With this Q&A, MIA is introducing a new feature: brief interviews with both professionals and users of the mental health system on topics of special interest to parents and families. They are designed to provide a closer look at new research, trends, and people.
Our first interview is with Nev Jones, Ph.D., lead author of a paper recently published in the journal Social Psychiatry and Psychiatric Epidemiology. It is titled “Investigating the Impact of Involuntary Psychiatric Hospitalization Youth and Young Adult Trust and Help-Seeking in Pathways to Care,” which is summarized in a March 18 article in our Research News section.
One of the study’s major findings: Youth who were hospitalized against their will for mental health reasons experienced the treatment as a form of punishment, and many said they were less likely to trust mental health care providers. What might these findings mean for parents?
Nev Jones (at left) is an assistant professor in the Department of Psychiatry at the University of South Florida, and a faculty affiliate of the Florida Mental Health Institute. Her major areas of focus include youth/young adult pathways to and through care, the social and structural determinants of recovery/disability, and participatory approaches to research and systems redesign. She also has lived experience of psychosis.
Q: Your study looked at the impact of involuntary psychiatric hospitalization on youth and young adults. You interviewed an ethnically diverse group of 40 young people 16-27 (mostly female) who had been in forced treatment at least once about their experiences and its impact, both during hospitalization and after release. What were you looking to discover and why?
A: Already when I’d moved to Florida in 2017, the use of “Baker Acts” (or involuntary mental health emergency holds), particularly among youth, had been the subject of numerous news stories and sometimes scathing investigative reports. And it’s not only journalists who have been paying attention: a few years ago the state commissioned a special report on the use of Baker Acts among youth. In the past few years, concerns have led to a long series of different proposed legislative reforms, some originating from advocates, some from legislators and their staffs. Even so, when I started work on this project, there were essentially no existing studies focused on the perspectives of youth themselves, with respect to either experiences in Baker Act (inpatient) facilities or the impact of Baker Acts on subsequent engagement with mental health providers. So that’s what we set out to do.
Q: Let’s talk about your key findings. About 2/3 to 3/4 of the subjects said their experience was negative, and harmed their sense of trust. What were the themes that emerged?
A: Overall, I would say the single most pervasive theme revolved around participants’ sense of their involuntary hospitalization experiences as punitive rather than therapeutic—observations grounded in the frequent involvement of police officers in initiation and transport, inpatient practices such as strip searches and the confiscation of personal items, the overall sense that facilities were more jail-like than therapeutic, and of course the attitudes of hospital staff.
A subset of participants told us how the first thing they learned from other patients, once admitted, was to “lie” to staff about any ongoing suicidal ideation or mental health challenges and “put on a happy face” in order to be released. For balance, it’s worth adding that not all participants felt this way—a small minority actually had positive experiences of their hospital stays, most often in cases in which they had had access to therapy and groups that they actually found to be helpful, and positive (rather than punitive or controlling) interactions with staff.
Interestingly, not a single participant in our sample indicated that they were opposed to involuntary hospitalization in principle. As one put it, it was instead “the execution” that was perceived as the real problem.
Q: How did that loss of trust play out during and after hospitalization?
A: For the majority of participants, experiences of involuntary hospitalization [IH] eroded trust in providers following discharge. Interestingly, however, in many cases distrust did not play out in the form of outright disengagement. Instead, many of the participants continued to meet with mental health providers (therapists or prescribers). However, a substantial proportion shared that they no longer felt comfortable disclosing suicidal thoughts or plans, even with providers with whom they otherwise felt connected.
This is, of course, extremely concerning, and while a study like this does not allow us to generalize, understanding whether these impacts would hold across larger, ideally representative samples and determining the proportion of young people experiencing these kinds of impacts is pressing. Likewise, we really need to develop a better understanding of the extent to which distrust persists over time, and the factors that may contribute.
It’s also worth noting that a not-insignificant number of participants also described what we termed positive “indirect” impacts – most often the sense that only after (and because of) the involuntary hospitalization, family members, friends or significant others had finally started to take their challenges seriously. It almost goes without saying, of course, that this finding really reflects problems (attitudes toward mental health/distress) that are not in fact intrinsically tied to hospitalization at all, and that we as a society clearly need to address in other ways.
There were also participants who reported that their IH experience served as a wake-up call, or helped shift their perspective on their own challenges in a positive way. For example, for some, seeing other youth who were experiencing more severe poverty or disadvantage helped some participants appreciate what they did have, or what their own parents were like in contrast to other parents they might have heard about.
