A Vision for Transformation: Mental Health Freedom and Recovery Act

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For most of my adult life, I have worked with people with severe disabilities.  It’s been with humility that I’ve witnessed the courage of many people who’ve faced enormous obstacles and seen their spirits in action. These individuals serve as examples for each of us – to face our challenges head-on; to do our best to rise above them; to focus on our gifts and talents; and to use them to do extraordinary things.

It’s been through my work in the field of rehabilitation, that I’ve come to believe in the human spirit and the strength that comes from learning to tap into its source.  When we do so, we open ourselves to new levels of hope and inspiration and endless possibilities to experience the fullness of life.

In 1990, the Americans with Disabilities Act (ADA) was passed by Congress and signed into law.  This historic act provided the “reasonable accommodations” needed to allow disabled people to enter courthouses, public libraries, city buses, local restaurants and the front-doors of employers; often for the first-time.  The “least restrictive” clause of the ADA has allowed those same individuals to find “inclusion” in their communities; to gain access to opportunities of all kinds; and to live full and productive lives.

The strides we’ve made in this nation for people with physical disabilities are in stark-contrast to the way we continue to treat those who have been diagnosed with severe “mental illness”.  I have yet to meet an adult with a physical disability who was forced to undergo a particular medical treatment or who lived in fear of having someone lock them up against their will if they were not “compliant”.

Nor have I heard that treatment caused “more harm than good” from what often appears to be the vast majority.  With physical disability, there are some people who might have preferred a less-intrusive surgery or were not pleased with a medical procedure.  But only in the area of mental health treatment is injury the common-denominator for so many who have been given a psychiatric diagnosis.

The one-size-fits-all paradigm of care known as conventional psychiatry is unlike any other form of medicine. Patient consent and participation is all but nonexistent; alternatives are often ignored; incarceration, drugs and ECT are used by force; and those who are injured are often left to sort through the fallout on their own, without recourse.

I put together a vision for Congressional legislation that addresses these concerns.  Once implemented, it will forever change the mental health system.  I hope you will take a few moments to read it.  Feel free to post a comment through the ISEPP link indicated.

http://discoverandrecover.wordpress.com/mental-health-freedom-and-recovery-act/

Yours in liberty and wellness,

Duane Sherry, M.S., CRC-R

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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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42 COMMENTS

  1. Dear Duane, Thank you for this thoughtful and comprehensive proposal. I would like to suggest that you add that all mental health providers be required to refer patients for assessment and treatment of physical illness, including those you list, and for toxic drugs and substances that can cause mental, mood, and behavioral symptoms prior to making any diagnosis and treatment of mental illness. In addition, until the DSM has been thoroughly revised or removed from use, all patients should have the right to demand and seek second/third opinions from other providers including those offering alternative assessment/treatment. Very best wishes to you for the success of your project. Marsie

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  2. Marsie,

    Thank you so much for taking the time to read the article, and for your comment as well.

    You make some excellent points – ones that need to be addressed.

    It’s difficult to put a vision together that addresses each/every point… In fact, most of the feedback I’ve gotten thus far is that it’s “too long.”

    But complex challenges require attention from many angles, and input from many valuable sources… such as yours.

    As addressed in the vision, this will take synergy – from professionals, survivors, many of us who want to see a transformation take place.

    My best,

    Duane

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    • Dear Duane,
      I don’t think the Mental Health Freedom and Rocovery Act you propose is too long. I posted my suggestions above with the aware ness that:
      1) All treatment follows from diagnosis.
      2) A diagnosis of “mental illness” should never be made without first assessing for real physical illness and/or effects of drugs/medication, both of which can usually be treated without heartbreak, loss of human rights, stigma, and long-term life consequences.
      3)Psychiatrists, as medical professionals, should be trained, as all physicians are, in making “differential diagnoses,” of physical illness, particularly those that can cause mental and behavioral symptoms. Until then they, and all non-medical therapists, should be required to refer for physical assessment.

      With this very important addition of physical assessment first, I would entirely support the Mental Health Freedom and Recovery Act. Is it your intention to seek input from others? Are you planning to present it to Congress? Have you thought of or have you created it as a petition to be sent to APA, DSM, government, etc?

