Developing a Participatory Model: The need to assess the core problems in mental health care through a shared perspective

Participatory Concepts:  A Driving Force – Part VI

Developing a Participatory Model: The need to assess the core problems in mental health care through a shared perspective

PeteEarley and Robert Whitaker are two award-winning journalists who have applied their skills to assess core problems within America’s mental health care system.  While their perspectives and
approaches are quite different, their books, articles and lectures shed light on many critical issues and are influencing advocacy.

“Crazy:A Father’s Search Through America’s Mental Health Madness”, chronicles Pete Earley’s attempts to help his son during several psychotic episodes, as well as his investigation into the “criminalizaiton of mental illness”.[18]  Earley has become a fierce mainstream advocate who argues passionately for better access to treatment, police Crisis Intervention Training and patient-empowerment tools such as PADs and peer specialist certification.  His perspective as a parent is very important for families seeking support.

Robert Whitaker is a medical journalist who co-wrote a 1998 Boston Globe series on abuses in psychiatric research putting him on the path to author two books on the topic. Whitaker’s investigative journalism has captured a lot of attention from both mainstream and peer advocates.  His book, “Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America”, won the 2010 Investigative Reporters and Editors Award for best investigative journalism.  In response to “Anatomy of an Epidemic”, a diverse group of people established the Foundation for Excellence in Mental Health Care, which quickly received over $2 million in donations to support types of studies and pilot projects that aren’t being funded today.[19][20]

Many practicing psychiatrists are also assessing the core problems within the mental health care system.  Phillip Siniakin, M.D. is a board-certified clinical psychiatrist and author who in the course of his twenty-five years of practice has adopted the perspective of postpsychiatry.  He describes the
adaptation of postmodernism to psychiatry as resulting in “treatment becoming a sort of ‘negotiation’ that honors the perspective of the patient and the ‘knowing not knowing’ of the doctor. Contrasted with this is the biological model where the patient knows nothing and the expert (doctor) knows everything.”  His book “Psychiatryland” strongly emphasizes patient-empowerment strategies.[5]

Participatory concepts in mental health care provide consumers with the ability to become engaged in recognizing symptoms and work in partnership with providers to select effective treatment options and recovery strategies.  These concepts give a voice to the patient and break away from the “Buck Era” of a non-participatory model.  In order to meet the critical need of strengthening the mental health care system, advocates should consider a unified agenda that embraces patient empowerment concepts.

Mental health advocates from diverse perspectives should consider: Is recovery from severe mental illness possible without Participatory Medicine?


1. World Health Organization (2001a) World health report 2001.Mental health: new understanding, new hope. Geneva: World Health Organization.

2.  Frost L, Heinz T, Bach DH. Promoting recovery-oriented mental health services through a peer specialist employer learning community. J Participat Med. 2011 May 9; 3:e22.

3.  Mahone IH, Farrell SP, Hinton I, Johnson R, Moody D, Rifkin K, Moore K, Becker M, Barker M. Participatory action research in public mental health and a school of nursing: qualitative findings from an academic-community partnership. J Participat Med. 2011 Feb 23; 3:e10

4.  Warne T, McAndrew S., Passive patient or engaged expert? Using a Ptolemaic approach to enhance mental health nurse education and practice., Int J Ment Health Nurs. 2007 Aug;16(4):224-9.

5.  Sinaikin P. Psychiatryland: How to Protect Yourself from Pill-Pushing Psychiatrists and Develop a Personal Plan for Optimal Mental Heatlh; Bloomington, IN, iUniverse, 2010

6.  BUCK v. BELL, 274 U.S. 200 (1927)

7.  Paul A. Lombardo Three Generations, No Imbeciles: Eugenics, the Supreme Court, and Buck v. Bell, J Hist Med Allied Sci (2010) 65 (1): 137-139.

8.  Standler R.B. “Fundamental Rights Under Privacy in the USA” Copyright 1998, 2004-2005 Available at: Accessed on April 04, 2011.

9.  Chodoff P., Involuntary hospitalization of the mentally ill as a moral issue., Am J Psychiatry. 1984 Mar;141(3):384-9.

10.  Elbogen EB, Johnson SC.  The intricate link between violence and mental disorder results
from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2009 Feb;66(2):152-61.

11.  Melamed Y. Mentally ill persons who commit crimes: punishment or treatment?, J Am Acad Psychiatry Law. 2010;38(1):100-3.

12.  Kallert TW. Coercion in psychiatry., Curr Opin Psychiatry. 2008 Sep;21(5):485-9.

13.  Mangicaro MA. Psychosis possibly linked to an occupational disease: an e-patient’s participatory approach to consideration of etiologic factors. J Participat Med. 2011 Mar 28; 3:e17

14.  EHLIS v. SHIRE RICHWOOD INC. US PLC – US 8th Circuit: Nos. 02-3933, 03-1057.

15. Sheehan KA. Compulsory treatment in psychiatry., Curr Opin Psychiatry. 2009  Nov;22(6):582-6.

16.  Oaks D. Principles adopted by 1982 gathering of psychiatric survivors.
Available at:   Accessed June 6, 2011.

17.   Gottstein JB. Unwarranted Court Ordered Medication: A Call to Action Available at:  Accessed June 6, 2011.

18.  Earley P. Crazy : A Father’s Search through America’s Mental Health Madness. New York: G.P. Putnam’s Sons; 2006

19.  Whitaker R. Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. New York: Crown Publishing Group, 2010

20.  Whitaker R.  Can Our Medical Model of Care Be Remade? Avalilable at:  Accessed June 6, 2011.


One thought on “Developing a Participatory Model: The need to assess the core problems in mental health care through a shared perspective

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