As someone with more than a few labels of my own, I struggle with their purpose. Our culture loves them. We define each other by them; we interact with each other based on them; we define our ways of thinking and seeing the world by them.
Economic status. Levels of education. Marital status. Sexual preferences. Race. Religion. Type of car driven. Diagnoses.
The problem with labels, though, is we know that they are subjective, based on the context of the label. They never represent the whole person. We all know someone with multiple post-graduate degrees who we think is a nitwit, and we know people without college degrees who are brilliant.
There are married people with no sense of loyalty and commitment, and Christians who make you wonder if they ever read about Christ.
But what about diagnoses as labels? Somewhere along the road to accruing my own labels and interacting professionally in fields driven by them, I began to see them as swords that cut both ways. Sure, it’s good to put a name to the challenges people face. Diagnoses can offer one perspective, one frame of reference.
In the end for me, though, the diagnoses are just words to say what I am in recovery from. They did not define my needs at the time I sought out mental health support or my potential in recovery. I’d argue, in some ways, diagnoses can hinder potential given the power of labels. My road to recovery was not specific to my diagnoses, and while it shares similarities with others with similar labels, it is also very unique to me and my needs.
Further, the people I met along that road to recovery may not have the same effect on every other person sharing my labels. Inversely, not everyone who attempted to help me based solely on my labels was really helpful. Worse, I could write a book about all the cases of misdiagnoses in mental health or over-valuing of diagnoses in mental health that negatively impacted the recipients of those labels.
In other words, these were cases when the labels meant so much to clinicians and providers that they forgot to actually pay attention to the client wearing those labels and the client’s needs.
And that’s the first on the list of problems I have with the hullaballoo between the LePage administration, the legislative Health and Human Services committee, and recipients of mental health services in Maine. The LePage administration has proposed moving large numbers of clients currently receiving services under one section of billing policy to other services under different sections of billing policy.
Clients, providers, families and other supporters testified in large numbers against the proposal, and the legislative committee has been hammering out a compromise with the administration that elongates the timetable for transitions.
I think the whole setup is stupid.
Just like our other labels in life, mental health diagnoses do not tell a complete story of an individual and the individual’s needs in a given moment in time. They don’t.
You could line up 10 people with exactly the same labels as mine, and we would have commonalities. However, in terms of what we may need in terms of services, you’d have 10 different sets of needs. Each of us would come to a provider in different ways, from different backgrounds with different supports, at different stages in our lives.
We’d each have different needs and different circumstances acting as barriers to our success. Sure, there’d be recurring themes throughout some of the cases such as housing, for example, but the intensity of those themes and expectations around those themes would vary from individual to individual.
You can’t be an individual and receive public mental health services, though. As soon as you receive those services, you become a diagnoses, a number, a source for filling in a billing box with a code.
That’s how it gets done. If you have this diagnosis or that diagnosis, then a provider can bill for this service or that service. Needs get talked about, but they are secondary to the diagnosis and what that diagnoses opens up for billing possibilities.
The horse is pushing the cart, and too many people with mental illnesses aren’t getting very far. Policymakers and legislators and successful service providers are doing fine. The folks waiting for that horse to get on the other side of the cart and do some darn pulling, however, aren’t.
How can we tell? The large numbers of mentally ill people who are in jail, who are homeless, who are turning to opiates and other hard drugs to cure what ails them. Do we need more evidence?
Which brings me to my other problems with this proposal — Section 17, Section 19, who cares? It’s all backwards and failing, as is indicated by the large numbers people with mentally illnesses falling through the cracks. It’s like insisting that contractors finish redoing one room while the rest of the house is in flames.
It’s time to call the fire department. It’s time to let clients’ needs drive services. If a specific treatment modality and/or medication management for a specific diagnosis is one of the established needs, that’s fine. But that’s all a diagnosis can establish, and, even in that capacity, diagnoses can still be questionable and subjective.
Needs aren’t subjective. Either a person is safe, or they are not. Either a person is able to cook and clean for themselves at a given moment in time, or they are not. Either a person is able to find healthy social connections and purpose in their lives, or they are not.
These needs may change over time, and the intensity of and changes in those needs may or may not correlate to specific diagnoses. We can’t uplift people and support recovery unless we focus on their needs. Instead of looking at people as walking diagnosis-based billing codes, we need to look at them as individuals who want to succeed and achieve the highest level of independence their individual life story allows.