Intensive Home Treatment for Acute Mental Disorders: An Alternative to Hospitalization


In 1978, I became the medical director of a general hospital psychiatric unit serving the twin cities of Kitchener/Waterloo in southwestern Ontario, Canada. Over the next four years, population growth accelerated, and more psychiatrists joined the department, both of which resulted in increasing pressure on beds. We reached a point where patients had to wait a dangerously long time to be admitted.

The provincial Ministry of Health policy was clear: no more funding for hospital beds—only funding for community programs. I couldn’t see a way forward. An acute day hospital did not seem feasible; most of our patients were too ill to reliably attend, and public transportation is poor. There were no workable models for a crisis residence at that time.

The solution arrived fully formed in August 1982, when, casually flipping through a psychiatric journal, I spotted a review of the book Home and Hospital Psychiatric Treatment by psychiatrist Fred Fenton and his home treatment team at the Montreal General Hospital: “The results are clear and consistent. Home treatment emerges as a safe, acceptable, effective, economic alternative to hospital care for all three diagnostic groups” (schizophrenia, affective psychosis, and depressive neurosis, all ICD 8 terms).

In 1979, Fenton’s group had conducted a randomized controlled trial of home treatment versus hospital treatment published in the Archives of General Psychiatry—a respected journal. Depending on diagnosis, 35-58% of patients avoided hospital completely. In 1982, it was an epiphany to suddenly look around the ward at all the patients and realize that we didn’t need to admit all these people; we could actually treat many of them in their own homes!

The book contained sufficient practical information on how to set up and operate a home treatment service. Modelled on the Montreal service, our intensive home treatment service (IHT), named the Hazelglen program after its location in a strip mall on Hazelglen Drive in Kitchener, opened in 1989.

Our results have been consistent with the research findings in Fenton’s and other studies. We have been able to treat many patients at home who would otherwise have needed hospital, and almost all patients and their families have preferred it to hospital.

Research which formed the basis of the current model of IHT started with Leonard Stein’s service in Madison, Wisconsin in 1978. This service has the potentially confusing distinction of being cited as supporting evidence for two prominent service models: IHT and Assertive Community Treatment (ACT).

Subjects were any patients in a crisis needing admission to the Mendota Mental Health Institute. After patients improved, they were not discharged from the program as currently is the practice in IHT today, but continued to receive intensive treatment with the long-term goals of improving their stability and social functioning. Stein’s study was replicated by Hoult in Sydney Australia in 1984.

In discussions between Stein and Hoult, it was decided that it was unrealistic to expect one team to provide both crisis care for a broad range of service users and intensive community care for the particularly disabled group requiring it. This resulted in the subsequent development of ACT teams serving a narrow group of patients long-term and IHT teams serving any patient destined for admission for a short term—up to six weeks. ACT and IHT are two branches of the same root.

There have been 18 comparative studies on IHT in five countries and four continents. All have shown that IHT enables a significant proportion of patients to avoid hospital admission altogether and for others to be discharged early. IHT patients’ improvement in their symptoms and their functioning was equal to hospital-treated patients; risk of harm to self or others was also the same.

How Does Home Treatment Work?

The easiest way to conceptualize how IHT fits into a mental health system is to think of it as simply an alternative to admission. It targets any patient who is destined for admission. Whatever is the clinical pathway to hospital admission in the community, just substitute IHT for the hospital. In actual practice, because IHT is mobile, because it is not bricks and mortar, more alternative routes into the service are allowed, such as from family doctors and crisis teams.

It is important to make the distinction between preventing admission and providing an alternative to it. Crisis services—usually acting for a brief time, can prevent admissions. IHT provides an alternative disposition for patients whose crisis has already been evaluated and who subsequently are deemed in need of inpatient level of care.

IHT is different from mobile crisis intervention services. Such services, often working with police services, provide rapid assessment of emotionally disturbed persons in the community. They help de-escalate crises, provide support and advice, and make referrals to community agencies—all within a very short period of time lasting up to a few days, usually. Such services may make referrals to an IHT team if the person would otherwise require hospital admission.

Care takes place in the patient’s home—which can include any temporary arrangement, such as a crisis house. A multidisciplinary team, including a psychiatrist, is available 24 hours a day, seven days a week. They make frequent home visits—often daily, sometimes two or three times a day. Treatment lasts up to about six weeks, and patients are then transferred to less intensive care such as an outpatient clinic.

It is not unusual for IHT patients to require hospital admission during their course of treatment. This is not failure. Indeed, if the service is targeting the appropriate level of acuity, it is to be expected that some patients’ problems may become more severe due to unpredictable stressors suddenly appearing or just the natural fluctuation of their illness. Ideally, there are close working relationships with a nearby inpatient ward where team input can be provided and can contribute to the discharge decision.

A key concept in home treatment is acuity. Acuity is a combination of five factors: risk, symptom severity, functional impairment, degree of cooperation, and degree of social support. IHT is aimed at patients in in the lower 40-45% of the range of acuity of those destined for admission. It is important to hit this “sweet spot,” the “Goldilocks” range; less than that and one risks wasting resources on patients who could be treated as an outpatient; above that creates unacceptable risks.

IHT can reduce hospitalization in two ways: avoiding it completely in up to 65% in some of the studies and by enabling early discharge of patients to an IHT service.

That many patients can be treated at home instead of the hospital should come as no surprise when we consider the fact that hospital psychiatric treatment boils down to just three things: we talk to patients and their families, we give them medication, and a few get ECT. These can all be done in the community.

Psychiatry is probably unique in this regard among medical specialties, in which hospitalization usually involves interventions that cannot be safely provided in the community such as electronic monitoring and complex, potentially risky procedures.

While hospitalization is a vital part of mental health systems, there are numerous negative aspects, such that it should be avoided wherever possible. It disrupts patients’ lives and can damage their social networks and social functioning. Hospital admission carries a lot of stigma and can be a strange frightening experience for patients; some groups may be particularly ill-suited to it. These can include refugees and other immigrants—many of whom may speak little English—developmentally disabled people, elderly people, homeless people, first-episode psychosis patients, and those with post-partum disorders.

Many crises that lead to admission (called the “referral crisis”) are triggered by life events and changes in the various social networks, of which the patient is a part. One of the negative aspects of hospital admission is that these social system factors are not recognized and dealt with sufficiently; the ascendance of biological psychiatry has not helped. It is estimated that an acute admission addresses only one-third (largely related to the individual) of the pertinent issues creating the need for hospitalization. Two-thirds (largely related to social circumstances) remain, to cause future difficulties after discharge.

Hoult lamented the “perseveration” of the mental health system, whereby patients may undergo repeated admissions without the underlying social system problems ever being identified.

Managing the crisis at home is an opportunity for patients to learn skills and insights that they can apply in the future. Families have said to me that it was the first time they had fully understood the patient’s problems and what is the best way they can help

The relationships established between patients and professionals are more equal and based on negotiation and partnership than when they are admitted. You’re on their home ground; they can ask you leave if they don’t like the way things are going; they are in control.

For IHT to work, patients need to have, or develop the right attitude: an awareness at some level that they need help; a perception of the team as benign experts who can be trusted and are potentially helpful; and an understanding that to recover they have to do certain things such as let the worker into their house, telephone them, engage in counselling, and take medicine if required.

IHT is consistent with the principles of recovery, particularly that of least intrusive interventions. For some patients, the fear of restraint is like the elephant in the room, a continuous threat that shadows the recovery process. Patients appreciate the, non-medical ethos of home treatment. They are more willing to tell clinicians about signs of impending relapse when they know it won’t lead to automatic admission—there is now an alternative. Involuntary hospitalization can be particularly dehumanizing, and two research studies have shown that IHT can reduce the need for it.

Megan: An Example

To give you an idea of how IHT works, its versatility and its holistic approach, consider Megan, a 19-year-old teacher’s aide. She was taking an enforced break from university studies, which had to be terminated the year before due to an episode of severe depression. She lived at home with her parents and two brothers in a large house; her father is a chiropractor and mother a homemaker.

I first met Megan at the hospital crisis clinic, where she had been taken in the early morning a family friend with whom she had been staying overnight, after she exhibited manic behavior. Megan had a history of cyclical mood swings, including what her mother and family friend considered risky and self-destructive behavior.

The hospital wasn’t feasible for Megan; she was adamant about not being admitted and wanted to keep working. After being admitted to the psychiatric ward, she had simply walked out, refusing to take the medication prescribed—and since she was not a danger to herself or others, she was not restrained.

After my conversation with Megan, she accepted referral to the IHT service, which she considered much less intrusive than being admitted to the hospital.

As part of the IHT service, Pauline, a mental health nurse visited her at home, as did I. It was clear that the home environment was a source of trauma and conflict for Megan. We learned that Megan had endured childhood sexual abuse from her uncle and physical abuse from one of her brothers. Her father had a drinking problem, and her parents had severe marital difficulties.

After Pauline and I had worked with Megan for a while, she agreed to start medication and gradually became more settled. Her mother began to talk to Pauline about her own problems, particularly her husband’s drinking, and started attending AA meetings.

As Megan improved, Pauline met with her and a counselor to help her get started on therapy for the childhood abuse issues regarding the uncle. After three months she was able to be discharged from IHT to outpatient follow up in my office. Eventually she was able to resume her university studies in her home town.

Like many patients with severe mental health problems, hospital was not a good fit for Megan, but with IHT she had an alternative. Twice, her family tried to get her admitted but she refused. IHT’s nimble versatility enables it to turn on a dime to respond to the complex ups and downs that are not unusual in the course of serious mental health problems.

Although the whole team were at some time involved in Megan’s care, a key principle of IHT—a designated named worker—is well illustrated here. Pauline was able to engage her in a trusting relationship, negotiating with her about every step of treatment and teaching her family how they can best help.

Home treatment deals with not only the patient’s immediate family group, but with the wider social context such as work; the aim is to deal with any problems relating to the illness in these various outside groups, with an emphasis on preserving the patient’ role functioning. Pauline worked with Megan, her family, and even her employer to help ensure Megan could return to work.

Hospital treatment in a case like this would typically have had a much narrower focus, mainly on symptoms and medication. Megan would have been discharged home with likely little or no attention to the family issues, or helping her negotiate re-entry into her job at the school. Megan would likely not have been able to transition as smoothly to sexual abuse therapy and longer-term treatment.

How “Psychiatric” is IHT?

Home treatment services vary in the degree to which they hew to a non-psychiatric philosophy, and the most enthusiastic in this regard must surely be the Ladywood IHT service in North Birmingham, England—which I visited in 2002 for my book.

“We don’t use diagnoses,” said the founder of Ladywood, psychiatrist Sashi Sashidharan. “Diagnoses do not lead to action, they are not reliable, [and they] can cause stigma. There is a danger of diagnosis trumping everything else, including the leaking roof. We make a problem list with the patient whose problems may be no money, no food; voices may not be a problem.” The service is specifically targeted at young Black men.

The initiative for the creation of this service was a revolt against the local traditional mental hospital, which served the ethnic population poorly, especially Afro-Caribbean people. Central to Ladywood’s philosophy was giving patients more power. Sashidharan was influenced by the innovations in Trieste Italy, where all the psychiatric hospitals had been closed.

