care about whatever fraud needs to be distributed regarding this case also? Perhaps the family, but they can be denied access to effective legal representation, threatened and intimidated into silence. “patients” will stop ‘treatment’ if you tell them the truth, and you will be doing people harm by speaking the truth. (where have I heard that before Mr Whitakker?)

            You bet your life the current system does not cater for all, and it is this creation of a false dichotomy that maintains and ensures that the ‘catering’ only gives us two types of Jello.

            And concealing the truth with falsehoods is not an effective means of ensuring it doesn’t happen again. Though making the claim that the victim was too far gone to help in the first place does provide a means to flip the script, and make calls for more money for a system that doesn’t cater to all to continue to not cater for all, but to simply apply more force until something cracks.

            Oh how I wish I had the ability to write. I’d write a letter to our Chief Psychiatrist, remind him of his letter to the mental Health Law Centre and ask if matters such as ‘there is mention in the documentation about the administration of benzodiazepines without knowledge, but the documentation about what was done seems to be lacking’. And the prescription for the signed post hoc is a crime so don’t dare ask any questions and bother to find out what was done because that would only make matters worse. Like the police when I explained about the Emergency Dept incident, they tell me “it might be best I don’t know about that”. Really? Organised criminals killing people in our hospitals and they don’t want to be made aware? Great.

            Your flagged ‘mental patient’ and if they want to kill you, so be it. We call that Public Sector Management and it ensures we are always right. Try complaining about our corruption when you have been ‘fuking destroyed’ and unintentionally negatively outcomed.

          • “Quite zen-like Boans. Or something.”

            Was it General Fisher in Korea when asked what it was like to be retreating (from the Chinese at Chosin Resevoir) said

            “We’re not retreating, we’re advancing in a different direction”.

            I dare say there is something in that for psychiatry, they’re not harming people, they’re healing them in a different way lol.

    • To think in terms of anti-Semitic versus Pro-Semitic, maybe at that time in the history the reporters did not have the words for the how and then the “why” occurs? Ask any artist, and they will share with you their language made visible? The joy that emerges from an exploration within can be a harrowing experience when the reconciliation/resolution begins to occur. Could there be something in the thought process that is not showing up in the Laboratory of Democracy?

      • The National Socialist Democracy I reside in for the moment is at a particular point in history where they are even telling our media not to publish articles that highlight the similarity between what was done by their counterparts in Germany during the 1930 – 40s and what they are doing here today. They are attempting to make it a crime, whist at the same time accusing the Chinese pf despicable behaviour in the laws they are passing.

        A rather clever method has emerged which has left me feeling privileged. One of the richest men in the country is being denied access to the courts by our State government (COVID Emergency provisions being the defense), and is suing them for $30B as a result. Our Premier has labelled him a fat slob and an enemy of the State, claiming that schools, hospitals and police services will need to be shut down if he should have his civil rights upheld in the High Court. The people of the State stand with the person who is ensuring that his civil rights are denied, and go along with the slander? Amazing what one can do when your riding a wave of popularity as a result of being an isolated place that has not, as yet, been significantly effected by this virus. They are even posting advertisments thanking us for our good work in stopping the spread, and talking like it is all over. Did I not get the memo?

        So it’s not just me being denied access to the courts, and not just me being slandered by the State when they have no defense for their unlawful conduct. This is a pattern, and one we should be concerned about, but ……. we’re not. Our Fuhrer has it all in hand, and there are plenty more waiting to get in should anyone wish to complain about the direction we are being taken. The “enemies of the State” can be unintentionally negatively outcomed, their wealth extracted for the benefit of the State (and to maintain vexatious litigation to deny citizens their human and civil rights), and the absolute hypocrisy of accusing others of what we are openly doing to our people will go unnoticed (arbitrary detentions, torture, etc).

        I can’t even get anyone to look at the proof of what I am saying. And can’t help but wonder why in a place where the claim is that they “advocate” for those who are having their human and civil rights abused. (They will expose their hypocrisy with what they say, and what they do).

  5. Thank You Robert for the brilliant Article,

    In my opinion the Medical Model has proven that it has NO Solutions – only Disability and Early Death.

    The Social Determinant Model has proven that it HAS Solutions and can even offer Self Actualization:

    https://en.m.wikipedia.org/wiki/Will_Hall

    https://en.m.wikipedia.org/wiki/Rufus_May

    https://www.ted.com/talks/eleanor_longden_the_voices_in_my_head?language=en

    https://www.independent.co.uk/news/people/news/a-first-class-recovery-from-hopeless-case-to-graduate-1808991.html

    https://en.m.wikipedia.org/wiki/Russell_Brand

    The Medical Model through Exposure to Psychiatric Drugs can even Cause “Schizophrenia” (similar to Valium causing “Anxiety”):-

    From My Own Case:-
    https://drive.google.com/file/d/1vYO9r1FkdJSv8Bi8Q3c3u9WXNZXkmxvO/view?usp=drivesdk

    As a result of ‘epidemic’ Misdiagnosis IMO:-
    Schizophrenia ‘epidemic’ among African Caribbeans spurs prevention policy change
    https://www.theguardian.com/society/2009/dec/09/african-caribbean-schizophrenia-policy

  6. I want to address some of these “talking points.” I wish we could really talk! Written comments with a 30 minute lag for moderation are a far cry from a real conversation.

