Is Public Psychiatry Responding to the Mental Health Crisis or Just “Treating the Chart?”

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“It seemed to me that all language is an excess of language”
—Samuel Beckett

As an urban community mental health therapist, part of my job is meeting with new intakes and completing their comprehensive assessment—their first step in getting connected to a primary therapist and psychiatrist, and a document they’ll need if they apply for any special programs. The role always gives me anxiety, because I never know what I’ll get—except, of course, paperwork. Recently, I had an intake come in with the records from all his previous psychiatry treatment—a thick stack, easily 300 pages. He seemed to think it would help him get cash assistance, but this was just a therapy intake. He was confused, not fully out of the psychotic episode that had landed him in the hospital weeks before.

His confusion was warranted. What sense did it make that he had been through hundreds of pages of notes worth of treatment (multiple other “comprehensive” assessments and progress notes written by assorted behavioral health staff, in addition to legal language justifying his involuntary admission, the use of neuroleptic medications, and the safety of his discharge to outpatient care) and yet was still essentially un-helped? After he left our hour-long meeting, I spent another hour writing, adding on to his stack of papers.

Closeup shot of a figure in blue/green scrubs holding a pile of paperwork and folders

I couldn’t help but reflect that my interview with him could have been more helpful in at least one concrete sense—that I could have paid closer attention to the emotional dimension of his predicament—had I not had the completion of this unwieldy document in mind. This scenario in public psychiatry settings is, unfortunately, a familiar one.

The topic of mental health is on the public’s mind, whether it’s the popularizing of therapy speak, the increased attention paid to severe mental illness and homelessness, or pop psychology advice on TikTok. It is clear that the federal and state governments, while they have made efforts to address what has been called a crisis—the new 988 suicide hotline, for example—have put little more than a dent in the problem. Thomas Insel points to this issue in his book Healing: Our Path from Mental Illness to Mental Health, remarking that the problem with the mental health care system in the US is that there isn’t actually a system in the first place. It’s a piecemeal, parcelized collection of public institutions, non-profits, and private agencies, funded by an equally complicated system of public and private money managed by insurance companies.

This “system,” however, is an elaborate bureaucracy with voluminous policies, as well as reams of data, assessments, and progress notes on people using care. To look at the records it produces, you would believe the result was comprehensive, thorough treatment. (I calculated that, if my clinic printed its notes, they would equal to a half ton of paper in one year!). Yet it’s a “system” that leads to the all-too-common scenario of my intake patient and his records.

Admittedly, paperwork in bureaucratic settings is an easy target, but there is something disingenuous going on when there is such a gap between the amount of writing and bureaucratic labor and actual health outcomes. Public psychiatry’s documentation creates an elaborate fiction about what treatment addresses and looks like, a fiction that under scrutiny ends up exposing the system’s many flaws, contradictions, and inefficiencies. And though a fiction, it has a real impact, interfering with the actual work of treatment: clinicians and patients are implicated in it, embedded within its rigid terms, often so thoroughly that they cannot get beyond it.

As clinicians, the terms we are given to describe our work inevitably shape the work itself, even if we don’t agree with them, and the patient is even more powerless is this configuration. The language performs a simplification and literalization of treatment, and since public psychiatry only improves itself within it own terms, it cannot see beyond this serious limitation. I believe that there is a crisis going on in our culture that mental health care does end up addressing, but where treatment is effective, it is certainly not because of the quantity or quality of the records it produces. Indeed, these records and the bureaucracy they reflect are patronizing and absurd in the face of the magnitude of human suffering psychiatry faces.

Perhaps the most apparent issue with our documentation is the material cost: a lot of public psychiatry’s already-limited resources goes to its maintenance, from the labor cost of actually producing it, to having high-paid dedicated staff whose main function is assuring documentation “compliance,” to the hiring of expensive third-party “consultants” to further address things like demonstrating medical necessity for insurance companies, HIPAA regulations, or liability/risk assessment. Further, new therapists and clinicians have to be trained in how to document “correctly,” a burdensome take for administrators because few believe this will make any difference for the patients.

