Agonia: Mental Health Advocates

2008-07-08T20:50:00.000-07:00

What to Do Now:
A Mental Health Consumer's Existential Response
To Being Left-for-Dead by Systemic Indifference

There were cries prior to the last (Kentucky General Assembly, GA) legislative session that there would be falling-through (the 'cracks' and otherwise) in the mental health system without requisite funding. OK. Kentucky did not do that-- but went to bankroll the highway-constructors instead. OK.

Consumers: do not look for 'help' of the kind we got in the 1990s and prior due to the hullaballoo that was incited by 'bleeding hearts' (unfortunately so called) who had just enough 'Sacred Heart Christianity' to advocate/lobby for what here locally is Wellspring (for the decomensated, providing housing and treatments), the Crisis Stabilization Center (an alternative to 'regular' psychiatric hospitalization), and certain other cautiously-drawn programmmatics. The General Assembly-- still under the sway of the get-to-work-slouch politics of the Zeitgeist of the first part of this decade-- has left us high:dry:dated. Don't look for charity-stories about us in the C-J as much. Do look for the popularity of 'lunatics' jokes. Do look for the MH agencies to "cut you loose" as Recovered-- Guy-- you are so well that you don't need to talk to the likes of us anymore anymore anymore!!!!!

I am already beginning to have reports trickle in of cut-back consumers lacking supervision and then doing mayhem; I am now beginning to see more and more consumer-looking people bagpeople on the streets; there is a suggestion that some are medicating selves with dope-- unable to get anymore the meds like on PAP-- "Patient Assistance Program"-- freebies once flowing from our CMHC-- and God-Forbid!!!-- it looks as though not a few more have taken to 'dealing dope' in order partly to fulfill a supply; I have indirect but tangible report that the jails-- pretrial, post-convicted-- are full up with types like us because there was 'no room in the mental health inn.'

Now I invoke something called "existentialism," nuts-like-me: in fine this means assuming the-real prior to assuming the-ideal, and living responsibly-- 'damn their hide anyway!' I am in a bit of a hurry right now, but this wisdom-- wise as you can get if you're a consumer of MH-- is like us getting old-hat, but had its mavens like Jean-Paul Sartre, Martin Buber, the ole-Nazi Martin Heidegger-- a motley crew alright and some said they were as crazy as they would now make us out to be. But 'to be strong at the breaking places' as suggested above now I am prescribing a dose of existentialism (tastes like codliver going down; victual as hardtack for the longtrek pilgrimage we now must face.) We need, in fine, to separate the existential from the essential and best we can BE REAL without ass-u-me guesses that some savior besides Jesus in human-form will come, make things all nice and forgiving again.

I have already limned a good portion of the-existential. The problematic we face is a downturn in economy-- a legacy of dust-under-the-carpet-lipservice by the policy principates-- in Frankfort as well as Washington. The shortfall in Frankfort with GA was a reflection of these variables-- in particular with the shortfalls created by the regime giving us the Budget Reduction Act of 2006-- and profound cuts in Medicare and the rest of the social welfare system. IF HELP COMES TO THE 'RESCUE' DO NOT LOOK FOR IT SOONER: LOOK FOR IT LATER. Between this instant and relief there will have been a body-count-- and some of those-there bodies will be of you-me-MH-types-- by whom I mean not just us-nuts but the kind ones who provided the service heretofore-- there will be LAYOFFS AND RUMORS OF LAYOFFS for these clement -- I prophesy with the sage tendency of one well-burnt in both the worlds of giving and receiving 'help.' So don't look for help. Look for ESSENTIALS to fill the gap in EXISTENTIALS...

First, Consumers: survive. Do whatever you can to medicate properly. This need not be expensive as you might think. If you have been so-liberated by MH that you no longer have a healer, check around, and here-and-there will be GPs (general practitioners) and occasionally NPs (nurse practitioners) who might be so kind as to Rx like chlorpromazine [Thorazine (r)] or its ilk-- not as good as the new ones but still dirt-cheap as a psychotropic. It is also true that a generic for the out-patented risperidone [Risperdal (r)] is online; look for it to be a potential standby for the 'expensive stuff' on the horizon in the aftermath/afterbirth of W's "New Freedom-- get-t-work" for us.

Second, be self-cognizant: measure your mentalities and manners with honesty, brutality. Assuming that there will be some psychotropic you can get after the fold-up of the '10s-decade the GOP planned for us in mid-this-decade, you should with some " 'Zine" another to get-by be able to detect when off-going is at-hand. BY ALL MEANS IN COGNIZANCE DO NO HARM: THE SOCIAL WORLD IN WHICH WE LIVE IN THIS UNTIED SNAKES OF AMNESIA (USA) IS WELL ACCUSTOMED TO NEWS-JUICIES ABOUT CONSUMERS SHOOTING UP PLACES LIKE VIRGINIA TECH AND NORTHERN ILLINOIS U: LOOK FOR NO SYMPATHY/EMPATHY FROM HENCE ON THESE MATTERS!!!! Yet with ruthless honesty you should be able to detect 'when it's getting bad.' At worst, the forensic/correctional psychiatric places still give a certain amount of psychotrops: but you will if you get 'criminaled' for something 'heady' lose liberty, and a good toehold we have acquired on the license-to-live.

Look for sometime cuts in form for the SSDIs and SSIs and Medicares and Medicaids you get: this will come at the far-end-flop of the coming pol upheaval-- when the GOPs again get control of White House, Senate, House-- and then the talk will be "we can't afford to keep these bums in cigarettes [or whatever stereotype for which we will be then-blamed.] This will come with 'freezes' at first in the cashflow, then rollbacks 'for the common good.'

Try to keep a domicile rented as long as you can. This is what the cops call 'permanent address' and it can differentiate between freedom and jail. In your place, it might be best not to go out unless you have to do so: and if you do exit domicile, in short order look for a dearth of transit-- meaning for sure that 'public transit' and the para-trans (which was cut from nuts short-after the passage of the Americans with Disabilities Act.)

Get a pet. If you can't in future-tense get petfood for want of bucks, befriend the birds, the squirrels, the cockroaches that hither/yon will certain obtain around you. The animals will be your-only-friends, your-only-solace in a world that WANTS to hate you because of the Birchites who have come, will come, and are-now.

Mostly: don't look-for goods, but look-out-for bads. The rednecks who kill with purse-strings-- somewhat gone but by the American dialectical logic will return-- want you your-hide your-exit.

And don't you forget this!

Existentially before Essentially,
Vernon Lynn Stephens, Culdee
D.S.M. IV-TR # 296.44
M.S.S.W. belatedly
In the Place Commonly Called 'The Desert'
Here: Louisville, Kentucky USA

2008-07-07T13:41:00.000-07:00

REJOINDER TO INSULT:
When Given Less, DO MORE--
Starting with (The Privilege, for Time-Being) of The-Vote

In Kentucky, as under several other juridictions, mental health consumers have but a privilege to suffrage-- not a right. But as many of us CAN vote, let us vote now -- in the Fall 2008 election and always-- for what is of-our-wallets, of social-justice, and of-mental-health.

Due to the shenanigans of the ancien Regime-- I mean the politics of the late 1990s to the mid-decade now (and you know -- all of you-- whom I mean) we now as mental health consumers are forced to take the short-end, while vastness of high-ways, and of thus high-way-robberies has taken place from our of-people-by-people-for-people-supposedly governance. This is a perceptible trend. Service in all areas has stiffled, suffocated, strangled little:little:lots over a series of times that have brought great bequeathment to the Welfare of War, the Welfare of Wealth, the Welfare of Weird.

There has been hue-and-cry over the large increases in what MH consumers have to pay for services-- a reality often unspoken and of which the public is dim therefore-- as well as the cutbacks in what is obtainable. NOW I cannot get certain kinds of lab-test for my several medical conditions (psychiatric + those-medicalities-caused-by-the-psychiatric) that are the reality of my retirement-age life. I have discovered-- as The Boomers retiring now will certainly have discovered-- that the Social Contract for the shortfalls of school:jobs:opportunities we got in youth-- and the liability of old-men's-wars-- would not be met on the far end of time with the 'carrot' of a social safety net. No. Due to the action of a callous Congress (you know who was in charge in 2006 and prior, not my party) we face the demise of Medicare/Medicaid as we know it-- much much much to the woe of the American Medical Association and all equity-minded folk.

In mental health, those who plugged 'equity' for mental health did not realize that equity for mental health CERTAINLY in fiscal and authorization-for-fiscality terms does not meet with equity in government. The Medicare and Medicaid both tend to stiffle mental health. The services which others get, we consumers in the receiving-end get not from America. On the other hand, we are now beginning to be expected to pay more for less service. The co-pay increases pinned to consumers now are by no means the beginning of such co-pays, such increases-in-co-pay: we shall in short-order be expected to give payment-in-full-not-in-kind for these services in psychiatry (not long really 'mental health') which are getting sketchy and augur to become imaginary.

For this reason, I am supporting Congress-folk who support MH issues like our equity-under-government problem. My present (Democratic) Congressman does support this cause, a matter which I receive gratefully, gladly-- all the while knowing that against the John Birchers in Congress (House and Senate) and in Kentucky General Assembly (GA) this will have been a bitter and probably unsucess-meeting battle. Unless...

WE VOTE!!!!!! So it is not very surprising-- as long as I am so condescendingly permitted suffrage/the-vote-- to VOTE MY WALLET. That it IS the donkey-party Democrats who do this so consistently (and not for 'jobs-back-to-work-bum' I cannot get under any circumstances)-- I shall VOTE DEMOCRAT PLUG DEMOCRAT PROMOTE DEMOCRAT.

Should the elephant-party GOP see the light in a real way-- and support MH-- then and only then will this position be reconsidered, re-drawn possibly. But there is strong tradition of this GOP clique-conservative-of-justice-little to penny-pinch-when-pound-wise is indicated, and where mental justice has been concerned, we have seen much violence-- the closure of asylums, the criminalization of the mentally ill in spates, homelessness-smirking, and now the short-end-of-courtesy from the strangle-funding of MH. The reversal in GOP will have to be more than a "New Freedom" of a right-to-work for mental consumers without jobs at all or opportunity for jobs. This is raw. Democracy demands difference to this indifference-- and certainly it would appear that the party named Democrat-- and thus for our democracy-- will deliver.

This is the most-responsible thing I can do, taking this stance-political-- after striving my utmost to ascertain that I for one shall NOT be victim to this studied and callous indifference from the Ancien Regime of Bushes Northups and McConnells. I hope these lackies do see the shortfalls of their soldier-mercenary-hire to the War-Lobby GOP-- but even the more, well-fried by these previously-mentioned brutes-- will VOTE DEMOCRAT in Fall, 2008.

--Vernon Lynn Stephens, Culdee
D.S.M. IV-TR # 296.44
M.S.S.W.

2008-03-05T16:24:00.000-08:00

A Dead-Letter-- Kentucky Constitution 145(3)-- As Dead-Wrong:
The Franchise to Vote as Privilege-- Not Right-- for the 'Insane' in Kentucky

I have beaten a drum for the statutory qualification of Kentucky Constitution 145(3) as being restricted into the present not-guilty-by-reason-of-insanity law-- Kentucky Revised Statutes 504.020, with any other usage in-- for example 'testamentary capacity' being termed 'incapacity' only. The feedback I am getting is that "we [mental health consumers] CAN vote'-- by implication 'what's the big deal?'

The 'deal' is that the franchise-to-vote is a RIGHT for all adult people who are not disabled by felony conviction, bribery in an election, or "idiots or insane persons"-- the last designation being in case-law defined as "every degree of unsoundness of mind" [ Pulaski County v. Hill, 97 Ark. 450, 134 S.W. 973 (1911)] -- which is persuasive authority across jurisdictions until statute defines-otherwise. That in Kentucky we DO vote as mental health consumers only conveys that times-have-changed toward lenient definition of what "insanity" is by venues in this state. Nonetheless, this practice is a PRIVILEGE extended to consumers, and in the same way that times-have-changed for now, times-can-change-back.

Frankly, the ghastly occurrence of the April 16, 2007 mayhem by a should-be-consumer at Virginia Tech has occasioned tightening of the mental health laws in that Commonwealth [see the Washington Post article on this subject, at this link]; the February 15 slayings at Northern Illinois University predictably may have a similar effect; psychiatric maven Dr. E. Fuller Torrey would seem in this vein to be recommending to the old-days with mental health asylum for 'bad actors" among mental patients [see the article from the Orlando Sentinel on this topic, here]. Given the 'official' case-law and statutory-law on this suffrage question-- which I find expansive-- I cannot rule out that the PRIVILEGE of voting I have practiced since age 18-- yea through all my mental tailspins-- would not be court-definable as "every [any] degree of unsoundness of mind" and thus this PRIVILEGE could-- 'just-like-that'-- be-booped from me... and you, too, if you are one who has some degree at some time of such "unsoundness."

There is ebb-and-flow to American history, to Kentucky history. The law that is 'on the book' about the disenfranchisement of the unsound-of-mind was actually to-the-crossing-of-t-and-dotting-of-i what was practiced up to the first half of the 20th century. Only by the grace-of-chlorpromazine, movies like The Snake Pit and One Flew Over the Cuckoo's Nest, the Kennedy New Frontier Legislation in the Community Mental Health Centers Act of (October 31) 1963, and the persistent agitation over time of do-gooders-- that we do have the privilege even to set the dinner-table free-to-eat in our places-- let alone the franchise to vote. Zeal to "do something about these nuts running around committing no-no's" could in time have the cumulative effect of reversal to total disenfranchisement we had when the case-laws were written which would in turn do-us-in.

Consider the black-civil-rights experience. One might have thought that the 13th Amendment (abolishing slavery) and the 14th Amendment (defining all as citizens, and that all thus having civil liberties) would effectively provided the civil-liberties black people ought to have into perpetuity. But something came along-- case-law again-- originating right here in Kaintuck-- the Plessey v. Ferguson which upon arrival at the United States Supreme Court [163 U.S. 537 (1896)] defined the civil liberties of people of color as being OK if they are "separate but equal." This had the real "unequal and separate" effect of legitimating 'Jim-Crow' culture in this land until-- with great exertion-- the civil rights movement and Brown v. Board of Education [347 U.S. 483 (1954)]-- the Supreme Court reversed itself and posited the valence of integration. It is not especially encouraging to me to hear-tell that conservative courts and political conservatism are pushing to eliminate the "strong" interpretation of integrationist law. It means, in so many words-- 'what-comes-around-goes-around'-- and that nothing good we in commonweal 'have' is necessarily 'ours for keeps.'

