Opinion: Why more mental health services won’t help


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Published: 03-02-2024 7:30 AM

Maurice Regan is a psychologist and former college professor. He lives in Pembroke.

Many news stories of personal tragedy include the suggestion that “mental health services” or more mental health services might have prevented the disturbing outcome. Sadly, many involved in these tragedies have had these services, many times, and without demonstrated benefit. In this My Turn, I will offer some reasons why many mental health services don’t work no matter how many services are made available. I will use “provider” to include psychologists, psychiatrists, social workers, and mental health counselors.

Providers consistently make the “fundamental attribution error,” a well-established finding from the behavioral and social psychology fields. When considering the causes of behavior, we fundamentally and falsely attribute behavior to internal or dispositional causes, not external or environmental causes. For example, depressed people live in depressing environments where they behave in depressing ways. They do not have an illness caused by a chemical imbalance. Psychotherapy to examine remote, internal causes or dosing them with drugs commits this fundamental error and such treatment is usually ineffective. Pushing people to change their environment with exercise, education, new social networks, and other productive, self-management activities has been known for many years to be effective with depression.

Behaviors we label as violent or psychotic likewise respond to environmental changes. When jail and prison architecture positively changed to the “direct supervision” model, jail suicides and other untimely deaths declined, and not because mental health services were available, the environment was better. Providers generally see normal people in abnormal environments, not the other way around. Providers should work on changing the environment.

Many providers do not know what they are talking about. When collaborating with others or attending continuing education offerings, I am amazed at the misinformation chronically promoted as fact. The source is often the providers’ formal education: colleges continue to teach and textbooks continue to report psychological beliefs and practices that are unsupported but continue to be accepted uncritically. Here, I am guilty. As I was leaving a college classroom after my course, a student presenter asked for my help getting the computer and projector to work and both she and the professor were stumped. After I solved the problem I was shocked to look at the screen. She was presenting on “learning styles,” a topic that has no research support in psychological or educational research and continues to cause damage to the education of children.

More examples. Though cognitive behavior therapy is currently promoted by many providers, most are ignorant of its early development and few conduct it properly. Effectiveness is generally between 40 and 60% suggesting about half the time the treatment will fail. Eye movement desensitization and reprocessing (EMDR) is based on a faulty notion of brain architecture and not surprisingly is no better than a placebo where you don’t have to move your eyes.

We listen to the wrong people saying the wrong things. When I hear or read of people who have had trouble with drugs or raising their children and they publically offer their advice to the rest of us, I often think, “Why should I listen to you?” These people need sympathy for misfortunes that may befall any of us but personal or family tragedy is confused with psychological expertise and advice. Ironically, I know many people who drink moderately or not at all and disdain other drugs. And I know many parents who quietly raised their children to productive adulthood. None of them are on the lecture circuit. The public does not get to listen to them and learn how they did it.

That great American psychologist B.F. Skinner wrote in 1977, “We now have the methods and technology for all to live a flourishing life.”

Might we now abandon our vague and erroneous concepts of mental health services, stop making the same errors, listen to the wrong people, and heed his message?