At Ladywood, much effort is expended to accommodate patients’ needs, even to the extent of paying for faith healers, mediums, and acupuncture. Staff work regularly with priests and Mullahs, and local churches, temples, and gurdwaras are a great resource. Patients are given an opportunity to select which drug they will take from a list. Practical help is emphasized and staff go to great lengths sometimes.

For instance, during my visit to Ladywood, a worker brought in a cat in a cage and proceeded to order kitty litter and cat food, in preparation for taking it to a patient’s home while she was in hospital.

The Ladywood team was a major influence in the development of the UK national plan to disseminate IHT.

The Success of IHT

England’s influential National Institute for Health and Care Excellence (NICE) clinical guidelines now list IHT as the first line choice of treatment for patients with acute psychosis and for patients with severe acute depression who are at significant risk.

The Royal College of Psychiatrists has created Home Treatment Accreditation Standards (HTAS) in 2013 and a fidelity scale called CORE was created in 2016 at University College London.

The mental health systems of  eight countries now feature IHT services: UK, Ireland, Australia, New Zealand, Netherlands, Germany, Norway, and Belgium.

In Canada, my IHT team was created in 1989 in Kitchener/Waterloo; a second team was established in nearby Cambridge in 1998, but was disbanded in 2007 due to lack of financial support; Hazelglen is still the only IHT service in Ontario.

Health care planning is the responsibility of each province, and British Columbia is the only one that features IHT in its mental health system; there are now five teams.   Vancouver General Hospital , the second largest hospital in Canada, replaced a complete mental health ward with an IHT team called “adult acute home treatment” in 2009. An IHT team had been created in Edmonton, Alberta, modelled on Hoult’s Sydney service, in 1993. A team serving only psychotic patients was established in Quebec City in 2016.

Buttonholing as many psychiatrists as I could at US conferences over the years, I could only find one IHT type service in the country—Baltimore Crisis Response—which I visited it in 2002 and included it in my book Home Treatment for Acute Mental Disorders: An Alternative to Hospitalization.

Some people who have been involved in the creation of an IHT service find it so rewarding, so different from working in a hospital, and they have such different relationships with patients and families, that they want to go out and “spread the gospel” of IHT. This was why I wrote my book and created my website, which is a repository of documents that can be downloaded.

In spite of the success of IHT in countries around the world, it feels like my efforts to disseminate the IHT model of treatment have met a wall of complete indifference. I have always thought of IHT as being a win-win proposition: for clinicians, it has many advantages for their patients, is evidence-based, and is mainstream in eight countries; for governments, it’s cheaper and as effective as hospital admission; for hospitals, it save beds and reduces pressure on ER’s; and most patients and families prefer it.

Barriers to uptake of IHT may be, in part, due to its inherent polarity: it provides conventional psychiatric treatment—same as the hospital—but it takes place in the patient’s home, the family are recruited to help, and social systems intervention is a major feature—different from the hospital.

With no actual experience of how IHT works, some stakeholders can focus on one or the other polarity. I’ve seen first-hand how non-medical clinicians and psychiatric survivors quickly dismiss IHT as “too medical.” In Canada, these two groups dominate committees that make decisions about adopting and funding services like IHT. As a consequence of this, for example, patients in Toronto continue to have no choice but hospital admission when in a severe crisis.

On the other hand, psychiatrists and other physicians, when contemplating what to do with a patient in a crisis, may dismiss IHT as not hospital enough. Everywhere I went, visiting teams for my book in the UK and in Canada, staff complained of how psychiatrists regularly bypass the service, admitting patients who could be treated in IHT, or if their patient ends up in the service, admitting them once a bed became available, even if the patient is by then settled in and doing well.

Neil Brimblecombe, Director of Mental Health Nursing at the Department of Health, England, concluded, “Essentially, for many clinicians, direct exposure to the benefits of home treatment services may be needed before they see it as a real alternative.”

When our home treatment was first launched, it was a rare physician who referred to us. Over the years, trust gradually grew, and doctors, non- medical clinicians, patients, and families began to accept us as a vital element in the local mental health system. We had developed a positive brand image—recognized as a team that could be trusted and relied upon to help patients. To thrive, the IHT model needs this positive brand image, which it now has throughout much of Europe and the Antipodes.

What Would A Comprehensive Alternative to Hospitalization Look Like?

The other two alternatives to hospitalization are acute day hospitals and crisis residences. Together with IHT, they form a triad of hospital alternatives. Each can work in tandem with another, in parallel or sequentially. They can also reduce the duration of hospital stay for some patients for whom admission could not be avoided.

Each of the three types of service is quite different in its method of care and has complementary strengths. Day hospitals provide structured activities, interpersonal contact, and prolonged contact with staff. Crisis residences offer a level of respite and asylum close to that of a hospital, but in an informal home-like setting

These two approaches are still significantly disruptive to the lives of patients and their families and not every patient needs them. In certain areas, they may be used extensively, such as in very socially deprived inner cities. For the most part, their place should be as a judiciously used addition to IHT, which, because of its nimble versatility and preservation of the patient’s usual family life, should be the default disposition for psychiatric emergencies wherever possible.


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.


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  1. So we’re back to using terms like “mental disorder” and “hospital” without quotation marks?

    I try to in principle bypass articles with headlines based on such offensive and fraudulent terminology; regardless of the content framing things in such terms is part of the problem, not of any solution.

    We’re missing Paula Caplan here at MIA.

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    • I agree, kindredspirit.

      “We learned that Megan had endured childhood sexual abuse from her uncle and physical abuse from one of her brothers. Her father had a drinking problem, and her parents had severe marital difficulties.”

      “Like many patients with severe mental health problems, hospital was not a good fit for Megan, …”

      Megan didn’t have “severe mental health problems,” she was a child abuse survivor, who was justifiably distressed.

      And this is the problem with the entire DSM based “mental health” system. Both the psychiatric and psychological professions, and their DSM deluded minion, are child abuse cover uppers. Which is the same thing as being a pedophile aider, abetter, and empowerer.

      And since the DSM “bible” believers can’t bill to assist child abuse survivors, without misdiagnosing them with one of their billable DSM disorders, over 80% of the so called “mentally ill” are misdiagnosed child abuse survivors.

      Our country needs to start arresting the pedophiles, and the “mental health professionals” as a whole need to stop stigmatizing and neurotoxic poisoning child abuse survivors. And, just an FYI, Megan was likely given an antidepressant, which can create mania, or “mood swings.”

      But we may thank the “mental health professions,” now that we all live in a “pedophile empire,” where child sex trafficking and pedophilia are running amok.

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      • You are correct. Megan was a survivor of childhood abuse . Childhood abuse is a risk factor for a large number of mental, physical and social problems as the ACE ( Adverse childhood experiences ) CDC Kaiser Permante study showed . But Megan was not just an abuse survivor -( if she was I would have referred her to a local service for abused women); she had a serious mood disorder . So, in the same way that physicians have to treat the physical consequences of childhood abuse such as heart disease, they have to treat the psychological consequences.
        Megan got help with her psychological problems , and she also got counselling for her abuse experiences – which- without our help in the first place would likely have not come to light

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        • So you aren’t a fan of the DSM and yet you’re perfectly fine with labeled Megan with a mood disorder, placing the problem within her instead of within the culture and family. What survivors need is restorative justice that holds abusers accountable. The label of being mood disordered or personality disordered is another subjective judgment from someone in a position of power over someone without it. You perpetuate harm by focusing your attention on the harmed individual rather than those doing harm.

          And yes, physical health problem are a manifestation of abuse survivors. But you cannot properly control for the effects that adult outcomes for abuse survivors often mean struggling financially, experiencing housing insecurity and food insecurity, etc, all of which contribute in significant ways toward those middle aged health problems experienced by abuse survivors. So focusing exclusively on what’s within the harmed individual response to harm rather than providing strong supports housing, meaningful work, good nutrition and non-pathologizing therapy is again, perpetuating harm.

          Psychiatric drugs (they aren’t medications) and psycho surgical interventions greatly harm already harmed persons.

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        • David, I think what a lot of survivors come to understand is that what looks like “mood disorders”, are really not “disorders”. They are responses and coping mechanisms no matter how fucked up.
          People look for understanding care, not treatment. It does no good to describe a state as “illness” or “disordered”.
          Of course people need someone or something. The something we have now is false. The language is false. Yes it’s a confusing landscape of characters and emotions which we do not understand but they are too complex to name and we really can’t move forwards in meaningful ways until actual reparations happen.

          Where shrinks can say “I am bewildered and overworked. This is not working”

          It has come to the point that death and illness is being psychiatrized. We medicate the dying, because “depression” is not a normal response to being ill or dying, when in fact, it is a physiological response. I’ve never seen someone elated over their physical suffering.

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        • How do you know she “had a mood disorder?” By how she acted? How do you know that how she acted was not simply a reaction to her abuse and oppression? What objective means do you have to distinguish who “has a mood disorder,” other than your own opinion or a subjective behavioral checklist?

          When I used to do hospital evaluations, I ran into many women who were diagnosed with “bipolar disorder” or “anxiety disorders” who were feeling suicidal or panicky. I asked every one of them about their current relationships and abuse history, and every one (except two who would not talk to me) shared horrible abuse that occurred when they were young.

          Maybe a “mood disorder” is no more or less than what happens to people when the stresses in their lives overwhelm their coping measures. In which case, do they have a “mood disorder,” or are they victims of a thoughtless and oppressive culture that continually puts people in a place where they can’t cope with the harm that they are repeatedly exposed to.

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          • Anyone who wants to understand the interplay of power dynamics in who gets labeled mentally ill in western culture can just look at the framing between different demographics.

            Young women with sexual abuse histories who attempt suicide are often labeled mood disordered or personality disordered.

            Middle aged white people (mostly men) who are often very successful in their suicide attempts are said to be involved in “deaths of despair”.

            Professionals of all stripes who attempt or complete suicide or experience emotional crises are usually referred to as being burned out.

            There are very clear distinctions made in the framing between those considered seriously mentally ill and those who are unfortunate victims of circumstance. When the poor or those with high ACEs or Black, Brown and sexual minorities or immigrants experience distress, we are generally labeled with one of the more severe DSM labeled and treated until we no longer complain, even if our lack of complaint is because we’re so drugged or brain-damaged that we have no ability to continue to express ourselves sufficiently.

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          • I agree. I’ve seen many articles on the high suicide rates among doctors, and there is not a single word about “chemical imbalances” or “genetics” or even DSM “diagnoses.” It is all about stress, burnout, loss of sleep, rough schedules, inability to maintain relationships, poor training… not a word about “mental illness” is raised. And the remedies are all about creating better working conditions, selecting for a wider range of personality traits, improving the training process, changing expectations. In short, changing the environment rather than blaming the person who has a hard time adapting to it. Why does this reasoning not apply to kids in school, or foster youth, or victims of domestic and sexual violence, or victims of racism, sexism, and other oppressive structures?