Yes. 'We' DO vote in Kentucky, and in places where these old laws are practically disregarded. These are "dead letters" on our books [see the related disambiguation in Wikipedia. ] But don't rest on those laurels, affected-ones-- just a single hard decision from a high-court, or a similar judgment from the Kentucky General Assembly-- say after some hopelessly misguided soul goes on a rampage-- disownable by us-- but our-definite-problem-not-a-definite-solution-to-woe-- could get re-read this old law with all the old vigor that once it had. I say again, do-not-rest-on-your-laurels. In spirit and truth, the-vote extended to the mentally ill is a modern perk-- a generosity extended not-to-cause-trouble-- but at opportune time the PRIVILEGE can be taken just as Cinderella's carriage turned into pumpkin at the appointed hour. Do not rest on your laurels.

What we have is not what black folk have with the 14th Amendment-- or what women got with the 19th Amendment-- no: we if definably 'insane' cannot vote here-- what option we have for suffrage is merely a kind of "wink" at the highest law in this land-- our Kentucky Constitution-- and a willingness to let-pass-in-order-not-to-make-trouble. But this placidity is legally only apparent-peace-- trouble obtains here, nonetheless. The CHARTER under which we operate-- our 'Kentucky Magna Carta' is whopperjawed. For this reason, I am troubled by the wording of the constitutional language, and want legal redress-- best as can be obtained-- with responsibility and equally-responsible-civil-action. "Eternal vigilance is the price of liberty-- --power is ever stealing from the many to the few"[Wendell Phillips, American abolitionist]; therefore let us keep-vigil-without-ceasing!

I do not rest my case!

--Vernon Lynn Stephens, MSSW
D.S.M. IV-TR # 296.44

Telephone: 1 (502) 561-5419
Anytime re MH/social-justice/human-civil-rights.
Email: freethink@insightbb.com
Anytime re MH/social-justice/human-civil-rights.

2008-02-27T16:55:00.001-08:00

More on the Suffrage Disenfranchisement of the "Insane" in Kentucky:
Legal Use of the Term 'Insane' Not Restricted
To Not-Guilty-by-Reason-of-Insanity (NGRI-- K.R.S. 504.020)
But Also to Non-Criminal, I.E. 'Civil' Use

With some vigor in the last entry to this Web-log, I tendered the accurate information that Kentucky Constitution 145 (3) CATEGORICALLY PROHIBITS "insane" folk from the franchisement-of-suffrage, the right-to-vote. The question in so many words has come to me: Yes, 'insanity' is a legal-term atop psychiatric determination; what does it mean-- by linguistic pragmatics-- in the legal sense-- in case-law and other policy determinations?

To the end of accurately-- and only with balance and accuracy-- addressing this particular question-- I went to the U/L Law Library on the afternoon of February 24 to check exactly what I point-at here-- the legal contextual definition in 2008 for "insanity". To wit, I went to Corpus Juris Secundum (CJS) 2007-- which is kind of a legal-definition encyclopedia (multi-volume) and to Kentucky Digest as well as Kentucky Revised Statutes. The "Kentucky" books all point to MH definitions for the non-criminal use of the insanity term, as well as to the not-guilty-by-reason-of-insanity term (NGRI, under 504.020.) The main law lexicon universally in this land is CJS; this discouraging use under the "mental health" section of volume 56 includes the following wording at exactitude:

"The word 'insane' ordinarily implies every degree of unsoundness of mind [Application of Jordan 270 Misc. 734, 10 N.Y.S. 2d 911 Sup. 1939-- says my corrupt CC!] Generally speaking an insane
person is one who is of unsound mind [Oklahoma Natural Gas Corporation v. Lay, 1935 OK 868. 175 Okla., 51 P.2d 580 (1935)]; one who once had a sound mind but has lost it through injury or disease [In re Hendrickson 12 Wash. 2d 600, 123 P. 2d 322 (1942)] According to some authority a person is legally insane if the person lacks the substantial capacity to appreciate the wrongfulness of his or her conduct or the substantial capacity to conform his or her conduct to the requirements of the law [ People v. Foster, 138 Mich. App. 734, 367 N.W. 2d 349 (1984)], although mere weakness of mentality or subnormal intelligence does not itself constitute insanity [State v. Bennett, 345 So. 2d 1129 (La. 1977)]."
CJS 56 "Mental Health" Section # 1, page 530.

Up to use in 1988, as a former exact employee in forensic psychiatry who wrote a patients' rights legal thesis at Kent, I can say that it would appear that most of the usage of the term "insanity" went for NGRI under K.R.S. 504.020; there was some usage under the civil incompetency-- "testamentary capacity" provisions-- with use conservatively-interpreted-in-generous-favor toward the alleged-incompetent. My proposal-- and I think it a modest proposal-- would be to draft legislation and enact same to the specification that "insanity" in Kentucky only be defined under the provisions of K.R.S. 504.020 and to use "incapacity" in every other sense previously used for this expression outside of criminology.

Stricter interpretation of insanity-- precisely consistent with the used CJS terminology-- could mean, with my having ~ 17 invols in which "I was a danger to myself by reason of mental illness"-- be defined OUT OF the franchise to vote. That the practice is now leniently interpreted in 2008-- as opposed to older strict practice-- would not imply necessarily that in 2030-- about my maximum predictable lifespan-- the standard could not be practiced more-restrictively. That I have voted all my adult life, all through the time since first psychosis in 1977-- MAY not mean that in tuffer times this condition will always prevail.

For that reason, I am speaking for the restriction to 504.020 use of "insanity," and thence to replace the term with evidence-based operational definitions altogether. A promising "replacement-term" for "insanity" in the civil-diminishment-sense looms with the term-- also a legal expression-- "incapacity." But there is absolutely no reason-- given the state of mental health recovery now-- yea unto virtual-if-not-total-remission-of-symptoms with treatment-MENTAL HEALTH CARE IS EFFECTIVE TO EVERY PRACTICAL EXTENT!!! In fine: this "fossil" on the Kentucky Constitution 145(3) is a spot/blemish that this 21st century mental health consumer finds disconcerting and would like to "petition the government for redress." For these and other equal-protection/due-process considerations I do define the mental health empowerment movement as a civil/human-rights endeavor. One would think that after the franchise to vote was extended to blacks with the 14th Amendment and the suffrage of women in the 19th Amendment there could be something/somewhere to eliminate a disenfranchisement of "the insane" as uncomfortably defined in CJS.

I was not-- incidentally-- direct-selling the idea that anyone would be of necessity obliged to agree with me on this civil-rights angle. I shall beat a drum for it... I have been a cry-in-the-dark all my life and can continue thus. But of the issues-- "the hot buttons"-- that turn-me-on-- you may include this one..."am willing to pay the necessary price."

--Vernon Lynn Stephens, MSSW

D.S.M. IV-TR #296.44

Telephone: 1 (502) 561-5419 anytime for MH social-justice/civil-rights.

Email: freethink@insightbb.com anytime for MH social-justice/civil-rights.

2008-02-22T14:47:00.000-08:00

The 'Insane' CANNOT Vote in Kentucky--
Suffrage-Disenfranchisement of MH Consumers
Due to Kentucky Constitution 145 (3)

Mental health consumers in Kentucky "the Dark and Bloody Land"-- and all righteous folk everywhere-- brace yourself for stern news: the 'insane' of this Commonwealth have an unqualified disability from voting in this venue! Read the Kentucky Constitution at Section 145 (3), where we are informed that "idiots and insane persons" are (apparently in all instances) prohibited from the right-to-suffrage.

Immediate qualification is necessary for this usage. Here as elsewhere now, "insanity"/"insane" are legal terms-- it is necessary to involve psychiatry/mental-health in determination of this 'incompetence,' but it is not the cause/sufficient-condition for the determination that one is 'insane.' I would say that almost exclusively we associate the term 'insanity' to use in a criminological context, where it becomes necessary to question whether a defendant "as a result of mental illness or retardation {she/}he lacks substantial capacity either to appreciate the criminality of {her/} his conduct or to conform {her/}his conduct to the requirements of the law" Kentucky Revised Statutes 504.020

I CERTAINLY have no objection to Kentucky's having an insanity defense-- and it would be raw injustice if we had none for such incapacity. But all witting parties know that "insanity" has a common usage, even limited psychological-science usage, and a broader context than the criminalistic setting. We know for example that the terms "insane"/"insanity" are oft invoked in proceedings related to "testamentary capacity" -- the ability to effect a will or contract-- see the Wikipedia article on this topic. But this is a limited usage: these terms are increasingly merely the pop and unscientific and limited-forensic way to specify mental incompetency.

I would counter that NOW-- decades after the closing of the "asylums"-- after the advent of chlorpromazine antipsychotic and the effective mood-stabilizers-- after a large number of us consumers have emphatically demonstrated that we are responsible and contributing and effective participants in the communities of neighborhood, nation, and world-- we can begin to retire this term to the antiquity it deserves. Cruelties inflicted on "the insane" mitigate against the utility of ever again digging-it-from-such-a-grave linguistically.

Accordingly, I tender the following not-too-timid proposal: why not pass a law to the effect that in Kaintuck-- or anywhere-- "insanity" as a word be 100% restricted to use under definitions of criminal insanity-- such as the K.R.S. 504.020 I cite above? It could even be that the other uses of "insane"/"insanity" will then have reason to wane from our vocabularies in time-- although there are societal forces that like to keep alive the-negative.

What if we don't do such an expedient move as to restrict "insane"/"insanity" to the criminal context? To wit, "insanity" can refer to the general proposition that one's behavior does not conform to societal expectations and that one is dangerous-to-self-or-others thereby -- see the Wikipedia article on "Insanity." This is exactly the sort of language that is contained in mental health commitment laws everywhere in this land-- including in Kentucky Revised Statutes for Involuntary Mental Commitment 202A.026

The "bottom line" for me -- with 17 "involuntaries" [essentially for 'shouting' usually]-- and all others who have ever been 'invol-ed'-- run some risk of for reasons good-to-someone for our prior declaration of danger-self/others-- be turned away at the polls under the harder interpretations of Kentucky Constitution 145 (3). This would of course be a political bombshell and nightmare to the power-elite for fire-put-out-damage-control, so I speculate that nowadays this would not occur. On the other hand, I doubt not at all that in Kentucky's murky human rights history this HAS occurred. For prevention, and for "cleaning up the dirty language" from the Books, I think we need-- all responsible folk-- to do something like what I recommend: to get this "insane"/"insanity" thing written restrictively to criminality NOW-- then eradicate its use forever by the substitution of new, evidence-based terminology.

Kentucky is not by any means alone in disenfranchisement -- to some degree or another-- of the "insane" from the right-to-suffrage. Actually, 37 states, the District of Columbia, and Puerto Rico have such legal-writ encumbering mental health consumers from the-vote. In this 21st century, decades after the Civil Rights provisions of the Americans with Disabilities Act-- we must all work toward this happy and just goal.

So as Social Work Matriarch Mary Richmond said, "Start where you are." My allies are perhaps to be found; the NAMIs and other mental health advocacy groups may wish to be vocal about this rank writing in the Kentucky Law. I fancy that I might find help from the Churches; in this regard I think it instructive that almost-to-the-point the local Catholics are in favor of lifting the prohibitions of the not-guilty-by-reason-of-insanity for voting privileges-- or so I have rather obliquely had intimation; the Presbyterian Church, USA, has its headquarters just down the street here in Louisville on Witherspoon Street-- they may want to "pitch in" for the civil liberties of mental health consumers. In fact, I think a lot of people would find this issue a lively topic. And it almost goes-without-saying that numbers of civil-rights-mavens, libertarian pols, and the mental health professionals probably could leap-on-this-with-abandon.

So as the lively bunch of Lexington (Kentucky) NAMI like to say "Let's get 'er done!"

--Vernon Lynn Stephens, MSSW
D.S.M. IV-TR # 296.44

Telephone: (502) 561-5419
Anytime for mental-health/social-justice issues.

Email: freethink@insightbb.com
Anytime for mental-health/social-justice issues

2008-02-16T14:59:00.000-08:00

A "Maroon Valentine" on Love-Day-- 2/14/2008--
For Kentucky's Orphan-People--
The Tight-Belt of Governance Tightens Like a Noose

On Valentine's Day, just this past Thursday, the Commonwealth of Kentucky House of Representatives hosted a get-together for the have-nots-- with the meeting of the Sub-Committee on Human Resources. I attended this convening-- and came away in a peculiar mood-- as if I had been one who attended a party hosted with some august ambivalence-- a congress of waifs celebrating an "Orphans Valentines Party" presented by a few well-intended hosts, with ambiance-- music-lights-decoration in minor-key.

The stimulus for this get-together was for imperiled folk-- those living close-to-the-wire-- the brain-injured, the severely retarded, the chronically-mentally-ill, and seniors-- all faced with short-change budgeting and short-change treatment by the system-- to speak up for themselves-- TO BE HEARD. This "HEARING" made discomforting listening to anybody with the least sense of conscience and decency-- I shall here recount the disconcertions that "hit me" there-- shocking and catastrophic words that were stinging to hear. But I went away wondering whether all this maroon-note-lamentation on the Love-Day 2/24/2008 was indeed HEARD by the great and august body of the power-elite after all. I shall explain in a few extra words...

This assembly was well-attended by the needy-- there were in excess of 150 people there-- an overflow crowd that had to be accommodated by channeling a number of attendees to a side-room-with-television-monitor. I did come early-- but it was crowded for the people-attending-- standing room only. Herein came testimony from those affected by the gutting of programs for the truly-wounded of Kentucky-- the autistic just-looking-for-a-home, the mothers-facing-death-and-then-incapable of-dressing-feeding-clothing-the-retarded-son, the devastated-mentally-ill-who-with-cuts-will-not-survive-make-it, the wives-of-brain-damaged-carwrecked-professionals-now-vegitating.

This assembly was under-attended-- in my studied estimation-- by representatives in the Kentucky House of Representatives-- I counted two such Reps-- one was the Louisville-Human-Cause-Champion Reginald Meeks-- and by another whom I could not identify despite some watching-previously of General-Assembly news on Kentucky Educational Television.

To me this dearth of Representatives and surfeit of needy-folk was most-telling: for I happened in early, to the meeting of some kind of sports-testimony for another committee like an hour prior to the Human Resources Sub-Committee meet: there the situation demographically was opposite. The Officials behind the bench hearing-witness were in abundance-- and there were guys at the table talking about some nifty plans for letting golfers play at Valhalla in Louisville during the Riders' Cup horse-race thing this year. The attendees were under-represented-- I had absolutely no trouble finding a seat.

From these presents, it is not hard to infer the priorities of this fast-women-and-pretty-horses-State. Kentucky does love its fine old horsey traditions-- and has always been "dark and bloody" (as the legend is that evicted Native Americans called this place) on the receiving end for the have-nots. True-- the Louisville Courier-Journal (CJ) sent in Deborah Yetter-- who functions as the social-action reporter for this organ-- who turned out a grabbing piece about how those affected by the nothingness of fiscal impossibilities imposed by shortfalls in the budget this year-- implying how there portends to be camps-on-the-street of the infirm-- a community adrift with milling suffering people-- in the "cold Kentucky rain" unless some effective remediation takes place.

