PACT: A Program Which Discriminates Against People With a Psychiatric Diagnosis

Mount Rainier from above Myrtle Falls

A few excerpts from a study on the effectiveness of the "Program of Assertive Community Treatment: A Review"

"Various authors claim that PACT is significantly more effective than alternate treatments in reducing hospitalization rates, that it is more cost effective, that it provides greater client satisfaction than alternate treatments, that it improves client functioning and symptomatology, and that it improves vocational functioning (Burns & Santos, 1990; Mueser et al., 1998; Olfson, 1990; Scott & Dixon, 1995; Solomon, 1992). However, an in−depth review of the 27 randomized clinical trials of PACT suggests that the PACT approach does not, contrary to these claims, demonstrate any significant positive effects (Gomory, 1998).

"This review further suggests that the prime mechanism of PACT is coercion, backed by the biomedical model, which justifies the very high "maintenance" (common or routine) use of psychotropic medication. The coercive and biomedical characteristics of PACT are well expressed in two statements: The program was "assertive"; if a patient did not show up for work, a staff member immediately went to the patient’s home to help with any problem that was interfering. Each patient’s medical status was carefully monitored and treated.  Medication was routinely used for schizophrenic and manic depressive clients. (Stein & Test, 1980, p. 394)

"Congruent with our conceptual model, we tell our patients that indeed we believe they are ill, otherwise we would not be prescribing medication for them. (Stein & Diamond, 1985, p. 272)
This paper will review the research findings on PACT, describe the development and utilization of coercion, and show how the medical model drives PACT."

"By using the biopsychosocial model to explain mental illness, PACT researchers are not using a scientific, but a scientistic model of explanation, not testable even in principle. By definition, this model allows any rationale for etiology: nothing is excludable (refutable) and ad hoc statements may explain away any potential falsifications. Its vague and imprecise nature provides a fertile environment for the growth of endless numbers of alleged etiological explanations. Strauss and Carpenter (1981, chapters 7 and 8) offer genetic, biochemical, psychophysiological, psychological, and social explanations for "serious mental illness".

"Further, psychiatry´s inability to demonstrate the existence of a discrete non−random syndrome of schizophrenia undermines a scientifically meaningful explanation of schizophrenia as a "real" disease (Boyle, 1990; Gomory, 1998). The failure to identify a specific biological dysfunction further impedes the likelihood of finding disease specific treatments."

"PACT a long−term, expensive, potentially abusive program˙continues to be promoted despite research results that demonstrate its lack of effectiveness."

From the National Empowerment Center:
"As the concept of “recovery” gains traction, however, there is also a risk that recovery principles and practices will become watered down and meaningless. It has happened  before. Consider the terms “empowerment” and “peer support.” Consumer/survivors use the word “empowerment” to mean that people who use mental health services make choices, control their own lives, and accept responsibility for their choices and decisions. True empowerment means a reversal in the power structure of traditional mental health service delivery, so that people can no longer be forced to do things against their will.

"The word “empowerment” is often stripped of much of this meaning, as mental health services claim to “empower” their clients while still retaining much or all of the decision-making power. When service providers talk about providing “empowerment services” or “empowering” their clients, they reveal a lack of understanding about the basic concept. Empowerment is something that comes from within an individual. No  one can “empower” someone else, although certainly others from the community or family can provide environments that facilitate empowerment. When we assist people to become empowered, we assist them to find their own voice, to make their own decisions, and to take personal responsibility and be accountable for finding their own pathways to recovery."

"Similarly, the term “peer support” originally meant people helping one another to achieve their own goals. Peer supporters, whether volunteer or paid, were there to  assist and encourage people to define what they wanted in life and to help them to  advocate for themselves. Peer supporters were also meant to function as role models, showing others that it is possible for people who have been diagnosed with mental illness issues to live fuller and more satisfying lives."

