Posted on

Why the Mental Health System in the US is broken

Once again, a client has lied to a mental health professional and someone ended up injured as a result of the professional taking the information at face value.

The problem is that the mental health professional was aware they were being lied to. But truth is not important in the treatment of mental health. As a matter of fact, I have been told time and again that learning to lie to a mental health professional was a sign of good mental health. It showed understanding that the act was wrong by attempting to not get in trouble for doing the bad thing. That type of avoidance showed healthy thinking, in their view, and therefore there was nothing they could to treat it.

For instance…let’s say you have an individual, Bob, who says “I want to kill Person A.” That statement can get you taken into custody and brought to a hospital for an evaluation under the “threat of harm to another” rule. When Bob gets to the hospital he says to the doctor “I no longer want to kill A, I feel better. It was a heat of the moment thing.” The hospital will then let Bob go as he has no clear intent to harm A. Bob then follows through on his initial statement and kills A.

The mental health professionals will say “Not our problem. A rational person can decide to kill – it is not necessarily the result of a treatable mental health issue. Bob lied to us when we asked him about it and Bob said he wasn’t going to do it. A mentally ill person would not know to lie, so, if Bob is denying the intent to kill Person A, then Bob is not mentally ill and we cannot treat him.”

Here’s the fallacy in that argument – it assumes that the mentally ill cannot learn. And what the mentally ill learn to do through contact with mental health professionals is…to lie.

You can teach worms to perform or not perform certain actions through training. And worms are not higher functioning human beings with diagnosable mental health issues. If every time a mentally ill person does or says something, and they are picked up and hospitalized, then that action is dissected with them in therapy, they will learn that if they lie about it, then they are rewarded with a raise in status, with more privileges, and eventually with discharge from the hospital.

Where they go into the community and continue to commit the same acts that got them picked up in the first place. Eventually they learn to manipulate the system – homeless and hungry? Admit to symptoms and get hospitalized. No longer want to be hospitalized? Deny the symptoms exist and be discharged.

This does not mean that all folks suffering from mental health issues do not focus and work their treatments. You’re looking at the Venn Diagram in the wrong way. It means for a sub-set of the population it is easier, or more profitable, to game the system rather than work their treatments.

And the system is ready, willing and able to be gamed.

I can’t tell you how many times I’ve gotten into heated exchanges with a treating psychiatrist or psychologist trying to get them to ask a probing questions. On my children’s life, the following conversation actually occurred:

“My client is violent in the community. Certain things trigger him.”
“Well he’s fine now.”
“Ask him about XYZ. It always sets him off.”
“I’m not going to ask him about that, I know he get’s violent.”
“Well, then you know he get’s violent, why are you saying he’s fine?”
“Because I’m not talking with him about that and he’s fine now.”

And…discharge. To have the client hospitalized again within hours because…someone asked him about XYZ and the police had to intervene.

We closed the hospitals and released the inmates with promises of community resources that never materialized. And now we have a homeless population that refuses to engage in services, or who game the system so effectively that there is no incentive to address any issues. We need a better solution, but it has to come from the very system that is being gamed – the mental health system.

In a way it has to break, fully break, under the stress and then something effective has to be built in it’s place. Until then, stop asking why it seems like it doesn’t work. It’s not going to get any better.