This made good "copy" in the CJ-- I read the online version doing my pauper-best to be well-informed via PC-- and even made a couple of comments to the Yetter publications on this sore-topic. But I am under zero illusion that this state-- beyond the FEW in-power like those manning the House Human Resources Sub-Committee then-- and the MANY who will just have to get rained/snowed-upon. We cowboy-rednecks in this wacky place REALLY DO seem to care about horsies and basketball and korn-likker and to-backer more than the suffering of people. While I read and was animated by the Yetter story on these issues, I doubt if there will be much hullaballoo from very many others... who seem the-much-more-concerned about the new stadiums that will have been built, and fightin' for the honor of ole Kaintuck' to make it all the way to the NCAA.

I attended this hearing in the anticipation that I might be able to get-a-word-in-edgewise about the dropped-out drop-dead situation of those I see on the streets in Louisville, those beneath the services provided by agencies, the hard-core nitty-gritty Untouchables who are seemingly left to die-- without the blessings of NAMI, the mental health centers, the day-care drop-in centers-- whose station is not mine, as I by pluck and huff-puff managed to pull myself from homelessness to this station-- not plush by any means-- but at least dry to rains and semi-warm in winter-- and with a viable landlord-- and this magic-box my PC-- from which I can connect to a world which seems never-to-have-heard-or-care of Untouchables of my ilk. But I in fine did not get the opportunity "to talk" -- so impacted was the waiting-line-of-testifiers with stories at least as grim as mine...but that is "par for this Unbridled State Golf Course."

I would like to express words in a certain sense of grief about the during-before-and-after of this "Orphans' Valentines Party." The arrow-of-time to accommodate the sequence of these events-- the elite-well-attended sporty committee with few "folk"-- the under-attended-by-elite well-attended with "folk" Human Resources Committee-- and the blip-in-the-most-conscientious-newspaper in this state-- augurs to be like a FLASH and FIZZ-- easily forgotten for coming news here of March-Madness-basketball, then the Derby, then baseball football and back-to-basketball-again-- will probably spell short-retention of the blood-and-guts issues ABUNDANTLY VOICED in this hearing.

The Sub-Committee meeting was focused on the possibility of raising the tobacco tax a few pennies-- we are as tobacco-producing state holding at 46th nationally on the cigarette tax-- which for all the crises limned by these hapless on whom I report above is supposed to send-some-help. But I truly have some doubts. First of all, this is a to-backer nuts state-- and secondly even a substantial boost (an unlikely event in view of the lobbyists) will not do much to comfort-the-afflicted; comfort-for-the-comfortable will be the more-likely status quo eventuality to these proceedings. There is talk of casino gambling-- and while I kinda grate at the thought of some of the misadventures incumbent with the high-living-gaming-set, it is true that "the people" do not really seem to mind forking out their fortunes on a bet as opposed to forking out some pennies for the-clobbered-in-society. Grudgingly therefore, I do support gaming-- which our Gov says will double our state revenues. But then: the Baptists and Holyrollers and the Gaming-Mafia of other states are ganged up politically against even this slim hope.

What [!!!] a "Maroon Valentine" we have received-- we Untouchables in this Unbridled State! The next thing I expect to hear will be that our bodies-- upon demise from Kentucky hypothermia-- will be composted to avoid the expense to counties of interment/cremation of the intestate. But then, the indigent in Kaintuck have always been left-to-die after disfranchisement-- Daniel Boone being one of the first in this regard-- kicked out of holdings in Kaintuck to die in Missouri -- then to have his holy bones brought back for memorial-as-hero in Frankfort cemetery. Some of my own kinfolk were 'Missouri-ed' also. Some were abolitionists in Boone County drafted by the Confederate Army-- "to fight for our lost cause of slavery." My great-grandmother on my mother's side was committed to hard labor at Central State Hospital status post partem depression-- and when she couldn't work having acquired TB-- she was interned to Eastern State to have her leg-rot-of-with-tubercular-tumors in seclusion-- and of course the state was KIND and USUAL enough to send her abandoned-thereby son a bill "for therapeutic services rendered."

SO STAY AWAY FROM THE DARK & BLOODY STATE-- LIKKER/TO-BACKER-CRAZY KENTUCKY-- ONCE YOU GET TRAPPED IN HERE-- YOU NEVER EVER GET OUT OF HELL!!!

--Vernon Lynn Stephens, MSSW
D.S.M. IV-TR # 296.44

Telephone: 1 (502) 561-5419 anytime for mental health issues.
Email: freethink@insightbb.com anytime for mental health issues.

2008-02-08T03:57:00.000-08:00

Litigiousness as Cause-Lost:
The "Maya-Karma" of Depending on Civil Trials
To Effect Social Justice in Mental Health

Mental health in America exists in a social-field, and the "field-effect" known to physics would seem to apply aptly to the conditions that obtain for us. By this I mean that mental health consumers are part-in-parcel with every other process in the social system, and changes in one part will eventually feed-over and "hit us."

There exists a reality that much of service-delivery in mental health is affected by the "asylum mindset" baggage that in effect discredited the social station of being "just a nut," and therefore one whose word is not to be taken/trusted as true. Under this mischief, EMS drivers will obtain the keys of a suicidal patient and "do a pitch" of these on the way to the psychiatric hospital-- and laugh about being able to "get away" this affront when it is time for the patient to return and unlock his domilcile for post-hospitalization-recovery. In the same way, the police will "lock up" any mental patient who walks within a mile of Central State Hospital in East-End Metropolitan Louisville-- the consumer may be just-visiting-a-friend, just buying a Snickers (r), visiting the gravesite of a former friend, but due to the phobic nature of the neighborhood around Central State regarding "those loonies they let loose all the time"-- any known mental patient walking in that vicinity is thus vulnerable. In the same way, a police officer-- who according to Kentucky Revised Statutes 202A.041 can function in defined mental health emergencies as (2) psychiatrists, a judge, jury, and correctional system in handcuffing a mental health consumer and carting her/him to University Hospital, for the treat of cup-of-coffee in a clean environment and the adulation of the nurses and attending staff-- and indeed with impunity may beat a consumer or "just rough 'im up a little" with utter impunity-- a service-complaint to licensure or JCAH will simply be regarded as "unsubstantiated" banter from a incompetent person. With glee, every plaintiff in a lawsuit-- upon discovering that the defendent has a mental condition (however treatable) can-and-will predictably win-the-case by presents to the jury that "this person is under psychiatric care" -- and should not be heeded as truthful.

There ARE injustices that affront us-- mental health consumers-- as a group. And the untreated/not-in-the-system dangerous-mentally-ill who go about doing mayhem OR the psychopathic deviate dope-pushers who with drug-money "cop an insanity defense" successfully with the-best-justice-bucks-can-buy are IN NO WISE a help to our cause. Nor are we helped by "ambulance-chasing" lawyers of the winner-take-all type, "heavy hitters" who will bring suit on pretexts, get large settlements after trumped-fights, the rewards of which go to pay all the legal fees. Nor are we in any way facilitated in quality of life or human rights by Mental Health Courts (called 'Mental Inquest' in this county of Kentucky) when those venues in each-and-every-case simply turn out "lock-up" verdicts, or unexplained "agreed decisions" for the consumer to do exactly what she/he HAS been doing all-along-- TAKE YER MEDICATION!!! In these and a plethora of practical ways "the asylum sociology" is still alive/well/kicking in this redneck state in a redneck country.

In other words, the mental health consumer is sans a monied endowment in a perilous condition when civil liberties and the right-to-life-liberty-pursuit-of-happiness-- in a way that is qualitatively hardly any different than the esteem asylum-residents had in 1950. We consumers would be operating under a considerable delusion if we regard "the system as being there to HELP us."

I propose another "gambit" for the mental health consumer-- and a better standard of conduct. We know from the teaching of Mohandas ('Mahatma') Gandhi that Truth-Force (satyagraha) is stronger than any social fiction whose intent is deceit-to-sustain injustice. Using such experiments-in-truth, Gandhi was able to evict the interloping landlords from the Imperial Raj of India to establish the Free Indian State(s). I propose with Gandhi that truth-force is absolutely the only defense we shall need-- or which will WORK for us in sustaining freedom-under-the-law.

In other words, in the instance of lawsuits-- should I ever be victimized by a "nuisance lawsuit" the pretext and context of this could only be that someone is trying to suppress the-truth-the-whole-truth-so-help-me-Truth[God]-- which as my sole editorial policy is all that governs this content. I realize that such Truth may make the comfortable-uncomfortable and only act to make the victimized-uncomfortable-have-meet-comfort; thus I do know that in this cowboy nation some privileged party may indeed take exception to this publication "organ" and try procedurally to "shut me down"-- not hard to do because I am impecunious/broke-independently on the money-end and cannot sustain costs-- especially I cannot defend against unbalanced/unjust systemic liabilities. But the very effort to "shut me down"-- when it happens-- if if happens-- should only be taken as an indication that "money doesn't talk, it SWEARS, obscenity who really cares, propaganda all is phoney" as singer Bobby Dylan sang in purer days.

Therefore, I am NOT inclined to go to trial-lawyers or seek court-remedies for all the injustices I know are exacted on people of my station. The maya-karma of becoming implicated in the deceptive gamesmanship of "getting a good case together for a settlement" will not in the first instance be tried here, only and abidingly the practice of truth-telling-- gently vigorously always-- until the conscience of the social-community "burns with fire" for what is being done. By thus feeding-the-adversary with his fictive-fare, such "fire atop the head" [see Romans 12:20 KJV] we generate will effect the vanquishing truth-force, the inexorability from which the phonies will never be able to effect escape.

My way is the HARDER/STERNER/MORE-AUSTERE WAY compared to get-backs and vendetta and quarrelsomeness-for-the-hell-of-it. To those who are in-it-for-self only, or who have a get-rich-quick mindset, the words I offer here will not delight. But ONLY this way I proffer or one like-unto-it-in-all-ways will suffice "by any means necessary" [a quote of Sartre employed too by St. Malcolm X-- see the Wikipedia article on this topic] to effect resolution of our civil-rights, civil-service crisis.

"I do NOT rest my case!!!"

--Vernon Lynn Stephens, MSSW
D.S.M. IV-TR # 296.44

Telephone: 1 (502) 561-5419 anytime for MH issues.
Email: freethink@insightbb.com anytime for MH issues.

2008-01-20T15:15:00.000-08:00

More on Mental-Health-Consumer-Assertiveness:
Comment on Such a Program's Inauguration in Lakeland, Florida

The Ledger-- a publication from Lakeland, Florida-- near Tampa-- recently reports that assertiveness-training will be provided for consumers at a local mental health system. This training will address the passivity and "learned helplessness" which people with mental illness not infrequently exhibit, for example in the reported tendency of 'regulars' at a drop-in center there to ask-permission to use the restroom. To this intervention effort I would like to address this entry.

This web-log-- I reiterate-- and all writing perpetuated under this aegis-- endeavors to "say the truth, the whole truth, and nothing but the truth, so help me Truth." Therefore I shall endeavor to describe this worthy effort for all mental health consumers not only from OUR side, but from as many other "sides" as my admittedly limited experiential perspective will permit.

First-things-first: I think it the best-of-ideas that there is now a flesh-and-blood movement afoot in brick-and-mortar mental health places to get the notion of consumer-self-assertion "off the ground." It is absolutely true that numerous consumers exhibit "learned helplessness," and there are times when essentially for strategic reasons I have shown such tendencies. Self-assertion-- as an aspect of self-determination-- is long-overdue for mental health consumers as a cohort/group.

Second-things-second: I do think it expedient, however, to note that our "learned helplessness" is typically a learned-response when it appears, an add-on from numerous inputs to the biological fact of schizophrenia, bipolar-disorder, and the schizo-affective spectrum betwixt the two. The Ledger seems to specify the care-giving system as having "paternalistic tendencies" that teach this 'helplessness'. I would respond-- having been "on the giving-end and receiving-end of the mental health profession"-- that only part of the mental health system abets lack-of-assertion, and part does not; and there are a number of inputs to this condition which are completely apart from the mental health system. In society in general, for example, stigmatization of mental illness is quite pervasive, reinforced by historic cultic beliefs in "demon possession," and by booster-shots subliminally of this cultic belief with numerous "mad-slasher" stories in film, and the news. We only need to hear a minimum number of times about the misdeeds of the deranged should-be-consumer who killed 32 innocent people at Virginia Tech last year, OR of the current (good publicity!) escapades of Britney Spears to reconfirm all these prejudices; and it is a simple fact that we get nearly as many such subliminal messages like this as we get of the black-faces presented on TV as perpetrators of some crime.

In fine, I do not think any amount of assertiveness-training for consumers will make this prejudicial attitude "go away" in society. Should we become the-most-assertive individuals in our communities, there will still be immense social ideation-- largely fictive-- to put down "those uppity mental patients." To those of sufficient age, such phrasing will have a decidedly familiar ring to it: exactly such talk was employed by those who were prejudiced against black people prior to the full-development of the Black Civil Rights Movement. And it is instructive to look at the social forces behind this movement to see the points I am about to make. The Fellowship of Reconciliation early on as well as the NAACP trained activists in self-determination and non-violent resistance to the evils of racial discrimination; Rosa Parks was heroic, but her effect came atop the concerted work and planning of numerous concerned others [see the Wikipedia article on Ms. Parks, here, to corroborate this assertion.] Martin Luther King, Jr., was a giant of a man, but again his emergence came with the concerted and shrewd political coordination of numerous others (some of whom had more-or-less beige skin-pigmentation.) [Again, see the Wikipedia article on Dr. King for corroboration to these contentions.] In all of these matters, it took self-assertion-- YES!-- but also self-assertion coupled with much politically-astute homework.

This is the gist of my point: no amount of self-assertion will bring about all the changes we desire without teamwork-- and to (as Frederick Douglass said) to 'agitate, agitate, agitate' on all levels to see that justice-be-done. Some portion of this activity will HAVE to be political and structural in nature. In this way, mental health consumers will have to learn the requisites of how-to-form-alliances and to develop interest-bases.

Of course mental health consumers need to be involved at base-one in this game; but one must in coalition building take on 'friends' as well. The much-touted family-of-consumer connection needs to be tendered as possible-- in my estimation this cannot be overdone: real families of real "patient-patients" in psychiatry have told me that they would prefer-- for all their trouble-- that she/he the consumer "was dead." Lock-them-up is not infrequently the response families have toward consumers; occasionally the mainline mental health groups like NAMI have speakers who espouse exactly these views. Yet this type of organization should not be discarded, but cultivated-- when possible-- in a constructive way. For numerous consumers-- including me-- family amounts to "a remote afterthought" whose concern for me is more biased on the whole than the most-prejudiced provider I have ever met. Other connections will thus be necessary to stabilize alliance, and relevant political action.

For me, concerned others, few-in-number, priceless-in-value, are the mainstay of my recovery. By these I denote my friends. Yet it is true that the typical inner-city consumer (where I live here in Louisville) may not have many friends. These, I say, need to be cultivated, always with some view that all relationship has a political/structural dimension-- in that the use of power and influence is exhibited down to the level of the social dyad.