These issues emerge from the conflicting interests in public health and the resulting bureaucracy, but also from the peculiar status of the discipline of psychiatry itself: where physical medicine can be described unambiguously (at least, relatively), and we can be certain of a concrete reality to which the language refers (not to mention that a physical trace might be left on the patient), psychiatry deals with something inherently subjective. And yet it’s required to document itself as if it weren’t any different, and this language, as with all of health care, become the basis for billing, proving policy compliance, and legal protection. This is a big responsibility to put on the language—it must ignore any ambiguity inherent to the enterprise of psychiatry, while also respond to external and inflexible demands. Yet, when these terms enter the medical records, they take on the status of facts.  This creates a problem in terms of the writing: it hardly flows from the nature of what its described. On the one hand, it’s experienced as a time-consuming but superfluous nuisance to be rushed through that bears only a tenuous relationship to treatment; on the other hand, there are real consequences if it’s not done correctly.

The example of the intake I did with my confused patient is illustrative. Even without any added writing, the template and its drop-down menus add up to 5 pages. I was required to go over  with him everything from the expected psychiatric history, to social history, religious affiliation, leisure activities, the minutiae of the patient’s tobacco habits, and beyond. I was supposed to use the Columbia Suicide Severity Rating Scale, a 27-item questionnaire supposedly measuring the intensity of suicidality that, if done verbatim, reads more like something an interrogator would use to ascertain guilt than a questionnaire that is meant to be helpful.

All of this is potentially clinically relevant, but it was compressed into an hour-long session, and my patient was not psychologically organized enough to truly speak about most of these items. And where he was coherent, I still felt intrusive, given that I would not even necessarily be his therapist, and certain themes had the potential to re-traumatize him. I wrote up the document as best as I could, translating his rambling discourse into the kind of concrete information the form wants. There’s something uncomfortable about this operation, giving subjective information more appropriate for the medium of poetry the weight of “facts” in a permanent medical record. And as always, I felt the absurdity of how ineffective his treatment would most likely be in comparison to the treatment ideal implied by the exhaustiveness of my assessment.

And I also couldn’t help but conclude, as I regularly conclude when I meet intake patients, is that all that really counted was that I demonstrated adherence to policy. I am a writer: I could easily enough have written an account of my interview with the intake patient that would give an accurate impression of what he was like and what might be his problems, but this document would not likely comply with the regulations. Instead I wrote a document that was largely vacuous (and certainly rushed and sloppy), yet nonetheless one of the most important documents in his cumulative records, the birth certificate of sorts of his treatment. The best I could hope for was that, tucked away somewhere between all of my box-ticking and performative language, was a paragraph or two with some genuinely useful information for another clinician to read.

The culprits of the policies that result in such unwieldy documentation are a combination of regulatory agencies (state, federal), insurance companies and their demands for demonstrating medical necessity, and internal policies that defend against liability for poor outcomes. The whole intake form, for example, is essentially a rubber stamp.

As such, I’ve come to consider our documentation as little more than internal political legitimation rhetoric, essentially covering up for our system’s stark inadequacy while pleasing regulatory agencies, whose motives are political and financial. Publicly funded psychiatry, now more than ever, is going through a legitimation crisis. It knows it doesn’t have the means to address the problem of public mental health. For one, it’s not even clear that what it’s dealing with is always pure and simple “mental health”—it is more accurate to say it is dealing with a range of social ills (poverty, anomie, the pernicious effects of social media, political division…and so on) which often present as a psychiatric illness, but which are not reducible to this category.

Further, the state of psychiatric science simply has limitations; it has not found any “cures” for the most severe forms of mental illness (it is not even decided on what should count as a mental illness in the first place). What care really takes is a robust, comprehensive system of psychiatric treatment mixed with social programs and social assistance (the likes of which Insel notes exists in Portugal)—the sort of system which our care’s rhetoric seems to imply could or should exist, but which doesn’t. There are simply not enough resources for such a system nor a willingness to invest in it.

