The Challenge of "Responsibility" in Mental Health Care

by Catherine J Rippee-Hanson

Encountering a situation where a hospital states that a loved one is "not accepting responsibility for their actions" can be perplexing and exasperating, particularly in the context of severe mental illness (SMI). This phrase may raise questions about its meaning and whether it is part of a hospital's role to instill a sense of responsibility. Emphasizing responsibility in treatment can lead to feelings of blame or guilt in patients who already struggle with self-esteem and self-worth. It can also undermine the therapeutic relationship by creating a sense of judgment rather than understanding and support. Patients are not expected to assume 'responsibility' for their illness; rather, they are being instructed to control their symptoms.

Let's take a step back and consider the context of severe mental illness. SMI often manifests involuntarily, influenced by complex factors beyond the individual's control. To suggest that someone with a condition like schizophrenia or severe depression simply needs to "take responsibility" can feel dismissive of the genuine struggles they face. This is not to say that accountability doesn't matter. However, the nature of mental illness makes this concept more nuanced than it might appear on the surface.

Imagine if hospitals took the same approach with physical illnesses: "Your broken leg isn't healing because you're not accepting responsibility." It sounds absurd, doesn't it? Just like physical illnesses, severe mental illness or brain disorders require compassionate care, appropriate treatment, and professional intervention. Behavioral changes, diminished insight, and cognitive deterioration are symptoms of severe mental illness (SMI). It's equivalent to hospital staff neglecting or dismissing a patient who cannot stop bleeding profusely from a wound. As part of this approach, the patient must be able to control symptoms, which they may or may not recognize, to qualify for treatment. Is the underlying assumption here that patients with severe mental illness (SMI) are somehow deserving of their condition?

The reality is, most people with SMI are doing the best they can under incredibly challenging circumstances. Mental health recovery is a complex journey that involves more than personal responsibility—it requires support systems, effective therapies, and medications. Effective therapies and medications are essential components of managing severe psychiatric illnesses, as they stabilize symptoms and improve overall functioning. These treatments address biological, psychological, and social aspects of mental health conditions. They provide patients with the necessary tools to cope with their daily challenges.

So, what should hospitals and doctors focus on? Instead of emphasizing "responsibility," perhaps the focus should be on understanding, empathy, and providing comprehensive care that addresses both the symptoms and the underlying issues of severe mental illness. This means creating environments where patients feel supported rather than judged, and where their efforts to improve their mental health are recognized and encouraged. Training healthcare professionals to recognize and treat mental health conditions with empathy and understanding can improve patient outcomes. Community-based programs that provide ongoing support and education to both patients and their families can also play a crucial role in fostering long-term recovery and well-being.

In the end, mental health care should be about helping individuals navigate their path to recovery with dignity and respect. It should be about providing the tools and support they need to manage their condition, rather than placing the burden of responsibility squarely on their shoulders. Family involvement is critical in the recovery process, as it provides patients with a support network that understands their struggles and offers encouragement. That is, unless the deterioration is too severe or the illness is untreated for too long, hospitalization is the only course. The notion of holding a loved one 'accountable' for their illness is absurd. It won't alter a single symptom or enhance their condition in the slightest.

Mental health is a shared journey, and it's essential to remember that everyone involved—patients, families, and healthcare providers—plays a vital role in fostering recovery and well-being. Families often face significant emotional and financial challenges when supporting a loved one with severe mental illness. They may struggle to understand the condition's complexities and feel overwhelmed by caregiving demands.  

Securing a psychiatric bed or an appointment with a psychiatrist for a loved one is a significant step for any family. It's crucial that hospitals and staff welcome them without prejudice, recognizing that patients should not be required to prove their worthiness or take full responsibility for their condition before receiving the care they need.