Increase Consumers' Role in System Reform: Although Consumers Have a Larger Role Than Ever before, Their Role Is Still Relatively Limited

By Bernstein, Robert | Behavioral Healthcare, August 2007 | Go to article overview

Increase Consumers' Role in System Reform: Although Consumers Have a Larger Role Than Ever before, Their Role Is Still Relatively Limited


Bernstein, Robert, Behavioral Healthcare


The immediate response by the media and the public to the tragedy at Virginia Tech, predictably, reinforced the stereotype equating mental illness with violent behavior, producing the usual calls for increased legal intervention in the lives of people with mental illnesses. But as the facts emerged, they blunted these alarmist demands. It turned out that the shooter had indeed been ordered into treatment. The fact that he never received it--that the community mental health agency responsible for providing the judicially mandated services reported receiving no referral from the court--illustrates the real problem: a woefully deficient service (non) system, understaffed, underfunded, and unconnected among its elements.

In recent years, such incidents have led to the enactment of mandatory treatment laws, such as Kendra's Law in New York State. To their credit, Virginia policy makers are taking a broader look at the complex world of public mental healthcare. Some legislators are arguing for greatly increased mental health funding, and a commission originally formed to consider the need for expanded outpatient commitment is now exploring overall system reform.

As the Virginia commission and bodies in other states undertake such examinations, newly empowered consumers of mental health services are seeking an influential role in the process. That such a notion often is regarded as revolutionary defies common sense. After all, who better to define the goals of system reform than those for whom it is to be achieved?

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It is important to recognize the irony when systems ostensibly dedicated to mental health belatedly and grudgingly begin to accept consumer inclusion. In the parallel world of physical healthcare, consumer empowerment is a good new business model, encouraging, for instance, a healthy lifestyle or a sense of shared responsibility for skyrocketing medical costs. Certainly, these aims can apply to mental health reform, but here the meaning of empowerment runs deeper and carries a longer history. Influence over one's world has long been considered a core element of healthy psychological functioning. Accordingly, in mental health circles, consumer empowerment should stand not only as an approach to prudent service delivery, but also as an important clinical hallmark.

This is still far from reality in current reform efforts. Notwithstanding prominent statements on state mental health agencies' Web sites professing commitment to consumer self-determination and policy directives for "consumer-centered" approaches, practices that dismiss consumer empowerment remain widespread. For instance, coercive tactics often enable providers to deal with consumers expediently, rather than therapeutically. And there is a strong push toward injecting "evidence-based" practices into mental healthcare. This is not in itself a bad thing, but the preponderance of inquiry in mental health reflects a pharmaceutical, rather than consumerist, mind-set. …

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