One of the areas I was required to assess with the same intake patient was his Social Determinants of Health. The presence of this screening in healthcare settings is relatively new, and an example of an initiative aimed at improving services. Indeed, it would seem to be a step forward that clinics would introduce this more holistic perspective on health, except that they aren’t doing anything differently other than adding to the sum total of paperwork and bureaucracy—another box to tick, one more thing for auditors to verify. We can’t actually address the social determinants of health any more than we already do. And in the case of my patient, it was simply redundant—I hardly needed an intrusive, 40-plus item inventory to know that social issues were part of his “presenting problems.” This tendency to “screen” for different conditions and problems is endemic to all of healthcare, and incredibly wrong-headed, given that adding more assessment to treatment without adding more time and resources is not going to change outcomes and arguably might make things worse, given that providers are less able to focus on what they can do within their limitations.

What makes the inclusion of this kind of assessment all the more patronizing to all involved is that it is at odds with other policy currents. It acknowledges, rightly, that health problems are related to, or even in some sense are, social problems; however, there is equal pressure from the insurance companies to demonstrate the objective “medical” nature of psychiatric issues, as if they were no different than a knee injury or a bacterial infection.  Our system’s risk management policies and overall strategy of defensive documentation is another counter-current: we document that our efforts at care (or lack of) can’t be blamed for failures. Put in other terms: our documentation is near-utopian in its scope and what it thinks treatment could address; but at the same time, it has an artificially narrow medical perspective; and finally, it rigorously, with airtight legal jargon and defensive language, obviates any responsibility for its all-too-common and frankly inevitable failures.

All of this documentation adds up to a significant psychological toll on the writer—how could it not? We are pulled in different, opposing directions, and rather than become therapists, we’ve become propaganda producers, painting a picture of our work that is supposed to legitimize it, but somehow collapses in on itself in its contradictions, and certainly does not capture what it’s like to do therapy.  We’ve done nothing more than produce flat, perfunctory, meaningless language—small black shapes on a screen taking up space that are still the only acceptable basis for demonstrating that we did our job. It’s no wonder community mental health therapists often quit and move to private practice, where they can choose not to accept insurance and document their work in the way they choose.

At times when I write my notes, I start to wonder if me, my actions and my patients have any meaningful existence at all other than in the documentation language. From an institutional-regulatory perspective all that counts, anyway, is that the correct words are there to demonstrate policy adherence; what they mean or refer to is unimportant. Sometimes the distance between the language and its supposed referent is so great that it’s as if the documentation is hermetically sealed off from any reality at all, and it’s tempting to consider that we would be better off if there were no patients in the first place. Certainly, it would free us up to do a better job with our documentation.

Take for example my intake patient from above. We did have one psychotherapy session a month later, when he was added to my caseload. In the intervening weeks he had stopped taking medication. He no longer believed he had a mental health issue or diagnosis or even cared about getting benefits. Rather he wanted to talk about a scheme against him involving implants in his brain, espionage, and attempts at mind control. Per health insurance policy I’d already written a treatment plan on him, despite only having met him once, a month ago. It was required to have “measurable” objectives (e.g. “patient will sleep at least six hours a night”) tied to his diagnosis, and also per policy the patient had to agree to it. I didn’t share my plan with him; nothing could be more absurd given that he didn’t see his problems as being psychiatric or even that what we were doing was therapy—he just wanted to talk to someone. That’s what we did. I let him tell the story of what was happening. It can actually be quite fascinating to speak with someone in the throes of psychosis—in the alleged madness, there are often glimmers of enlightenment. But this is crudely attenuated by time constraints and the fore-knowledge of the note that will be written.

In this case I wrote an account of the session that made it sound like I performed a procedure on him, offering things like “cognitive restructuring” or “reality testing” and somehow demonstrating medical necessity but without invoking the idea of psychiatric illness, given that that this would be patronizing to the patient, and he would have access to the note. I also had to document that he agreed to his treatment plan, and that he posed no danger to self or others. In effect, very little of what I wrote bore any meaningful relationship to what took place between us, and the specter of an imaginary auditor, threatening to deny payment or, worse, hold me liable for the patient’s misfortune, hung over me.