Social-organizations beside the family and friendship are a matter of some ambivalence on a value scale of effectiveness. There are numerous churches which SAY "we love the mentally-ill much: we heal them," which is an attitude that cuts-both-ways in that the 'healing' given is rooted in a spirituality of exorcism, as I have indicated; of course this mind-set is not evidence-based, but more to my disconcertment the condescension implied by these religious groups betrays deep-set negative attitudes, an estimation that these-afflicted-souls-need-our-salvation as the final note. I would say-- consistent with the teaching of Jesus-- that should a professedly religious body refuse "you as you in existential-good-faith ARE"-- then by all means "depart out of that house or city, shake off the dust of your feet" [Matthew 10:14, KJV.] But by all means, have your exit known, and your reasons-- non-acceptance due to prejudice-- for your withdrawal. Other voluntary groups, clubs, associations, fellowships, fraternities/sororities may actually be somewhat less-prejudiced than many churches, but like the Black Civil Rights Movement again, these may not be ready to "hear" an agenda that deals with the woes of disenfranchised mental health consumers. In so many ways these topics may be considered 'Verboten!' The agenda at all endeavors should be to soften this 'forbidden state.' If the group is totally unwilling to serve a topic on mental health parity-- defined broadly, in a social sense of equity-- then only by modeling acceptable behavior long and hard-- even if it is difficult-- may be the only viable option. Sometimes with non-religious groups, too, the most-responsible thing a consumer can do is "dust her/his feet" of such people, exactly as with the churches.

In this process of respect for self-determination, mental health providers/professionals have only a "few rotten apples": I have found really sadistic providers about one-in-twenty-- in this discipline/profession does not matter much-- the psychiatrists have their quota of "meanies" as much as the psychologists, social workers, and nurses. In general, though, the kind of sadism practiced-- when it appears-- may be verbalized as condescension -- "I'm-only-trying-to-help-you-" sadism. In this case, though, with such people in general in fact, CORRECT BEHAVIOR may become the only effective way to deal with them. Of course, when it is an option, the service complaint can be such 'correctness' from the consumer. On the whole, then this is the seldom-seldom-necessary gambit for the egregious professional. More likely, the consumer can obtain service with the least sadism, the least cruelty, the least condescension than may be the case from social clubs, churches, families, yea even the so-called mental health advocacy groups. It is nothing but convolution of reality for such groups now to hold up providers-on-the-whole as the culprits in thwarting consumer self-initiative/determination!

"By their fruits, ye shall know them!" [Matthew 6:20.] If a person supposedly interested in me-- or such a group of folk-- talks about nothing but what a drag it is to have types like me out on the streets, not "put-away" like in the old days-- the GOOD old days-- then I would have to say such an interest however presented is POISON-- whether it be an advocacy group, a family, a social club, a church, or a professional. Coalition-building should not be attempted with such-like: they need to be shunned! But if from any walk or ilk we encounter people who REALLY DO abet my liberty, equality, fraternity-- then by all means these need to be cultivated, and in ways that speak to micro-power, and by that politics. I have actually found this interest motley in all kinds of groups-- some of which say they are interested in mental health consumers and others not. To my assessment, the providers look more like allies -- for the most-part-- and not adversaries. I wish the drumbeat I now hear too much-- toward blaming the HELPERS we have-- who figuratively and literally 'provide' -- and away from the real responsibility of those who provide-not.

Assertiveness then is an important aspect of what we consumers need to DO: it is part of our requisite responsibility. But not all the discrepancy falls because we have not assertively asked for justice: what-we-ask-for is a service unavailable to us at request or demand or price. The structural imperative thus becomes: ORGANIZE BY ANY MEANS NECESSARY! BY POLITICS CERTAINLY! WITH COALITIONS OF SADISTS, NEVER! As in the example of Rosa Parks and Martin Luther King, Jr., such existential/political responsibility and action will be the real framework from which assertion will "work."

--Vernon Lynn Stephens, MSSW
D.S.M. IV-TR # 296.44

Telephone: 1(502) 561-5419 anytime for MH issues
Email: freethink@insightbb.com anytime for MH issues

2008-01-14T09:35:00.000-08:00

Recovery in Mental Health as "..a Combination of Rights and Obligations"

Mental health "recovery" is the by-word in this field today. It seems to mean an emphasis on empowerment, partnership-with-providers, and aggressive-community-treatment (ACT) more than aught-else. The term "recovery" seems nuanced from the standard (medical) definition of this word, which at this social locus denotes "remission-of symptoms" essentially. This in time may prove to be a merry source of confusion, conflict, yea competition between providers and consumers (as well as other stakeholders in mental health.) I have 'come down' of late into promotion of mental health recovery as a movement; however, it still would seem as though the potential dissonance between the movement's terms and the terms of the mental health discipline(s) will require clarification.

None of the salient definitions from the "recovery" movement that I have read suggest that there will be in all cases a total remission of symptoms. The talk of being a "survivor" in an asymptomatic state is on close examination brave utterance, and even these survivors will usually and forthrightly say that some mental health consumers remain symptomatic. On the other hand, there seems to be a waning of the old-line provider-types who see as IMPOSSIBLE recovery in psychiatry as meaning a nearly-asymptomatic state. This has to do with the veritable fact that outcomes for even the most-severe psychiatric diagnoses have become-- with treatment-- more-benign, more-favorable, more-optimistic. However, clarification of terms and agendas in both camps-- I regret that there are becoming "camps" and "sides" in this teamwork-- might help and abet constructive work in this area.

I prefer the term "empowerment" as an overall descriptive for this process with mental health consumers: this puts the discussion immediately into the realm of human/civil rights language, and this seems to be exactly what is meant when publications cite recovery as "...a way of living a satisfied, hopeful and contributing life even with the limitations of [mental] illness" (William Anthony, Ph.D., 1993)--"...the process in which people [with a mental illness] are able to live, work, learn, and participate in their communities" (the President's New Freedom Commission on Mental Health, July, 2003)-- "... a journey of healing and transformation for a person with mental illness disability to be able to live a meaningful life in communities of his or her choice while striving to achieve full human potential or personhood" (SAMHSA, ~ 2005, may have provenance from Dr. A. Kathryn Power, Director of SAMHSA at the time.) What is defined-in-context in other words is quality-of-life as well as self-determination more than the elimination/obviation of a clinical state per se. Here I think we "have something" on which to work.

Actually, on the issue of quality-of-life and self-determination, there will be little quarrel from providers. Indeed, this type of terminology is specified in-- say-- the Code of Ethics of the National Association of Social Workers (NASW.) And neither the psychiatrists nor the nurses nor the psychologists have any ethical qualms with this agenda of informed-consent-to-treatment-unless-dangerous-to-self/others. And, as I have indicated, the empiricism works into a moderation of the notions of outcome/prognosis for the mental disorders generally.

While there may be tiffs about "recovery" as full-remission to some in mental health, few anywhere would argue contra the person's best-obtainable quality-of-life OR self-determination. I think it better to use "empowerment" as the general term for this process, referring to the specifics of this type of quality and determination. Not only doe this have justification in terms of usage I have limned here, but for the civil/human rights aspects-- upon which I shall devote words in the next portion of this entry-- this word-choice seems optimum.

There was a time when mental patients were locked away into total-institutions-- euphemistically called asylums-- where for the mishap of schizophrenia or bipolar-disorder one would "do life"-- dwell incarcerated until death-- in conditions in many ways not distinguishable from prison. In about 1956 came chlorpromazine and lithium -- then the inexorable process of deinstitutionalization, after which mental health consumers went to eke out community existences-- not uncommonly very isolated/lonely existences-- on their fare of neuroleptic-and-shunning by almost everyone. For a time we were not "welcome"; to degrees this is still so, although not to the extent that existed in the 1960s-1970s with the ubiquitous urban mega-personal-care-homes (PCHs) which became the "new back wards." Until quite recently and until quite-quite recently in venues like Missouri, mental health consumers would not vote. Occasionally one finds reports that marriage is prohibited HERE AND NOW because one/both of the participants have a mental disorder. Because of the deranged killer at Virginia Tech-- slaying 32 people in pique after being jilted-- we may fully expect stricter-laws on the "book" about mental illness incarceration, and in practice more-highhanded-arrest-practices in mental health-- for which no apologies will now be given. Jailing of mental patients-- a crime-against-humanity decried by Dorothy Dix in the 19th century-- is NOW a common practice-- 25-35% of the population of people residing in jails are mentally-ill. As these impinge on "life, liberty and the pursuit of happiness"-- that which EVEN applies to those who would be "put-away"-- there ARE civil rights' aspects to this condition. The term EMPOWERMENT is thus with no reservation a "good" term to use for the real-need-- not the brave-utterance extraneous.

We consumers have a REAL rights' issue with which to deal. But with rights come responsibilities. Not all the responsibilities are subtended by the guidelines providers have occasionally in-print about "what the patient needs to do." These statements all tend to be one-sidedly-in-favor of the provider, are virtually like the bad-old-days' "yellow dog contract" not to join unions in the 1930s and prior in Kentucky coal-mining. We consumers DO need to be responsible to providers-- who have no bounden obligation to treat us like indulged babies, and can "fire"us as much a we "fire" them. But in a larger sense, I mean to say that the mental health consumer needs to expert philosophical/existential responsibility in her/his life-- which means a devotion to having the wherewithal to make informed choices about one's condition and treatment-- and to "take what happens"-- the risks for mistakes and not to project these to "that doctor, that nurse, that psychologist, that social-worker who MADE ME DO THIS MISTAKE."

I do not see enough informed responsibility-- of the existential/philosophical kind-- or of the assuming-responsibility-for-mistakes-type in the mental health consumer movement-- on which by now I have four decades of experience. NOTHING IS CHANGED if either we "let go" without service complaint a sadistic provider; NOTHING IS GAINED by feeling defensive about the actions of these 'uncaught' deranged commiters-of-mayhem who should be in the hospitals designed for such folk; ONLY FOLKLORE AND OPINION-OPINION-OPINION is uttered if we do not study mental health, our conditions, our cures, our legitimate outcomes/prognoses. All of these matters require people who will either exhibit a measure of responsibilities -- or who will be treated like babies and criminals. These terms exactly would seem to apply to the social contract which has been afforded to the mental health consumer: let us know both ourselves and our rights through empowerment; recovery-as-being asymptomatic is entirely another issue, not as important as this-first-desideratum.

--Vernon Lynn Stephens, MSSW
D.S.M. IV-TR # 296.44

Telephone-- about mental health: 1 (502) 561-5419 anytime
Email: freethink@insightbb.com anytime

2007-12-26T22:55:00.000-08:00

On Mental Health Consumers Showing Anger
About Prejudice against Mental Illness:
The Lines and Fine-Lines
Between Aggression, Assertion, and the Survival-Instinct

In "A Working Definition of Empowerment," by Judi Chamberlin, Psychiatric Rehabilitation Journal 20(4):43-46, I read that "[l]earning about and expressing anger" is an important facet of defined empowerment [for mental health consumers]. I wish to explore this topic, from the rather-predictable standpoint of what social science has to say on this topic-- and then to embellish this with report of my own observations and experiences on this matter.

In general, the folks who study these things usually make a distinction between such anger/hostility as is expressed aggressively versus assertively. "Aggressive thinking focuses too much on pleasing oneself at the expense of others. Aggressive thinking often ignores the impact of one's behavior on others. It is an "I win, you lose" position. Aggressive behavior includes many forms of domination and direct manipulation. Aggression usually aims at getting control of situations or getting ones goals met no matter what the consequences are to others" [see "Assertion Training: Be More Competent and Confident With Anyone!," by Tom G. Stevens , at this link.] On the other hand, assertion means "Asserting yourself means asking for what you want and need. Assertion is not aggression; it is not a process of demanding, taking, bullying, cajoling, whining, complaining or stepping on others. Self-assertion is about asking for what you want, directly and from a position of strength, without demanding or begging" [see "Assertiveness Training," by Mark Sichel, at this link. ] It is commonly said that the process of becoming assertive may require training, such that "[t]he basic idea behind assertiveness training is to practice assertive actions until they can be repeated even under stress" [see "Assertiveness," giving an overview of this training at this link. ]

Generally speaking, I would say, most people subject to mental illness have problems in expressing anger: they will do so either aggressively or passively (I tend to fit into the latter category.) This problem area generally comes with a hylebiopsychsocial loading-- conditioning and biology therefore do play a role in this set of difficulties [see "Aggression," in Wikipedia at this link ]. On the other hand, this problematic is not unique to the cohort of mental health consumers: frequently "normal people" [albeit with some bad habits] engage in aggressive behavior-- the type acted passively perhaps being more common [as more-socially-acceptable] than the physical type of aggression. Assertion implies elective behavior: in hopeless conflict-- where the outcome is certain to be BIG-TIME LOSS, it can be reality based "not to play." Most conditions of this type are not-so-lossy, however, and the skill of assertiveness really implies some discernment-- the ability to detect situations-- generally social-- when "constructive engagement" is a possibility.

As humans-- professionals are not immune from anger-resolution problems: one very frequently encounters passive-aggression in the mental health profession-- the aggressive-aggressive type only surfaces now and again-- and sometimes have surprising power to survive in the system despite the usual discomforts that collleagues and virtually all others feel toward them. Sometimes the mechanism behind this is displacement-- "kicking at folks" figuratively when frustration is met. In other conditions, it becomes quite apparent-- especially when one wits that "the problem is not what I say, it's that I said it."

In psychosocial work-- by which I denote psychiatry, psychology, social work, nursing, and (pastoral and other) counseling-- it is apparent that the passive form of aggression is quite acceptable, practice, particularly if a clinical reason for humiliating behavior can be explained/imagined. In particular-- while it is necessary and when done correctly is valid-- diagnosis can and is played as a "game" with sadistic intent. Accordingly, the person on the receiving end of diagnosis-- and this applies to clinician-colleagues as well as "patients"-- may not infrequently be the real, though subtle victims of aggressive intent on the part of the "diagnosticians." While there are protections developing for MH pros against this raw use of diagnostics as a "weapon" [ see for example the section on "Impaired Professionals" in the NASW Code of Ethics ] -- frequently a successful weapon-- for being one's cruel self and getting away with it-- this is certainly not the case with clients/patients/consumers and aggressive behavior-- as fancifully or really defined-- will routinely net a "bad diagnosis." The sequelae to this gamespersonship in mental health is of quite wide distribution-- such that a consumer with a "legitimate beef" with the clinic/clinician(s) will still run a certain definable risk of being defined as "a personality disorder" [like antisocial, schizotypal, passive aggressive] when in fact the real "owner" of this diagnosis may be the person writing this up in "the chart."