"Unfortunately, in many mental health programs today, people who are called “peer supporters” are used to encourage and even enforce the system’s goals rather than those of the individual. When “peer supporters” are part of a team that stresses compliance with treatment as the primary value, they are not able to provide true peer support, which means people working together to achieve self-defined goals."

summary
PACT is a program that is based on the "medical model" and relies on psychiatric drugs that are expensive and statistically inefficacious for roughly 75% of people diagnosed with chronic or residual schizophrenia. Drugs used can potentially cause a wide variety of iatrogenic illnesses and co-morbid conditions like Heart Disease, Diabetes, Obesity and Tardive Dyskinesia.  Drugs which have a serious impact on both quality of life and longevity, are forced upon people, with coercive methods for ensuring compliance routinely being used.   The medical model and it's inefficacious "medical treatments" are forced upon those targeted; under color of law.  The people who are labeled are targeted for "special treatment," with drugs and/or electroshock. These "treatments" are not safe or effective, and have fatal risks.  The PACT program stigmatizes the very people PACT proponents declare "benefit" from it.

Seriously, why would denying a person the right to refuse harmful ineffective treatments be justifiable?   How could using misinformation, manipulation and coercion to gain the person's 'cooperation' thought to be justifiable?  How is this Ethical conduct for a mental health professional?  How can manipulation of the truth, coercive and manipulative tactics be 'therapeutic' for the person treated in this manner?  Calling it 'medical treatment' does not in fact make coercion therapeutic; nor does declaring the drugs "safe and effective" change the fact that the claims are not supported by the evidence, but are perhaps based on wishful thinking, false advertising, willful blindness and fraud.

Involuntary Treatment Laws deprive people with a psychiatric diagnosis of their Induvidual Rights to Substantive and Procedural Due Process of Law.  It is in all reality, discrimination against an entire class of people under color of law. When psychiatry is "practiced" using these methods it is criminal, not medical.  A psychiatric diagnosis stigmatizes those who are labeled; once diagnosed, people are effectively denied the same rights a person without a diagnosis takes for granted.  A person with a psychiatric diagnosis is in reality, denied what the Founding Fathers declared to be universal, inalienable rights necessary for life, liberty and the pursuit of happiness.  A psychiatric diagnosis is an obvious stigma, that is culturally entrenched.  The stigma and the resultant increase in discrimination people with a psychiatric diagnosis experience is a direct adverse effect of telling a lie repeatedly with authority, the lie: a psychiatric diagnosis is evidence of a brain disease, defect, chemical imbalance, or neuro-biological condition. 

Ultimately, there is no question that psychiatry uses unscientific methods.   Psychiatry substitutes a consensus of subjective opinions for empirical data to develop criteria for all the psychiatric diagnoses.  Worse, psychiatry develops treatment protocols, which do not rely on the clinical trial data, indeed, which ignore the data altogether, to  use consensus.  The Evidence Base does not support psychiatry's Practice Parameters for the treatment of schizophrenia in particular, yet people with this diagnosis can be forced under Court Order to be treated with teratogenic drugs with fatal risks.

Is there any doubt the source of the stigma is the diagnostic label itself?  Intentional or not, matters not even a little; bio-psychiatry has in effect, validated bigotry towards those it diagnoses, and teaches discriminatory attitudes towards them by using coercion, manipulation and subterfuge as 'treatment tools' and encouraging family members and others to use them as well.

Psychiatry has Police Powers and uses the Courts to force people to get treatment with inherent risks that include disability and death; for a diagnosis that is based on a hypothesis, not a medical certainty,  or even a THEORY, being a yet to be validated hypothesis...  This abuse of power and authority is fueled by conjecture, gossip and inuendo and results in thousands of people across the globe being effectively stripped of their Human Rights.

Here in the US, the Court Orders for inpatient or community based "assertive treatment" can rely on gossip as a basis for the order, ignoring the Rules of Evidence.   In my son's case outright lies were used---forgery and perjury---were used to strip my son of his rights.  My son's individual rights, under the US Constitution were not effectively secured or defended.  This not unusual, it is the norm.  The crimes committed by mental health professionals, and Officers of the Court were not investigated when reported, and this is also the norm.   It is discrimination based on a psychiatric diagnosis.  This was all done under Color of Law and is evidence that the diagnosis is the source of the stigma; and the discrimination starts with the way that psychiatry is practiced.  

Effectiveness of Antipsychotics in Patients With Chronic Schizophrenia


Program of Assertive Community Treatment: A Review


Voices of Transformation

Originally published July 3, 2011
photo credit: wikipedia