After this session—sensing I wasn’t going to helpful, I can only assume—my patient didn’t attend his next appointments with me or his psychiatrist. However, because he had been deemed “high risk” due to his previous psychotic behavior, I had to call him multiple times, his family members, and even a Mobile Crisis team that tried unsuccessfully to visit him. At some point he was hospitalized again in another facility and, determining that because of a previously undisclosed drug problem we could not treat him after discharge, I had to carefully document this reasoning and my conversations with his inpatient psychiatrist and social worker (throughout this time, I had no actual contact with the patient). I thus added another few pages to his chart. It was as if I was writing about a fictitious character, whose actual existence was unimportant compared to my linguistic presentation of him, a presentation which had to carefully show how good a job I was doing while also scrupulously protecting myself and my institution against any liability—as if somehow, from the confines of my office, I had some power over this patient’s life, if only he would just comply—and because he just wouldn’t comply, there was no one to blame for his misfortune other than himself.

This state of affairs is what is meant by the cynical expression “treating the chart.” It’s a common expression that has deep implications: we don’t do real work, we perform a linguistic representation of work.

Naturally none of this is good for treatment. Aside from the material cost of the writing, there’s the psychological risk that we begin to internalize the documentation: there’s no longer a separation from the real business of treating patients and the essentially false way have to document it. Patients become bureaucratic subjects, their status as real people diminishes, and since they inevitably fail as bureaucratic subjects, we feel that we’ve failed too, our efforts are futile. Why can’t they just be helped the way our charts and rules and regulations suggest they’re supposed to be?

This not to say that people aren’t helped in public settings and that I and my hard-working colleagues (including the administration’s whose unfortunate burden it is to enforce bureaucracy) are not doing meaningful work. But this work more than likely has little representation in in the record. For example, I once helped organize a picnic for a group of patients with severe mental illness, and this was one of the more meaningful things I’ve done in my career. Yet it was written up as a “health education” event about hand-washing to prevent the spread of covid-19. Likewise, the documentation of the subtleties of building trusting, understanding relationships with therapy patients is essentially irrelevant to questions of “medical necessity” and “measurable progress” in treatment. Often, it is as if we help patients in spite of what the rhetoric says we’re supposed to be doing.

It is, of course, not surprising that a big, underfunded bureaucratic system such as the one that regulates public mental health treatment would be ineffective. That flows from the condition of late-stage capitalism. But what I am getting at here is something more than just pointing out the policies’ many problems and contradictions. Specifically with psychiatry, there is something inherently problematic about using language as the basis for regulation and administration, because something that is tenuous and ambiguous has to behave as if it’s concrete. On the most basic level, I do not want how I describe my work as a therapist to be held to this standard. And how is my language or a clinic’s language in its charts reliable as a source on which to evaluate the quality of its services? The only way that our notes could truly be used as a way to evaluate our work would be if there were few constraints on how and what we write: then, though it would be highly subjective, our choices as writers might reveal something about the treatment.

Similarly, there is no way that from the documentation we can assess whether new polices are helpful. In fact, it seems that there is a perverse logic in which, from a regulatory standpoint, policies that are documented are good because they have been documented, and they are documented because they must be good. It’s a closed system, beside which you have a different reality taking place between clinicians and patients, patients who have no true voice, and whose deviance from the treatment fiction described in the documentation is, with more of the same rhetoric, explained away.

To address this unwieldy problem of documentation in public psychiatry would take a willingness to bar interference from outside pressures—namely, insurance companies and economic/business interest—from shaping policy and enforcing regulations. Simply put, notes should be written with the sole aim of clinical utility in mind, and perhaps they should not even be made available to any other party other than healthcare providers. Policy makers need to devise ways to assess quality of care and outcomes that actually consider the experiences of clinicians and their patients and patients’ families, and not just audits. Policies and initiatives need to be commensurate with the real capacities of institutions, otherwise they are little more than empty rhetoric that is nonetheless labor-intensive to maintain and ultimately detracts from what can be done.

I don’t believe our system in its current state is in any way meaningfully responding to the surge in need for more mental health care. The simple fact that insurance reimbursements for behavioral health are stagnant is proof enough that the new initiatives side-step a fundamental problem, that the system is underfunded and neglected. I do believe we are able to help people, in spite of all our flaws—but I doubt that anyone who has had a positive experience with community mental health care will get much of a clue as to why they were helped by looking at the massive digital paper trail their treatment created. And for anyone who has been helped, there are just as many like my intake patient, who could rightly say all he got out of treatment was 300 pages of nonsense.