This is the upshot for the mental health consumer: one has to be extremely careful in expressing anger to mental health professionals: they will quite frequently "play with this," by psychopatholgizing what may indeed be even quite assertive, needs-based pronouncements from the client; this in turn becomes-- an INVALID to this extent-- stain on the consumer's record; one may even assume that there are clinicians "looking-for/ferreting-out" as much aggression from an assertion as possible: IN THIS THE 'DONKEY'S GLUTEUS MAXIMUS' SYNDROME WILL BE IN EVIDENCE-- BUT IT WILL HURT THE CONSUMER-- IS DEVILISHLY HARD TO OUTLIVE-- AND EVEN A VERY PLAIN-SPOKEN ASSERTER CAN FIND HERSELF/HIMSELF IN A "PICKLE" OVER SUCH SHENANIGANS.

From the "inside" and the "outside" of the mental health profession, from much lived experience, I can vouch for the verity of what I contend here. While submissiveness to this form of psychological sadism is definitely counter-indicated for the consumer-- one still should carefully weigh all contingencies as a person with mental illness when taking up issues with the MH pros-- one certainly runs here a risk of unethical and invalid diagnostics-- as well as punitive measures-- including involuntary hospitalization when outside the institutions-- and seclusion/involuntary-medication/shock-treatments/psychosurgery-- depending on how the clinician(s) see you and how cruel and how dishonest they are.

So: CAVEAT!!! Beware! Pick-and-choose your conflicts with mental health clinicians with savvy-- and by all means be assertive, non-aggressive as possible. This will not be 100% insurance from keeping you from involuntaries-- but it may help.

--Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV-TR # 296.44

Telephone: 1 (502) 561-5419 anytime
Email: freethink@insightbb.com

2007-12-25T01:06:00.000-08:00

What Happens When Mental Health Professionals Who Are Consumers
"Come Out of the Closet":
The Telling Case of Kay Redfield Jamison, Bipolar Psychologist,
And the University of Louisville (Kentucky) Libraries System

It could be that Kay Redfield Jamison, Ph.D. psychologist, is the most-prolific mental health professional who-- as a person with bipolar disorder-- is a consumer as well of mental health services. Her books are "serious" and usually quite academic, and all relate to the topic of her experience with mental illness, both personally and professionally. According to the comprehensive Web-source "Bookfinder.com," Jamison has out nine (9) published works; these nine include her beautifully-written An Unquiet Mind (1995) and its translation into Spanish, as well as Manic-Depressive Illness (1990)-- at the time and unto now THE authoritative statement on bipolarity as a biopsychosocial condition.

But let me explain the "treatment" this signal writer-- a MH professional who admits to being bipolar-- gets from a major American academic library system-- the University of Louisville system-- which includes a panoply of University libraries-- including those for arts and sciences and medical (including psychiatric) books. According to the search I did this night, "Jamison, Kay Redfield," in this system renders but an announcement "Your search results in no hits!" This finding almost certainly means that these several libraries contain NO books by Jamison. According to the Table D-- on cumulative binomial probabilities-- a cognate for the "sign test"-- in Nonparametric Statistics for the Behavioral Sciences, 2nd Edition, by Sidney Siegel and N. John Castellan, Jr., 1988-- this 0:9 skew reaches a confidence-level of P < .002-- "would occur by expectation-of-chance only once in 500 totally-random trials." Phrased in a Bayesian way, using calculations that are more-in-vogue now, this skew has an odds ratio (OR) stands at .0229 with 95% confidence-intervals between .0038-.1378.

Both of these sets of figures are what is called "statistically significant." But like the sign test, these data only show that some condition here is non-random. A kind of post-hoc analysis is possible, however, in an effort to explain-away why this non-randomness should occur. I shall do so by way of "thought experiment" (which is a valid technique used in such disciplines as physics and astro-science) in order to derive an exhaustive list of putative hypotheses for this differential. More or less in the spirit of the "principle of charity" used in logic, I shall derive such a list with the emphasis on the most defensible exclusion-strategies for the library system here and those wh0 influence the selection of its books.

The University of Louisville libraries system esteems Jamison not to be a significant academic writer. This thesis might be used only tenuously, for outside of this system, Jamison is well-respected both by the public and by academics; she is considered a "saint" to mental health consumers.
Jamison's work is TOO OLD, DATED to be in the collections. Again, with a collection of hundreds of thousands of books-- if not a number in the millions-- some of which date back to the 18th and 19th centuries-- this argument does not seem persuasive, either. And besides, most of Jamison's books are of recent vintage-- less than 20 years "old."
Accident/Other: The library systems did not KNOW about Jamison or of her important psychosocial work-- particularly on bipolar disorder. Again, as in Louisville, I have witnessed Jamison's theses being discussed in colloquia for mental health professionals, this claim does not persuade either. "Miscellaneous causal possibilities" seem too SKETCHY to limn here.
Those who influence the selection of library books for the system-- professors who recommend books and the professional librarians who purchase them for the system-- DO NOT ESTEEM THE WORK OF JAMISON PRECISELY BECAUSE SHE IS ESTEEMED TO BE MENTALLY ILL-- AND THUS DISCREDITABLE EVEN IF SHE WOULD PRESENT THESES OF THE PROFOUNDEST VALIDITY.

Of these theses, it is hard to avoid the conclusion that the latter is fairly persuasive, if not THE reason for the non-presence of Jamison's books in the system. If prejudice is not the entire reason for this "zero," it would still be difficult to explain this extremity to the other causes above besides the disparagement that is afforded so-called "impaired professionals" in mental health and in academia generally.

Speaking from my own experiences as a former mental health social worker, I have good reason to think from my "heuristic" that this form of prejudice toward MH pros who have experienced mental decompensation as a live factor in how mental healthers stigmatize the psychiatrically ill, and then too especially the mental health professionals who have had these conditions. I always got good "job-ratings" for my performance as a psychiatric social worker; I never ever told patients in that capacity that I had mental illness-- and my jobs did not essentially consist of psychotherapy but of supportive psychiatric services and social-history taking; but when I told fellow MH workers that I was bipolar-- BAD THINGS WOULD HAPPEN-- bosses would ask for my immediate resignation for the reason that "I talk too much"-- there was much obvious gossip and "diagnosing" of a negative sort-- when I was "pulling" a solid 40 hours of work per week under stressful (forensic psychiatric) conditions-- had two forms of professional certifications (ACSW and CSW-- and was well on my way to LCSW)-- and had two peer-reviewed professional publications-- TO BE TOLD "YOU WERE TALKING WITH XYZ COLLEAGUE ABOUT YOUR DIAGNOSIS-- YOU NEED TO GO TO THE HOSPITAL"; two psychologists insisted on administering a psy test on me on such a "diagnostic question" and after passing the test-- and he exactly told me so-- he reversed himself with the madding crowd and said that "things indeed were going on in my head" because I told some colleague that I had been in a psychiatric hospital for decompensation; in group therapy class at the Kent School of Social Work, I was given an hour's worth of the "hot seat" (all MH pros know what the hot-seat means-- a total-gang up on a member for a time) because another classmate was sure that I had "some deep dark secret that the group should know" and later when I helped this guy get a job where I worked upon telling him about my psychiatry experiences, he did his utmost to get me run-off/fired. And I could and may someday go on... but in what I say I do think I have experiences which would corroborate stigmatization against mental health professionals like myself and Kay Redfield Jamison-- the focus of this discussion.

HERE IS THE RUB: 1. while it is sometimes painful-- "one gets CLOMPED" -- for "coming out of the closet" as a mental health consumer ; 2. it is also true that "There are many ways to fight [mental-illness- ] stigma. The simplest way is to "come out of the closet" and present "positive visibility" in the community and the media" [see "How to Use the Media to Fight Stigmas and Discrimination," by Susan Rogers, National Mental Health Consumers' Self-Help Clearinghouse ] it is also true that mental health empowerment in part consists of "Assertiveness-- being able to clearly state one's wishes and to stand up for oneself-- [which] helps an individual to get what he or she wants" [see "A Working Definition of Empowerment," by Judi Chamberlin, Psychiatric Rehabilitation Journal 20(4):43-46, Spring, 1997 at this link ]; 3. as mental health professionals who are consumers, we need to abet the process of this assertiveness, because "We mental health professionals have unwittingly reinforced ... devaluation of consumers... Individuals with mental health problems and our families also have contributed to stigma and discrimination by being silent about our illnesses, by promoting coercive approaches (in the case of some families), and by not effectively organizing politically to alter public attitudes and policies" [see "All We Are Saying Is Give People with Mental Illness a Chance," by Paolo del Vecchio, M.S.W., Psychiatric Services 57(5):646, May 2006 ] .

Therefore the mental health professional who is a consumer is in a special cohort-- and we need by all accounts to show leadership when blatant and subtle discrimination occurs. This with exactitude would seem to be our existential calling. Thus now I hold up the cause of Kay Redfield Jamison and the non-presence of her important books in the libraries of the University of Louisville. In the same way, historically, black people had long experienced the dearth of materials in mainline sources for the content of black thinkers/intellectuals/writers. An important thinker like Jamison for mental health NEEDS at every count to be shown here: SHAME SHAME SHAME ON THE UNIVERSITY OF LOUISVILLE AND ALL ASSOCIATED WITH ITS LIBRARIES FOR PERPETUATING THIS INJUSTICE!!!

--Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV-TR # 296.44

Telephone: 1 (502) 561-5419 anytime
Email: freethink@insightbb.com

2007-11-26T17:16:00.000-08:00

BOOK REVIEW: Stigma: Notes on the Management of Spoiled Identity
by Erving Goffman, Jason Aronson [publishers], New York, New York, 1974 (1963)

"Stigma refers to a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with mental illnesses. Stigma is widespread in the United States and other Western nations. Stigma leads others to avoid living, socializing, or working with, renting to, or employing people with mental disorders - especially severe disorders, such as schizophrenia. It leads to low self-esteem, isolation, and hopelessness. It deters the public from seeking and wanting to pay for care. Responding to stigma, people with mental health problems internalize public attitudes and become so embarrassed or ashamed that they often conceal symptoms and fail to seek treatment." -- Executive Summary of New Freedom Mental Health Commission, Achieving the Promise: Transforming Mental Health Care in America," lined/'versified' text for which may be found at a recent work of my construction on Google Base (link here) -- with the help of Notepad + + and Mr. Alan Reed's "Simple Concordance Program" freeware; this quotation is at paragraph-number 353.

Abundantly, for the people who are mentally ill, stigmatization is a living, real problem. We must stay out of "trouble"-- meaning concretely the mental hospitals, but also too frequently jails and homelessness-on-the-streets; on the other hand we are systematically given "trouble- that-betroubles-us-the-more"-- as when we are discriminated against in non-psychiatric-medical-treatment, loans, housing rental/mortgage, employment, even at known times in voting and jury-duty. This social force has not gone unnoticed in social-science literature of late, and has become a buzz-word-sanguine in psychiatric literature. [See, for example, "Stigma in Psychiatry," by Alison J. Gray, Journal of the Royal Society of Medicine 95:72-76, February 2002 ; ALSO " Usages épistémiques et sociaux de la stigmatisation. Pour une approche philosophique du concept de stigmatisation,"
Marie-Joseph Bertini, L'Information Psychiatrique 83(8), 2007 (English translation of abstract available at this link) ; ALSO "Stigma ! Vaincre les discriminations en santé mentale," by
Jean-Luc Roelandt, Aude Caria, L'Information Psychiatrique (translated English abstract at this link.) ] In this entry I shall hearken back to what may be the first seminal literature on the subject of stigmatization-- essentially as it is defined in the first paragraph, above-- in the work Stigma: Notes on the Management of Spoiled Identity by Erving Goffman, Jason Aronson [press], New York, New York, 1974 (1963.)

Prior to the advent of this last-mentioned work, to be reviewed below, the word "stigma" largely had a usage with theological overtones. We know of the "stigmata" (the plural of "stigma" from the Greek) of the Five Wounds of Jesus and reputedly of saints, but even here there was some sense too that a stigma was an emotional scar/mark that adversely affected one's social identity.

It was Goffman, though, who seemingly brought to front-and-center this terminology for use with all people who bear "marks"-- visible and invisible which have the effect of discrediting them in their communities/society (page 4.) Here Goffman does not restrict stigmatization to mental patients (although they are here acknowledged to suffer from stigmas) but of the general class of discredited folk: Goffman in a word strives properly for a truly sociological view of stigmatization as a social process (pages 146-147.)

However, Goffman has much to say that is 100% germane to the condition of mental health consumers here-and-now, and from its publication mental health advocates of all types have proffered this as being 'about persons with mental illness.' Very briefly, I shall outline some of these contributions to uplift for the mentally ill humanity, then discuss their implications for our lot.

Goffman says that the principal [existential] issue with the stigmatized is one of "acceptance" (page 8.) The stigmatized person's main objective is to be acknowledged as essentially normal (page 20) in which "... [o]ne phase of this socialization process is that through which the stigmatized person learns and incorporates the standpoint of the normal, acquiring thereby the identity beliefs of the wider society and a general idea of what it would be like to possess a particular stigma" ( page 32.) In other words-- stigmatized persons-- including people with mental illness -- tend in time to take on the prevailing views of society about themselves and their general and stigmatizing condition(s).

This trend has untoward consequences. One possibility is to attempt to "pass" as having no stigma, or to hide its indications [ "reverse passing"]-- "[t]he management of undisclosed discrediting" (page 42 and sequence.) This passing-tendency is well-known among the persons with mental disability-- we are told explicitly and implicitly "not to talk about your old psychiatry." It is easier to "pass" with a psychiatric condition than might be in other social situations-- among black people and Asians for example this is by no means easy to do-- although plastic/cosmetic surgeons do busy themselves frequently with requests to make clients "pass for white." [ Regard this phenomenon in China, Korea, and Japan; observe also the 'whiteness' of Michael Jackson on mag covers.] The mentally ill person may often easily "pass for straight" by assuming a normal lifestyle and NEVER EVER HINTING that 'abnormal' psychology is afoot somewhere about.

Goffman speaks of another trend which is telling to me: the movement to "come out of the closet," and do supremely-competent works, publish, produce "be fruitful and multiply" this surfeit of competence. We have long known of the"special Olympics" generically-speaking-- those who by excellence prove themselves to a hesitant world, and by universal acclaimation win the "laurel wreath" of societal victory-- simple appreciation for "being great." Of very late, so recently out of life-incarceration in the public asylum, we mental health consumers have also taken this route. In my experience, people like Kay Redfield Jamison (a psychologist with bipolar disorder and expert on bipolar in her own right), Nobel-prizewinner John Nash (a person who has "gone public" as having schizophrenia), Ernest Hemingway ( a great writer who had bipolar disorder); and of late mention is made that Abe Lincoln and Winston Churchill suffered from major depression; theologically, it is even argued that Biblical prophet Ezekiel had major mental illness [perhaps associated in my estimate with temporal lobe epilepsy-- see analysis in Peake's Commentary on the Bible, Routledge, London, United Kingdom,1997 (1962), page 569.] Coupled with this tendency is a trend toward specialty -- and interesting-- publications indicative of transcending stigmatization (Goffman, page 25.) In the budding mental health consumer movement, there is a decided thrust to "go public" by publishing openly the haps/mishaps befalling the persons who are mentally ill, showing up now on the "Web" in abundance.

