I won't be reading Rob Wipond's book or other publications by Mad in America writers. I think it is regrettable that he is offered a forum here. I hope that most of your readers are academic researchers and professionals who are smart enough to see through his faulty assertions. His claim that "70-80% or more of us by adulthood" will be …
I won't be reading Rob Wipond's book or other publications by Mad in America writers. I think it is regrettable that he is offered a forum here. I hope that most of your readers are academic researchers and professionals who are smart enough to see through his faulty assertions. His claim that "70-80% or more of us by adulthood" will be diagnosed with a mental illness conflicts with less than 50% claimed by the National Institutes of Health (NIH) and his statement that it "vastly opens the funnel into detentions for many people will have a psychiatric diagnosis" is nonsense! Such claims illustrate a fundamental problem with mental healthcare policy in the United States: A desire for a simplistic one-size-fits-all policy to meet the needs of a complex patient pool with vastly different needs. Given that a vast majority of persons with diagnosed mental illnesses have highly manageable less-serious conditions, where involuntary commitment is irrelevant and medication is often not even a part of treatment protocol, simplistic policies based on irrational fears about involuntary commitment is killing those with serious mental illness. Many so-called advocates find the sickest of the sick stigmatizing (i.e., shameful) and would rather pretend they do not exist--they might be an obstacle to social acceptance or professional advancement of the less sick. But only about 5% of the U.S. population have a serious mental illness and a minority of them might benefit from involuntary care at some point in their lives. So involuntary care is truly irrelevant to the vast majority with less serious diagnoses, but that does not work for the idealogical anti-psychiatry bias that Wipond and his colleagues at Mad in America wish to promote. What he wants to do is remove a treatment option for persons who are abandoned by those concerned so much about the stigma that it enables ableist thinking about psychiatric illness to the detriment of a minority who are more likely to end up homeless, imprisoned, or dead as a result of the policies they wish to promote. As a parent and caregiver for an adult child with schizophrenia, I have never attempted to involuntarily hospitalize my daughter. But I resent Wipond's wish to interfere with my ability to do so, if there ever comes a time when it is necessary--for example, if she is living on the streets. In Texas, where I live, involuntary commitment is exceedingly difficult to obtain. Even if I had legal guardianship, I would be prohibited by Texas law from involuntarily hospitalizing my daughter. To do so would require a court order which would likely be declined, unless my daughter was subjected to court-ordered competency restoration so that she could be prosecuted for a serious crime that was committed while incompetent. How much sense does that make?
A few points about the meta-analysis he provides to support his assertions that "every study that actually followed deinstitutionalized patients found that very few ended up homeless or in prisons, and most prison and homeless populations today don’t generally have higher-than-statistically-expected lifetime prevalence rates of mental disorders." Again, this statement is unsupported if one looks more closely at the data and considers the population that involuntary commitment is meant to serve today. Most of the studies in the source Wipond cites are from countries with incarceration rates that are many times lower than the U.S. incarceration rate. And, even the U.S. states from which small numbers of formerly institutionalized patients are drawn have incarceration rates lower than the world-highest U.S. average. Even using the tiny numbers from the couple of U.S. studies from Indiana and Rhode Island, one can use a little arithmetic to see the incarceration rate for persons who were previously institutionalized is several times higher than the incidence of serious mental illness in the U.S. population. Furthermore, the study does not quantify how many of the deaths associated with those formerly institutionalized are due to homelessness or shootings by police who are the typical first-responders for mental health emergencies in the United States. Those should certainly be considered bad outcomes. The susceptibility of some persons with serious mental illness can be found in other reputable sources: The Bureau of Justice Statistics claims that nearly one-quarter of persons in U.S. prisons and jails show signs of psychotic disorders and the Substance Abuse and Mental Health Services Administration (SAMHSA) claims that a similar percentage of homeless persons have serious mental illnesses. These are the rare individuals, like a person in Austin who spends his time busting up limestone blocks and cutting down trees on public parkland in a delusional battle against Satan, who might need involuntary care. Wipond thinks such care should be unavailable, because he would rather pretend such persons do not exist. Does he also oppose involuntary commitment of persons with dementia and profound intellectual disabilities to longterm care facilities? Would he like the freedom to live homeless or imprisoned like some of the the sickest of the sick who have lost reality contact?
The inpatient unit now is the psychiatric equivalent of the ICU (which is not the case historically). Getting rid of it would leave us scrambling and a bunch of sick people on the streets or locked in the basements of their homes (as such cases are in countries without much psychiatric care)
Exactly this...the same applies in much of the UK. In a city like London an informal (ie voluntary) admission is now the exception, which has left our inpatient units as warehousing for compulsory treatment (which means medicine). No longer the therapeutic community that we learned about when I was starting out...
I am in total agreement with you. You have the kind of informed consumer that Rob Wipond ignores and Awab fails to give adequate attention. As a evidence-based mental health academic professional, I find the misinterpretation appalling of basic epidemiological data and meta analyses, Thanks for calling them out.
