Alternatives 2010: Answering Critics

 I normally post my blog on Mondays but after the firestorm that my last blog caused, I feel I should answer some of the comments.
1. Why don’t I participate in the blog comment section?
 I was trained as a journalist and was taught that a newspaper published an editorial and then readers reacted with letters. It was considered improper for a newspaper to add a comment to a letter. Why? Because the letter writer would not have an opportunity to reply to that note. Obviously, blogs are different and I have noticed that many bloggers do interact with readers.
I have chosen to not do that because I think the comment section should be for readers to give their reactions. 
At this time, I don’t plan on changing my policy, especially because I am behind on writing my newest book, which has nothing to do with mental health. This doesn’t mean that I don’t read and think about all comments. I do.
 
2. Personal attacks. I have a thick skin, but no one likes to be attacked personally. I find comments about how grateful a reader might be that I am not his father or that I might be in need of professional counseling for my own mental health to be inappropriate and unnecessary. I was taught that when you didn’t have any merit to your argument, you attacked the person who disagrees with you. That is a tactic that I have always tried to avoid and I tend to dismiss comments made by people who engage in that sort of behavior.
My son, Evan, who oversees this webpage has told me that most blogs have warnings posted about abusive personal comments. We are going to discuss this and take appropriate action.
3. Government funding. The issue that I wrote about in the blog was whether or not the federal government should be paying for a mental health conference, especially Alternatives 2010, which by its nature implies that it is going to offer a different points of view from the mainstream. 
Before I wrote my blog, I checked the SAMHSA website and could not find any other conferences that it supported financially nor specific treatment programs that it underwrote. Several commentators cited incidents where tax dollars were being spent on Medicare and Medicaid, and they argued that such payments pushed the medical model of recovery. I did not find those arguments very compelling.
But what I did find compelling was a comment that pointed out that outsiders were responsible for peer-to-peer services. I also thought a comment by Lawyerbytrade was helpful when he suggested that funding the Alternatives 2010 conference helped level the current playing field when it came to consumers’ opinions.
I always try to be open to comments with reasonable arguments. I also don’t mind admitting when I spoke too soon.
So, for what it is worth, I have no problem with the government supporting the Alternatives 2010 conference – especially since I was assured that the Alternatives 2010 conference was open to anyone, which means the National Alliance on Mental Illness, Mental Health America, the Treatment Advocacy Center and other groups could attend.
As long as it is open to everyone, and welcomes healthy discussions and different points of view, then I will support it. 
4. Involuntary Commitment Laws.
I have always argued that involuntary commitment laws that focus only on immediate danger are short-sighted. Nothing I read in the comments section has made me change my mind.
As a society, we have endorsed the concept of involuntary commitment: rightly or wrongly. What this means is that this debate is not about whether or not involuntary commitment laws are a good or bad idea. That was decided decades ago and is well-established in the law. If we now want to re-open that debate, then let’s do it.
But the real issue here is when the state should exercise its authority, not whether or not it has that authority.
I believe focusing exclusively on dangerousness is short-sighted because I have seen examples of persons who have suffered and have died because no one could intervene to help them. Most states have recognized this fault and have added clauses that allow judges to consider whether a person is incapable of taking care of him/herself or may be gravely disabled. I think those are reasonable approaches.
Trying to find better language does not automatically mean that a person is in favor of stripping away civil rights. It means that he is seeking a better alternative.
I also have said that I have no idea how to resolve this issue. Involuntary commitment is not something that should ever be treated lightly.
Which is why I have repeatedly raised the issue of what is an acceptable standard? Can we craft a better system than our current one? I think we should. And I do not think that raising these questions makes me an enemy. Instead, I believe consumers should want to be involved in such a discussion since, as many commentators point out, they have the most to lose. Rather than attacking me for questioning our current standards and criticizing the “dangerous” clause, I would welcome ideas that either explain why our current system is the best possible or how we can approve it. 
5. Forced Treatment
Forcing someone to accept treatment should always be a last resort and forced medication, in particular, should only be done in critical situations, under careful review and after a number of safeguards have been met. But sometimes a civil society has no choice but to intervene when someone is mentally incapacitated. Leaving them psychotic and abandoned  delusional in our streets and in jail is not humane.
 That is what I always have said. 
I believe the number of persons who are forced to go into treatment would be a much smaller number if we had better mental health services.
This is why I have always argued that good mental health involves having access to good medical care for the entire body, as well as housing, jobs, addiction counseling, transportation, and being accepted as an important and valuable member of society. In recent years, I have especially become an advocate for Housing First.  
I have always believed in listening to consumers. That is why I have a clause in my speaking contract that says I do not appear on discussion panels that do not include consumers.
 I might not have written my book if – when I took my son to an emergency room – we had been greeted by a peer-to-peer specialist or mental health counselors who had been trained in more compassionate ways to help my son rather than being greeted by an emergency room doctor who was busy with other cases and advised me to wait until my son became dangerous and hurt himself or someone else before bringing him back.
In the past several years, I have visited more than a 100 mental health programs and I now know that there are many ways to better handle the situation that we encountered. What frustrates me is that many of these  methods are not available nationwide.
In a perfect world, no one would ever have to be forced to accept any kind of treatment against his/her will, but this is not a perfect world and people do end up with mental problems that disrupt and threaten their lives.
I am haunted by the man in Miami who believed a devil was inside his body so he chewed a hole in his wrist to let that devil escape. What do we do about him? Leave him to end his life, bleeding and delusional?
What do we do about the fellow sleeping under the bridge in Georgetown who once was a lawyer but now does not know what day it is or what year it is? Why do we assume he does not want our help and leave him under that bridge?
What do we do about Freddie Gilbert, a man in the Miami Dade jail who couldn’t speak because he was so disoriented. Do we leave him naked and speechless in that cell?
 