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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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18 COMMENTS

  1. Very timely article, I am in the process of writing a paper for ISPS conference in Finland on a related topic, more about the types of language used to describe issues and how inadequate it is to access anything meaningful about the client and how it greatly limits any sort of treatment. Thanks!

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  2. Here in red state USA…

    Community mental health clinics are all about drugs into people. Everybody is prescribed at least a low dose neuroleptic. Apparently dopamine is enemy number one. The cops have assigned parking in the lot. Counseling usually means short term talk with a self important person more interested in keeping one in line and on the miracle meds than in listening or addressing anything.

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  3. I’m order to address any of this, it’s first necessary to acknowledge and denounce the long history of eugenics and anti-disabled policies and rhetoric that exists at the core of Western culture. Acknowledging the root of late stage capitalism is a good start, but we have to expand upon what that means, materially, for clinicians and the people they try to help.

    Over the centuries since the inception of capitalism as a political and economic ideology the cultures of the people it has been imposed upon have suffered greatly. We see it first in Europe and among the various European cultures. The stripping back of traditions that don’t serve capital and the commodification of the cultural elements that can be twisted to serve capital are the basis of the cultural hegemony imposed by the endless pursuit of profit. That stripping back is barely noticeable among most European descended peoples around the world because it has been so thoroughly accomplished. However, the same process can be seen more clearly at work under the colonial and imperial conditions outside of Europe. The ethnic cleaning of native populations, the Transatlantic slave trade, and the ongoing colonial projects across Africa and Asia all show what we no longer remember about European history: how our cultures were destroyed and replaced with the consumer culture of modern capitalism. That is accomplished through a triage of sorts. Those who are useful to the capitalist class, as laborers or consumers, are kept while those who are not are systemically criminalized and othered. The most frequent and helpless targets of these policies have historically been the disabled, including those with psychiatric disorders. Laws against public ugliness, policies that systemically sterilized the disabled and other minorities, as well as the criminalization of disordered behavior are just some of the historical examples of such policies (some of which are still ongoing in the US, IE the war on drugs).

    While many of these policies have been nominally reversed or repealed, the reality of what happens on the ground is very different. Those old policies and laws may be gone, but their spirit lives on in modern counterparts. Family Services routinely take children from their parents for no reasons beyond poverty and disability. Though the language on the official forms steer clear of making it so obvious, much the way treatment documentation obfuscates the reality of the failure to treat so many people in need of help, it nonetheless continues the long tradition of punishing those in need of help for needing that help and not having the resources to get it on their own. The primary method of doing this today is gatekeeping vital services behind a wall of means testing and imposing harsh restrictions and limits on those who manage to successfully navigate the system to finally gain those services.

    The wait time and amount of paperwork and meetings and evaluations necessary to get on any kind of social services is beyond onerous. Maybe don’t ever get the services they need simply because the application process is inaccessible to those who need it most. Then the process is repeated every 6 months or every year, usually, resulting in the need for so many case managers that have to assist in keeping up with the endless paperwork and evaluations. None of these assistance programs exist to fully help anyone, and there’s often the need to apply for multiple programs in order to actually receive what little services are available without crushing out of pocket costs. Even when someone gets full, permanent disability, they have to continually go through the process of proving they’re disabled to continue receiving the assistance. Additionally, under those conditions, they are legally barred from having any amount of wealth or income above a pittance that isn’t even enough to survive on. This serves to drive these populations into institutional services, often nonprofit, but many private organizations also exist and make a profit from serving these people. We see it often with the elderly who are increasingly falling into the hands of private care facilities that drain all the savings and value from their possessions, leaving nothing for the grieving families at the end. With the disabled or can be even worse as most exit these services long before their passing and are left with nothing to support themselves and a tainted public record that often leads to lost job opportunities and other assistance that might be available, but only for those who successfully navigate the entire system and maintain compliance to it.

