Why Mental Health Industry Sucks: Their Focus Is Not Understanding Human Nature
and inevitably most mental health treatment modalities fail in the long run
I have been looking at studies in the UK testing contingency management as a treatment modality for people with addictive disorders. These offered modest financial incentives (in the form of shopping vouchers) for people using addiction drug treatment services to stay off drugs and/or to complete a course of Hepatitis B vaccination.
Media reaction:
The Independent. 8th April 2014. “Health matters: Incentives for drug addicts should be explored”
Let’s start with the main issue — I believe the desire to get better needs to come from the person themselves and not through bribes.
I’m highly sceptical about paying or rewarding people, so they fix their problems. I don’t think treatment should involve rewards or punishments but rather a chance for people to explore their issues at a deeper level with the help of a professional who is aware of trauma and its impact.
I think contingency management would only be effective for a short period as I find it unrealistic to expect that giving a £10 supermarket voucher to someone who has experienced lifelong trauma will make a difference. People with addictions have complex needs. How is a voucher supposed to help a woman who, for example, is addicted to heroin and stuck in an abusive relationship with a partner who is also addicted to heroin? How will it help her when she can’t leave because she is financially dependent, has no qualifications for a job, and can’t call social services because she is scared they will take her child away?
Personally, if that was me and I tried to seek help, and they gave me some voucher to buy groceries for £10 as if this can even begin to solve my problems because I’m supposed to feel “rewarded”, I would have felt angry. But, I would have felt valued if someone could genuinely understand the complexity of these problems and how much I’m struggling and made me feel heard even if they couldn’t do anything to change my situation.
The reality is there is no quick or cheap cure to addiction or any other mental health problem.
We need to stick to trauma-informed approaches, which will work in the long run instead of trying to create quick solutions that don’t last long but give the appearance of success for a short while.
There is a “fake it until you make it” attitude in the mental health industry. For example, there is this pretention that there are proven scientific methods that will cure addiction or trauma or other disorders even though many studies show all these medications and therapies do not work in the long run.
The truth is we don’t know how to help these people, so why are we trying to attract more of them? Drug and alcohol rehab success rates are very low, so isn’t it a case of us attracting people, putting them through treatments that don’t work, and they end up feeling more like failures when they don’t succeed?
Isn’t it better to use the money on training mental health professionals so they recognise the complexity of these problems and the importance of the ability to analyse and reflect on others’ subjective realities?
Most people with mental health problems don’t realize they are dysfunctional because their behaviours are learned strategies and coping mechanisms, which serve a function and make sense based on how they interpret the world around them.
This is why it’s not possible to change someone unless they have somehow realised that their behaviours are indeed problematic and have a desire to change. When that happens, that’s when they should seek help.
I don’t think there is a need to bribe or try to attract people who don’t want to be treated or are not sure they want to be treated with vouchers as it is only possible to help people who want to change, in which case they won’t need the vouchers.
When someone with addiction comes in for treatment, mental health professionals need to take a step back and ask, “What’s the whole story?” because people never have an addiction on its own without any other problems in their lives.
I think there is always an issue that gets out of control, which leads someone to treatment, but there is more in the background. And if they only solve one problem and leave everything else as it is, then obviously relapse is inevitable.
Changing behaviours without understanding the underlying reasons why and resolving them will not last.
There is a reason for every dysfunctional behaviour even if it looks self-destructive and wrong from the outside. For instance, there are many reasons for substance misuse, which can include depression and anxiety but also insomnia, for example.
Even two people with anxiety can have different underlying causes; one may have social anxiety due to feeling unlovable, and the other may have social anxiety due to body image issues/body dysmorphia, using drugs to feel more confident but also to lose weight. The latter would benefit from treatment for eating disorders, which may indicate that they have perfectionistic tendencies. Maybe they believe unless they are perfect, people will judge them.
On the other hand, the first patient may have issues around feeling unlovable no matter what. Because their parents rejected them, they may automatically assume that everyone else will reject them too and feel paranoid, as opposed to the second patient who may have received some love from their parents but only when they accomplished something/were successful in some way.
Both have similar problems in many ways, but they are also different people. “Addiction” or “genetic predisposition” cannot describe these problems as they are just too simplistic.
The most important thing for mental health professionals is to recognise this complexity and help the patients become more self-aware.
The first patient I mentioned above, for instance, feels paranoid because, in their reality, people will always reject them, but realising that everyone has a different reality and their one isn’t necessarily true, or the same as other people’s perception can help them challenge their assumptions, which can help them feel less paranoid and anxious, which can then help them with their addiction.
Having studies that claim it is possible to help these people just by offering them vouchers based on short-term results simplifies their problems in the eyes of mental health professionals and the public (Why invest in something so simple to cure?).
Even if the vouchers worked for a little while, they would never be a solution. Someone’s body dysmorphia won’t go away just because they receive a £10 voucher every week. Actually, it doesn’t go away even if they have cosmetic surgery. It’s just not that simple.
If you enjoyed this post and would like to read more, you can subscribe here — https://medium.com/subscribe/@ella_harris to get an email whenever I publish a story. You can also buy me ☕ via — https://ko-fi.com/ella_harris