      I’d like to see it posted on Madness in America in its entirety and not just as a link, if possible, as it so clearly addresses so many of the concerns discussed her.

      Blessings and hope for the future.

      Marsie

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  3. Marsie,

    We are in agreement with assessment and treatment for underlying physical conditions, which can often be the root cause of what conventional psychiatry defines as “mental illness”. These conditions are far-too-often, overlooked –

    http://discoverandrecover.wordpress.com/2011/09/15/root-causes-of-mental-illness-and-non-drug-solutions/

    In fact, as we go, I’m certain that there are many other conditions that could be added to these…

    One of the reasons I wanted to post the vision for this legislation was to get input from others, such as you.

    Where in the proposed act would you make the change, and how? (as it refers to the language). If you and others can be specific, it would be helpful.

    I would like to see a final version drafted, and posted as well. Hopefully, we can work on the language together. It will then need to be sponsored, and lobbied. This will take approaching House Members and Senators, until we find sponsorship.

    Re: Strategy

    The first part if coming up with a consensus of what the final proposal will look like – to iron-out the rough spots, and put in legal language.

    For any person interested in helping get this off the ground, something as simple as forwarding this Op-Ed link to a group of which you are a member would be a good way to have dialogue begin…. Here on Mad in America

    For instance, for those in medical practice, send the link to fellow colleagues who are members of the Institute for Functional Medicine, American Board of Integrative Holistic Medicine, etc. For psychotherapists or counselors – send the link to fellow professionals, and the American Association for Marriage and Family Therapy or National Association of Cognitive-Behavioral Therapists…. For survivors, send the link to fellow survivors and the International Network toward Alternatives and Recovery, the Copeland Center for Wellness and Recovery, etc… On the legal side, the National Association for Rights Protection and Advocacy, MindFreedom International, PsychRights…

    Once we begin to have dialogue from individuals in these groups about what it is they would like to see in the bill… How it is they would like to see it written, we can then begin to develop a commitment, and enthusiasm to get this done… once-and-for all… With the same determination and will as those involved in the civil rights movement, and the passage of the Civil Rights Act of 1964.

    Duane

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    • Dear Duane,
      I’m very glad to participate in this project and appreciate all your efforts.

      In the first paragraph under system transformation I suggest that you change “illness model” to “mental illness model” in quotes. I also suggest that you add a second and third paragraph under System Transformation that state the following (in your own, clear language,not necessarily in this order):

      All individuals who enter the mental health system should be provided with comprehensive assessment for physical illness and drugs known to cause emotional, mood, or behavioral symptoms prior to any assumption, diagnosis, or treatment of psychological problems. Prior to diagnosis of psychological problems, all psychiatrists/medical providers would be required to assess, test, and/ or refer for differential diagnoses of possible physiological causes. Prior to diagnosis of psychological problems, non-medical providers would be required to refer individuals for assessment for physiological illness/drugs.

      The current Diagnostic and Statistical Manual would be replaced by a system that includes physiological illnesses known to cause so-called psychological, mood, and behavioral changes, and psychiatrists and other providers would be required to refer patients so diagnosed to the appropriate medical specialist for treatment. Diagnoses in the DSM with no known physiological etiology would be removed. The new DSM or other-named system would acknowledge that psychological suffering and problems are not “brain disorders” or “mental illness” but are part of the human condition that can be helped by the empathy and the support of other human beings. Insurance companies would be mandated to cover treatment so provided.

      I also think that the training of psychiatrists and research about the harmful effects of psychotropic medication, ect, and psychosurgery needs to be more explicitly addressed, including iatrogenicity, but I think that this would require more input from psychiatrists sympathetic to this cause. (Critical Psychiatry in the UK would be a good place to ask for input.)

      Thank you again, Duane. Please ask Bob Whitaker to post this on the Mad In America Facebook page where it can be read and shared with other supportive groups there.

      (I think I should have posted this response after your comment that follows.)

      Marsie

      I would also change “illness model” in the first paragraph to “mental illness model” in quotes.

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      • Thank you, Marsie for your input.

        Rather than make edits to the original right away, I’d prefer to gather some more ideas and make the edits all-together; then post more a (more) final version.

        The proposal will likely end up looking quite-different from the original as we go along; in fact, will likely have legal terminology once it’s ready to be presented to a bill sponsor.

