1) System treatments that degrade, demean, control and manage behavior, place restrictions on economic and physical mobility, thus conveying the message that clients of mental health services are dangerous, unreliable, incapable of making decisions about their own lives and treatments and unable to provide cogent input about how a competent mental health system might function.

Of all sources of stigma, the worst is systemic and organizational low expectations for the persons allegedly served and behavior managements that keep clients dependent on the system for substandard services without adequate and decent social supports or access to client operated programs as an adjunct to the traditional medical model methodology of dealing with emotional distress. This emphasis on drugs and psychiatric coercion as best practices draws attention and resources away from the desperate need for psychosocial supports and networking proven effective to help labeled persons pursue their dreams, achieve their goals, improve the quality of their own care and existences and mend their shattered lives.

We are not supposed to say that the system's rock bottom expectations and exclusively medical model approach is more the problem than the solution. Mainstream advocacy agencies receiving system money for their operating budgets certainly won't speak out on this forbidden subject, and most advocacy organizations are operated by mental health professionals in ways that benefit those professionals and the system, too. Only when the board of an advocacy agency is comprised of 50 percent clients will the priorities change from force and overdrugging to an array of decent community supports and client delivered services.

In other words, advocacy benefits many special interests, including mental health professionals, drug companies and acute care aspects of the system, especially with the push for insurance parity, which will only result in payments for more substandard and coercive treatment involving heavy drugging.

So mental health clients themselves must take responsibility for finding the ways and means of revoking the hopeless, dependency-making social death sentence pronounced by most systems delivering mental health treatments without ancillary socioeconomic supports for the targets of their interventions.

2) Proliferating media messages that perpetuate the systemic perceptions of dangerousness also divert resources away from community care and psychosocial supports into increased acute care hospitalizations and drug cocktail interventions.

What we really need to integrate and become self-determining are supported work programs, housing initiatives, peer to peer networks, peer leadership trainings, public education projects aimed at reducing stigma, making social change and transforming attitudes. Until the social opprobrium associated with psychiatric labels and histories is ameliorated, lawmakers won't approve redirection of funding for consumer operated programs proven to reduce the revolving door problem and give clients of mental health new hope for finding a way back into the mainstream of life.

At the federal level, agencies like the Center for Mental Health Services division of Substance Abuse Mental Health Services Administration are requiring evidence of best practices for the programs they fund. Although stigma is repeatedly cited in reports and articles as a huge impediment to social integration and good quality of life for clients, no body of research exists on its impacts or methodologies of fighting it. Best practices for mitigating the impacts of stigma are not high on the priority list of most government sponsored programs, which concentrate largely and misguidedly on promoting the medical model rather than changing the dynamics of human relationships and outworn, destructive social traditions.

This lack of research on stigma and the will to go beyond misconceptions to integration with the mainstream is largely attributable to the exclusion of consumers from the table when mental health policy and programs are planned by system officials, lawmakers and advocacy groups who are too dependent on federal, state and drug funding and too oriented around mental health professional agendas to follow a common sense direction of abandoning labels and medical model propaganda in favor of supporting people through emotional, spiritual and values crises.

The South Carolina Client Network proposes to offer alternatives to medical model hegemony that benefits special interests and excludes clients of services from the table when policy and laws are made. A strong network of clients dedicated to changing the balance of power in mental health politics can advocate for real change and reforms that result in services respectfully delivered and cost savings to society, not to mention salvaged and self-directed lives for those seeking real help in their emotional, spiritual and values emergencies.