People With No Alternatives to the Disease Model Are Satisfied With It

This post was originally published on, Robert Whitaker’s website about creating alternative approaches to mental health care.

Peer support is an alternative to the disease model

Peer support is an alternative to the disease model

Four out of five adults, youth, and family members of community mental health centers (CMHCs) in New Hampshire told researchers they are satisfied.  Three out of four said their quality of service is good, despite repeated budget cuts.

How do people who have never seen alternatives  to the disease model know if they are satisfied with what they have?

Would fewer clients and families be satisfied if they were told about alternatives to the disease model, like Corinna West’s story of how her alleged incurable brain disease was cured when a peer re-framed it in distress language?


Excuses to Ignore Alternatives to The Disease Model

Mental health bureaucrats and policy makers will never ask that question or answer it, but they will quote their self-serving “satisfaction with the disease model” statistic all the time, especially next winter when they beg the state Legislature for more money – or a smaller budget cut – to do what they’ve always done the same way they’ve always done it.

Other states are no different, but the University of New Hampshire Survey Center, NH Bureau of Behavioral Health, the UNH Institute on Disability (IOD, an affiliate of UNH), and the 10  community mental health centers (CMHCs) do a sophisticated, federally-funded client satisfaction survey every year.

Lawmakers have started to sense that CMHC’s don’t make anybody well, but they’ve never been shown alternatives to the disease model  either.  And they still think they need CMHC’s and their drugs to protect the public from mass shootings and mayhem.  CMHC bureaucrats are happy to let them believe that.

Squeeze our budget, and the cuts will pop up in law enforcement, jails, drug abuse, and domestic violence, they say every year at budget time.

Funding CMHC’s Is the “Only Game In Town”

"Mad Pride" Founder Judi Chamberlin Opposed Funding Disease Model

“Mad Pride” Founder Judi Chamberlin Opposed Funding Disease Model

Good, outspoken CMHC critics at NAMI NH, the Disabilities Rights Center, and the state Consumer Advocacy Council, who all know, and say among themselves, that the CMHC’s care more about their bottom lines than client outcomes or client rights, continue to support funding the same old disease model services in the same old system.

“It’s the only game in town, and we have to speak with one voice to the Legislature,” one outspoken critic of CMHC’s told client advocates in a private meeting.

Even the leaders of the consumer advocacy council and directors of the state’s independent peer-run agencies, the one alternative to the disease model offered by the state,  join the CMHCs’ choir before the Legislature every year.  If the CMHC’s lose funding, their programs will lose funding too.

These advocates, progressive newspapers, and other enlightened voices for humane government, blame the Legislature, and underfunding, for the shortcomings in the mental health system, which everyone here admits is “broken.”  The expression “our broken mental health system” is used by everyone who wants the Legislature to give the system more money to continue its practices and behavior, and resist alternatives to the disease model.

Disturbing Survey Findings

But the general satisfaction finding is just the first finding in this year’s survey, which was published May 22, 2012.  “New Hampshire Public Mental Health Consumer Survey Project, Summary of Findings 2012,” also shows what the IOD calls “areas of concern.”

  • Close to one half of new consumers (in the past year) reported that they waited one month or more to have an appointment with a psychiatrist or nurse practitioner. (Shame on the Legislature, it implies.)
  • One in three adults with substance use concerns did not agree that substance use issues were addressed in their treatment plans, that they received treatment from their CMHC, or that staff offered them referrals (32%).
  • Only two-thirds of consumers felt they were active participants in their quarterly reviews. (That’s a violation of state law and client rights.)

Other good news in the survey is that families reported a significant increase in child outcomes, from 55% (2008) to 65% (2011), and the majority of consumers surveyed reported coordination between mental health providers and primary care providers (62% of adults, 52% of families, and 62% of youth)

The Public Mental Health Consumer Survey Project, funded by a grant from the federal Substance Abuse and Mental Health Services Administration (SAMHSA), is a joint initiative among the Institute on Disability, the UNH Survey Center, the Bureau of Behavioral Health, and New Hampshire’s 10 CMHCs. For more information, visit the project website.

Can you support funding disease-based systems if you support alternatives to the disease model?


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