        But that’s okay…
        This will be a work-in-progress. And ideas like the ones you offered will help make this a good bill!

        With appreciation,

        Duane

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        • Marsie,

          Do you know any of the members of the Critical Psychiatry Network?

          If so, would you mind forwarding the link to this Op-Ed to them, and ask for their expertise.

          I really appreciate the comments you’ve made thus-far… These are the items that need to be addressed by medical people – written in terms that can be understood by legislators, but in ways that non-medical people cannot fully appreciate (without clinical experience in some of these specific areas).

          I think we’re off to a good start, Marsie!

          Thank you!

          Duane

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          • Marsie,

            Thank you!
            This is the kind of action we need to have to help get this off the ground!

            I really like your idea of having a permanent FaceBook page – Hopefully, if enough peole begin to make comments on this Op-Ed link, we’ll quicly outgow this approach and need a central place to focus our efforts.

            IMO, the FaceBook page should be focused – like a laser-beam… With members of the page who are willing to share their own visions, experiences, expertise – with a single strategic plan – to get a bill written, sponsored, lobbied, passed in both houses and signed into law.

            Am I crazy enough to think this vision can become a reality?

            You bet I am!

            Gratefully,

            Duane

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          • Marsie,

            I created a new subtitle, ‘Comprehensive Medical Evaluation and Diagnosis’ to address the issues you brought up.

            Government-funded, run clinics and private carriers are addressed separately, because I’m not sure how and IF it is a wise idea to dictate how private practitioners are allowed to operate. This will be a sticky area, especially as it pertains to “freedom” of people seeking help, and those who would argue they are trying to help.

            Again, we would need several people in a group to fully discuss these and other areas, with legal expertise, along with clinical experience.

            Duane

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    • I’d add the need for more protection against unauthorized disclosure of patient’s data and use of it by police and other government agencies as well as private entities. Medical files should be confidential and accessed only by doctors either upon patient’s consent or in an emergency (e.g. accident leading to patient’s unconsciousness when reaching to patient’s family is not feasible) or if treated as evidence in a legal case. Moreover, the patient should have the right to access all the medical information on him/her stored by any government or private entity free of any fees and a right to request of removal of such information (with some time limits if the information is required for legal or insurance proceedings but the the “statue of limitations” should apply).

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  4. Duane,

    I always enjoy our many email exchanges. It is obvious to me that your life experiences have blessed you with a rare perspective which developed a sensitivity to the plight of others.

    Your writing style is that of a gifted craftsman.

    While “all the king’s horses and all the king’s men” continue to assess, or contribute to, the core problems within the mental health care system, the general lack of communication and understanding fosters adversarial conversations and opportunistic greed. Advocacy resources on the internet have become a breeding ground for confrontation, confusion and ineffective support of a unified advocacy agenda.

    Meanwhile, the peaceful warriors among us seem to have been tapped on the shoulder by the same source of hope, faith and compassion, creating a catalyst for change.

    The power of electronic communication is certainly fast at getting things done quickly, but it is also very efficient at creating viral chaos.

    The virtue of patience really pays off when you finally come to realize even in the digital age, spirit maintains its mysterious movement. The power of faith moves mountains.

    As a volunteer blogger for the International Society for Ethical Psychology and Psychiatry (ISEPP), I appreciate the many heartfelt contributions individuals have submitted to post on the blog.

    I have found ISEPP to be a truly welcoming organization, with members who are both mental health professionals and nonprofessionals supporting an alternative advocay agenda. We need to question: is the lack of affordable alternatives hindering the paradigm shift. In my opinion the lack of affordable alternatives is what empowers mainstream psychiatry and I appreciate ISEPP as an organization that sponsors an annual conference focusing on alternatives to biological psychiatry.

    Announcements such as the new ruling in Florida which requires Medicaid to pay for Applied Behavioral Analysis (ABA) for symptoms of Autism is the first sign of hope I have seen.

    Duane, I am truly honored by your contributions to the ISEPP blog, supportive efforts and kind hearted words. Your words are truly inspiring and I put this together for you. Namaste’ Maria Mangicaro

    Desiderata of Mental Health Advocacy

    Advocates who go placidly amidst the noise and haste remember what peace there may be in prayer, meditation and belief in a higher power than the APA. There is a lot of darkness in the mental health care system, you will need more than a lightsaber on your journey as an advocate.