Q: What are the implications of your findings on the likely trajectory of how a youth engages with the mental health system after hospitalization?
A: This is where I’d again say that we really need more research—our work highlights the potential stakes, but we badly need data from much large, ideally representative, samples. That is, we need to understand the scope of the potential problem, and the range of ways in which IH may be impacting youth over the longer term.
Q: What are the take-homes of your research for parents and family members? How can they use the information in this study to help them make decisions for, and/or with, a child who is experiencing first-episode psychosis or another mental health crisis such as suicidality?
A: A lot of mental health anti-stigma or wellness campaigns push the message that “help is out there.” I think the fallacy in this, and the underlying problem here, is that high-quality mental health supports are in fact extremely difficult to identify and access. And I do want to stress quality, because the majority of the participants in our sample had received some form of therapy prior to their initial IH, but experienced it as “ineffective” and in extreme cases, harmful. (For example, several LGBTQ participants described treatment that bordered on conversion therapy.)
Further, while it’s easy to forget this as an experienced advocate, clinician or researcher, most parents have no prior background in mental health treatment or services, don’t know how to navigate insurance, don’t know where to begin. In a crisis, there’s rarely the time to engage in extensive searches or consultation, so not knowing what else to do, many end up calling 911 or taking their child to the ER.
Other parents can of course be an invaluable source of information, and in some cities or countries there are genuinely helpful crisis centers (that do everything they can to *avoid* involuntary interventions) or warmlines. But this is far from the case everywhere. When it comes to support for first-episode psychosis, the same holds—in some places, even the best options would fall far, far short of what would be considered even a basic standard of care. So I don’t want to be discouraging, but also don’t want to shy away from the fact that we need major structural policy reform in this country. Until we do, I think we’ll see the same patterns of over-reliance on acute and crisis care because the community options that should be there just aren’t there.
Q: Is it always up to families, or do authorities play an outsized role in involuntary hospitalization? If so, what can parents who are against their kids being involuntarily admitted do to help them have a better experience, during and after admission?
A: First of all, regardless of the age of their clients, all providers should explain the exact circumstances under which they would or wouldn’t initiate an involuntary hold. (State involuntary treatment laws vary considerably, so this will often depend on the category of provider and the state in which they’re located.) In our study, both the youth and parents we interviewed*, indicated that they often felt blindsided by provider or school decisions to initiate an involuntary psychiatric hold. And many did not even know what this (in Florida context, a “Baker Act”) was. Having these conservations at the start of treatment is obviously a good idea. During [a child’s] inpatient stay, visiting regularly (or at least as much as the child/family member wants) is always a good idea and, to the extent allowed, bringing clothes, games or books from home. Above all, sending a message of unconditional love and support.
Once a child (or young adult) is discharged, my advice would be to provide as many opportunities as one can to allow the child/young person to discuss and process their experiences. And do so in a validating, affirmative way. (I.E., don’t downplay feelings of anger or resentment if that’s how the child is feeling.) If they are interested in further therapy or other mental health services, make sure that’s comfortable with and feel they can fully trust the provider(s) they’re working with. If you have to “shop around,” it’s absolutely worth it.
Q: How does this research fit into your larger research and social justice agenda?
A: I would say that a lot of, if not all of, my research has been dedicated to amplifying the extent to which we hear from and learn from the experiences of key stakeholders—clients and families—and take stock of the complexities involved in navigating issues of access, quality of services, power dynamics in the context of services, and ultimately outcomes.
My concern with a lot of the literature out there is that it dramatically over-simplifies the picture of what’s going on and, by extension, what needs to change. Of particular concern are practices which, however normalized they may currently be, in fact negatively impact or risk negatively impacting service users/recipients. And it’s all the more concerning when this ( interventions that are potentially harmful) happens at the beginning of young people’s engagement with mental health services. And even more so when these harms (or the interventions in question) could relatively easily be prevented or were never appropriate or warranted to begin with.
Q: How does your lived experience with psychosis and the mental health system inform your goals in studying this topic and in your advocacy?
A: Honestly, when I’m conducting research, I’m above all trying to listen to and learn from participants and their experiences, in all their richness and complexity. But my own experiences, I’d argue, certainly orient and attune me to these narratives in particular ways—[for example] an awareness of the degree to which real and perceived power imbalances structure recipients’ experiences of services, as do diverse social, cultural and structural conditions, and of the complexities of the impacts that relationships with providers can have.
