Questions of Medical Ethics

Ethical and epistemological quandaries examined

Minnesota Not so Nice on Mental Health

National trends deny access and blinker research ethics.

Garrison Keillor’s “A Prairie Home Companion” presents us Minnesotans as well intentioned and self-effacing, if a bit stuck in our ways. Real-life Minnesotans know, though, that “Minnesota Nice” masks some self-delusion some passive-aggressive tendencies: in philosopher Louise Antony’s words, we can “be very ‘nice’ and deeply cruel at the same time.” This is especially true, it seems, when it comes to the needs of people who have a mental illness. Here are some examples:

NICE: We (modestly) pat ourselves on the back for our high physical health ranking, behind only Vermont and Hawaii. We’re not even very modest about our health- and eco-conscious Twin Cities bicycle culture.

NOT SO NICE: At the same time, we leave those with mental health problems out in the cold. Per capita, we have the nation’s lowest rate of psychiatric beds, having closed 50% of them in recent years. Outpatient care is under siege, too. A thousand people suddenly lost services in March 2014, when a major provider closed in semi-rural east central Minnesota due to lack of funding.

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NICE: Addiction treatment center Hazelden is a household word, and we have a thriving AA culture.

NOT SO NICE: Minnesota is among the states with few substance abuse facilities that accept Medicaid, especially outside the Twin Cities.

NICE: Our University of Minnesota’s prominent psychology and medical faculty contribute to basic and translational science aimed to help those with mental illness.

NOT SO NICE: Despite an international outcry, the University’s administration refuses to seriously review its own human-subjects research standards after the death of Dan Markingson in a psychiatric drug trial. The institution’s own bioethics department has few members who prioritize doing so.

NICE: Minnesota has long offered MinnesotaCare to cover the access gap for those who cannot afford health care coverage. This program is now being rolled into access via the Affordable Care Act’s health exchanges.

NOT SO NICE: In 2012, legislation being spread nationally by the conservative group ALEC passed quietly in Minnesota as part of an omnibus bill. Statute 256J.26 requires random drug testing of people who receive food or cash assistance if they have had a drug conviction in the past 10 years. One positive test cuts benefits 30%; two cuts benefits for good. No treatment is offered. (Legislation to repeal has been introduced.)

So the irony of our no-so-nice approaches to the mentally ill cuts deep in Minnesota. But the issues are national. They include inadequate funding for mental health care, including substance abuse and addiction treatment; the co-opting of psychiatric (and much other) scientific research by private interests that in part drives the University of Minnesota’s response to the Markingson case; and the pushing of bills that harm individuals by deep-pocketed business interests.

Does your state out-nice Minnesota?

Susan C. C. Hawthorne, Ph.D., is an associate professor of philosophy at St. Catherine University.

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