    As far as possible be on good terms with all other advocates regardless of professional status, mental health background, organizational or church affiliations.

    Speak the truth, jump up an down on Oprah’s couch, but just remember to listen respectfully to others, even the glib and Tom Cruise; they too have their story.

    Avoid loud and aggressive pharmaceutical representatives, they may mean well but they also make a lot of profit selling “treatment”.

    If you compare yourself with NAMI, you will never be able to compete; for although they may mean well too, always they will be backed by Big Pharma.

    Enjoy your advocacy as well as your plans to help others. Keep interested in a unified advocacy agenda, we need to be humble; it is a privilege to contribute to changing the fortunes of time.

    Exercise caution in your beliefs; for the world is full of trickery and snake oil salesmen. But let this not blind you to what virtue there is; many practitioners strive for best practice at affordable prices; and everywhere there is hope of finding a caring source to facilitate healing.

    Let others be themselves and choose your words carefully. Especially, do not force treatment or negative opinions. Neither be cynical about hope for those labeled mentally ill; for in the face of all aridity and disenchantment it is a pillar of strength to lean on.

    Take kindly the counsel of doctors practicing Integrative Psychiatry and Functional Medicine, gracefully risking their professional reputations to help patients who otherwise would be treated by main stream psychiatry. Nurture strength of holistic spirit to shield those you advocate for. But do not distress yourself with dark imaginings that Tom Cruise will someday rule the world. Many fears are born of ignoring the value of a celebrity advocate actually speaking the truth and willing to take a stand against Big Pharma, the APA, Hitler, vampires, alien invaders and all other forces from the darkside.

    Beyond just imagining a paradigm shift, be less critical of other and work together towards it actually happening. They are a child advocate of the universe, no less than the trees and the rock stars; they have a right to be heard and taken seriously.

    And whether or not it is clear to you, no doubt the APA is starting to see the light. Therefore be at peace with Big Pharma, whatever you conceive it to be, because whatever our pain or illness might be, someday we might need a drug or two. In the noisy confusion of mental health advocacy keep peace with your soul, it’s the only thing that you own. With all its shams, drudgery, psychiatric hospitalizations are sometimes a necessity. Strive to improve the mental health care system.

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    • Maria,

      Thank you….I’m truly touched by your kind words.

      I too have enjoyed our email conversations, and have learned SO MUCH from the ISEPP blog that you moderate.

      I especially appreciate how you put such a carefully selected mix of material on the site – both integrative medicine and psychotherapy/counseling. Like you, I’ve come to understand that there are many ways in which people heal, and continue to grow… Behind an individualized-approach is attention to both mind and body. And the spiritual-side is probably best summed up by C.S. Lewis: “You don’t have a soul. You are a soul. You have a body.”

      The ‘Desiderata of Mental Health Advocacy’ poem is something that obviously took some time to write… and it will take several readings before I fully appreciate the wisdom (and humor). It’s great… There’s a lot there!

      Fear not, I will remember to take my “lightsaber” on the journey!

      In solidarity,

      Duane

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  5. Hi Duane
    Well done on the interesting and insightful article. I have always been a huge fan and have shared the link with my friends in America. I hope you garner a huge response and support… and that your efforts are rewarded in the best way possible.
    Blessings to you and family
    Mands

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  6. This a a great recovery act, and a good one for people to read which will give them insight into what is actually lacking in the mental health “real world” for advocacy and treatment, etc. I like how you compared the disabled services vs the mental health services, they are indeed night and day and should not be! I also like how you added in the psych med withdrawal, and more!

    Thanks! and
    Good work!

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  8. Dr. Moffic,

    Freedom is a pretty radical concept.

    It hasn’t been tried in many places on this earth; at least, not for long. It remains an experiment in this country… One that folks diagnosed with “severe mental illness” have yet to be included in.

    The proposed bill is a vision to expand choice in treatment – particularly, non-drug treatment, without coercion or force.

    This is not about the talk.
    This is about the walk.

    Can you join?
    I don’t know.
    Can you?

