Questioning the System

The podcast discusses the freedom of choice in mental health treatment. It questions the medical model of diagnosing and medicating mental illness and explores the right of patients to refuse treatment. The social worker's role is examined, with a focus on challenging oppressive practices and fighting for social justice. The movement towards de-institutionalization is discussed, as well as the need to prioritize human rights and dignity in mental health care. The limitations of the medical model and the importance of addressing societal factors in mental health are highlighted. The critical model of social work practice is advocated, which emphasizes listening to individuals and empowering them to set their own goals. The podcast also mentions the importance of structural reform and normalizing people's experiences rather than pathologizing them. Finally, the podcast acknowledges the work of health workers who advocate for their clients' rights and emphasizes the potential for positive Hello, and welcome to a contemporary debate and social work practice podcast, where we talk about current issues surrounding mental health in Australia. I'm Erin, and I'm studying a Master's in Social Work at Griffith University. In today's episode, we will discuss freedom of choice when it comes to mental health treatment. We will talk about the medical model of diagnosing mental illness and prescribing medication, and whether patients have the right to refuse treatment. If you or someone you know is struggling with mental health issues, please listen with caution, and if any content is triggering, 24-hour support is available through Lifeline on 13 11 14, or Beyond Blue on 1 300 22 46 36. When you think of a typical social worker working in a mental health ward in an Australian hospital, you probably think of their role as one of social support to the psychiatric medical team. The social worker is the one whose role it is to support the patient and the patient's family in understanding their disorder diagnosed, to explain what needs to happen in terms of hospitalization, medicalization, and to put ongoing supports in place for when the patient is discharged. Maybe referring to a community mental health social worker to come for home visits and ensure the treatment plan is being followed. What if instead, a typical social worker who sprang to mind should not uncritically uphold the dominant medical model of mental health, but instead was active in deconstructing systems of power, in challenging oppressive practice and in fighting for social justice. This is the critical model of social work practice in the mental health field, and it is alive and questioning the social construct of mental health practice in Australia and around the world. Like many people, I never had a reason to question the medical model of mental health until it hit me personally. I believed that just as you become physically ill and require medication prescribed by a doctor, you can become mentally ill and require medication prescribed by a psychiatrist. Then one day I received a phone call. It was from one of my best friends. She was calling from a locked mental health ward in a Sydney hospital. She was diagnosed, prescribed medication and forced to take it, even when she did not believe in either the diagnosis or the medication. This is the human face of one of the contemporary issues within the current practice context of mental health. Who are we to determine who is free to accept treatment and who is coerced into treatment against their will? The mass movement towards de-institutionalization, which began in the US and England, was founded on Goffman's research into asylums and findings from institutions that strip patients of their role in society and enforce obedience through coercion. Australia followed suit. We no longer have mental health institutions. We now have locked mental health wards. What a win for neoliberalism. Lange 1999 says that hospitalization is no better than imprisonment with both institutions providing little in terms of any therapeutic aims. As an emerging social worker, I am deeply concerned about human rights. The Universal Declaration of Human Rights states that all human beings are born free and equal in dignity and rights. Everyone has the right to life, liberty and security of person. No one shall be subject to torture or cruel, unhuman or degrading treatment or punishment. The decision to remove a person from their home against their will and to spin their rights to liberty, security and humane treatment are at stake here. In his book, Mental Health Ethics, Barker talks about how mental health social workers were more in favor of de-institutionalization and community mental health care than other members of multidisciplinary health teams. Our core values of social justice and rights for human dignity and self-determination mean that social workers must take an active stance against the structural discrimination that robs vulnerable community members of their freedom. Social workers have taken a critical stance against the medical model, which compels psychiatric diagnosis and treatment whether the patient consents or not. We live in a democracy where hospital patients with any unmedical condition are free to accept or reject treatment. Why then does psychiatry deem itself above the law by coercing control and administering medication, sometimes by physical force, in order to control human behavior that is deemed unacceptable? Thomas Satz writes about the stigma of mental health resting on laws aimed at controlling people said to be mentally ill and dangerous to themselves and others. Satz believes that the