It must be remembered that Goffman is a sociologist: he intends here to describe stigmatization from a detached, objective-as-he-can-get perspective. At one point toward the end of the work, he even goes so far as to say that stigmatization may have a socially useful function, that is, for controlling "deviance" (page 138), but almost immediately prior he DOES accede that

"Tension management and information management have been stressed-- how the stigmatized individual can present to others a precarious self, subject to abuse and discrediting. But to leave it at this creates a biased perspective, imputing a solid reality to that which is much shakier than that. The stigmatized and the normal are part of each other; if one can prove vulnerable, it must be expected that the other can, too. For in imputing identities to individuals, discreditable or not, the wider social settings and its inhabitants have in a way compromised themselves; they have set themselves up to be proven the fool" (page 135.)

This truth is just beginning to "register" in the American psyche, concomitant with the emerging consciousness of persons with mental illness that they are-- as Jesse Jackson utters every Project PUSH meeting-- "I AM SOMEBODY." Clearly there was a time, not long ago at all in history, when the opposite was shoved on folk with mental illness: the message that we are second-third-fourth-fifth-sixth-seventh-eighth-ninth-tenth-eleventh-twelfth-thirteenth-class citizens-- if even that.

Therefore for mental health consumers in the 21st century, Goffman's message rings with particular relevance. What is to be gained-- except to flatter social arses and boors-- our silence and our "passing with invisible disability" when we can be proven able, enabled ?

The road for us-- the peers who have suffered from the stigma of mental illness--need now to become lionized, courageous, resourceful. "Merely following doctor's orders" on the backwards and bedlam-barracks is not the order of the day. Bravely, and responsibly we need face our "New Freedom" and banish to the shadows every vestige of the sadisms-- and its obverse-- the patronizations-- which have heretofore held us captive. We can do this in partnership with the possessed of "wiseness" -- outsiders who understand but do not experience our condition except vicariously(Goffman, page 29): with this confederation we certainly will WIN.

Therefore let us-- the stigmatized and all wise ones-- down this promising path. We cannot but succeed. The way is easy for we have been accustomed to keeping-balance under conditions of imputed failure. I say again, WE SHALL WIN, WE SHALL WIN, WE SHALL WIN!!!

-- Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV-TR # 296.44

Telephone: 1 (502) 561-5419
Email: freethink@insightbb.com

2007-10-31T12:54:00.000-07:00

The Need for True Consumer-Orientation in Mental Health:
Simple Marketing Orientation to a "Population Seen, Not Heard"

This entry will present a modest proposal: that the mental health consumer is to be "heard" as well as merely "seen" -- or "preached-to"-- for services, that a "consumer-centric perspective" be applied in the delivery of psychiatric services and in mental-health-advocacy. While I must admit that "the customer is not always right" in mental health-- there are certainly a minority of times when we need involuntary services-- the general orientation of all service-provision in mental health seems to be overweeningly: "Take this as prescribed, and come in for your next appointment"...alternatively, by certain would-be advocates "don't listen to the shrinks-- do this/that/the-other that WE espouse as alternative medicine." The real amount of feedback about what the "customer" in mental health wants seems to be minuscule, and often what is served-up is a reflection of numerous other public and agency and so-called MH-advocacy considerations having nothing to do with the comfort-level of those on the "receiving end" of service.

On the other hand, beginning with the "new vocabulary" in no small part stimulated by the National Alliance for the Mentally Ill (NAMI) the terminology for "mental patient" has increasingly shifted to the expression "mental health consumer." We are now called "consumers." That is a usage that is nearly as polite now as calling people "gay" who used to be called, less-flatteringly perhaps, "homosexual." To this end-use, we witness a number of entities that purport to "serve mental health consumers," like "The National Mental Health Consumers' Self-Help Clearinghouse," He@lth.com's Website "Mental Health Consumer Connection," "The Texas Mental Health Consumers," "The Alaska Mental Health Consumer Web," "The National Coalition of Mental Health Consumer/Survivor Organizations," "Pennsylvania Mental Health Consumers Association," "Georgia Mental Health Consumer Network, Inc.," "The National Empowerment Center," "M-Power"-- a Massachusetts organization-- "Recovery, Inc." may be cited in this connection-- and there is also a group called "NCMHPC: National Coalition of Mental Health Professionals and Consumers, Inc.," (to which I have been a sometime-paid-member... I say with pride and to express possible conflict-of-interest/affiliation.)

All of these by intent-- I say with numerous others-- are good, and the federal mental health and substance abuse agency-- SAMHSA-- professes profound support and encouragement of the work of these organizations. My purpose however is to stress another matter than the intent of these organizations, only their protocol(s). My words are NOT intended to be critical, but a "call for effective design." Again, this is not to suggest that mental health consumer/survivor groups have bad design, only that what they do could be re-directed in ways that would more-fully achieve the stated-goals/objectives these organizations profess.

To commence on this foray, I need to specify my own perspective/orientation/even-biases: I have been a mental health consumer now for the greater portion of my biograph; that I acquired the requisite credentials and worked in mental health professionally is really parenthetical to this discussion; but to the point I have been on the "receiving end" of services both by mental health agencies/professionals and by the organizations which are supposed to "advocate" for my/other-mental-health-consumers' needs-- like NAMI and the Mental Health Association (to a limited but finite extent) and Recovery, Inc. and KyMAP (a Kentucky mental health consumers' organization) and briefly the National Empowerment Center (in a side-connection to KyMAP.) While like all things this exposure has been a "mix" in all human aspects, I will have to posit initially that my experience has on the whole been more "positive" than "negative," and that everything I utter here is intended to be constructive and put-forward on the basis of still-limited information. In other words, I have no precise idea as to how ALL the organizations I have listed on this page "do their homework," only to what I have seen/heard/touched/"smelled" with the mental health consumer organizations to which I have been exposed do with the "design" and "consumer-service delivery" components of their activities.

My contribution is based on an utterly-simple proposition: that if WE are mental health "consumers" then the same principles generally-applied to consumer "marketing" (which of course need not-- by any stretch-- be by necessity a commercial endeavor) apply: we need to regard what is the prevailing model for this well-established discipline as a "learning experience," and to perhaps instruct on how a "consumer-orientation" in general is accomplished "outside of our fold." Now "marketing" is a well-established discipline-- and I know from exposure to the language of the mental-health groups that the inspiration for the term "consumer/consumerism" herein derived from the argot of the marketing specialists in business. So I shall spend a moment of the reader's time limning the basic concepts of marketing, before examining my witness to what-the-consumer-movement-means-in-mental-health:

We read in the (instructive if incomplete) article on "Marketing" in Wikipedia: The Free Encyclopedia that marketing consists of "a social process which satisfies consumers' wants." In further elaboration, this source suggests that service-agencies have three additional requisites-- 'people, process, and physical-evidence-- that are in-addition-to those four required in a endeavor which has a productive orientation (the four-- which are needed for all orgs including the not-for-profits-- are 'product, pricing, promotion, placement'-- the "four--basic-- Ps"): thus we can speak of "the seven Ps" of good marketing for not-for-profit/service-rendering organizations in mental health. The specific requirements for proper marketing-orientation are: 1. determining customer/consumer need-- which by whatever valid method can be termed marketing-research (see "Marketing Basics," in Free Management Library ) ; 2. effort need to be made-- especially in not-for-profit/service-delivering agencies-- to do "customer/consumer service" as an essential part of the enterprise (see "Basic Guide to Nonprofit Program Design and Marketing," from the last-mentioned source here.) By adhering to this customer orientation, I hear Scott Carson, President and CEO of the Boeing Corporation (making aircraft) say that a business that thrives finds such input absolutely essential ( source: Mr. Carson speaking in a broadcast over "The Research Channel," this day-- Wednesday, October 31, 2007, at 2:00 p.m. EDST.)

To what degree do the sundry "helpers" or "would-be helpers" maximize the consumer-orientation in their "consumer advocacy"? My response is tripartate: 1. the State agency -- principally Central State Hospital-- with whom I have dealt has very-little-if-any-consumerism about it-- here one is expected to "just shut up and take it"; 2. the community mental health center-system (CMHC) that serves me-- "Seven Counties Services" in this region-- provides a surprising amount of opportunity-- through simple suggestion to the staff, opportunity to attend and participate in Board meetings, and -- when all else fails-- appeals to the Agency Ombudsman; 3. the agencies which are supposed to "advocate" my rights (don't want to be nasty-- they are listed above, though) have yet to ask (my/essentially-anybody's) consumer-evaluation/opinion about much of anything: instead the appeal is to the family of the consumer (which inevitably WILL have its own bias/heuristic-of-availability which sometimes will differ from that of the consumer/client) and occasionally to special-interests -- "crackpots" and "vitamin people" and "squeaky-wheels-in-mental-health," rather than to US-- THE CONSUMERS THEMSELVES.

This makes the mental health so-called advocacy groups to skew heavily toward what-minority-interests-want, not toward the prevailing-reality-for-all/every-other-mental-health-consumer/client/service-recipient. TO THIS DAY there are voices in "consumer-advocacy" -- such as elements of those in NAMI and the National Empowerment Center-- who would put-forward for schizophrenics and schizoaffectives a megavitamin therapy with niacin and vitamin C when these have CLEARLY demonstrated not to be effective ( see review, "Megavitamin and Orthomolecular Therapy in Psychiatry," American Journal of Public Health 64(4):410, 1774 ; ALSO Entrez PubMed abstract for "Megavitamin and Dietary Treatment in Schizophrenia: A Randomized, Controlled Trial," by K. Vaughn and N. McConaghy, The Australian and New Zealand Journal of Psychiatry 33(1):84-88, February, 1999.) This is NOT to say that there are no dietary/food-supplement-additives useful for any psychiatric conditions, for clearly vitamin thiamine is essential for treating (alcoholic) Wernike's/Korsakoff's syndrome, and the omega-3 fatty acids are beginning to show some promise for the treatment of major affective disorder, for example. But to "rally troops" around the lie-- here that vitamin C and niacin "cure" schizophrenia -- is very-close to popular deception. Similarly, to claim-- as do exponents in the National Empowerment Center-- that taking psychotropic medication by "consumers" is optional-- when ever-so-abundantly-evidence-lies-in-the-contrary-- comes pretty close so promulgating pseudoscience to a cohort that needs-nothing-but-facts-and-reality as its guide. "Recovery, Inc." also comes close to hoodwinking mental health consumers by having hardly-impaired-at-all-one-time-prior consumers read from a Quotations-of-Chairman-Mao-type book slogans which are-- by "training the will"-- cure mental illness.

Indeed, due to the charismatic nature of the way groups coalesce sociologically, and due to the typical history of organizations with ideological underpinnings-- if one might be permitted the analytic method of Max Weber-- such a bias toward original eccentricity in founders is to be expected: but this is not to suggest that in each case the eccentric founders should be heeded forever/always-- for the simplest and most-compelling reason that such individuals are likeliest to have gotten themselves into the role of establishing a new community by virtue of having been "deviant from mainstream." So it is in mental health: "consumerism" needs to outgrow the ideological underpinnings that motivated the peculiarities that impelled -- for essentially wrong-headed motives (the "right motives"-- with evidence-- are OK)-- need to be discarded for true needs-based intervention. And in advocacy, there is no higher need than to do what has not been done by any of these groups-- with whom I have had experience-- which are supposed to "really be helping me."

Thus I/we need organizations which will really "sit down and listen": our cause is real and just, has nothing to do with "weak wills" or "not-taking-our-vitamin-C." We need never listen-- in a true marketing orientation-- to banter about either of these subjects when they have been proven incorrect-- or to anybody-else's-idea about what makes-us-comfortable-when-we-do-not-feel-comfortable. The "willpower" gambit has been tried on us-- doesn't work; the "vitamin gambit" has been pushed on us-- doesn't work; but what does work (in addition to taking scientifically-demonstrated psychopharmaceutics) are simple things like visitation, and the opportunity to sit down with someone (call her/him a psychotherapist or whatever you want) to explain all our LONELINESS and HOW MUCH THIS HURTS...AND BOY!!! THIS DOES BETIMES HURT; we need to be spared from homelessness; we need -- because almost to a one we are destitute-- public-health/Medicaid/Medicare; and certainly we do not need arbitrary "busts" with beatings and handcuffs by the police when we have raised our voices; we need something but "kangaroo" Mental Health Courts-- ones that will LISTEN when we try to explain that WE GOT BEATEN BY A PROPERTY-MANAGER WITH AN OAKEN STICK, DECLARED "CRAZY" AND SENT TO THIS LOCK-UP-AS-DANGEROUS-TO-OURSELVES; we need so many basic, basic, basic things that the "advocacy groups" backed by jaundiced "families" with limited knowledge and equally-limited-yet-Machiavellian-social-skills are NOT providing for us. [Here there is more "correction for misbehavior" required of my "advocacy groups" than from any professional mental health agency.]

Again, I wish to state in the profoundest way I can that these words here are not intended to be unfair/negative criticism-- only an assertion that virtually to a one the "advocacy groups" that are supposed to promote my needs and to a substantially-lesser extent "the professionals" profoundly do not practice "consumer marketing" but instead promote their OWN AGENDAS... And this too would be OK with me if/when their objectives are evidence-based/scientific-- and little there is to suggest betimes that such is the case.

"What the customer wants" is not always obtainable, necessary, or even desirable in the case of mental-health-service-delivery: nevertheless in hundreds of simple ways, the marketing orientation-- implied by the fact that now we are called "consumers" of this type of service-- could certainly sans "agenda-setting" by anyone-else be practiced with overwhelming good effect!

---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV-TR # 296.44

Telephone: 1 (502) 561-5419 anytime
Email: freethink@insightbb.com

2007-10-26T07:56:00.000-07:00

A Sometimes-Stigmatic-Struggle: "Not in My Back Yard" (NIMBY):
Local Resistance to Group/Foster-Care/Supported-Living/Just-Being-Neighbors
For the Chronically-Mentally-Ill/Mental-Health-Consumers

Due to the cultural stereotypes of what "crazy people" are reputed to be, and occasional/infrequent mishaps which do occur when the mentally ill live unprotected outside of the residential hospital (there are now "partial hospitals," too), mental health consumers are recognized to be among the least-desirable housing rentees and undesirable neighbors. According to SAMHSA-- a federal mental health and substance abuse agency, a common stereotypic response in communities is "not-in-my-back-yard!!!" (NIMBY)-- and thus efforts must be made to assure that the mentally ill, in the "diaspora from the asylum" do not "fall between the cracks, wash-out, hit-the-skids, and end up either in a jail for vagrancy or dead of exposure in a back alley."