Voices like Rob Wipond and their amplification by Awais are the cause of the current crisis in care for the severely mentally ill, not the solution.
I won't be reading Rob Wipond's book or other publications by Mad in America writers. I think it is regrettable that he is offered a forum here. I hope that most of your readers are academic researchers and professionals who are smart enough to see through his faulty assertions. His claim that "70-80% or more of us by adulthood" will be diagnosed with a mental illness conflicts with less than 50% claimed by the National Institutes of Health (NIH) and his statement that it "vastly opens the funnel into detentions for many people will have a psychiatric diagnosis" is nonsense! Such claims illustrate a fundamental problem with mental healthcare policy in the United States: A desire for a simplistic one-size-fits-all policy to meet the needs of a complex patient pool with vastly different needs. Given that a vast majority of persons with diagnosed mental illnesses have highly manageable less-serious conditions, where involuntary commitment is irrelevant and medication is often not even a part of treatment protocol, simplistic policies based on irrational fears about involuntary commitment is killing those with serious mental illness. Many so-called advocates find the sickest of the sick stigmatizing (i.e., shameful) and would rather pretend they do not exist--they might be an obstacle to social acceptance or professional advancement of the less sick. But only about 5% of the U.S. population have a serious mental illness and a minority of them might benefit from involuntary care at some point in their lives. So involuntary care is truly irrelevant to the vast majority with less serious diagnoses, but that does not work for the idealogical anti-psychiatry bias that Wipond and his colleagues at Mad in America wish to promote. What he wants to do is remove a treatment option for persons who are abandoned by those concerned so much about the stigma that it enables ableist thinking about psychiatric illness to the detriment of a minority who are more likely to end up homeless, imprisoned, or dead as a result of the policies they wish to promote. As a parent and caregiver for an adult child with schizophrenia, I have never attempted to involuntarily hospitalize my daughter. But I resent Wipond's wish to interfere with my ability to do so, if there ever comes a time when it is necessary--for example, if she is living on the streets. In Texas, where I live, involuntary commitment is exceedingly difficult to obtain. Even if I had legal guardianship, I would be prohibited by Texas law from involuntarily hospitalizing my daughter. To do so would require a court order which would likely be declined, unless my daughter was subjected to court-ordered competency restoration so that she could be prosecuted for a serious crime that was committed while incompetent. How much sense does that make?
A few points about the meta-analysis he provides to support his assertions that "every study that actually followed deinstitutionalized patients found that very few ended up homeless or in prisons, and most prison and homeless populations today don’t generally have higher-than-statistically-expected lifetime prevalence rates of mental disorders." Again, this statement is unsupported if one looks more closely at the data and considers the population that involuntary commitment is meant to serve today. Most of the studies in the source Wipond cites are from countries with incarceration rates that are many times lower than the U.S. incarceration rate. And, even the U.S. states from which small numbers of formerly institutionalized patients are drawn have incarceration rates lower than the world-highest U.S. average. Even using the tiny numbers from the couple of U.S. studies from Indiana and Rhode Island, one can use a little arithmetic to see the incarceration rate for persons who were previously institutionalized is several times higher than the incidence of serious mental illness in the U.S. population. Furthermore, the study does not quantify how many of the deaths associated with those formerly institutionalized are due to homelessness or shootings by police who are the typical first-responders for mental health emergencies in the United States. Those should certainly be considered bad outcomes. The susceptibility of some persons with serious mental illness can be found in other reputable sources: The Bureau of Justice Statistics claims that nearly one-quarter of persons in U.S. prisons and jails show signs of psychotic disorders and the Substance Abuse and Mental Health Services Administration (SAMHSA) claims that a similar percentage of homeless persons have serious mental illnesses. These are the rare individuals, like a person in Austin who spends his time busting up limestone blocks and cutting down trees on public parkland in a delusional battle against Satan, who might need involuntary care. Wipond thinks such care should be unavailable, because he would rather pretend such persons do not exist. Does he also oppose involuntary commitment of persons with dementia and profound intellectual disabilities to longterm care facilities? Would he like the freedom to live homeless or imprisoned like some of the the sickest of the sick who have lost reality contact?
The inpatient unit now is the psychiatric equivalent of the ICU (which is not the case historically). Getting rid of it would leave us scrambling and a bunch of sick people on the streets or locked in the basements of their homes (as such cases are in countries without much psychiatric care)
Totally.
Exactly this...the same applies in much of the UK. In a city like London an informal (ie voluntary) admission is now the exception, which has left our inpatient units as warehousing for compulsory treatment (which means medicine). No longer the therapeutic community that we learned about when I was starting out...
I am in total agreement with you. You have the kind of informed consumer that Rob Wipond ignores and Awab fails to give adequate attention. As a evidence-based mental health academic professional, I find the misinterpretation appalling of basic epidemiological data and meta analyses, Thanks for calling them out.
Voices like Rob Wipond and their amplification by Awais are the cause of the current crisis in care for the severely mentally ill, not the solution.