    Duane

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  10. Reverend King spoke of peace and of justice.
    His words were a double-edged sword –

    “Never forget that everything Hitler did in Germany was legal.”

    “Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that.”

    “The hottest place in Hell is reserved for those who remain neutral in times of great moral conflict.”

    “A nation or civilization that continues to produce soft-minded men purchases its own spiritual death on the installment plan.”

    “I have decided to stick with love. Hate is too great a burden to bear.”

    His was a message of hope.
    But it was also a strong call to action.
    And he did not tip-toe around what he believed in, and what he knew needed to take place.

    Yes.
    He and others welcomed many to “walk” with them.
    Keyword, “walk”.

    Duane

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    • Sonia,

      Thank you!

      I enjoy reading your many comment on the Mad in America site!

      Having spent many years working with blind people, I’ve grown to appreciate this quote:

      “Alone we can do so little; together we can do so much.” ― Helen Keller.

      In solidarity,

      Duane

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  12. Re: Facebook Page

    Robert Whitaker reminded me that Mad in America has a Facebook Page, for anyone interested in beginning to develop strategies for the Mental Health Freedom and Recovery Act.

    This is the link for Facebook, Mad in America –

    https://www.facebook.com/madinamerica

    This is the link (to copy/page) to refer readers to this Op-Ed –

    http://www.madinamerica.com/2012/05/11866/

    If others begin to show interest, I’ll join in, but would prefer to not try do this this all-alone, because it will take an enormous team effort to be successful.

    Duane

    Duane

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  13. At this point, I’m asking for anyone who has an interest to put the link on the Mad in America Facebook page, and see if we have people interested in this cause.

    If I do so, it will appear as a one-person effort.

    From some folks I’ve talked with, the consensus seems to either be that it’s “too big a task” or the “timing is not right”.

    I hope we being to organize… and to act…
    sooner, rather than later.

    Duane

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  14. I totally disagree; this is not too long. This is the second time I’ve run across this and the only problem I have with it is that you put the important words that link to other information in a different color than the rest of the text. I don’t have access to a color printer so can’t run it off. I hope you don’t mind my attempts to copy it to share with others. Please let me know if you don’t want me doing that. Anyway, that’s the only criticism I have. And, like you, I think that this movement forward needs to begin now and not later. The time will never be “convenient” if we keep waiting around.

    One problem that I have is that I refuse to think if myself as disabled just becasue I got entangled in the so called “mental health” system. I refuse to see the people that I work for as being disabled, although almost every one of them believes that they are.

    thanks for your dedication and your good work and for coming up with this. Keep up the good fight! It doesn’t hurt to have a good lightsaber either!

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    • Stephen,

      IMO, it’s the mental health system and conventional psychiatric “treatment” that causes the disability.

      If we replace the system, with one that offers hope; the disability rolls will be replaced with people who are able to work.

      What a concept, huh?

      Duane

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    • Stephen,

      IMO, it’s the mental health system and conventional psychiatric “treatment” that causes the disability.

      If we replace the system, with one that offers hope; the disability rolls will be replaced with people who are able to work.

      What a concept, huh?

      Duane

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  16. The ADA was truthfully a cheap answer to deny people with mental illness to become a suspect class. Additionally, Congress lied about their findings of blatant prejudice, leaving those who are and were stigmatized to feel singled out. Of course, the recent donations from the pharmaceutical companies probably helped them sleep at night. I have also never heard of combating discrimination by placing a label on it and defining it as different. Legal equality can only view to people as being equal if they can be seen as the same. Most people don’t understand how difficult that makes it to achieve. Without status, mental illness is left under the rational basis test which means that the law is assumed Constitutional as long as it can be reasonably connected to a legitimate government concern. That means the burden is on you. To add to the complication, concepts like “reasonable” and “legitimate” are vague at best. Segregation was once considered reasonable and legitimate. The ADA represents the illusion of rights; not the actualization. It secures lots of guinea pigs for the pharm companies and allows the continued stigmatization across the country. Never trust your rights to someone who has nothing to lose, and the ADA will choose monetary personal gain over others freedom every time.
    The truth of the 14th Amendment is to protect the simple right to live in anonymity and without the abuse of stereotypes for political or personal gain. The ADA is an abuse of power for profit and should be disbanded. We have a better chance without them.

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