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  2. Well at least the author, a psychiatrist, admits that there are certain groups of people not suited for psychiatric hospitalization: “These can include refugees and other immigrants—many of whom may speak little English—developmentally disabled people, elderly people, homeless people, first-episode psychosis patients, and those with post-partum disorders.” Unfortunately, he failed to include freedom-loving individuals, people experiencing extreme fear, anti-authoritarian individuals, or people with PTSD from past incarceration/hospitalization. By widening the populations considered not ‘suitable’ for hospitalization, we would probably end up with close to zero amount of people who are suitable for ‘treatment’ in a restricted facility. In our enthusiasm to create cheaper models, lets not forget that there is a strong human rights incentive to veer people away from restricted facilities. Let’s not forget that there are millions of people who have been harmed by a psychiatric incarceration in a hospital and all the activities that routinely happen in those places besides the ‘disruption’ of a person’s social life such as seclusion, restraints, forced injections, threat of forced injections, loss of liberties including access to private phones at will, loss of liberties such as dietary choices. I could go on and on. This article, while making some good admissions for a psychiatric, glosses right over the harm of forced psychiatry. Let’s not forget that most people inside psychiatric hospitals are there by FORCE. And of those who voluntarily admit themselves, many lose the right to check themselves out.

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    • Let’s simplify by expanding the list to include: EVERYONE! NO ONE who isn’t voluntarily asking for it is appropriate for psychiatric “hospitalization.” In fact, calling it “hospitalization” is a misnomer. “Psychiatric detention” is the most polite term I could come up with. “Incarceration” is closer to the truth.

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      • Lest there still be those who consider such semantic corrections “extreme,” it should be noted that in legal briefs and proceedings the residents of “mental hospitals” are referred to as INMATES. “Psychiatric inmate” is NOT a term concocted by the movement.

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      • Under ” How does home treatment work-” fourth paragraph, I say that” home” can mean a crisis residence; it can also include women’s shelters. Of course we would never arrange home treatment for someone abused in the home. I regularly visited patients in the local women’s shelter.
        Sometimes- because home treatment actually discovers previously acknowledged abuse -as was the case with Megan

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          • “How can you reduce your exposure to violence in your life?” rather than “How can we work together to stop people and institutions participating in violence against citizens?” Or even more so, “What is going on in our society that creates and encourages violence and oppression, and what can we do to. change those conditions?”

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        • Do you think psychiatric drugs are appropriate treatment for abused women? Wouldn’t prosecutions of their abusers be a better use of resources?

          This also assumes the woman is going to avail herself of crisis services which are almost exclusively directed toward the poor. Class stigma plays a major role here.

          “ But psychiatrists warn that the eleven percent figure masks the true prevalence of domestic violence among the middle classes, upper classes, and even those families in the one percent. Statistics are primarily derived from organizations such as domestic abuse shelters that cater to impoverished victims,

          If spousal abuse is something that happens to “poor people” that society blames for their troubles, then any person who admits to suffering intimate partner violence must contend with the additional shame of being associated with “low class” behavior for which they are somehow responsible. Such contempt compounds the fears of reputational loss that battered spouses suffer, keeping even those who can free themselves from their situation unwilling to seek help. “The notion that ‘silence is violence’ takes on a whole new meaning for the upscale: their silence keeps them bound on the path of abuse,” writes Weitzman.

          In her book, Weitzman maintains that the women she saw in households with annual incomes above a hundred thousand dollars were even reluctant to mention the abuse in therapy. “Only with the greatest reluctance did the women I worked with reveal the abuse they had suffered, even within the safe confines of my office,” she wrote.“

          I was once a poor woman in DV shelter. No woman with any other choice uses those services. And the idea that she needs psychiatric treatment instead of a good lawyer is extremely pervasive. Your response of bringing your treatment to a crisis shelter only makes my point. Poor women are treated so badly that more affluent women suffer in silence.

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        • Let me make it even more clear for you. It’s easy to get away when someone is physically battering you. But the most mentally damaging abuse is not achieved with a man’s fists. It’s coercive control. It’s financial abuse. It’s psychological. It’s emotional cruelty. It’s manipulation to distance her from her family and friends. It’s telling her that if she leaves, all the money will be spent on lawyers and she’ll get nothing. It’s threats to use past psychiatric treatment against her. It’s even more insidious when the abused is disabled and being supported by an affluent spouse. Abuse that leaves bruises is the easiest to escape. Abuse that wears down and breaks a woman’s psyche gets diagnosed as depression and a multitude of other health problems.

          Your suggestion that you can “treat” her emotional crisis in a DV shelter reveals how little you know. I’ll stop here, I’ve made my point.

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  3. “ Marital rape or spousal rape is the act of sexual intercourse with one’s spouse without the spouse’s consent. The lack of consent is the essential element and need not involve physical violence. Marital rape is considered a form of domestic violence and sexual abuse. Although, historically, sexual intercourse within marriage was regarded as a right of spouses, engaging in the act without the spouse’s consent is now widely classified as rape by many societies around the world, repudiated by international conventions, and increasingly criminalized.

    The issues of sexual and domestic violence within marriage and the family unit, and more specifically, the issue of violence against women, have come to growing international attention from the second half of the 20th century. Still, in many countries, marital rape either remains outside the criminal law, or is illegal but widely tolerated. Laws are rarely being enforced, due to factors ranging from reluctance of authorities to pursue the crime, to lack of public knowledge that sexual intercourse in marriage without consent is illegal.”

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    • “ Sometimes I said no, and he kept going, and I… left. I mean, my body stayed, but the rest of me went floating up and to the right. Dissociation sounds scary, but it doesn’t feel bad. Sometimes it feels like sliding into a warm, cozy bed. A secret, safe place where I can stay as long as I want. It’s the coming back that breaks me open. That’s when I always cry.

      Perfect Victim is the model against which all other (normal, flawed, human) victims are judged, and trust me, we all come up short. Perfect Victim says no clearly and often, fights off her attacker like a honey badger, and if she can’t get away, she continues to profess her non-consent throughout the encounter, ideally by shouting “no” and continuing to fight as best she can. Perfect Victim has the courage of a hundred armchair quarterbacks. Perfect Victim bites and scratches. Perfect Victim spits and sobs. What she doesn’t do is give in. What she doesn’t do is get wet. What she doesn’t do is make her rapist breakfast.“

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  4. “Multiple studies have found that domestic violence survivors have higher-than-average rates of suicidal thoughts, with as many as 23 percent of survivors having attempted suicide compared to 3 percent among populations with no prior domestic violence exposure.

    It’s not just physical violence that’s linked with an increase in suicide. Verbal and emotional abuse are also connected with higher risk, as well as the duration, frequency and severity of abuse, and the presence of other factors such as PTSD, childhood trauma, depression and substance use.”

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    • “ The Florida Coalition Against Domestic Violence reveals that 50% of women with mental illnesses are victims of violence. More specifically, 50-84% of female victims suffer from PTSD. According to the same source, 63-77% suffer from depression, whilst, 38-75% of women report feeling anxiety. This indicates that there is some correlation between domestic violence and mental illness. In addition to the aforementioned illnesses, victims of domestic violence may also suffer from substance abuse, psychotic episodes and suicidal thoughts.”

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      • SOME correlation? The correlations with biological markers come in at single digit correlations at best, while here we’re talking 50-80%. I’d say there is a VERY STRONG correlation with “mental illnesses,” and that’s not counting the damage that does not show up at the “mental health system’s” door.

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  5. “Domestic abuse is a leading problem in American homes and it can take many different forms. When the abuse leaves no physical marks, outsiders may not recognize when all is not well and the abused person can find it challenging to translate what’s happening.

    “Gaslighting” — a term that became popular after the 1944 movie “Gaslight,” in which a husband slowly makes his wife think she’s going crazy through a long game of deceptions — is an insidious form of psychological abuse. It’s an intricate web of lies woven to break down one partner’s sense of self-worth and perception of what is real.

    “When you’re black and blue, you can point to the bruises and you can say ‘This happened to me,’” Dr. Robin Stern, associate director of the Yale Center for Emotional Intelligence, told TODAY. “But when somebody is undermining your reality and you simply have this feeling that there’s something wrong … women moreso than men, but men too, tend to point their fingers at themselves and say, ‘I did something wrong.’”

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  6. “That many patients can be treated at home instead of the hospital should come as no surprise when we consider the fact that hospital psychiatric treatment boils down to just three things: we talk to patients and their families, we give them medication, and a few get ECT. These can all be done in the community.”- yep, that’s great- drugging and shocking all done in the “community”. How much better to be fed neurotoxic chemicals and brain damaged briefly as an “outpatient” and sent home.Real improvement there. Let’s “drug” the poor victim of sexual abuse and trauma. What a great idea-

    This scheme is seen as an “alternative”? same kind of torture and lack of insight into how to treat the distressed and terrified. Appalling.

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    • Thank you. I stopped reading it myself when I realized there are no life preservers in existence buoyant enough to keep my head above the sea of bullshit.

      The take is privileged. It perpetuates harm against harmed populations. It does nothing to hold abusers accountable. And it places the dysfunction within the harmed individual instead of squarely on the shoulders of the powerful who do harm.

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  7. “But in all this discussion about the realities of domestic violence, one perspective was clearly left out: the people who are imprisoned for defending themselves against abusers. Where are the stories about how the legal system often punishes abuse survivors for defending themselves, usually after the legal system itself failed to ensure their safety?”

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  8. “Violence against women is widely recognised as a violation of human rights and a public health problem. In this Series paper, we argue that violence against women is also a prominent public mental health problem, and that mental health professionals should be identifying, preventing, and responding to violence against women more effectively. The most common forms of violence against women are domestic abuse and sexual violence, and victimisation is associated with an increased risk of mental disorder. Despite clinical guidance on the role of mental health professionals in identifying violence against women and responding appropriately, poor identification persists and can lead to non-engagement with services and poor response to treatment. We highlight that little research has been done on how to improve identification and treatment of victims and perpetrators in contact with mental health services, but that mental health services could play a major role in primary and secondary prevention of violence against women.”

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  9. “ Domestic violence stems from a desire to gain and maintain power and control over an intimate partner. Abusive people believe they have the right to control and restrict their partner’s lives, often either because they believe their own feelings and needs should be the priority in the relationship, or because they enjoy exerting the power that such abuse gives them.

    Tactics of abuse (in any form) may be aimed at dismantling equality in the relationship in order to make their partners feel less valuable and undeserving of respect.

    Being abusive is a decision: it’s a strategic behavior by your partner to create their desired power dynamic.

    Regardless of the circumstances of your relationship or past, no one ever deserves to be abused and you’re never responsible for your partner’s abusive actions.”

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  10. “The first thing that came to mind when I heard about COVID restrictions and mitigation strategies was how exceptionally dangerous this time could be for women living with abusive partners. “Self-isolate,” “stay at home,” “practice social distancing,” and “recession” are all words likely to be terrifying to many women who are living with intimate partner violence (IPV). The lives of these women are often filled with fear and danger under normal circumstances, but during this new normal of the global pandemic, the lives of these very often “invisible victims” are at an increased risk for more violence — and even murder.”

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  11. “Know the Warning Signs:

    My partner has injured me badly enough that I needed medical attention

    My partner follows me everywhere I go or needs to know what I am doing at all times

    My partner has threatened to hurt my children or pets

    My partner abuses alcohol or drugs

    My partner has forced me to have sex

    My partner controls my money

    My partner tells me who I can spend time with

    My partner calls me harsh names and makes me feel worthless“

    “Individuals who have experienced IPV may have many health problems beyond any immediate physical injury, including:



    Posttraumatic stress disorder (PTSD)

    Suicide attempts

    Substance abuse

    Gastrointestinal disorders”

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  12. “ Intimate partner violence may constitute physical, sexual, or psychological harm upon a current or former partner or spouse. In these situations, offenders try to control their victims through fear, intimidation, threats, or force. Perpetrators may humiliate their targets, control what they do, withhold information, isolate them from friends and family, and deny access to money or other basic resources.

