So…how are we now to tell people what’s good or bad mental health care?
This past week, President Trump directed officials at the Centers for Disease Control and Prevention (CDC) to cease using seven terms, including “diversity,” “vulnerable,” “science-based,” and “evidence-based.” While as amusing as comedian George Carlin’s routine, this move leaves many social services, health, and behavioral health leaders befuddled as to what the administration believes should guide professionals and advocates in our responses to people who are seeking help for adversities that have impacted their lives.
Mental health and addiction care have forever been magnets for well-marketed remedies without regard to any documentation that they will help or even harm people. Over centuries, these have ranged from sadistic physical measures to some psychotropic medicines that did more damage than good to a bevy of “snake oil” and body-assaulting remedies, some that continue to abound in the marketplace today.
I will never forget conversations I had with a tearful psychiatrist, Dr. William Turner, an early board member at Clubhouse of Suffolk, who painfully lamented his participation in the 1930s in lobotomies at Long Island State hospitals and the VA. I also recall a tour of our nation’s first public hospital in Williamsburg, opened in 1773 by Virginia’s Governor as the “Public Hospital for Persons of Insane and Disordered Minds” where tools of torture were used – purported science that could cure “persons who are so unhappy as to be deprived of their reason.” Treatments “consisted of restraint, strong drugs, plunge baths and other ‘shock’ water treatments, bleeding, blistering salves…(and later included) an electro-static machine.” Virginia’s Governor hailed these treatments as “science” for “diseases of the brain and nervous system, and the mentally ill (who) chose to be irrational.”
So, pursuant to this CDC directive, what shall become the most-trusted source for care recommendations to people who ask for help for themselves or loved ones? Some considerations, I guess, might include:
- Social media optimization: “What treatments are approved as: ‘Facebook-Friendly Care,’ ‘Highly-Twittered Help,’ or ‘Most-Instagrammed Treatment’? Of course, the repeal of net neutrality may mean “pay-to-play” competition among healthcare providers to promote their products and services.
- Spiritual guidance: “What treatment does God want me to pursue?” (Note: Many wonderful clergy leaders have been working with behavioral health leaders to help ensure that their congregants can access the most responsible information.)
- Bartender or illegal drug dealer: “Sir, I want to stop using your products and services. Who can best help me?” Or, more progressive:
- Apple-directed care options: “Siri, who should I go see to help me with my mental health problem?”
To be fair, behavioral health care has not always been adequately directed by “best science.” But, we remain at a time when there are mounting major challenges to helping people access mental health and substance abuse care. These include combating stigma, a workforce that is not sufficiently competent culturally or linguistically, forthcoming Medicaid cuts, and inadequate networks and payment confusion in insurance and managed care companies. (A “shout-out” to the just-released “Project Access” report by North Shore Child Guidance’s CEO Andy Malekoff and his colleagues!).
Amid our nation’s opioid and suicide crises, which includes our military Veterans, this censorship of health care communication imposed on our leading health safety organization just doesn’t seem helpful.