I’m also acutely aware of the many disjuncture’s between the views and priorities of different stakeholders: service recipients, family, providers, administrators, researchers. And sometimes these differences are articulated, sometimes they’re not – sometimes service users are experiencing things in a completely different way, but have neither the opportunities nor the power to more publicly or visibly voice them.
* * *
* Jones’ parent interviews will be reported in a future publication.
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.
There is no such thing as Mental Health Care. When people abuse other people with toxic drugs by force, then blame their victims this is called a crime not care.
What we need is to ascertain is the extend of the criminality – how many victims has there been through out the ‘career’ of the abuser called a ‘health care professional’.
I’m sure you know about or at least have heard of Vera Sharav:
There is always a level of force when the psychiatrist can lock you in jail and/or forcibly drug you. Most examples of psychiatric force take the form of, “do what I say or I force you and then it will cause you even more problems.”
Which is then labeled “voluntary.”
If the increased use of the Baker Act on young people in Florida is any indication, I would say that there is little to deter forced mental health treatment from seeking young people. I mean if you have a quota to be reached, you’ve got the unwilling subjects to be victimized right at hand. Need I say more?
Wrongs are going to occur so long as young people are not granted rights, and as with older people, the right to refuse dangerous, damaging and unwanted treatments is chief among them.
But in order to ensure the right to refuse “treatment”, one must first recognize compulsory “treatment” as a crime.
Isn’t it? As with all rights, we’re sort stuck with what the US Constitution says in that regard. If these wrongs are indeed wrongs, the US Constitution should protect us from them, requiring a court decision, making them (i.e. wrongs), as it were, crimes. As far as I’m concerned compulsory treatment, or compulsory mistreatment if the facts be known, is criminal.
Quite right! – Compulsory “treatment” is against the law. Moreover, it contradicts the basic, constitutional provisions of the law! And therefore it should be punishable! The law has everything for this. The problem is that these basic provisions of the law are being ignored. In law introduces other provisions that are contrary to the constitutional ones. And these other articles of the law legitimize psychiatric coercion. That is, the law simultaneously operates mutually exclusive provisions. Psychiatric apologists rely on provisions that are contrary to the Constitutional! Which is obviously illegal.
Thank you Miranda. Very valuable interview and publication.
There is no “anti-stigma” campaign, it is advertising.
It is trying to put the blame of “stigma” onto the public.
Besides, that “stigma” schtik does not do the teenager a lot of good if the
only people who are actually the perpetrators of stigma are the shrinks and staff.
But they are not stupid and won’t go back to a place where they are treated like criminals.
One “anti-stigma” campaign showed us what the real goal was. It had people wear shirts with labels. One persons shirt had “bi-polar” her sisters shirt had “sister” The goal is to objectivity those labeled with “mental illness” to reduce stigma for everyone else. One result of this is to make people feel better if they force and push the objectified on drugs.
In psychiatry forums saying someone is mentally ill is helping them. Saying they are not defective and don’t need deadly drugs is stigmatizing them. In psychiatry stigma means preventing “the mentally ill” from accepting they are less than every one else.
And where is “stigma” actually practiced? Does it matter to me if my neighbour thinks I’m defective? But it matters a great deal if the physicians and nurses see that someone labeled me defective. The only places it actually matters in how I get treated is in the very places that labeled me defective.
It’s not stigma, it is persecution. My neighbour cannot persecute me within the law.
My doctor can. The cop can. The courts can.
“Stigma” is a term which describes bigotry against the psychiatrically labeled. It’s not for us to “overcome” but for people to STOP DOING. (It’s easily “overcome” by rejecting the psychiatric milieu entirely, and the mentalities which accompany it.)
In essence, psychiatrists impose stigma on society. They replace legal and moral categories with invented, psychiatric ones. – Instead of guilt – disease. Instead of a trial, a diagnosis. Instead of punishment – treatment. There is no justice, protection, retribution … There is only a need to adapt, fit used to the current situatio. No matter how immoral and criminal she is. Psychiatrists present this as mental normality. And oblige everyone to conform to this disgusting pattern.