    Persons who suffer such interpersonal violence usually report a range of negative mental and physical health outcomes.6 Sometimes, police officers seek this information from individuals caught between reporting their abuser and fearing how the “system” will treat them.”

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  13. “On average, more than half of the women seen in mental health settings are being or have been abused by an intimate partner. There are specific diagnoses that are commonly experienced by these women: post-traumatic stress disorder (PTSD), depression, and anxiety. In addition, traumatic events produce profound and lasting changes in physiological, arousal, emotion, cognition, and memory- changes that wouldn’t necessarily result in psychological diagnosis.

    It’s important to understand that someone’s mental health can be impacted without having PTSD, depression, or anxiety. Whether or not someone develops PTSD as a result of domestic violence depends on numerous factors, not everyone is impacted in the same way. The ways in which a victim-survivor’s mental health can be impacted can include: difficulties with being productive at work, school, with caregiving, establishing and engaging in healthy relationships, and adapting to change and coping with adversity.

    A victim-survivor’s mental health can also be weaponized and used as another form of violence and harm. Mental health coercion is a commonly used tactic that is targeted toward the victim-survivor’s mental health as part of a broader pattern of abuse and control and includes: deliberately attempting to undermine a survivor’s sanity, preventing a survivor from accessing treatment, controlling a survivor’s medication, using a survivor’s mental to discredit them with sources of protection, support, to manipulate the police or influence child custody decisions, or engaging mental health stigma to make a survivor think no one will believe them.”

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  14. Let’s be honest. This is still a form of psychiatric hospitalization. Even going to a psychiatrist and therapist on some sort of “out-patient” patient is still hospitalization. In the latter, most find it easier to walk away from the situation. First, remember, according to the article, the “therapist” was able to calm “Megan” down so she could begin her drugs. Second, having someone to come into your home, although she still lived with her parents, is more than intrusive. I think this could be construed, at least, in the United States, as a possible violation of the Fourth Amendment. Of course, I am no legal or constitutional scholar, but it seems like it could be construed as such. It allows the therapists, etc. to see inside the home of where someone lives, which is “none of their business” if you ask me and, could be even more detrimental to the well-being of the “patient.” This is just a way for the mental illness industry to get even more of a toehold into the very private life of their unassuming victim. To borrow one of my college friends comments, “This Sucks!” and I add “This Sucks Bigtime!” Thank you.

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    • I had hoped to make it clear in the blog that home treatment services are ONLY intended for people who agree to receive help in their home; that they have complete control as to whether they participate or not and can change their mind any time

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      • I have no doubt that your model avoids hospitalization but it still presumes that the best way to help those experiencing an emotional/mental crisis is psychiatric treatment rather than restorative justice and reparations for harm done. Therapy and drugs do not produce long term success for harmed individuals because it keeps them occupied with chasing an internal flaw when their response is the normal response to harm. It creates a situation where the problem is believed to exist within the individual instead of in the family, community and culture.

        Psychiatry is firmly entrenched within a greater carceral state which punishes those whose issues are most commonly boiled down to trauma, poverty, racism, and other oppressions. You can’t fix any of those with intensive home treatment. And it lets the powerful who continue to perpetrate harm off the hook.

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  15. “It is important to hit this “sweet spot,” the “Goldilocks” range; less than that and one risks wasting resources on patients who could be treated as an outpatient”

    Crikey, no laughing matter but I had to laugh.

    For people who are new to this and think all that’s being said is a good step

    ‘patients’ – victims of psychiatry.

    ‘treatment’ – abuse to torture to death at the hands of forced psychiatry… no joke it’s very real and on-going. You’ll be killed as an outpatient where ever and well as in a hellhole.

    And you might like to read this:

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  16. This approach is truly frightening, not only can one become incarcerated in a hospital setting but also in one’s own home so the individual has no escape from psychiatric abuse. I am truly disappointed in MIA for publishing and promoting this article.

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    • Dr David explained that it remains a “choice”. That the troubled person has a “choice” whether to see and use psychiatry or not.
      In Canada though and probably elsewhere, the choice is that or nothing. And also, it will be recorded that the “person refused help for their severe mental illness” or “patient is refusing further engagement with the treatment team” which of course is then on all your records.
      How do you think the arthritis specialist or heart specialist will treat you when he sees that?
      And the next time your friends call for “support”, it might come in the form of no “choice”.

      In Canada we do not have a choice of “mental” “care”. It is ALL provided by the same college of physicians and surgeons.

      I mean yay, I would much rather see my family member in their home, but I’m not getting choice of a different approach under a different paradigm. They HAVE to follow the guidelines of colleges, which is really eons old. I’m not sure if in Canada we have uniquely hip and radical docs who question the DSM and all that goes along with the paradigm. I have not heard of anyone. Surprising for such a huge country not to be birthing some GREAT thinkers.

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      • The first “choice” should be to choose to decline any “help” that the person finds unhelpful. And that should include the “choice” to reject the framing of his/her problems as a “mental illness.” That choice is seldom if ever afforded by those in “the system.” Once that choice is denied, any further “choices” become fairly illusory.

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        • Yes and the author says that they give the person a ‘choice’ of drugs, there is NO mention of drug free therapy. For me my home is a refuge, a place of safety, the physical address may have changed over the years but the concept of home and the feelings of security remain intact. The notion that ‘care’ in the community is any better than ‘care’ in a mental institution is a myth. Twenty years ago when I was briefly incarcerated I met a young man, not much older than my daughter who was there because he had suffered terrible abuse as a child and he didn’t want to be injected again with brain damaging chemicals that lasted for three months and made him feel dreadful, he was in constant pain both physically and mentally from the ‘treatment’, the ‘care’ in the community.

          Fortunately I escaped psychiatry and their corresponding drugs and have never looked back. I work full time and pay my taxes for a system that damages people when they are at their most vulnerable

          I am going to report this article as not in the spirit of MIA.

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  17. In fact everybody in a state of acute psychosis thinks that it the way it is. Doctors will inject something and the rest will do sea trip or something like that. Otherwise people wouldn’t call an ambulance. This understanding lies somewhere deep in the subconscious and at the peak of psychosis pops up where the sun’s rays reach.

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  18. Hi David.
    “Diagnosing” and “medicating” is
    a very privileged position.
    But yes, I guess you would always be called upon and needed.
    We all fulfill roles.

    Has your team considered the possibility of not sharing the “diagnosis”
    with other healthcare providers? There is absolutely no need for a GP to
    to know someone has the dreaded neurosis. Or do you think
    the DSM labels are helpful in real science?

    Do you believe in privacy? Are there things in your life or about you that you
    would not want others to know?

    Think about me having the power to give a description of you that contributes and affects the way you
    see yourself, in your vulnerable state, and how others treat you. And please,
    let us not call it stigma.

    It must be difficult to be able to tell the difference between drug effects and “natural fluctuations”. I mean how does one do that since the drugs are whole brain disruptions.

    Anyway, it sure is a very privileged position to be able to become part of chaos, and remain the calm and safe one.

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    • Privacy laws in Canada, especially as they apply to health care, are very strict. So, no, we would not share any information with anyone without the patient’s permission
      As for the DSM,I am not a fan. I don’t find it useful and agree with most of the criticisms of it

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      • David I was talking about real privacy. Not regarding sharing with family. We have no privacy in Canada and our “health” records are seen by any doctor that wants to see them. It is unethical because it results in horrible treatment by the very people that are supposed to deal with people’s health.
        I had this happen to me a few years back when a specialist dug back 15-20 years prior.
        It also happened with the man who had to crawl out of an emergency room in Ontario, and was kicked out due to his “bi polar”, even though he was later diagnosed with gullain barre syndrome.

        So once a doctor enters them into the electronic health system, it is not private. Even if I have seen a shrink, it is there for other doctors to think of what they so conjure up.

        I think you are probably doing the best with what the current paradigm is. However false it is. You entered into a world of woe that were labeled illness, or disorders when in fact labelling or drugging has only brought us farther from the real understandings.
        Not an easy life for the aware kind of psychiatrists that were caught up in it.

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  19. This is What Really Works for “Schizophrenia”

    (from “SelfHood”, by Dr Terry Lynch)

    “…The following is an illustration of the importance of self-generated security to a strong sense of selfhood and mental wellness. I referred briefly to Stephen’s story in the chapter on self-generated security.

    Prior to attending me in his late thirties, Stephen had been diagnosed five years previously as having paranoid schizophrenia. The level of loss of the components of selfhood, including the ability to make oneself feel safe, is at the extreme end of the scale in people diagnosed as suffering from schizophrenia. He attended me to explore possible avenues of recovery.

    I could see how Stephen was diagnosed as having paranoid schizophrenia. He saw threat and danger everywhere, when objectively there was none. Stephen’s level of selfhood was at rock bottom, and this was a fundamental underlying reason for his problems.

    His paranoia was entirely understandable as seen from his perspective, given that one of his main experiences was that he constantly felt unsafe, unprotected and unable to generate any personal security for himself.

    This was borne out in his second session with me. As I mentioned briefly in the section on self-generated security, ten minutes into the session, Stephen looked terrified, and I asked him why.

    He replied ‘I’m not sure I can get out of this place alive’. There were only the two of us in my office, and nobody in the waiting room. Objectively, there was no threat to Stephen, but he genuinely felt terrified for his life. He described the raw terror he felt almost constantly.

    I focused on enabling Stephen to progressively raise his level of selfhood. In particular, I worked with him on self-protection and self-generated security, because his lack of these dominated his life, the reason for his fear-filled thinking. I reassured him many times that in general he was much safer than he thought he was. We explored the various experiences of terror and paranoia in detail. Stephen gradually comprehended that he was indeed much safer within these situations than he had thought.

    I explained to him that his terror-filled, paranoid thoughts were an outward projection of his inner fear and self-doubt. In public places, he would often have thoughts such as ‘they’re talking about me. I can tell by the way they are laughing that they are laughing at me’. Now, he realized that what he was feeling was more accurately expressed as ‘I feel extremely unsafe, insecure and unprotected right now. I feel terrified, and I’m scared that there could be threats to me here in this crowded place’.

    This change in his understanding brought about a considerable shift. Previously, his thinking was preoccupied by the supposed threat that could lie around every corner. Now he was bringing his attention back to himself and what he was actually experiencing. Stephen was now aware of his own terror and inability to make himself feel safe, whereas previously he was not aware of this and instead was entirely focused on the dangers that lay waiting relentlessly for him everywhere.

    As Stephen was now truly aware of the role he played in his paranoid thinking, we had something substantial to work on. I used every possible opportunity to discuss self-protection and self-generated security with him. We explored his experiences of paranoia in great detail as they occurred.

    Our work became firmly grounded on what had actually happened within himself and his personal space in a given situation, rather than focusing on his projections into, and his assumptions about, others and the outside world. People experiencing paranoia also experience their thinking speeding up, reflecting their terror.

    Thoughts keep coming, in an ever-more-frantic cascading sequence. The person creates an entire scenario in their minds based on their initial first thoughts. The initial thought may be somewhat based on reality. For example, a person across the bar happens to look in their direction.

