(cross-posted from Beyond VSH blog, here)

The very nature of self-determination as well as independence would seem to dictate not merely having freedom of choice, but rather also include both the freedom and the right to ensure one’s self-defined and self-expressed wishes, choices and decisions are not defined, limited, narrowed or controlled by outside influences, no matter how well-intended or well-meaning.

Each person needs to decide as well as do what is best for themselves and, as such, they are the only one who actually knows what that is during any given moment or circumstance.

When it comes to health care and, most particularly concerning mental health treatment and related matters, save (i.e., except for retaining one’s own) true and actual freedom of choice regarding such decisions, this means that like most anything else in this life there are truly no absolutes, nor should there be any imposed on any person(s) by anyone else.

Hence, in order to ensure true parity between health care and mental health care treatment systems (versus merely addressing how these separate and unequal systems and services are paid for under the pretense of parity), the use of force and coercion within the mental health systems needs to be completely done away with before these systems can truly become ones of empowerment for everyone involved. This would be real change, since it is what is sorely needed and because it is also very long overdue.

Whether on an inpatient, outpatient, or community basis, the use of force or coercion in mental health treatment is clearly wrong. Force and treatment do not go or work together. In fact, each works in opposition to the other.

Treatment that is free from the use of force or coercion in all forms embodies what is essential to what often becomes termed as recovery: i.e., person-hood, self-determination, hope, faith, responsibility, and independence, as well as interdependence.

Force and coercion only works to foster and enforce dependency, victimization, anger, violence, helplessness, and irresponsibility.

Force and the fear as well as the intense anger and even rage that it creates does not ensure safety or security; rather, it is the use of force that destroys them. Using force is easy. Choosing alternatives to force may at times appear to be difficult, yet it need not be impossible. Many options are available when force and coercion is not the governing paradigm.

If the force/coercion paradigm were no longer in place, the power imbalance that currently exists would cease or, at least its base — or, otherwise the basis for it — would lose its authority.

Resources currently being employed to bolster the force paradigm could be better and more readily used instead to meet the basic human needs of individuals; needs that are either not met in a way of a persons choosing or not met at all.

The varied needs of people within the mental health system include, yet are not limited to: non-segregated, non-congregate housing; tenant-based rental assistance programs; home ownership programs (designed by persons they are meant to assist and packaged to assist persons living on very low incomes); income; food; properly funded peer support programs and services; training; employment; quality health care, including dental care, etc.; and, transportation.

Meals on Wheels, personal assistance services (modeled along the same lines as someone with a physical disability would be eligible to receive), and Part B-Independent Living Services as well as other such essential programs and services can play meaningful and vital roles in supporting individuals labeled with psychiatric disabilities to live independently in communities as well as living situations of their choice.

To accomplish such however would take a major shift in resources to fund these and other much-needed programs and services. That said, the money for doing so already exists and is instead being spent in one form or another elsewhere, typically in the most costly fashion and often in a manner or mode that is too little, too late and, in addition, could be termed as well as considered deliberate indifference.

What will be required is the political will and courage to redirect funds in order to meet the needs of those the system is supposed to be serving, but is currently failing; not merely by political leaders or bureaucrats either, but by every citizen.

We must do several things, including but not limited to these:

• End civil commitment and abolish the insanity defense for persons labeled with psychiatric (or emotional) disabilities;
• Hold people fully accountable for their actions if a crime is committed and then proven within the criminal justice and correctional systems, regardless of whether or not an individual is labeled with a psychiatric disability;
• Shift resources to fund a system that helps to meet the needs of individuals labeled with psychiatric disabilities in a way of their choosing and make mental health systems completely voluntary;
• Use a voucher system to allow people real choices both in selecting care and/or service providers and the actual care and/or service that they may choose to receive.

Often there are concerns raised about what should be done if someone is out of control, troubled or in need of treatment when their state of mind and/or behavior is being questioned.

While the issue appears to be complicated by several factors, including current constitutional law regarding an individual’s rights in criminal proceedings, it is my belief that people can be held more accountable by changing how they are treated, by abolishing the insanity defense, and by ending civil commitment of individuals labeled with psychiatric disabilities.

Being out of control or labeled with a psychiatric or emotional disability should not be an excuse and violent or other criminal acts should not be tolerated if a person is proven to have committed a crime.

If no crime is proven to have been committed however, yet the person appears to be out of control or troubled, they should be offered voluntary assistance only or otherwise be left alone. In addition, more tolerance and understanding of others and their differences is actually needed, not less of it.

If an individual is not committing a crime, but her or his actions are annoying others, then they should not be detained or interfered with — just like anyone else. Being annoying, out of control, or being labeled with a psychiatric or emotional disability in itself should not be grounds for imposing society’s will.

We should not be able to hold people accountable for actions that we think that they might do at some future point in time.

People should, however, be held fully accountable for proven criminal violations of the law.

In addition, the justice system should never be misused simply to compel forced or coerced mental health treatment when no actual or real crime has been proven to have been committed by an accused person either. There needs to be serious protections against such being allowed to happen as well as stiff penalities imposed and enforced upon those who falsely report someone else of a crime the person in fact did not commit in order to compel treatment for that individual.

In closing, it is my strong belief that it is possible for us as a state and society to finally rid ourselves of the terrible burden of force and coercion within the mental health system.

Doing so would be very liberating to mind, body and spirit on both an individual and collective basis, especially when sharing with and supporting each other as we journey into the unknown together.

Morgan W. Brown is an advocate, writer and blogger living in Montpelier, Vermont.

Author’s note (Wednesday, September 30, 2009): the above commentary is drawn various previous writings of mine including commentary entitled Self-determination and independence versus force and dependency published in the Spring 1991 edition of the National Empowerment Center (NEC) newsletter (here), which was drawn from original commentary that was initially written and then edited into various versions during the period of late 1986 and early 1987.