Neighbors who hear that they have prospects of living with mentally-ill person(s) will be provoked to "grassroots"-- albeit untoward-- agitation against this possibility. Sometimes, this agitation can have an ugly quality. In a report "Home for Mentally Ill Battles Stigma," in Star News of Elk River Minnesota, October 23 of this year, it was reported that upon news that a foster home for the mentally ill was contemplated by the Wright County Adult Mental Health/Residential Services program for the city of Ostego, locals circulated a advertisement that the opening of this home would bring in "sexual predators, drug and alcohol addicts and [additionally, by implication, as-if-to-make-matters-worse] mentally ill people into their neighborhood, and that these people might and [sic] abuse their children..." Only with diligent -- and apparently by this publication as-yet-unfinished effort-- the mental health agency and the residents themselves have done yeoman "PR" and community/social service to undo this prejudicial trend. For example, residents hold block-parties, are prime movers in "Neighborhood Watch," and shovel-out-snow from the driveways of housebound elderly neighbors. Nevertheless, despite this concerted altruism on the part of the mental health consumers who live in the home, certain neighbors still harbor misgivings about the very existence of the home "next door to us," as it were. One resident-- a woman-- persists in fretting about whether this group home will have been a 'cover' for sexual predators and the violent-mentally-ill, saying "We know more of the intent perhaps initially...but we don't know that it will escalate to these other types of individuals that move into the home." Even the visitors to the foster-home residents are feared, on the grounds that these would be "driving through her neighborhood, and she does not feel she would be able to let her young children go down to the neighbor's house to play if there are strange vehicles in the neighborhood."

The article just-cited writes favorably of the residence of the mentally ill as "neighbors." This is not always the case, however, as the 'slant' of a publication often reflects the policy concerns of the writer, and to a larger extent, of the publisher. To a limited extent, this trend toward negativity surfaces in a story "The Dilemma: Not Enough Room for the Mentally Ill," The Flint Journal (Flint, Michigan) on October 21 of this year. Here, the untoward and aggressive behavior of a mentally-ill person living with his mother at home, in which this individual (adult, male) was known to smash car windshields, and menacingly brandish swords toward people, and assault people. The point of this article-- though-- is not contra the notion of the presence of such people in the community per se, but only that foster homes -- like the one in Ostego, just described, are needed to house (certain) deinstitutionalized mentally ill. One could still obtain from a reading of this article, meta-communicatively, the sense that "those crazy people really don't belong here, WITH US." Of course, no falsification seems to be involved in presenting this story: there ARE mentally ill people-- a minority-- that perpetrate asocial/antisocial/violent acts. It would depend on which part of the "reality"-- the greater-or-the-less, one wishes to present in such accounting. The mentally ill know only too well that the "Son of Sam" and "Leon Klinghoffer" stories of notoriety about certain violent mentally ill people are by far the exception and not the "rule" where the conduct of mental health consumers is concerned, yet the stories make "better press" than the well-meaning-struggles-of-saps-who-lost-employment-then-mind-and-try-to-make-it after psychiatric hospitalization.

Thus it is EASY to lose one's "happy home" as a mental health consumer as a consequence of (even mild) misconduct through eviction, and HARD betimes to re-locate after such a tailspin. I would say-- on the basis of hard experience-- that the stigma against renting to the mentally ill rivals that toward racial minorities or even to hardened criminals, "fresh outa the joint." Speaking from my own (Louisville, Kentucky) rental history as a mental patient "looking for a home", that eviction can come almost capriciously -- with trumped up reasons-- utterly unprovoked calls-to-the-police netting a putative "record of mental busts" which can thus get the consumer labeled a "nuisance" and expelled from domicile. But whether the eviction is for "lead paint in your windowsill-- gotta move" or for misbehavior-- the effect of eviction is DEVASTATING-- likely it would be on this account that one is never again able to find a "place to live," (especially) with cost-economies. From there, the trail for the consumer who "falls between the cracks," i.e. does not fall under the protection of some agency like Seven Counties Services (here) with its "wraparound services" and "shelter-plus-care" provisions for such contingency-- the result can be easily the skid-row result to which I alluded, above.

In this city, Louisville, it may betoken community non-acceptance that there do not appear to be "foster homes" for mentally-ill adults. What we have instead are an array of alternative residential facilities, such as the long-term "personal care home" (not indifferently identical to hospitalization) at Central State in Anchorage (a Louisville suburb.) And too, there are other not-public personal care homes which largely cater to the needs of the mentally ill-- one is just a few blocks from here, adjacent to Churchill Downs. Then-- more or less as an "answer" to the group/foster-home concept-- Louisville has Wellspring-- a non-profit organization established as a spin-off of the local NAMI chapter which sponsors 6 residential, rehabilitative therapeutic communities and 14 independent-living home-complexes for the mentally-ill. Seven Counties does not have foster homes per se-- according to information I received from their General Administration as of this date; this probably has to do with the fact that such programming would interfere with the ongoing projects of Wellspring.

This is not to suggest that it is difficult/impossible for the falling-through-the-cracks to occur: of this I am a "total evidence." The lead-paint eviction I experienced left me-- for honorable reasons-- in a disconnect from all of Seven Counties' (and thus Wellspring's) resources, and for an agonizing time I "had to prove myself" in dubious circumstances-- trying to 'buck' the stereotype that I was some kind of "freak" because of my uncomely position of being mentally-ill-and-on-the-town. My spell of official homelessness was rather brief, but I had to do battle with the attitudes of rooming-house managers, and of the general community-askance toward mental-health-types-who-live-in-rooming-houses-- until by happenstance I arrived at this place from whence I now write-- "a cheap apartment with adequate maintenance and an understanding landlord." To get to this happy point, I would nonetheless have to say, requires the "blood, sweat and tears" of which (affective-disordered) Winston Churchill spoke, the working through/around/over the small-mindedness of those who simply lack understanding of who I really am as well as lacking the sheer willingness to permit such empathy. I am well-aware that numerous people take "the media" as their source of connection-with-reality and thus as perception of what-is/ought-to-be. I know that the "bad press" generated by certain deranged culprits who do things sufficiently-bizarre to wind up as headline news WILL impact me-- in short order-- trying to do my best to be an ethical, "Eagle Scout" and an ambassador "taking asylum apart from the asylum" in my (impoverished) neighborhood-ambience. It is at times an up-hill climb: the likes of the Virginia Tech mayhem by an (untouched by institutionalization) should-be mental patient on April 16-- as well as all the other published stories of "bad apples from our barrel" who make tabloid-type news-- THIS EFFORT IS NEITHER EASY NOR ALWAYS SUCCESSFUL. So to the stars and the imputed-God-Who-cares-- I bid my prayer to "make it" and hope that all peaceable mental health consumers do the same.

--Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV-TR # 296.44

Telephone: (502) 561-5419
Email: freethink@insightbb.com

2007-10-19T17:26:00.000-07:00

Florida Automobile Accident Victim
Reports Discrimination Re Head Injury
Mis-Read Psychiatricly Due to Past MH History

In my role as ad-hoc mental health advocate, I get calls from desperate people -- those who have experienced and are experiencing the raw end of discrimination in palpable ways. Not infrequently, these folks lack the social and fiscal resources to do much more than "cry in the dark." Often the call to me comes out of desperation, where, back-against-the-wall, they turn to me-- a mental health consumer pledged to "the truth, the whole truth, and nothing but truth, so help me Truth" -- what Mohandas Gandhi called "the Truth-Force" (satyagraha) in order to get things done. Enough people read this web-log that there is more-than-promise that this objective of effectiveness might be met.

So it was that a Florida woman-- with Louisville, Kentucky connections-- called me on Thursday, October 18 about what has to be -- to my unfortunately casual hearing-- blatant discrimination due to her prior history of mental hospitalization. This woman, who identified herself as Faith Summut, said that she was involved in an automobile accident recently in the Sunshine State-- and sustained serious head injury. After some wrangling, all unkind to her, she was declared the victim-- NOT at fault-- in this accident. But when she tried to get Florida lawyers to take up her cause in litigation, she was spurned because years prior she had been hospitalized psychiatricly at Central State here in Louisville. The lawyers with whom Faith consulted apparently felt that the psychiatric history would weigh against court proceedings where the goal would be to determine the nature of the injury/dysfunction inflicted by the accident. Now, Faith is strapped for income; she wanted me to call her in the p.m. after our brief introductory conversation, provided she "still had minutes on her cell phone in the evening." When I called, the telephone number appeared to be valid, but subject to the restriction Faith most feared-- not enough time left for the conversation.

Accordingly, I have only a limited amount of information on which to base this report. I would like to have corroborating data, and much more of it-- but nevertheless CAN report on the experiences of people like Faith when the legal system-- like much of social order-- comes to bear on the mental patient when "trouble happens." Faith's account of the "short-shrift" treatment she has been getting from Florida lawyers is not indifferently like what countless other mental health consumers experience when ADVOCACY is needed for genuine torts which are inflicted upon us. The VERY FACT of knowing whether a victim of mishap is a psychiatric patient can make the difference between fair treatment by "the system" or none-at-all or even being victimized as "just another nut who should be locked up in the crazy house" instead of a participant of social amenities.

If Faith's situation parallels the situation in Kentucky, she could-- if she "raised heck" enough-- find herself in seclusion restrained on "emergency mental inquest" because merely showing anger to the "powers that be" can facilely be taken as "dangerousness to self/others." In Florida, this is done under the Baker Act; Kentucky has identical provisions under a Kentucky Revised Statute number (Chapter 202A.) For reasons that I find puzzling and irksome, "pesky" people can be involuntarily hospitalized after crimes or serious injury have been inflicted upon them, whereas there are other people -- like the Korean student at Virginia Tech who this April killed 32 innocent people after an unsuccessful effort at involuntary-- manage to "slip out of the grips of the law" when in fact they REALLY NEED LOCK-UP!!!

The situation about which Faith conveyed to me relates to a highway-traffic accident. But because discrimination against the chronically mentally ill is a pervasive factor in society, the "consumer" can expect the short end of justice when-- inter alia-- the legal/social matter pertains to the marketplace, the workplace, in housing, in pubic accomodation. The mere fact of "talking to oneself" in a restaurant can make a fretful waitress "call the cops on that guy," and IF the cop who comes does find out that this one-talking-to-himself is a psychiatric patient-- he runs excellent prospects of a mental health "bust," and in the process also runs great prospects of being "roughed up" by the cops-- a matter about which the hapless one can do nothing. When it comes to eviction, a landlord who has suspect grounds for removing the "stuff" of a mental patient due to the requirement of eviction-court waiting can expedite matters by having the cops "get him mad," and of course in this schlock mentality madness = mental illness, just sufficient for an involuntary-- then either putting the sap's belongings in the dumpster or SELLING IT on the open market. I myself -- as I have conveyed in this web-log-- experienced a landlord breaking into my apartment in the West End of this city, beating me enough with a oaken stick to break my left hand, then telling the cops "Mr. Stephens had been making a lot of noise down there, and I caught him beating his hand against the wall; PUT HIM AWAY!!!," which story the cops "bought" and sucessfully got the "danger to self" sustained with an involuntary in Mental Inquest Court.

We are thus looking at a pervasive pattern of inequity-of-service due to the flagrant stereotyping of mental patients. The pattern persists in every kind of amenity this society/community has to offer "respectable" folk. Elsewhere, in articles on Google Base, I have described just how "whopperjawed" this imbalance is: 80% of even the most-psychotic individuals NEVER "cause problems," while 20% of psychiatric inpatients cause 100% of the mayhem, and 2% cause 66% of the violence so storied in the media-- in newspapers, magazines, the electronic media-- and in cinematic abortions like "Halloween," with plot predicted on the thesis that a mental patient escapes from an asylum and goes on a super-killing-spree. For these misconceptions, and for the minor-minority which do all the mad criminal mischief, WE ARE WRONGED AS A COHORT OF BENIGN-MENTAL-HEALTH-RECIPIENTS.

I am so glad that Faith was able "to get a word in edgewise" to me on her at-the-limit cell telephone: her story speaks to a grim reality, the plight of all hapless souls who must deal with prejudice before and excluding-of social justice. Heed Faith Summut's case: heed the case of all mental patients subjected to "kind and usual punishment" when service should be mandated. AND ALL WHO HAVE SIMILAR GRIEVANCES SHOULD FEEL FREE TO CONTACT ME-- AT THE NUMBER/ADDRESS CITED HERE AND THERE ON THIS BLOG-- WHENEVER "IT HURTS SO."

---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV-TR # 296.44
Agonia
743 East Broadway #155
Louisville, Kentucky
40202-1711 (USA)

Telephone: (502) 561-5419
E-Mail: freethink@insightbb.com

2007-09-07T21:46:00.000-07:00

Medicare & Medicaid Cuts-- Up to 40% Less in 8 Years--
Will Gouge the Well-Being of Mental Health Consumers, and Others

On December 20, 2006-- with the overwhelming help of a Republican Congress-- President George W. Bush signed into law H.R. 6111, the "Tax Relief and Health Care Act of 2006." In his remarks prior to making this bill law, the President touted the fact that tax cuts would supposedly help low- and middle-income people, and that "health savings accounts" would make for affordable health care. Medicare cuts, however, he said would be a distinctive feature of this bill, consistent with the conservative agenda of the presiding Senate and House-- if not the pragmatic operation of the federal judiciary. In other words, it seems to be the assumption of the eclipsing Regime that the American does well with healthcare savings as long as "work works," but the situation may become more iffy by far: 1. if and when you get sick enough to be disabled; 2. when you retire or-- as a disabled person-- merge with the Social Security Retirement crowd.

The cuts will be steep in Medicare: by the year 2015, the schedule is for out-payments in Medicare to be reduced by 40%, while estimated inflation of real medical costs will increase by 40%. It is also quite true that Medicaid-- for the truly indigent-- including the millions of "grannies" and "grandpaws" who worked at average-or-more income and used Medicare until the funds run out-- THEY DO RUN OUT IN TIME-- many of them in one of the three forms of nursing home (personal, intermediate, skilled)-- WILL BE FACED WITH CERTAIN, SURE UNDERTREATMENT-- AND BETIMES PREMATURE DEATH. Obviously, for the many who worked and "played by the rules," voted for Reagan, the Bushes-Two, and Mitch McConnell-- THERE WILL BE RUDE AWAKENINGS COMING, JUST "DOWN THE PIKE," IN JUST A FEW YEARS, WHEN RETIREMENT/SICKNESS OCCUR-- AS THEY WILL IN EITHER ORDER OF SEQUENCE.

This cluster of developments concerns not only the "have nots," but the "haves" with wits and compassion about them: the American Medical Association (AMA) for example-- never known or interpreted to be a bastion of liberalism (in the sense meant just across the 49th parallel, in Canada)-- is stridently trying to undo the effects of this most-unwise and most-insensitive legislation. In a recent piece on the Internet, for example, the AMA stated,

"It is critical that Congress take action this year to replace the cuts [those indicated above] with positive updates based on practice cost increases. In a recent AMA survey of 8,955 physicians, 60 percent reported that they would have to limit the number of new Medicare patients they treat due to next year's cut. The Medicare Advosory Committee has recommended that Congress increase payment by 1.7 percent in 2008 in line with the estimated cost increase."