    The person runs with this, creating a complicated sequence of events in their minds, a fantasy created under the influence of immense terror and great lack of inner safety. In a matter of minutes, sometimes seconds, they become convinced that there is a sinister plot to harm them in some way. I used these experiences to get Stephen thinking about the accuracy of his interpretations of these episodes. I explained the futility and the dangers of attempting to read people’s minds, a habit that generally results in erroneous conclusions.

    He began to experiment with these ideas in areas where it really mattered, in the real world. In public places, Stephen would remember our conversations, notice how he was feeling, and whether or not he was attempting to read the minds of others.

    For example, when in a bar and a paranoid thought sequence was beginning to gather pace, he was able to stop for a minute, bring his attention back to himself. He could now connect with what was going on for him, look around him, and reassure himself that at this moment, he was not in any danger. In contrast, like a rabbit caught in headlights, Stephen would previously have become increasingly transfixed by an unfolding scenario outside of himself, that he was actually creating through outward projection of his feeling unsafe.

    I had encouraged Stephen to see things as they were, to resist the temptation to read into people’s actions and gestures and create his own fictional version of events. His previous pattern of projection had being going on constantly for him, but at an unaware level. He did not realize that he was doing this himself.

    For example, if a person looked at him and then looked left, he often concluded that this meant he was in trouble. If they turned their face to the right, it meant he would probably be okay, for now at least. Stephen believed that he was just tuning in to what was really out there in the world, but he was in fact creating this scenario himself.

    I suggested to Stephen that he needed to separate out the other person’s action from the meaning that he (and not the other person) was placing on this action. I explained that he was relinquishing his power over himself to other people, most of whom neither wanted this power nor were aware that they were being dragged into this situation.

    Stephen grasped these ideas and applied them in real-life situations, and in time he was able to extricate himself from his previous pattern of terror-based paranoid thinking. We explored methods of raising his level of self-protection and self-generated security.

    These included repeatedly reminding himself that he lived within his personal space and boundary, that this was his space, that he was safe within this space, and that there was much he could do in any given situation to make himself safe. When feeling unsafe, he would appraise the situation, see things and people as they were and be aware that any meaning he attached to them was entirely his creation and had little or nothing to do with other people or the situation.

    He reassured himself repeatedly every day that he was safe, that he could make himself safe and protect himself in any situation. When he experienced an episode of extreme fear or paranoia, he practised what we had done together many times in my office.

    He separated what was really there from the story he had created, and then reassured himself several times that what he feared would happen had not actually come to pass. This practise had the desired effect.

    His level of self-protection and self-generated security began to increase, slowly at first, then gathering pace. Stephen made considerable progress in raising his level of selfhood, of which, for him, self-protection and self-generated security were key factors.

    Because he was doing well, his psychiatrist agreed to reduce his medication slightly, and I subsequently continued the process of gradually reducing Stephen’s medication.

    Stephen has been off all schizophrenia medication for over three years. He lives a full life, goes where he likes, thrives in social situations, and has a level of selfhood higher that at any previous time in his life…”

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  20. Many have expressed concern with this article and the attitude expressed in it regarding domestic violence. I share their concern. I also have another concern. The author states that the services are available ONLY to those who desire it. But, if you say No to this type of arrangement, must the individual do time in a psychiatric hospital? I would say, in my experience, in America, that would very probably be the unfortunate case. Maybe, the individual might be allowed into a Day Program Alternative as I was some years ago. I am not sure what year. It’s the drugs, you know. I was locked into that, also, and had to be formally released as if I were in an in-patient program. Maybe, you could just save money amongst the taxpayers, stakeholders, etc. and just put one on those electronic bracelets on the individual. Because, no matter, how the treatment, etc. is done to the person (and it is always done to the person) the person is now an inmate, even if the person can appear to come and go as he or she pleases. It reminds me of the finale of the cult classic of the late 1960’s the British Based Television Show, “The Prisoner.” All of the “prisoners” thought they were now free of this “island” they were exiled. However, when they returned to London and went to go inside their apartments, they did not open their door on their own with a key. In fact, just like on that exile island, they would step on some sort of “strip” and their door would “magically” open—just like how they entered their apartments in their exile. So, please, tell me, who is free to live as they were meant to live, happily and healthily? Who? Who? Who? It’s just one imprisonment for another and this could be worse in some many ways. Thank you.

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    • If you have time, please click the link to the Dr Sahidharan video, that Sam ( comment just before yours ) mentions. This video conveys the ethos of home treatment . Responding to your question, it all depends on who is referring the patient to the home treatment service; it’s possible some referers may tell their patient that they will have to be admitted if they do not agree to home treatment. But we would not continue to treat that patient if they did not want it; it would be unethical and impractical. It is hard for me to convey what home treatment is like in such a short article. The patient experience is very different to hospital . Have a look at my website for articles that describe home treatment

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      • The problem, David, is with psychiatric “treatment”, not the location. You don’t seem to understand this as a provider who believes in psychiatric “treatment”. We do not need an alternative to hospitalization that delivers treatment as usual – medication and ECT – in people’s homes. We need an end to medicalized approaches to distress that rely on DSM labels, medications and psycho surgical techniques. Most of us here support psychosocial responses like Soteria houses, “peer” respite, Open Dialogue, mutual aid and similar forms of “alternatives” to psychiatric care either before or in conjunction with abolishing the unscientific field of Psychiatry. But this is not an “alternative” to psychiatric care. This is psychiatric care in a less restrictive setting. That’s what we are objecting to. Whether or not your patients appear willing to accept this in order to avoid medical incarceration is irrelevant. The power dynamics may legitimately be beyond your comprehension for someone in your position. But I can assure you they exist whether or not you are willing to see them and considering how great a percentage of the psychiatrized population ended up that way due to abuse of power and control, and how thoroughly psychiatric drugs and psychosurgical techniques have been shown to do more harm than good, it is indeed surprising to see this here. I can only assume that the funding from Soros Foundation has something to do with the “promoting all sides” approach that seems to be increasingly happening here at MIA.

        I do hope, though, that the MIA editorial staff sufficiently prepared you for the reception this “alternative” would receive here.

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        • From the comments here , it is not clear to what degree the readers are speaking for themselves -ie they personally would not want to be a patient in an IHT service, and to what degree they are talking on behalf of all mental health service users- ie such services as IHT should not exist-for anybody- and MIA shouldn’t even allow such blogs to appear
          If it is the latter, then it would behove the readers to familiarize themselves with the literature on IHT as it pertains to service user satisfaction, rather than just assuming all service users would think like they do
          The research in England ( and it is almost all English ) shows overall , pretty good satisfaction; when there is dissatisfaction , it is often not with the IHT model itself, but with how a particular staff conducted themselves or when things did not run efficiently .
          Common reasons for satisfaction were the holistic , relatively non-medical approach of IHT , the personal relationship with their assigned staff, practical help with daily problems , involvement of patient’s social network and family , and its flexibility . There are two papers about this on my website and other studies can be found early with Google.
          Hazelglen had very high levels of satisfaction in a questionnaire
          Like most things in life, there is likely a spectrum of opinions among service users about ” psychiatric treatment” ranging from complete rejection of it, to substantial acceptance. It looks like readers of MIA are very much universally at the complete rejection end. Service users who are generally accepting may be less likely to read sources like MIA i suspect .
          Opinions likely vary country by country . I have no experience working in the US. In Canada one sees the usual range of opinions but in my experience over five decades is that there is pretty good acceptance of ” psychiatric treatment ” in the population . I wonder if managed care is a factor in service users dissatisfaction . I read about ” 15 minute med checks” that psychiatrists are apparently restricted to doing in some settings. In Canada, I am free to spend 45 -60 minutes with my patients – in which I will do counselling, prescribe medicine, discuss practical problems -anything that is required- all paid for by medicare

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          • You couldn’t be more tone deaf here.

            Most of us here consider ourselves psychiatric survivors, not service users, while most of the general population is still taken in by psychiatric propaganda. It would behoove YOU to explore why there is such a strong and vociferously vocal contingent of survivors pushing back against your message here. We are intimately familiar with the harms of the biomedical approach to distress. Most of us have at least read Bob Whitaker’s book Mad In America. Here is a list of other titles you could peruse if you care to actually hear and understand the feedback you’re receiving:

            Anatomy of An Epidemic
            Psychiatry Under the Influence
            They Say You’re Crazy
            Toxic Psychiatry
            Thinking About Suicide
            A Mind of Your Own
            Your Drug May Be Your Problem
            How to Become a Schizophrenic
            The Myth of Mental Illness
            Coping with Panic
            The Emperor’s New Drugs
            Saving Normal
            The Bitterest Pills
            The Collected Schizophrenias
            Lyme Madness
            Big Brother in the Exam Room
            How We Do Harm
            Let Them Eat Prozac
            Resisting Illegitimate Authority
            The Revolt Against Psychiatry

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          • I am sure that lots of people who have been forcibly psych “hospitalized” would give your approach a big thumbs up. I think you are missing the context of these comments that doing a better job of using less force and coercion and attending more to social conditions would be an IMPROVEMENT, but that it does not address fundamental issues of power and pretense of “scientific-ness” in the current model, that are both misleading and potentially dangerous.

            I once worked at a nursing home ombudsman’s office for the State of Oregon. I recall a home that was shut down and put into federal receivership still received over 80% “good” or “excellent” ratings. A lot of folks are willing to go along with whatever is offered and feel like if they’re treated with some level of respect, they’re AOK. They are generally unaware of the damage that may be done to others, and sometimes even to their own potential growth, because they’re doing what they’re “supposed to do” and they don’t know of any other way.

            There are any number of folks who post here who might in the past have given in-home treatment high marks, and only realized over time that the “treatment” wasn’t really helping or was making their lives worse. And like I said, it sounds WAY better (in most cases) than being locked up after being arrested by the police! I mean, who can’t see the relative advantages there! Yet the basic assumptions of the system, that people “have bipolar,” that they “need treatment,” that drugs “correct chemical imbalances” or some physiological/genetic problem, are all still there.

            So the question to me isn’t what your customer satisfaction ratings are, or whether “acceptance of treatment” is higher. The real question is what COULD happen to these folks if the current paradigm were scrapped and they were approached from a standpoint of people who have experienced difficult times and need support, rather than people who “have” a “disorder” and need to be “fixed?”

            I want to say that I do appreciate your efforts. But I would encourage you to listen a little more deeply to the feedback you are receiving, and don’t be so quick to dismiss it as people who “don’t understand” or “reject treatment.” I’d suggest you listen from a standpoint of saying, “These are people who report having been severely damaged by the system I essentially believe in and promote. How and when is this happening, and am I inadvertently contributing to this kind of event, even when I think I’m doing things right?”

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          • Oh, and just by the way, DO you tell your clients that long term use of antipsychotics can lead to permanent movement disorders, diabetes, heart disease, weight gain, and possibly an early demise? If you don’t, why don’t you?

