Fighting with both hands tied behind their backs

My pageview stats for the past several days tell a stark tale: I should stop writing about mental health, and go back to renewable energy*. So naturally, here I go with another piece about mental health. Ever the contrarian.

*Of course, if I really wanted to make clickbait, I’d probably write about nothing but Bernie Sanders.

The mental health care system has often come under attack in Vermont for mistreatment or overtreatment of patients, for alleged forced hospitalization, restraint, or medication. Indeed, the practice of psychiatry in general has few friends in the state. There’s a simple reason for this, and it has nothing to do with the quality of care.

It has everything to do with privacy.

Medical practitioners are legally bound to guard patient confidentiality. This is a very good thing, and I would not seek to change it. However, one of the unintended effects is that when a doctor or nurse or hospital is accused of harming a patient, only one side of the story is heard: the patient’s. If providers tell their story, they are breaking federal law and the ethical standards of their profession.

Real-world case #1. In a January article on VTDigger, Dr. Marvin Malek said that in one week, two psychiatrists were “punched in the face” by patients in the Vermont Psychiatric Care Hospital. (He can say that because he named no names, nor did he divulge anything that would identify the patients.)

Now, say one of those patients went to the media, complaining of harsh treatment inside VPCH and not mentioning the punch. VPCH staffers, including the doctor who was assaulted, could not respond to the patient’s charges. They would stand alone and unchallenged, and would shape public attitudes toward VPCH and mental health care.

If you think that’s outlandish, well, let’s turn to real-life case #2. In January of 2014, a psychiatric patient at Fletcher Allen Health Center made a number of calls to local media, alleging she was being held against her will. She finally found an advocate in Mike Donoghue of the Burlington Free Press. He interviewed her several times in the hospital and wrote several stories about her case. All of them contained her side of the story but nothing of the hospital’s or the doctors’.

Donoghue’s regular stream of stories generated quite a bit of adverse publicity for the hospital. “Held against her will,” stuff like that. Providers could not publicly explain why they believed they were doing the right thing.

The echoes of that brief controversy, whatever they are, have become part of the anti-psychiatry background noise that’s so thick in Vermont. Did the doctors do the right thing? Was Christina Schumacher the best judge of how she should be treated at that moment?

We’ll never know. All we do know is that she raised a well-publicized hue and cry. That’s the only available narrative of her case.

So yes, it happens. Real-life stories are only half told, and the half is always on the same side: the aggrieved patient with a tale of abuse, neglect, overmedication, restraint, or any number of other alleged horrors of mental health care. The other side of the story cannot legally be told.

Those who have a hand in mental health public policy in Vermont would be advised to always bear that in mind.

2 thoughts on “Fighting with both hands tied behind their backs

  1. rp

    Secrecy within the medical profession can be necessary, as in the cases here – to protect patient identities.

    It also seems to be rather too rampant when it comes to being able to rate individual practitioners, symptoms/causes against outcomes. Perhaps the laypeople can’t fully understand the nuances of medical care but some disclosure would be helpful. At least we’re starting to see some transparency vis-a-vis hospital effectiveness.

  2. chuck gregory

    I would imagine providers could respond with generalizations that would hint at the other side of the story: “It is standard policy when a patient punches a nurse in the face that he be confined to his room against his will for 20 hours a day. We are not saying that’s what happened in Patient X’s case, but we advise you to ask him about the circumstances of his confinement.”


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