    Is it as bad as locking them up forever and sterilizing them? Of course not. The end result is largely the same, however. Many end up homeless, ignored, and forgotten until they either can no longer survive or they end up in the prison system where they make useful slave labor for US manufacturers. They provide a never ending source of public concern for various social ills and are often used as political footballs, excitedly in the realm of firearm legislation where the only socially acceptable public discourse revolves around the rhetoric of the dangerousness of the mentally ill, without any further inquiry into what that means, exactly, or what should be done about it. It does give many politicians license to propose and pass legislation that targets people in need for incarceration, institutionalization, and disenfranchisement.

    Ultimately, this core feature of Western society and capitalism itself cannot bear the existence of free and supported disabled people, such as the people being discussed in this article. No amount of policy and legislation changes are going to change that because no human is considered valuable to this system unless they can be exploited for profit in some way. There will never be treatment under these conditions, only the bare minimum needed to keep the quarterly stock market value increasing eternally. Many care agencies over the last several years have been bought up by private investors looking to turn a profit on the inevitable influx of people in need of services thanks to the combination of deteriorating economic factors and the long legacy of the failures to address COVID-19 in any meaningful way. Our system has to radically change to even begin addressing these issues with anything other than lip service.

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  4. When the psychiatrists will beagan to speak in real terms about Remote Viewing Control, Holy Spirit, biofield, hypnosis, suggestion, telepathy, telekinesy, pirokinesy, psychokinesy, clairvision, psychotrony all the World will be happy!

    Parafă
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    Truta Marius (under hypnosis)
    Lung-gom-pa with e-mails.

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  5. The hospitals and involuntary admissions are now becoming Determinatal to one’s health. People are being treated without knowing all the facts and evidence that is crucial for individuals to get the correct treatment . A lot of times they are brought in by people who are unqualified and it makes the jobs of the hospital harder. The paper work Is a joke not many people know how to properly document or create a plan of action to help these individuals.

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  6. Daniel, You see things as they are. I worked for th VA 15 years ago and wrote a piece similar to yours wherein I brought to light how the new treatment planning software had unintended negative consequences due to it being a long series of drop down menus, boxes, and visual search tasks. It didn’t produce a clinically useful document and it only frustrated me as it put additional unnecessary work between me and my patient. It was incredibly frustrating. I had a Jerry McGuire moment wherein I stayed up late until the early morning and wrote a 2 page review of the harmful nature of the new software. Needless to say it felt great to write it as it allowed me to speak honestly about how God awful this bureaucratic task was; however, nobody gave a shit. I moved on and found another job as I couldn’t deal with it anymore.
    You speak the truth……

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  7. I agree that taking notes on “clients” can be hard, off putting, and difficult, especially with “chart” language that could perhaps dehumanize the client and, if a client saw notes, alienate them from their treatment and recovery journey. Perhaps not just in note taking language; but note taking on clients in general is completely de humanizing; and should not be done at all. I have both worked in and been a client in a mental health setting; and one of my proposed solutions is for the client to keep, craft, and record their own notes, at the end of each therapy session, as an option in therapy. No more “last time one had suicidal ideation or thoughts?” questionaire questions, more like, “Write a paragraph about how you’ve been feeling for the past few weeks for your initial self-file.” Best of luck in your endeavors, and thanks for this article criticizing mental health language in “charts”, J.

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  8. Hi Dan and others commenting:

    Excellent article about how the documentation interferes with and has little to do with good outcomes for mental health service delivery. I learned early in my career that a good therapist working in the public mental health system must be multi-lingual and speak at least two or more languages. One language is for the chart, one language is for the client, and perhaps a third language for colleagues.

    The therapists who can master these different languages will not only survive in the system but flourish. Those that can’t will leave or be forced out. A good supervisor/manager knows about this multi-lingual requirement for staff and is good at helping staff learn the different languages and how to utilize them.

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  9. Bureaucracy is about power and profit. It enables politico-economic agenda to hide behind institutionalized procedures implementing policy according to mechanical norms of data processing which appear neutral and objective, ‘the way things are’. But its supposed necessity if not efficiency is double-edged, serving ruling interests’ control of people’s lives by establishment of obstacles to resources, like endless mazes of requirements and records, which maintain exploitative and oppressive social conditions.