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          • David, I think Steve gave you a great reply.
            I think some of us used to be “megans”.
            I am all too aware of “satisfactory” reports. Patient reports. I know personally of SO many people on psych drugs past and present, who only ever go “meh” when I ask. They feel there are no options, they are sick and this is what is available. And of course they prefer a non forced version to deal with their “sick”.
            In fact my niece and nephews gramma died in 2019, after many years on effexor, and shock. She had encepalopathy with 10 years basically being bedbound and then thankfully developed pancreatic cancer and went swiftly. She never ONCE complained about psychiatry and neither did her spouse in the long obituary he wrote. They saw it as inevitable and so my niece and nephew are being raised in an environment that taught them that these are “treatments”.
            Sorry, but we cannot settle for treatment satisfied people who are “satisfied” because nothing else exists. So of course they are not looking on MIA.
            Some slaves looked and when they were set free, they were worse off, because they were sent free into nothingness. So they had to send their children back to masters to be able to earn a bit of money but never enough to move away from the constraints. “So there, that’ll teach you to look for alternatives, we just won’t give you any”.

            Any feedback you are getting here is purely about a false paradigm being spouted by the industry and temporarily satisfied customers. Some of them will be satisfied until they die.
            What is wrong is that it is still a complete falsehood underneath it all.
            MANY people believed being a slave was all there was and some were happy. And yes they were more miserable when thrown into nothingness. No help, no support.

            When a questionare is sent out, there is never enough space to write any context. And we also never hear the context of the disatisfied in these reports.

            I understand that you yourself had to go the extra mile to achieve the IHT, butting egos/narrow thinking and such…. Which is strange considering you were not changing the paradigm. And I believe that perhaps you or/and your team really are more caring and holistic. And perhaps you might even have a few that can escape psychiatry permanently, meaning they can escape some of their and others minds.

            Governments OWE it to the people who want support, but who do not want it to come in the form of sitting in a chair, to give them the choice of being label free and have FULL privacy about the “facts” of being “sick in the head”. This is simply a governments way, it’s about not providing the proper education, or supports to deal with the MYRIAD of problems that living in social circles will bring.

            We can’t even make it perfect for everyone, but we made wheelchairs for those who cannot walk unaided. It’s not a character
            fault to not be able to walk.

            Anyway, I am pleased that you engaged with everyone

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        • But this is not an “alternative” to psychiatric care. This is psychiatric care in a less restrictive setting.

          Just to interject — objectively speaking I’d still have to say this and Open Dialogue, etc. are more of a continuum than an either/or, as all the “approaches” being spoken of are centered on the individual, not the system. A truly “alternative approach” would be to prioritize the immediate collective revolutionary transformation of the material and spiritual conditions under which we live. This is a political and economic struggle, or it needs to be, if all this ostensibly “individual” misery and alienation are ever to be eliminated.

          As for the semantics of the term “alternative,” nothing healthy and right is an “alternative to psychiatry,” but the way things should naturally be. “Alternatives to psychiatry” is more appropriately applied to alternate types of torture or poison, or repression.

          None of this is meant to detract from anything KS has been saying btw.

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      • While there is no doubt that some people would find this approach far less oppressive, it does not reduce the power imbalance and the frequency of coercion or abuse. I’d say that a person who agrees to “voluntarily” be treated at home under fear of being forcibly “hospitalized” is in no wise voluntary. Additionally, if the recipients of these voluntary “services” are only offered biological interventions, or are forced to accept biological interventions as a part of the package, or are misinformed about the limited benefits and potential long-term costs of these interventions (including the very real possibility of a significantly reduced lifespan), or are not offered the full range of alternative options (including sending y’all away at the door), we are still dealing with degrees of coercion, and the “voluntary” nature of these services is undermined.

        Just a question: does your service tell those who are recommended to take antipsychotic drugs that they are risking shortening their lives by a decade or two by accepting this “service?”

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  21. Interesting comments. But I have a question. Are some of you saying that almost ALL people who are suffering from what is called “mental illness” (such as severe depression, bipolar disorder, schizophrenia) are reacting to severe abuse or horrible situations in their environment? I’m not denying that is sometimes the case. But how often? What is the relationship between innate vulnerabilities and mental breakdowns? Some people can be unable to function because they lost a job. Other people confront illness, death of loved ones, divorce, etc. and still manage to go on. I don’t think we know what leads to “mental illness,” except that there are undoubtedly numerous causes. And wouldn’t that mean we should accept various treatments, as long as they’re reasonable of course.

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    • I would agree with the “multiple cause” theory, and that overt or specific trauma is not required to fit the “criteria” a “mental illness.” Of course, the fact that someone “fits the criteria” means essentially nothing at all if the “diagnosis” has a wide array of possible causes.

      The main problem I have with these “diagnoses” (and others will raise other problems, I’m sure) is that they lump together people who have nothing else in common besides feeling, thinking or acting in a certain way and ASSUME that 1) all these people have something wrong with them, 2) they all have the SAME thing wrong with them, and 3) some form of “treatment” should help ALL of them “get better” in someone’s eyes. Of course, these “diagnoses” have absolutely no scientific validity at all, as Thomas Insel, the head of the NIMH, himself admitted years back. He said it’s like someone diagnosing “chest pain.” It is meaningless to make such a subjective and broad “diagnosis,” because it includes people who have literally nothing in common with each other besides a surface manifestation of some sort. It is not possible to conduct any meaningful research on a group of people who have no common trait. What would you be studying?

      As to “innate vulnerability,” I’ll go to an analogy. If 50 people got hit by a car at a certain intersection, and 35 of them broke their legs, would we be studying that group for a diagnosis of “weak bone disorder” and find out what kind of “genetic vulnerability” they had to their leg breaking? Or would we study the intersection or crossing and find out why it is that so many people are getting hit by cars there?

      Just for a little icing on the cake, the most optimistic estimate of the “genetic” contribution to any single “mental disorder” is well below 10%. Whereas people diagnosed with “schizophrenia” correlate with childhood abuse/neglect at an 80% rate or higher. Correlations between abuse and “anxiety” or “depression” are even higher. So the very idea that these “disorders” have a “genetic etiology” is over 90% mythology.

      One question to leave you with is this: If there is a less than 10% genetic component and a more than 80% environmental component, and the genetic component is the one thing in the equation that can absolutely NOT be altered by any means, why are 90% of the dollars spent on studying genetics and physical interventions and a paltry sum being spent on studying environmental effects and how to ameliorate them? I think the answer says a lot about the ostensible “objectivity” of the current system leaders, don’t you?

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      • I think the research dollars go to the areas that will make the most money for the interested parties, pharmaceutical companies, psychiatrists, physicians in general. It’s easier and more lucrative to have people take a pill (and convince them it works) than to examine the more complex causes of psychiatric distress.

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        • Agree 100%. The whole subject and industry is corrupt from top to bottom. But that’s another reason that these DSM “diagnoses” are so dangerous – they allow the industry to continue the fiction that these drugs are “treating” some sort of “medical condition,” rather than prescribing them to suppress feelings/thoughts/behavior about which they have no rational understanding, nor any intent to come up with one.

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    • Yes, many causes exist that are not specifically trauma-based. Infection is one well-known cause – syphillis is the historic example but Lyme disease also causes extreme depression. Lyme patients describe it as the worst depression they’ve ever experienced. Lyme patients can also experience psychosis due to central nervous system infection and brain inflammation. When lyme is properly treated, the mental effects are relived as well. Autoimmune disorders are another well known cause of mental distress, again due to factors such as systemic inflammation, brain inflammation and poorly controlled pain. Bowel disorders are known to effect the mental functioning and the theories suggest multiple routes from direct messaging from harmful bacterial overgrowths (blautia blooms are implicated in chronic Lyme disease (PTLD)) to faulty enteric nervous system signaling to the brain. Drug abuse is another way to screw up your mental functioning, and the use of high THC content cannabis is correctly implicated in the development of psychosis. Organic brain disorders result from physical trauma such as TBIs and stroke and also tumors. Genetic causes, though rare, are real and include missing chromosomes, duplicated chromosomes, and copy mutations.

      What is completely missing from all of these causes is treatment that treats the cause because the current approach to mental health care does not attempt to discern etiology, instead opting for chemical treatments and groupings of symptoms. My personal experience, and that of a great many others, involved a number of causes from systemic infection to autoimmunity to high ACEs to intimate partner abuse that all converged to produce a barely functioning adult and chemicals weren’t even a bandaid for all of that. They actively did more harm than good from the very start. And telling me the reason for my distress was a chemical imbalance for which I needed a lifetime of drugs produced an extremely poorly functioning person who is actually damn lucky to even be alive at this point.

      So, is it all trauma? No, of course not. But it isn’t a chemical imbalance either. The drugs and psychosurgical techniques used by psychiatry are both actively harmful to the majority who use them and actively disempowering and lead to our disturbingly high suicide rate and our shockingly low recovery rate. The legacy of the last 200 years and particularly the last 40 years of psychiatric “care” will go down in history as one of the greatest missteps in the entire history of medicine. No amount of intensive home treatment involving current psychiatric methods will change this fact.

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    • As for which of the labels are most closely associated with environmental traumas, they would be the personality disorders, the dissociative disorders, schizophrenia/schizoeffective disorder, (complex)PTSD and ASD, attachment disorders, and panic/anxiety disorders. And those cover a massive percentage of the overall psychiatrized population.

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    • Marie, you are asking a question to where there can only be hypothesis, and which every human still grapples with and is something we should not come to conclusions about and develop harmful drugs or “treatments” for.
      The practice of psychiatry has led to way more harm than good and it is a very biased narrow belief system, of how others are lesser or do not meet “normalcy”.
      It is “resilience” you talk about that allows one to meet adversity, and others not. But it is also “resilience” shaming, kind of like telling people they missed something in their development, “you are not the same, you have less in your character. Because in the normal world, you should be able to be like that guy over there, and since you cannot, you have a disorder”
      These are simply suppositions made by privileged people who don’t even know how they developed to be privileged not to be having a break down.

      And the resilience, the nature vs nurture has never been completely answered because if one child in a family was the sensitive one, we have zero clue if that pregnant mom might have been distressed by deaths or other things while carrying the baby, or if the baby fell out of the crib, or the baby/child had a lot of ear infections, other infections. A loud noise will affect a 1 year old Susie in ways it does not affect a 4 year old Johnny and the parents wonder why Johnny is so brave, yet . Perhaps parents then start treating the fears in numerous “maladaptive” ways. “maladaptive” in the sense that the way we create worlds for a certain normal, then the child might not fit so well, constantly bumping into barriers. So it is obviously not direct abuse but yes we develop from our environment. It is the naming and “treating” these difficulties that continue to harm people greatly. For other disorders of the body, it is not held against you or “treated” if they do not know what the cause or condition is. Neither are they told that the way they walk or are unable to run or work, must be treated. In fact, with the mind, if the proper environment is allowed, most start to flourish, because it is experiences that shape you, not “treatments”. Psychiatry treats people who come from generations of “hardships”, not due to anyone’s fault. We have constructed a view that if you DO fall apart because of stresses that do not affect others, that there is something wrong with that person. It always points to the thing that makes them up as a unique individual, that they are “faulty”. Faulty wiring. Since we are what we eat, how does having to view yourself as faulty in the head, make one feel good? Someone feels “faulty” or others say they are, and psychiatry says, yes you are sick, disordered.