    I live at the outskirts of this “system.” I have been trained in various types of treatments, have worked a little as a volunteer in disaster recovery situations and have some limited experience as a treatment provider. I am trained on theories of etiology, but mostly within my own frame of reference.

    Point 1. Not quite. There are more than two models of care, and more than two models of etiology.
    However, I don’t think the “medical model” has ever been serious as an etiology. It is a marketing ploy for the purpose of selling psychiatry and the drugs they prescribe to the general public. It has no place, really, in the field of mental health, as it attempts to rebrand this as a problem of physical health, which it obviously isn’t. The “medical” model has been totally abused by psychiatry, but we should understand that it is abused by regular medicine as well. MDs have been working hard for years to shut out non-drug forms of treatment from the benefits of “health” insurance coverage. MDs want to get paid! They want this, apparently, much more than they want a healthy population. This is a sign of creeping immorality in this profession, as has been seen in many professions, and in academia. It cannot and should not be overlooked. It is a very important aspect of the problem.

    To elaborate briefly, there are several nutritional models, several traditional “medical” models of care, including ones from the East, and there are a variety of spiritual models of care. These models cover both mental and body problems. Some models see the two spheres as closely-related, not really separable.

    Point 2. I don’t think this is important, as mentioned above. Neither model really addresses etiology. They are treatment models, and as an extension, income models and class models, you could say. You would expect a treatment to have some connection to etiology (causes), but I don’t think either model seriously addresses this, nor is intended to. “The system” doesn’t care that much about root causes. It cares a lot about levels of income and hierarchy.

    Point 3. I can’t speak to. I haven’t read the reports. But it makes sense that the “social work” model (as I might call it) would have better outcomes, as it is more patient-oriented and less income-oriented. People respond to being cared about. This is a basic truth I have been taught.

    Point 4. The whole culture of academia and “reports” is part of a management system that is worried about money flows and political power a lot more than about real outcomes for real people. Any intervention that actually results in a person “getting better,” becoming more independent in mind and body, is a threat to the system, which thrives (or so it seems) on dependency. I am not saying that a non-criminal system would see things this way. But we cannot assume non-criminal intentions for the current system!

    Point 5. Predictably. Point 6. Clearly so.

    Point 7. “Access to care” should read “caregiver access to funding.” Point 8. There you go.

    Point 9. Good for that model. I assume this is an open-and-shut case. The only “problem” with this model is that it doesn’t provide a sufficient income stream to those interested in being in charge.

    Point 10. You aren’t going to get a lot of “diplomacy” on this particular website. Lives are being ruined and lost. Billions of dollars of taxpayer money squandered on false solutions, all for the benefit of an arguably criminal elite. We only attempt “diplomacy” because of the power of their weapons, not because we really respect them.

  7. Robert, this is a great article and it’s wonderful you shared it here. I’m wondering, though, if you are also reaching out to such aforementioned boards and councils and are initiating these discussions. It sounds like you might be, and are trying to be careful about how you communicate and to whom you communicate.

    As much as I love this site, I think it easily turns into an echo chamber. I love the idea of having dialogues with people who are mainly familiar with the medical model, yet aren’t as aware of other models, such as the social determinants model. I work in a mental health crisis center, and as far as I can tell from my conversation with clinicians, these other frameworks aren’t taught in clinical education. And in the time I did go to school to study psychology, these alternative models definitely were not mentioned. I think there may be great openings for conversation with newly licensed clinicians and psychiatrists who are just going with what they were taught.

    In any case, there may be value as well in at least sending letters to mental health boards and councils (maybe even sending books, like Anatomy of an Epidemic! haha). You are eloquent in your presentation of this discussion, and I would just wish for decision-makers in mental health to hear your words, even if they might be hesitant at first.

    One last thing I will add – though I believe in diplomacy, there are times, as well, where sometimes the pen needs to become the sword. What I mean by that is, with some, the message can be lost due to both their arrogance and due to catering too much to what one believes they would accept. At that point, communication becomes superfluous.

    However, I believe there are times and situations where a hard-hitting truth needs to penetrate the barriers of arrogance – and that may mean speaking to pain points. One pain point is the reason people enter the mental health career field, to help others. If you are conveying how some of what they are doing may actually be HARMING people, that gets their attention. They obviously will not likely agree. But it DOES get them, even for a moment, to take what you have to say seriously. And that may be enough to plant a seed. I would not take this approach with someone who already has some openness.

    However, I have learned the hard way that if I cater too much to a person and try to be too diplomatic, some people will take on the patronizing, dominant role and think your heart is in the right place, but they won’t take you seriously. That, in truth, ends conversation – even if it’s a polite way to do it. And the beliefs remain unquestioned…

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