Protecting the right to live: Socialism in community mental health

One of the things that makes citizen activism and demonstration such an effective way to spur on social and political change is that it involves the working people on the front lines in our country (as opposed to the far removed). In the context of activism, the people calling for change are real people with real professions, and as a result, real expertise. Because of the perspective they provide, we aren’t forced to rely on politicians, who are either pretending to be an expert on those areas they legislate, or represent their own self-serving interests. Instead, we can listen to the plight of those around us who are really struggling. After all, the only thing ordinary (but exceptional) activists have to gain is positive change for all of us.

As an activist, I feel blessed that my perspective is grounded primarily in an area that I think, is most direly in need of immediate change; (mental) health.

Those of you who know me well probably already know that I haven’t been the biggest proponent of much of what our country is up to at the moment.But, I can say that, in an ideal sense, we did start out on the right ideological track by penning a pretty decent description of the rights to whicheveryone in our new nation would be entitled (though, of course, I would have gone further). And, the first of these, as described by the Declaration of Independence, is the right to life.

A lot of people have different interpretations about what exactly it means to have the right to live, but I like to be as parsimonious as I possibly can be. I interpret this idea as if it meant that the author thought it was important for everyone in our country to have the right to stay clinically alive, when possible.

But, does everyone, at present, have the ability to stay alive in the United States? They do, unless you’re poor, of course! Healthcare accessibility is as exclusive as the wealth gap in our country, and it’s surely on a track to get worse. It seems that many of those who are concerned with expanding their own wealth seek to interpret the right to life as “the right to live as is. “

This unearths an interesting philosophical question (which I’m admittedly much less qualified to answer): Is restricting access to healthcare really preventing someone from living?Without droning on for hours about the measure of a public being the level of care provided to the richest of its members, let’s just say that we’d be hitting middle ground if we settled this by using a vague term people often use to avoid difficult questions like this: reasonable. It is indeed restricting someone’s right to live when you prevent them from accessing all reasonable means of care that would offer a possibility of bestowing upon them their right to live.

What’s reasonable? I haven’t the first clue; I’m not a doctor.And, the first indication that something is going awry should be that those providing the financing (e.g., those seeking to maximize their own profits) for medically-related treatment have more of a say in providing treatment than does a professional in the field. Obviously, I’m sure we’d all feel much better if an expert (as opposed to an entrepreneur) made the determination regarding what treatments might be considered reasonable for any specific ailment.

I certainly believe that there is no hope of providing the rights to which we’ve entitled everyone in an inherently capitalist system. It is impossible to protect everyone’s right to something (an inherently universal assignment) and then leave that right as a competitive endeavor (an inherently exclusive system). In effect, the statement we make by not pursing a socialized healthcare program is that we don’t think that everyone deserves the right to live, and I hope I’m not the only one who isn’t comfortable with that.

Of course, mainstream health isn’t exactly what I intended to discuss when I started writing this, although many of the criticisms I level at the current system of health care certainly apply to mental health care, as well. We unquestionably happen upon a unique set of social problems when we take up mental health. Luckily, this happens to be a field in which I have some (although, at present, very limited) knowledge.

Nearly everyone who’s taken a high school or college-level introductory psychology course is probably familiar with the foreboding roots of care for the mentally ill. Over the past century or so, however, we’ve finally begun making some useful strides when it comes to caring for this unique population. Of course, trailblazers in mental healthcare, like Philippe Pinel and Dorothea Dix, for example, helped to reform the discipline and taught us how to treat people humanely, no matter what their condition. Then, John F. Kennedy ushered in the community mental health movement, which sought to make mental healthcare and services more accessible to all. This was a great idea, and it represented a substantial step toward bringing people the care they so direly needed. Unfortunately, this measure only brought treatment geographically closer to specific populations, and it ignored the more daunting obstacle of economic disparity.

This obstacle was certainly recognized as a problem by many administrators, and soon, the sliding scale payment system was born. The effort allowed clients in need of services to have their bills reduced according to the level of their income. While, to some, this effort might be viewed as commendable, it only reduced the insurmountable and all-too-common problem of disparity between a desperate economic situation and soaring costs of treatment for psychological disorders. Despite the unmistakable nature of these problems, management teams at community mental health centers all over the country continue to make profit the primary goal of their practices, and consequently, restrict the accessibility of care to those clients who are most in need.

It’s troubling that we have commonly understood the right to life as a concept of which mental illness is excluded. Even if life-and-death problems, such as suicide, are left out of the question, mental ailments (by their definition) cripple, maim, and destroy, even if not in the physical sense. As a result, mental illness should be actively considered as a part of a person’s general right to life as if, by its contraction, it restricted one’s ability to live in the same ways that enduring Parkinson’s disease does.

The real problem that is unique to the issues of capital and mental health, however, is the idea that continuing to add financial pressure to the life of an individual with a mental ailment may exacerbate and prolong mental illness. Those who are familiar with psychological research will be readily aware that, apart from the etiology of a mental disorder, additional stressors commonly alter the overall course of the problem for the worse (Liem & Liem, 1978).

It’s no wonder that research in the discipline constantly reveals that income inequality is related to the prevalence of mental illness (Pickett, James, & Wilkinson, 2006).And, despite geographically accessible services and aggressive preventative measures, mental disorder is still as prevalent as it once was at the advent of differential diagnosis.

Of course, many landmark advances in the field, such as the advent of the sliding-scale pay system, were significant steps in the right direction. Unfortunately, though, this system evades the idea that the mental health facility is still ultimately a profit-seeking institution. Clinicians are judged not based upon the quality of their work (as in, a set of outcomes that determines some advance toward health in our clients), but rather, on the amount of hours that can be billed to the client. If nothing else, this method of evaluation is evidence of the blunt truth: capitalism’s only goal is to bear some profit, not to care for people.

In this environment, we should not be surprised when our patients don’t get better. They (much like those treating them) are not entirely free to pursue health, but instead, are beaten down by the structure that intends to keep them poor.Overall,in a world where many of those ailing from mental illness must choose between their treatment and their family’s dinner, I find it hard for mental health practitioners genuinely interested in the well-being of their clients to ignore the need to commit to activism for the cause of socialism.

Tyler Wray is the Chair of the Emporia State University Chapter of YDS (Kansas) where he is a second-year graduate student working towards his MS in Clinical Psychology.

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