      And the truth is that IF there were early injuries, bumps or hardships or abuse, that made life more challenging or brought more fears, if neurology cannot see where those injuries happened, or the birth defects, then psychiatry has no business drugging shit they know nothing about.
      The VERY FIRST visit to a shrink should identify which programs, life styles might be helpful, NOT which drug. What if your first visit to a shrink was identified as needing a 6 week adventure trip that includes stuff you have never done? What if your insurance paid for those adventure trips? What if the trip was full of abnormals? Perhaps another 6 months in programs that pertain to possible interests. Perhaps some assertiveness guiding. Or “care and empathy for others”, guiding.

      After a year of a variety of involvements with other people and successes, failures and fun, what would the outcome be?
      There is money to be had for creating disability.

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    • Are some of you saying that almost ALL people who are suffering from what is called “mental illness” (such as severe depression, bipolar disorder, schizophrenia) are reacting to severe abuse…

      One problem is with the question, as there are no consistent categories of thought or behavior which can be legitimately “called” anything. Everyone’s subjective experience is unique, despite psychiatry presuming to quantify it.

      Many forms of trauma are given such labels. So is any other emotional or mental state deemed problematic (for whatever reason).

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  22. “Mental Illness” is something applied to you. It’s not like a broken arm or leg or even like a cold or strep throat. In many ways, “mental illness” is an illusion, illusory, almost like a “magic act” done to you for all the wrong reasons. Yes, you might not feel like yourself. You might be sad. You might be angry. You might be upset, confused, even disoriented about something. You may even hear conflicting voices; your parent, teachers, society, etc. Some even have mal intent and want to harm you. Some are just confused themselves and just want to share their misery of confusion. So, you go for help, the secular parish priest, aka the therapist/psychiatrist, etc. They give you a “diagnosis”, ply you with drugs, try to mold you with all kinds of alleged therapeutic interventions until you no recognize yourself. If you have been abused physically, sexually, emotionally, etc. or involved in some sort of traumatic situation, on one level, it all seems so right. Why? It’s a sanitized version of what you have previously endured and not only that it is approved by law, by society, by authorities you try to trust. But, somewhere inside you know something is just not quite right. The birds no longer sing to you. The sky is not it’s blue of longing anymore. When it rains, the raindrops hurt all over. And, when it snows, you just want to pretend it does not exist. And the sun, you already know about the hole in the ozone layer. You don’t have to be told now. There’s a hole in the sun. And the night sky is not full of the stars and the moon. It just looks like it has the measles or chicken pox. This is your brain on the drugs and the therapy. And, you realize this is not the way out of the confusion, the sadness, the anger, the trauma, the abuse you already experience. This is just more trauma, more abuse heaped upon you. But, you can not verbalize or articulate this. For although, you make be walking around, you can not really speak and if even you could speak, no one would or could hear you. This is the fate of those who seek help, either knowingly or unknowingly in the “mental illness system.” This is what happens when you seek out something that you thought would be good for you, but, is really bad for you. And, if though, you may not be consciously aware of it, you are trying to find a way out, because, if you don’t, you may die a premature death or maybe even worse, you are alive, but, such a shell of yourself, you might as well be dead. So, how do you get out of this? You see, it doesn’t matter what kind of hospitalization you might have endured, because, all of it is a form of hospitalization. How do you get out? Some sadly never do. And if you do get out, much of you, is forever changed. You are damaged, your brain, your body. It’s all individual. How it affects you may affect someone else differently. How you survive the withdrawal and what happens afterward is, in many ways, incredibly unique, tailored it seems just to you and you alone. But it is not all tragedy and pain. If you survive this you will be stronger, although your “stronger-ness” may look remarkably different than any other survivor. But, still no matter how strong, you might be overcoming this and being victorious over this, you will always live with this “niggling” thought at the back of your mind—why did I let the do this to me? why? But, even though that thought is almost always there, do not let it paralyze you. You have survived this for a purpose. You have survived to help others through this journey and lest we not forget, to help yourself through this journey. “Love your neighbor as yourself.” Thank you.

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    • You broke the code Rebel. And took it a little further. Hoping you’ll be working with the AP movement asap — in a way you are already.

      A random thought or two on strategy —

      1) Nothing happens in this corporate system that runs our lives — that is, nothing not in the interest of profit — without sufficient mass pressure.

      2) “The public” is WAY too clueless about psychiatry for our goals to be endorsed any time soon, given the degree of mass ignorance about what psychiatry is and does, which is actively promoted by the psychiatric industry. Still mass pressure remains the only strategy that will ultimately work to extricate government from psychiatry, as psychiatry props up the whole system big time. Without the government sanction of force psychiatry would rapidly wither away. And without psychiatry the system would have to resort to brutal fascist-type repression on a regular basis, which is messy and expensive.

      3) Survivors are generally the only people with sufficient consciousness and motivation to drive public education in matters anti-psychiatry. There are of course others as well, and this is not a broad brush. But there are also many more who echo our rhetoric as they pursue careers in “reform” psychiatry, which actually does immense harm.

      4) Hence it is not only important but VITAL for survivors to have our own forums for discussing not only this but a myriad of related issues. We can’t “educate” the public to anything but our own confusion if half of us are calling for abolition and the other half just want psychiatrists to treat them better.

      Once we have unity among survivors based on reason and analysis, not wishful thinking and emotion, we can THEN proceed to raise public consciousness, and from there proceed to the struggle finally achieving some concrete success, not just “improved” drugs and prisons still called hospitals.

      Anyway I just felt motivated to break some of this down, as sometimes I take it for granted when I write. But these are some of the givens that I base my comments and conclusions on.

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  23. “The research in England ( and it is almost all English ) shows overall , pretty good satisfaction; when there is dissatisfaction , it is often not with the IHT model itself, but with how a particular staff conducted themselves or when things did not run efficiently .”

    “Care” the the Community” in the UK is horrific – we have a situation whereby psych nurses are going around injecting people with neuroleptics in public places. And of course they go into peoples homes and inject people.

    Maybe if you were subject to being injected with neuroleptics you would have a different opinion and come to understand that psychiatic drugs are a form of torture and major human rights abuse not ‘treatment’. Psychiatry has to be abolished and psychiatrists who have tortured people be subject to the law, their assets removed and given to their victims. Here is one example on MIA:

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  24. David I looked at your website a bit.
    In general it is the “safer” way to go but I think we all
    know that it operates within the same framework.
    I was particularly bothered by this.

    “Education about mental health problems for patients and their social network”

    Now I think it’s incredibly dangerous to explain to the family “what is WRONG” with
    their family member. Because you really can’t. You nor I have ANY clue about the
    millions of unique interactions they have within families and how it might
    manifest itself in one.
    That ONE, is not the “ill” one and so it’s crappy to tell families that.
    It would be responsible to tell families that how each person responds to outside and in home
    relationships is too complex to be able to define or judge with simplistic labels.

    I also think that in the case where the stress and unique interplay might cause people difficulty,
    perhaps new homes could be found for them and considering it takes $9,000 for admission to a bed, we
    would be better off spending that money on creating comfortable safe environments for people.

    This “medicine” business is just so false on so many levels. Have you met the thousands of kids and women damaged from these “medicines” or lying in their graves? THIS can only EVER be used IF the client has absolutely very CLEAR information that they are damaging and scramble up every single cell.

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  25. Having started out the comments on a critical note, I’ll get just a bit contrarian to say that I’m a little confused by the general level of criticism being directed at this particular author, as in terms of basic assumptions I don’t see anything here significantly more objectionable than in any pro-psychiatry MIA piece. It could be that the consensus is shifting about what is considered “progressive” and Dr. Heath didn’t get the memo; however I also think some of this is based on illusory conceptions of what psychiatry is in the first pace.

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    • @oldhead:

      Hey, I was going to wait to post this. I ordered this book for $9 bucks, used, & it’s going to take to the end of this month to get here. I have a lot to say. But I can say some of it now, so…I composed this in WORD & it’s a tome. I made it as fun to read as I can. Researching this stuff makes me sick to my stomach. I’ve had to move through bouts of extreme fear & anger to get ‘er done. So here goes (the Kenda’s Law article made me change my mind about posting now). This took a long time, but it’s, well, timely:

      Part One: (written on February 10, 2021)

      I got a used copy of this author’s book & while I was waiting for it, I bookmarked this article & prepared a metanarrative to something I have been tracking & felt is worth mentioning. You said: “I’ll get just a bit contrarian to say that I’m a little confused by the general level of criticism being directed at this particular author, as in terms of basic assumptions I don’t see anything here significantly more objectionable than in any pro-psychiatry MIA piece.”

      I think the response to this article is more about the larger implications of forced psychiatry as opposed to only pro-psychiatry. If someone gets a referral to Intensive Home Treatment (IHT), forced inpatient hospital treatment MAY or may NOT be the result of “non-compliance.” The “MAY be a result of ‘non-compliance,’ is the part that’s of interest to survivors. Of course. And that’s been pointed out.

      As you said, it is also about “the illusory conceptions of what psychiatry is in the first place,” and by treating “mental illness” in THE HOME, it brings up problems that are beyond the definition of “mental illness” (or lack thereof), and aids to covering up child & domestic abuse. By its very definition. Or lack thereof. But David Heath can circumvent that argument, for a while at least, by saying he does not include this to mean covering up for child abuse as he treats these “patients” out of a home setting. But he didn’t answer Kindred Spirit’s, or Steve’s question. Which Steve asked TWICE now. (also, at the time of this writing there is an article about refuting False Memory Syndrome—a lot of people, including me, have buried trauma memories, & therefore, treatment in the home wouldn’t catch this—but that goes back to the observation KS pointed out: the “diagnosis” itself is the error)

      You said, “It could be that the consensus is shifting about what is considered “progressive” and Dr. Heath didn’t get the memo; however I also think some of this is based on illusory conceptions of what psychiatry is in the first pace.” Yes, he either 1) didn’t get the memo, or 2) he DID get it. And doesn’t agree with it. This is in the sample pages of the book if you want to read further online without getting the book:

      Home Treatment for Acute Mental Disorders: An Alternative to Hospitalization

      From the foreword, by Anita S. Everett of Johns Hopkins University:

      “While 20 years ago there was a considerable debate regarding the cause of many mental disorders, we now know that many of the most seriously disabling illnesses have a clear biologic and genetic basis. We have new medications that offer significant advances in terms of long-term tolerability and physical safety compared with medications that were available 25 years ago. We have an array of services that are supported by science and are designed to provide support and to promote independence and self-reliance in community settings.”

      In regards to pro-psychiatry pieces on MIA, this one seems particularly retrograde. The book & the excerpted paragraphs are from 2004, to be fair. And here is the opening paragraph of the foreword.

      “There’s no place like home…” Dorothy chants as she clicks together the red ruby slippers and hopes for magic transportation back to her home. In this 1939 movie classic based on Frank L. Baum’s novel, The Wizard of Oz, Dorothy desperately seeks the peace, comfort and safety of the Midwestern farm home from which she came. The story begins as the young Dorothy character becomes frustrated with the conventions of the farm and seeks adventure through running away. Not unlike the course of an UNSTABLE MENTAL ILLNESS as it unravels, she encounters many unconventional thrills, risks, and perils along the way. In Oz she makes new friends, many are actually existing companions from Kansas, but existing in distorted ways.” (emphasis added)

      O.K., you get the drift. Was it a coincidence that the character being compared to the “mentally ill” person-in-question was a child? Or that The Wizard of Oz is a children’s book? So why did I spend money on this book? I needed it to make an argument about how the government is closing loopholes in states that do NOT have mandatory outpatient commitment laws. And I’m going to use Maryland, mostly, as an example. Here is Maryland’s Inpatient Commitment Law:

      *Maryland does not have an outpatient commitment law.