 
 
If a person ends up in homeless and unable to care for himself or in jail, then society is in charge of caring for him. Does this change the equation? Does it make us more responsible for him?
These are tough issue worthy of honest debate.
Where does this leave us?
It leaves me feeling unsatisfied and frustrated.
I am a parent and I freely admit that shapes my viewpoint. I learned long ago as a parent that I can not control my son or force him to do what I want. Nor should I. Instead, I support him, talk to him, stand by his side and advocate for him. Most of all, I listen to him. This is why I have asked him to prepare an advance directive so that I know what he wants if something happens. As a parent, I feel that working with him is exactly what I should be doing.   
But I also will not abandon him. If he begins hearing voices, taking his clothes off because he thinks that makes him invisible, and talks about killing himself, I will become his advocate and do what I can and what is necessary to keep him from becoming homeless, incarcerated or killing himself.
If you are a parent, you understand.
What makes me angry is that we do not have an unlimited range of services that can be tailored to his needs. Instead, we are forced to chose the best of the worst. And that is what we should be discussing. Why are there not better programs, better treatments, more alternatives.
All of us deserve better.
Do my son and I agree on everything. Absolutely not. In these debates, we have chosen to disagree and to defend our different viewpoints — but also have promised to respect each other.
I imagine that would be a good position for all of us when it comes to these issues. Listen, respect, and try to find some common ground and more reasonable solutions.
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As soon as I post this, I will be catching a flight to Portugal to look at mental health systems there and meet with university students and several of that country’s leaders. I hope that I learn something from that trip that can help me advocate when I return home.
About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.

  • Tgskale

    Absolutely outstanding, Pete. This is heartfelt and honest and thorough. There are no easy answers. What do we do for the man you described who feels there are demons inside, or the man under the bridge who is too disorganized to care for himself? We see people with untreated neurobiological illnesses present as you describe every day. And each day, we do the best we can to help them to a place of safety, offering housing, food, empathy, respect, dignity, and yes — medications at times. None of us want to “force” anything. Each situation is unique and requires careful attention. We have many people who could probably benefit from medication to help ease the hallucinatory or delusional material, but they choose not to do so. And, that’s OK. We’re with them every step of the way. Safe travels to you and bring back good information to share with us.

  • JAS18

    Would like to see a discussion about the overly obsessive, view with “freedoms” and “civil rights.” Too many in our society have an imbalanced view of “civil rights.” I’m the sister of a mentally ill man. I would guarantee you that if I had a chance to time travel and go back into a time before my brother’s illness struck and get to tell him he would get psychotic breaks, break the law and endanger not only his own life, but the lives of innnocent people because he was off his meds, I guarantee you he would have told us to do all we can to help him with his illness, including forced hospitalization and medication. I also feel this obsessive, imbalanced way of thinking of personal and civil rights as it relates to mental health tends to be driven off the road (to an unreasonable degree) more often by men than women. I think (overall) men tend to have an overly vigilant belief about “control” and “personal/civil freedom.” This is a topic I wish Mr. Early would discuss on his website. Thanks for all you do Mr. Early.

  • Suedeborah

    i hope that you do see this mr. earley,
    met you at the convention center in knoxville tn where you were speaking. my 25 yyear old son is bipolar. recently took diet pills and chantix legally pre scribed by his family physician who knew my soon was bipolar. soon after son had a violent uncontrollable rage and stabbed my husband, then hit him with a barbell. this was a sudden violent outburst. son had never been violent before. husband 10
    weeks in hospital now with a traumatic brain injury. son in a detention center awaiting trial in june. son’s psychiatrist shocked that family physician gave him those drugs. all parties appear to agree that mental illness and those meds don’t mix. all well and good but doesn’t change a thing. who is responsible. i guess making money prescribing legal drugs in this country is a lucrative business for many. never mind the drug cartels in mexico, what about the lives of my son and my husband. what about me a mother and a wife? my 2 daughters?