medical model is constructed for protection, while psychiatry then becomes a vehicle for social control which pharmacies or companies seek to make a profit off. This can be seen most nights on the news with newsreaders stating that perpetrators of crime have a history of mental illness or reporting on a latest defendant pleading not guilty by reasons of insanity. This rhetoric perpetrates a dangerous myth that people with mental illness are a danger to society and need to be controlled either by means of physical restraint in prisons or locked hospital wards or so medicalized that the danger is neutralized. The DSM simply cannot account for the complexities of being human. Back in fraud's day, the diagnosis would probably be hysteria. As late as 1973, homosexuality was listed as a mental illness. Psychiatrists made this diagnosis by looking at human behavior and deciding what does and does not fit in society today. There isn't a scientific basis for diagnosis of mental illness. Psychiatrists have tried squeezing mental illness into the same medical category as physical illness for what I believe is a political agenda aimed at social control. Social workers, however, cannot be a person apart from an independent social context in which they exist. Depression does not spring from nowhere without a cause and it takes more than Zoloft to heal a person. The rising rates of anxiety and ADHD in children and adults are not happening in isolation. They're a response to the world we live in and we need more than Ritalin to address the primary cause. Can you imagine a world with a mental health model that was built upon compassion for human suffering? Informed by this critical social work lens, we would no longer blindly accept the medical model of mental illness. We would not even do empowerment for people. We would listen to people and let them set the agenda for the outcomes that they want to achieve for themselves. In order to provide the necessary support for people experiencing any kind of distress or difficulty, we must first begin by asking them, what is it that's distressing you? What has happened to bring you here? What do you think needs to be done in order to help you deal with this? Stepping away from the current model of treatment and cure of individual problems will be returning to the social work roots and emphasising structural inequalities and the importance of social reform. In this world, the foundations would rest upon respect for basic human rights, such as freedom and protecting the vulnerable from violations of power, which is very simply about normalising people's experiences rather than pathologising them. This way of doing social work was for the person as a whole, not simply the diagnosis. If my friend was treated with this level of humane compassion, her journey through the mental health system would have been much less traumatic. She would have been seen as an incredibly brilliant medical student and artist, who is the expert about what is going on in her world. Instead of being given diagnosis after diagnosis, medication after medication, having someone listen to her would have been a far more effective treatment that actually got to the heart of the issue. Even as reading that the myth of mental illness has helped me deconstruct these ideas about the medical model of mental health, so reading Gabor Maté's The Myth of Normal helped me deconstruct this toxic culture you swim in, one that is not meeting our mental or spiritual needs. Dr Maté is one physician who does not take the medical model of mental illness. He says, I don't want you to call what you have mental illness. You have been injured. Because mental illness comes from somewhere very specific. It has a story, and in that story, the person at the centre is the only one that has no power. Even if we did stick to this medical model, it ought to begin with a mandate of first, do no harm. Locking patients up and forcing medications does harm. It is dehumanising to take away someone's human rights and treat them as a diagnosis of their behaviour without taking their lifetime of experience into account. Not using a diagnosis does not interfere with our ability to do good social work. In fact, how much better could we do that without using labels? Instead, we want to refocus on the specific challenges the person in front of us is facing in their life and how we can walk alongside them. Powerful ways of allowing people who have been disenfranchised to reclaim their power is by holding onto the unwavering belief that people have the potential to grow and change positively. Social work advocates for their clients. Action can range from questioning practices such as forcing medication and locking patients in their rooms or on wards, to political protests, writing petitions to change abusive legislation that allows people to strip other people of their basic human rights. By choosing this critical model of social work practice within the mental health field, we continue questioning and deconstructing a system that robs people of their autonomy. Thank you to all health workers who use this critical social work lens to advocate for the rights of their clients. As I've said, it is often by maintaining their rage and a vision of a better world that social workers are able to keep working in oppressive and dehumanising structures. Thank you for joining me in my journey of seeking to understand human rights in current mental health practice. I hope it has helped you think about what you would like to happen to you. If things stop working as they should, and the sort of compassion we want to bring to fellow human beings who are suffering. See you next time.