    Accordingly, only small percentages of people eligible for such minimal programs of social welfare as exist make it through the obstacle courses, and then only to remain buried in further procedures designed to limit benefits, subject to sudden change and termination. Ironically, this is often ascribed to bureaucratic breakdown and inefficiency, as if these objectives are not intended, even as bureaucracies operating on behalf of ruling interests from the Pentagon to Wall Street show no such sign of inconsistency when it comes to imperial power and capital profit, welfare for elites.

    We live, or try to survive, in a society based on abuse and trauma, with most of us means to others’ ends of power and profit. The interventions of the medical industry, including psychiatry, not only are way downstream from the source of collective misery from social injustice, but also insidiously serve ruling interests, from financial predators of insurance to snake oil sales of the pharmafia, under cover of health care which buries systemic causes with case-by-case treatment burdening if not blaming individuals for neverending adaptation to organized evil and insanity. What prevails is a system of sick care for permanent customers of industries profiting from human suffering and making for more misery.

    Rather than pursuing dubious reform through endless mazes of regulatory bureaucracy running protection rackets for power and profit, we should strike at the root of our captivity to business as usual with revolutionary establishment of more just and egalitarian relations among us.

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  10. This is a truly remarkable, insightful article. Though many have critiqued the bureaucratization of the mental health system and the onerous, inane paperwork demanded of it’s practitioners this article uniquely frames the problem from a linguistic perspective pointing to how the use or rather misuse of language serves to obfuscate the problems within the system thereby perpetuating them. It calls for a re-imagining of how we assess the effectiveness of public services; to move away from superficial measures which only serve to make the system more ineffective and inhumane. It should be required reading for anyone studying public or health care administration.

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  11. No mention of the corrupt practice of “verballing”? That’s quite an oversight Daniel. During a Royal Commission into Police corruption it was found that

    “Verballing is the false attribution of a confession or admission to a suspect. On the evidence before the Royal Commission, the practice of verballing ranged in degree between the fabrication of an entire record of interview or statement, in which a full confession is made, to a subtle change of words to cast greater suspicion on a suspect. Ultimately, if the verbal were contested in court, the police officer involved might commit perjury in support of the false statement.”

    Officers who were not good at this corrupt practice were at times sent for “creative writing” classes to ensure they could obtain wrongful convictions. And we wonder why our Court system is struggling?

    I have a document here which is a good example of ‘verballing’, and unlike many of the documents which were used to slander my character and to enable State sanctioned violence against me (for disagreeing with someone no less) this one is a statutory declaration and carries significantly more weight than the others. There are laws governing how it is to be completed in both the Mental Health Act AND the Statutory Declarations Act.

    In order to defend the contents of this document, Authorisied Mental Health Practitioner who completed this Form would have needed to travel through time and space to make “personal observations” and perhaps this time travel was the reason he failed to document significant facts which did not suit his false and fraudulent narrative which he did actually observe (for example the fact I had been ‘spiked’ with date rape drugs to assist him with his series of crimes. That narrative dropped once he could have a doctor with prescribing rights forge a prescription and make these drugs my “regular medications” Compound and conceal evidence of a criminal offence, conspire to pervert the course of justice…… lucky they can ‘drop’ anyone they like with a chemical kosh huh? )

    I must say that despite what you write above, I am glad to have these documents which show that I was subjected to an arbitrary detention, kidnapped and then tortured for 7 hours (see Article 1 of the Convention). The State was not so happy about me having them and began a vicious attack on both me and my family.

    Part of that attack involved other documents forged for the purpose of concealing a number of significant offences (the use of date rape drugs administered without knowledge [spiking] to enhance the “acute stress reaction” caused by police). The removal of documents demonstrating the ‘verballed’ stat dec, and the insertion of other documents to create the appearance that I had been a ‘mental patient’ of this hospital for more than ten years (note it is a crime in my State to call police and tell them that a citizen is a ‘patient’ of your hospital to have them kidnap people for you).

    And then there was the “editing” of the documents by the FOI officer…….they went through some 10 year old documents and selected some of the information I had shared with someone like yourself. Information of the most personal nature which had been shared and documented in good faith. I won’t tell you what that information was (as the intent of such poisoning is to have the victim damage themselves by trying to defend the slander released in such a fashion) but lets just say it was presented in a manner to do the maximum damage despite it having absolutely nothing to do with the matters my legal representatives were asking about.