Personally, I think forced treatment should be made illegal, since my experience with it was by a now FBI convicted, foreign trained, doctor. Who was having lots and lots of innocent Americans medically unnecessarily shipped long distances to himself, having his foreign trained psychiatrist partner-in-crime “snow” (massively drug until only the whites of the eyes show) the patients, in the hopes they’d stop breathing. So he could have unneeded tracheotomies on people done for profit. And, most certainly, they neither allowed family, nor friends, to visit while committing these crimes.
In other words, forced treatment is being used and abused for unethical and greed inspired reasons. And most certainly, this kind of egregious, and illegal, misuse of forced treatment, does make a person lose trust in all so called “mental health” workers. Especially once one has found the medical proof that both the antidepressants and antipsychotics can make people “psychotic,” via anticholinergic toxidrome, a medically known way to poison people. Thus finding the medical proof of two of the iatrogenic, NOT “genetic,” etiologies of “psychosis.”
The ADHD drugs can also make people “psychotic,” a third way the psychiatric industry iatrogenically makes people “psychotic.” Truly, the industry should be ashamed of their betrayal of their clients, their clients’ families, and of the “big lies” they, and the pharmaceutical industry, have told to the entire world.
“If you tell a lie big enough and keep repeating it, people will eventually come to believe it. The lie can be maintained only for such time as the State can shield the people from the political, economic and/or military consequences of the lie. It thus becomes vitally important for the State to use all of its powers to repress dissent, for the truth is the mortal enemy of the lie, and thus by extension, the truth is the greatest enemy of the State.”
— Joseph Goebbels
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And what a staggering embarrassment it should be to the “mental health” industries, now that we all live in a “pedophile empire,” largely due to your systemic child abuse covering up, by DSM design, profiteering.
The majority of Americans did not learn from history. However, this is not surprising, since our history teachers did not teach us the stories behind history, and merely made us memorize dates. So some of us had to research into history and medicine, to garner insight into the systemic crimes of the globalist banksters, the religions, and their army of scientific fraud based “mental health” minion.
I think the article picture is perfect. It is exactly like that, even for adults.
The observer and the observed.
It is the observers job to tell kids that their feelings/thoughts/emotions are illnesses or disorders.
However, the observer will not share their innermost thoughts or feelings, except the ones that are regarding the client’s wrong and ill things that need treatment.
This was funny the first time, now it’s just redundant.
With only 40 people interviewed, this is a very small study.
The findings are more or less expected.
Is the problem they are trying to solve how to make torture and slavery more acceptable to its victims? Is this the new aim of “social justice?”
Sounds like you’re on the right track. “Social justice” generally needs quotation marks around it, much like “mental illness.” Difference is that “mental illness” cannot exist; social justice can but mostly doesn’t. Today however it has become a term which often perpetuates identity politics, hence the quotes.
A psych nurse practitioner (who had a knack for his checklist routine) told me ‘hearing voices’ isn’t illegal. He must have assumed I wasn’t aware of that. He showed how little he thought of (all) of them, and how low a bar he put on (all) of them.
I told a physician that I heard my dead grandmother tell me she ‘was here to help’, after I asked her why she was there. The prescriber upped my major tranquilizer/’antipsychotic’, with my apparent submission to go along to get along. At some point then or later, he said he’d ‘rather see a fat Evan than a psychotic Evan’.
If doctors/nurses in psych hospitals know you have used psychedelics recently, they can infer that your ‘hallucinations’ are likely connected to the drug use, and feel they have folded a letter and put it in an envelope. Even if there was relevancy, they don’t know they possibly dismiss, blot out, destroy, and prevent a religious birthright.
The interviewee should remember this when she advocates for programs/treatments for ‘1st episode psychosis’ in young people, and perhaps she does, and I haven’t fully recognized it. How does ‘set and setting’ influence a ‘psychosis’? If my voice tells me ‘I love you’ rather than ‘you should kill yourself’, if my voice describes the evils and sufferings of humanity to make me conscious of them, etc. should I submit to a ‘treatment team of clinicians and service-providers’, pay for them directly or indirectly, and walk ‘their’ labyrinth?
I know this topic spans all diversity and variability, and people should have a choice and negotiate these things, including smashing it with a drug-hammer by a doctor’s root-tearing. But keep convention away from me. Not only do I not want to touch them, or have them touch me, with a 10-foot pole, but I don’t want them swimming in my pool or feeding my chickens.
Perhaps you can see some reasons I am attracted to the title and theme of this interview.
it must be very exciting.