      INPATIENT COMMITMENT MD. CODE ANN., HEALTH-GEN. § 10-632(e)(2). The hearing officer shall [o]rder the release of the individual from the facility unless the record demonstrates by clear and convincing evidence that at the time of the hearing each of the following elements exist as to the individual whose involuntary admission is sought:

      (i) The individual has a mental disorder;
      (ii) The individual needs in-patient care or treatment;
      (iii) (iii) The individual presents a danger to the life or safety of the individual or of others;
      (iv) (iv) The individual is unable or unwilling to be voluntarily admitted to the facility;
      (v) (v) There is no available less restrictive form of intervention that is consistent with the welfare and safety of the individual; AND
      (vi) (vi) If the individual is 65 years old or older and is to be admitted to a State facility, the individual has been evaluated by a geriatric evaluation team and no less restrictive form of care or treatment was determined by the team to be appropriate.

      Alright, let me take # 4 first. “There is no less restrictive form of intervention.” Well, IHT covers this, & it’s called Mobile Crisis Home Treatment Services in the United States (as well as other acronyms). In addition to MCHT, Maryland (and other states) also have ASSERTIVE Community Treatment, which is the same thing as Assisted Outpatient Treatment (IOT), or close enough. In other words, it’s a shell game. And a shell game that the reformists cannot follow because they are not looking at the spider web of monies in service of FORCED TREATMENT. All of these overlapping programs, including hospitalization, converge to catch any & all would-be “non-compliant” victims. (survivor, as a term, must needs be past tense)

      Monies are coming in from everywhere, not just from the 21 century Cures Act, but later, in Crime Prevention monies, which can & will be used for “mental health” funding. This includes the development & use of pre-crime & predictive programming software. From David Heath: “The easiest way to conceptualize how MCHT fits into a mental health system is to think of it as simply an alternative to admission. It TARGETS any patient who is destined for admission. “(emphasis added). I know you understand how I feel about the word “Target.” Additionally, Maryland has a spider web application process for any group who wants to apply for ASSERTIVE Community Treatment (similar to MCHT, but entraps & infringes on the civil liberties of a slightly different type of victim), here:

      (also, let me add at this point, that there is a strong Consumer presence in Maryland, & those reformists who rely on their paycheck are certainly aware of the $ trail. Some of the consumer groups are cross-listed in those already awarded money. This will not surprise an abolitionist, but a reformist who is NOT getting a paycheck from these sources may or may not need to have that pointed out to them)

      With talk of defunding the police & reallocating the monies to “mental health,” and with the *doubling* of graduate applications for social work and counseling during the pandemic, I think you can see where this is heading. All MCHT & ACT treatment programs use therapists, social workers, psychologists (in addition to psychiatrists), &, in some cases, “peer counselors.” After graduation, these people will have debt & need jobs.

      While we are talking shell games, the appeal for *some* to have home treatment over hospital “treatment” obscures the real reason for the funding of these programs. This is something that a reformer would miss—distracted by the appeal for *some* in what looks like a reform or improvement in “treatment”—“there’s no place like home” to be poisoned & shocked.


      These are the true intentions of the funders, more so than the “practitioners.” But the practitioners have to play along. In the online pages, you can read “A senior psychiatrist in Britain, very involved with MCHT, implied crisis had become a buzz word: ‘we have to use the word crisis, in order to get the funding.’”

      OH REALLY?

      Which brings me to bullet point # 3: “The individual presents a danger to the life or safety of the individual or of others; “ In the book, Heath delineates two levels of intervention: urgent & emergency. I’ll spare you the headache of having to read this & go straight to the point: “However many psychiatric emergencies can arise in situations where stress may play only a minor role as a precipitant or perhaps none at all. Others include STOPPING MEDICATION, SUBSTANCE ABUSE, AND DISTURBED BRAIN BIOLOGY.” (emphasis added)


      So, although we all know that the 21 c. Cures Act rolled back the need to have “presents a danger to the life or safety of the individual or others,” it still was up to each state how they were going to achieve this. In Maryland, it’s with the help of the Consumer/Reform-minded community programs, in Pennsylvania it took a different turn. In House Bill 1233, the bill loosens the standards for IOC to include “noncompliance” to taking “medication.” So, strictly a legal stance. It also loosens the “individual presents a danger or safety of the individual or of others,” definition to include the person’s “state-of-mind” anytime up to 48 MONTHS PRIOR to that determination. So THAT’S NEW. In the article below from Public Source:

      “Why aren’t counties using it?
      Just because no counties are implementing the new law doesn’t mean they won’t in the future. Counties choose whether to opt out or implement the policy on an annual basis, with the next deadline in January.
      “It’s not off the table,” Eisenhauer said.
      “According to Eisenhauer, the Pennsylvania Office of Mental Health and Substance Abuse Services was charged with providing the forms and instructions on how to implement the new law.
      “Eisenhauer also expressed concerns over the law’s four-year look back period, which he called “exceedingly long.”
      “Whatever was going on in your mental health history four years ago should not necessarily be relevant to your mental health today,” Eisenhauer said.”

      The bill passed in 2018.

      NAMI was one of the most outspoken critics AGAINST the bill, since it provided no funding. And some of the counties within Pennsylvania are not enforcing the law for that reason. So, states with the largest reform/consumer presences can actually be more restrictive to survivors!!! As Consumer groups have watchdog groups to thwart forced treatment. Unless it comes to their own paycheck. Or, in other words, follow the money.


      And one last observation about the state of Wyoming, Title 25, for IOT. I think the language is interesting here, because it outright restricts travel & nanny-state’s your social circle. It’s built right into the law, as opposed to being an obnoxious part of home treatment.

      “ Conditional outpatient treatment may require periodic reporting, continuation of medication and submission to testing and restriction of travel, consumption of alcoholic beverages or drugs, associations with other persons or other reasonable conditions …. the rest is here:

      For such a libertarian state, I guess the freedoms do not extend to the “mentally ill.” And there’s another odd observation about their commitment laws. It has a different definition of “resident,” than what I’ve come across. Or maybe it is in other laws, and I haven’t checked. To be committed, you only have to be living in the state for 90 days & you can be locked up (!). I assume that’s to “deal with” 1) transients or 2) people who want to have their residences in other states with less restrictive IOT laws if a family member lives or works in Wyoming (although, there aren’t any bordering states with more lax laws). The only saving grace about this state is that it rarely uses its laws. Although it built a big, new shiny hospital, so maybe that’s going to change! They need some warm bodies to put in it after all, because, you know, people need JOBS!

      “(xv) “Resident” means a United States citizen who has been a resident of and domiciled in Wyoming for not less than ninety (90) days and who has not claimed residency elsewhere for the purpose of obtaining medical or psychiatric services during that ninety (90) day period immediately preceding the date when services under this act were sought or imposed. . . you can read the rest, here:

      I’m going to wrap it up now. Sorry for the tome. But this will lead nicely into what I have to say next.

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  26. Dr. Heath, I’m sure you mean well and have good intentions on trying to improve people’s access to “help” but from my perspective the resistance is to the type of “help”. If it follows standard psychiatric protocol to ignore all environmental factors, including all context and cause, and instead label the person “disordered” and needing drugs to render them accepting of harmful environments, it will not be an improvement on in-hospital psychiatric treatment.

    I live in Canada and it would be interesting to know whereabouts psychiatrists are allowed to provide psychotherapy (and have it billed to the public system) ? It seems pretty standard that the first appointment is 50-55 minutes (possibly a second one at 40 minutes) but after that “treatment” is mostly a 15 minute med-check once a month.

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    • Rosalee -look at section on how IHT works. I state there ,that one of the differences between IHT and hospital treatment is that the environment factors are thoroughly identified. On my website there is a section on this with hyperlink to Dr Paul Polak’s papers-he was a pioneer in this regard
      As for how psychiatry is practiced in Canada, I say this: in our IHT Hazelglen, I saw patients for one hour each time and in my private office practice I saw them for an hour each time usually.
      I retired from full time practice in 2007. Since then I have noticed that it can be hard to get good psychiatric follow up with long appointments. There seems to be more of a shortage of manpower . Some psychiatrists still practice like I did -especially in their private office practice .

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      • Strangely, i would recover at home, with a cast on my leg while being introduced to Lithium in the late 70’s. Fieve’s book was referenced but the idea of a legitimate alternative was never offered, being that in the doctor’s notes I would later read, “Worst case experienced”. The reinforcemed beliefs from within our family was not always about empowering behavior through logic. Rather, the sheer force/fear of a parent releasing punishment would drive one into a space to endure the hurt, the pain and suffering.

        Ironically, I would be transfer to Waterloo to study Regional and Resource Planning and having worked off the meds by the early part of ’82, became a customer in the mental ward of the KW hospital on King Street. You might have even monitored or known some of the people aligned with the University, as more progress was made from working with the Gestalt Therapist along with having a wonderful mentor, who was extraordinarly helpful in encouraging that I return to Waterloo to complete the degree. My physician uncle would over rule any decision making on my part, the campus doctor would also push the idea of getting back on meds, so as I surrendered to their thinking (I can’t say acquiesced) then the idea became, “What if one comes apart in awares, while trying to understand the nature of a mind, struggling with disordering and ordering thoughts?” more along the lines of reporting back to others afterwards the logic that was being framed then as “The Self-Organizing Universe”.

        Compared to what I would eventuially experience returning to home, was a system of care that was not as sensitive aas to what I had experienced in Canada. The Human Rights Charter seemingly was written better or so it seemed than the civil rights laws that were being developed a the time.

        Now, the home has become more susceptibile it seems to a digital currency that is churning on keeping energized the digital while not realizing the impacts of economies shaped by a pharma, that was licensed and dispensed without understanding the ecological impacts. How can this be addressed, now? Through any of the studies at the Perimeter Institute, of comprehending where minds in wonder are trying to make sense of the Whole Life?

        Thanks for your sharing and explorations of even attempting a better way to realize health care.

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  27. That would be a life saver for my son if it really existed in Waterloo region nowadays. I sent this post to Family Dr who never heard about it. She tried to contact Grand River hospital with no luck. There’s a webpage
    mentioning it and a phone number that never returns the innumerous voicemails left.

    No, I can guarantee nowadays unfortunately nobody is coming to you house to see you if you have mental illness and it’s not related to pandemic since we have been suffering with this situation for three years.

    If this kind of medical procedure really still existed in Waterloo region that would be a dream come true!


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  28. Is there a way to converse with you? For I was a graduate student at Waterloo and I would be caught between your practice, the gestalt therapist who served within the Department of Environmental Studies and my Uncle, the family Doctor back in Arkansas. The nature of his intervention triggered a response, that has taken a life time to unravel. And by reading, learning, constant study and awareness for the work of Whitaker and others, a stronger truth is emerging that may or not be unsettling to the Justice Departments and practice of medicine. Many lives have been lost and are being lost because in part, every one, while unique is on a bit of a different journey. Congratulations on your book. I would experience the hospital along with the compassion of the KW culture. Much different from what I have encountered.

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