    So it that sense Daniel the documentation your producing may be used some 10 years down the track to deliberately push a victim of corrupt public officers to their death. I understand you have a “good faith” defense in that you no doubt don’t complete these documents with this in mind….. this is something to be left for others to do should they see fit to “fuking destroy” someone who dares complain about being kidnapped and tortured by the State.

    So I disagree with your above assessment. In as much as I disagreed with the National Socialists disposing of their documentation as the allies marched into Germany. Documents completed in “good faith” but which as a result of political changes became an inconvenient truth.

    Sometimes it requires reading between the lines as to what is meant by a request for an “acute stress reaction” (ie Police bashing to ensure the ‘patient’ is pliable) or “unintended negative outcomes” (the production of ‘air hunger’ with a cocktail of morphine and benzos) etc etc.

    I understand that our Chief Psychiatrist is a ‘protection’ from these criminals, and who simply ensures that no complaint is ever found to be in favor of the victims. Now there’s a document I’m glad to have (a letter from a C.P. which demonstrates the total lack of accountability even when the proof is provided. They thought the documents had been retrieved and thus continued with their vicious attack until it became clear the police (and their ‘shills’) had failed to retrieve the documented proof)…… a Chief Psychiatrist who “provides expert legal advice to the Minister” and yet he doesn’t even know what the most basic protections of the law actually are? “suspect on reasonable grounds that a person be made an involuntary patient” (with “criteria” set out in the Act) becomes “need only ‘suspect’ that a person be referred for an examination by a psychiatrist”. This removes the legal protections afforded by our laws by taking away the burden of proof. Which shouldn’t be a problem anyway when the Mental Health Practitioner is forging false statutory declarations right? But there is a need to provide a reason for NOT LOOKING when you KNOW the document was forged.

    So I think you may underestimate what these documents can actually be used for. Sure, for now, the swine that are using the mental health system to arbitrarily detain and torture citizens (and then dispose of them should they ever decide to complain), are using them to “edit” legal realities preferred by the State…… but somewhere down the track one would hope that their crimes against humanity will be exposed for what it was….and along with that the hypocrites who provided support for them with their deliberate ignorance and turning a blind eye. “just doing my job” is no longer an excuse given the Article which denies the “superior authority” cause for inflicting torture on citizens. A knowledge that what you are doing is torture means you simply shouldn’t do it…… or be sure that the State will ‘snuff’ the victim should they get the proof.

    These documents you see as a waste of your time, “treating the chart” (is this a euphemism for fraud?), may become vital in ensuring the people who completed them serve the time in prison they rightly deserve. The test of THEIR integrity is contained in those very documents.

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    • Might I add in regards the corrupt practice of “verballing”. The Commissioner writes that;

      “The practice of verballing has some serious implications for the administration of justice. An accused may be convicted wholly or in part on the basis of fabricated evidence, bypassing the checks and balances of the law designed to ensure that each accused has a fair trial.”

      The significance in regards mental health ‘treatment’ is even more dangerous. It must be easy to justify that someone further down the line will pick up on the ‘mistakes’ and ‘errors’, but what if they don’t? What if they are in a hurry and take the word of the frauds?

      And anyone with a basic knowledge of the MH system would tell you how easy it is to start drugging someone against their will, and then call the result of that drugging an ‘illness’ that requires more of the drugs causing the problems. I mean consider this statement by the Senior Medical Officer who suggest I be given enough tranquillizers to lay an elephant out for a month should I show signs of ‘agitation’ (keep in mind I’m not to show agitation after being snatched from my bed at the point of a weapon, tortured and kidnapped)

      “potential for violence, but no history or clear intent”. So I am to be force drugged for his paranoid delusions?

      At least the people ‘verballed’ by police will eventually get out of prison. Some have done 14 years ….. but their not deliberately being brain damaged for complaining about the ‘verbal’, and spending the rest of their life being drugged and incarcerated at random times for their “non compliance”.

      “The welfare of the people in particular has always been the alibi of tyrants, and it provides the further advantage of giving the servants of tyranny a good conscience.” Camus.

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