The mentally ill certainly are affected by this. While only 2-4% of the total population is comprised of schizophrenics, schizo-affectives, bipolars, the organic-brain-syndrome patients, and -- we need to mention the so-called "retarded"-- the best research shows that these comprise about 17-19% of enrollees to Medicaid and at the same time constitute 8.53% of enrollees in Medicare. What is more, it may be anticipated that a large portion, the "brunt" even, of cheap-as-hell medicine will hit the population of mental health consumers even harder than the general population: the hullaballoo about "mental health parity" also implies that the federal goverment itself does not equitably distribute funds for psychiatric care-- despite plenty of pressure to apply parity in the private sector. We-- meaning "mental health consumers"-- do not have a particularly powerful lobby-- nor have we historically shown much real skill as a group-- despite some weaklings-being-covertly-led-by-stronglings-called-a-mental-health-self-advocacy-movement. No: while it is possible to get quasi-plastic surgery for one's tummy (the bariatric operation is a freebie in Medicare), the mental health consumer will do well to get a "script" for some expensive-as-hell atypical antipsychotic from a Nurse Practitioner (not a M.D. usually, these days) and out-the-door with you!!! More likely it is getting that the psychiatric patient will "fall between the cracks," die in the grass-unmown of some backlot or languish in the new "backwards"-- jails (which give some lip-service occasionally to treating the mentally ill who happen into their custody-- a complete return to the incarceration-of-psychotics which outraged Dorothy Dix and all.)

I have mentioned nursing homes: a large contingent of mental health consumers reside in nursing homes (PCHs)-- preponderately personal care homes. It has ALWAYS been true since the inception of publicly-funded nursing homes that if a mental health consumer is in a PCH-- she/he will have to be sick-sick-sick-sick-nigh-unto-death's-door-indeed to get "intermediate" or "skilled" care. One certainly should assume that this bias will persist-- and become even more blatant and raw as a result of what the Congress-- and President signed into law in 2006 (and before in the same penny-wise-pound-foolish mode.)

INDEED: the mental health consumer has much to dread, even to feel terror, for what conservative Washington has inflicted on Medicare and Medicaid. Whatever way we have voted in the past-- "fightin' for Flag and Country" or not-- even if we like mean and callous politicians who "kick them deadbeats in the pants"-- we need as a cohort now to heed the real wallet issues that affect us-- as they will soon affect all Americans directly-- that when the chips-are-down there will be no "safety net" or security-- but because of the Ancien Regime we shall only face "the skids."

This sounds partisan-Democrat: very well, when I see a Republican party that does not oppose every imaginable form of socially-enlightened legislation or program-- beginning in the dawn of my awareness with opposition (vigorous!) to the Social Security Act, and to Medicare, and to Medicaid, and to the Americans with Disabilities Act and to the Community Mental Health Centers Act of 1963-- and just as vigorously oppose and blacklist people who espouse such utilitarianism-- calling them "bleeding heart liberals" (meaning "Sacred Heart Democrats" etymologically-- the "Catholic Vote" of the mid-20th century)-- THEN PERHAPS I SHALL SAY THAT THERE ARE REPUBLICANS WHO IN FINE "ARE WORTH A DAMN." OTHERWISE: NO!!!

Think about this, Republicans, especially Republicans-who-are-affected-by-mental-illness-- consumers, families, professionals: just what and when will YOUR PARTY heed what the arch-conservative John Rockefeller uttered, "With the accumulation of wealth comes increasing (social) responsibility."

---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV-TR # 296.44

E-Mail: freethink@bellsouth.net

2007-08-26T20:47:00.000-07:00

On the Mentally Ill Who Become Missing Persons:
A Troublesome and Troubling Reality

My eye hit upon a story from Canada the other day-- the publication in the Vancouver Sun of a report that an 85-year-old bipolar woman -- Moira "Betty" McFarland-- "disappeared herself" by getting on a bus in Vancouver, B.C. with a ticket to go to Edmonton, Alberta-- and thus has not been seen since the middle of this month (August, 2007.) The description in the paper is revealing -- Moira is subject to depression, agitation, anxiety, and lethargy; she must walk with the assistance of an aluminum cane. Released late in July from a mental hospital-- a place she has reportedly frequented a number of times, for duration-- she simply left a note for her husband of 62 years that she was "leaving." She is known to deny her own name on request. From what I can tell from the Internet, Mrs. McFarland has yet to "turn up" to this date.

This story parallels another item--this much closer to My Old Kentucky Home-- "Missing Man," as reported from Lex18 television dated June 23, 2007-- from here in Kentucky of recent date, where a bipolar man-- Travis Wilson, age 27 in the "mountains" of Bell County east of here went missing, apparently as a sequel to having a flat tire in that sylvan locale; he is said not to have been on mood-stabilizing medication for several weeks. Search and rescue efforts had been nearly abandoned at the time of the posting, and almost certainly are so now-- two months later with no positive result.

As a topic followed by Websites like "Treatment Advocacy Center," see entries for January 19, 2007 and March 15, 2006, one can get a clear sense that this "going-missing" is a "mishap that happens"-- with varying degrees of trauma to social-others depending on the "ties" of the mental patient-- chronically, and all over the United States and the world. Sometimes the missing subjects turn up dead, not necessarily of foul causes, as was the case of a bipolar man described in METROWEEKLY (of Washington, DC), January 18, 2007-- Donald Charles Ebe whose skeleton-body was found in a woods not too far from his Virginia home some time after simply walking away from a responsible job as receptionist in an "upper-crust" residential complex. The investigators who reported on the finding of the body said "it's not looking like anything but him just laying down [and dying.]"

Stories like this compel the mental health consumer to reach for explanation to a public which largely cannot fathom the "means, motive, and opportunity-structure" (which does obtain-- if in an illogical way-- even with mental patients in deep psychosis) behind such elopement. I think I can speak for myself as an example-- because I have BEEN THERE. I shall relate the circumstances of my hapless running-away-- perhaps in a way as to illustrate how betimes this behavior -- while abortive to the caring-ones left behind-- results from patient-impulses which need not be reprehensible. In my first psychosis some thirty years ago-- I left my wife completely "out-of-the-blue"/unannounced (to her) and "escaped" from home in the suburbs and professional job (as social worker) to head off to Indiana north-country. From misconstruction of something a man had told me, I wanted to go to the penitentiary in Michigan City, Indiana and serve out the sentence of a man whom I inferred was innocent of the charge for which he was "serving." I got as far in my Datsun as Purdue (the city known for the University by that name) when I had a flat tire, and to make a long story short, went to live in the "woods" in that suburbs (not very "wild woods," I'll have to say) until the police found me, and rather than lock-me-up, they permitted me to go to Our Lady of Peace (mental) Hospital here in Louisville. [It was the beginning of a long, bitter story of struggle with myself, my symptoms, and a community/society willing to have only-so-much-tolerance for my discomfiture: I am still-- though improving somewhat-- in that phase, after 21-- mostly involuntary-- hospitalizations for bipolar affective disorder.]

From my experience, I know that psychosis can mean the radical re-definition of the meaning of a (social, etc.) situation: the logic works for the assumptions it has, but the definition-machine has gone awry. Harry Stack Sullivan speaks quite adequately of this condition when he (mostly in reference to schizophrenia) invokes the notion of "parataxic distortions" in the psychotic-- meaning that the person in psychosis interprets incorrectly -- yet personally-- in serial logic ordering of events-- feels a connectedness that no one else makes with physical and social reality. This is not too far from the notion of "ideas of reference" [see this term in "Glossary: Terms in the Field of Psychiatry and Neurology"] so commonly witnessed in the psychotic process. Now in the end, the floridly psychotic manic and the same condition in the schizophrenic produce-- or can produce-- nearly identical symptomatology; and indeed much of the recent literature to this point suggests a blurring/overlap between the manic and schizophrenic conditions in the neurological substrate etiologically.

In this particular instance-- the case of "going missing"-- the elopements doubtless have a motivation. Logic needs to be evaluated -- the modern logicians would tell us-- modally-- that is according to the linguistic mood from whence it obtains. There is a moral logic and a deductive logic and an inductive logic-- and by virtue of the ideas-or-reference factor only the inductive logic feature may decompensate in people like me, "on the loose." This does NOT mean, of course, that the mentally-decompensated cannot "get themselves in a peck of trouble," and when that does happen, it is not an overweening possibility that any "insanity defense" will work to undo things in the social order. While with me, for instance, the desire to serve an innocent man's prison sentence might be considered the height of altruistic "martyrdom," I never was understood for that-- or forgiven, by my mental health professionals (I had one of top-flight Louisville psychiatrists upon arriving home), by the police (who only saw a wretch in an Indiana woods that day of "arrest"), nor was I ever again trusted or much-beloved by my spouse. It took ten more years of stuggling with this failure before she -- for this and every perceived/fancied psychopathology she saw in me-- ASKED FOR A DIVORCE. [OK: I didn't fight it: it was UNCONTESTED utterly out of respect for the trauma I had in all inflicted on her. From then on, I had to face-the-fray of life utterly alone, with only the cops to get me to the hospital when need-be.]

What one does in psychosis-- for whatever motive-- has consequences. The crimes one commits, which from the individual perspective of the patient may have a defensive or sympathetic rationale-- nevertheless "sting." Likewise, the business of "going missing" for whatever reason: of course, the elopement inevitably works out horribly for the one-who-runs; yet and still it will probably will deep-fry terror in ordinary "caretakers" and it is not impossible that secondary mental/emotional disturbance may occur in these loved-ones. A perceptive explication of the mental health contingencies associated with having a missing friend/relative is well-enounced in the Australian site, "Someone is Missing: Common Mental Health Issues," [undated]; here the one perhaps substantive weakness in the writing is its sole depiction is of psychic distress to the caretaker of the missing person, rather than of the sequelae of distress generated by a mentally-deranged eloper herself/himself: nothing is said about the specific contingency of a mental patient's missingness as causative in psychological trauma in others (like, for example, the generation of PTSD-- post-traumatic stress disorder), but it can hardly be doubted that due to the sheer misunderstanding-factor of such runaway-events, we may anticipate even greater stress/depression/anxiety-related disorder in these loved ones than may obtain in other disappearances, which in fact may sometimes be intuited as validly and realistically "getting away from a bad situation."

Accordingly, I think these stories and this material touches a deep nerve in social conscience-- both for the repentant mentally-ill eloper and perchance for thoughtful members of the "madding crowd." While elopements did occur from mental hospitals back in the bad-old-asylum-days, they must have been more rare, for these institutions were by and large fenced/walled-in edifices from which escape was not easy. Now in a bittersweet day of "life, liberty and the pursuit of happiness" for the mental health consumer, conversely escape is easy-- but the griefs caused by escapes-from-"reality" like these will never be easy. One may then consider this writing a "call for reflection, study, and (reasonable) action."

---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV-TR #296.44

Telephone: 1(502) 561-5419
E-Mail: freethink@bellsouth.net

2007-07-19T06:38:00.000-07:00

S.O.S. for California's Integrated Services for Homeless Adults
With Serious Mental Illness (AB 2034)!!!!
...A Proven-Effective Program Slated for Elimination by Governor Schwarzenegger
Despite Patently Ample Funding

According to the online version of the Los Angeles Times, sometime around the middle of this month (meaning July, 2007) Governor Arnold Schwarzenegger of California of California announced that he would eliminate-- for a professed budgetary shortfall-- the state's social service program known as Integrated Services for Homeless Adults with Serious Mental Illness (AB 2034), a program which has been successfully operating since its legislative inception by the California Assembly in 1999/2000 (under the gubernatorial watch of Gray Davis.)

At another site, I have published a document entitled "A Social Program That Really Works: California's AB 2034 (Integrated Services for Homeless Adults with Serious Mental Illness" -- inferentially quantifying the astonishingly positive effect of this program--which showed dramatic decreases for the homeless mentally ill in the number of days "off the street," days-in jail, and psychiatric-hospitalzation-days, in addition to an increase days of full-time/part-time employment by this group. My analysis was based strictly upon the "hard facts" of published California reports on this program to the government dated 2002 and 2003-- and therein I derive that as the program stood in 2002, there was one chance in 12350-with-5483-zeroes totally random trials that the profound skew of reported positive impact was "happenstance." For the comparable 2003 figures, the result-- which included positive employment data to which I allude here-- was that such a result would occur by happenstance once in 12-with-71120-zeroes totally-random trials.

The rationale that California "lacks the money" for this program hardly seems credible, for the following reasons: 1. In November, 2004, the people of California voted in Proposition 63-- which taxed millionaires (which California has in a certain abundance) 1% of their income, the funds for which were ear-marked exclusively for (community) mental health; 2. Schwarzenegger's own proposed 2007-2008 budget for mental health is-- accordingly from Prop 63-- rather awash in money-- showing an increase projected from $1.6 billion in 2006-2007 to $1.8 billion this fiscal-year (2007-2008)-- see "Welcome to California's Governor's Budget 2007-2008-- Program Enhancements and Other Adjustments-- Department of Mental Health" ; 3. the cost of AB 2034 -- currently at $54.9 million per annum-- represents about 1.1% of the current mental health budget, .14% of the state's Health and Human Services budget, and .05% of the total budget of California-- see "Welcome to California's Governor's Budget 2007-2008: Proposed Budget Summary." I do NOT know whether AB 2034 gets federal subsidy: if so, as is usual for such programmatics-- then the argument for state-penury is further diluted.

Even if the Integrated Services... program lacks federal fiscal support, it certainly gets encouragement and endorsement from "the feds." At the top-most level, President Bush himself has considered AB 2034 to be an exemplar for his New Freedom Commission (as it is by the private advocacy group NAMI-- see "Model Program: Integrated Services for Homeless Adults with Serious Mental Illness" at this link.) The program is also held up as a national model by the federal "United States Interagency Council on Homelessness" as well as by the SAMHSA-sponsored agency GAINS -- for its substantial positive, evidence-based practice in housing for the homeless-mentally-ill. In this vein it is worth noting that the and State of Georgia and other venues have planned to model their community-based mental health programs around AB 2034.

Given all these factors-- and the Governor-of-California's reticence to be overly specific about his motives for this proposed elimination, it is to be expected that mental health advocates hither and yon-- but perchance not so much California's Prop 63 millionaires-- are agitating to prevent this planned travesty. "Housing California" just put out a flyer decrying this move by Governor Schwarzenegger, with the statements "4,900 previously homeless, mentally ill individuals will be turned out on the street overnight. California already has more than 360,000 homeless people on any given night, with 90,000 of those in Los Angeles. The governor should be expanding this program, not proposing to cut it." The Mental Health Association of Greater Los Angeles-- perhaps less stridently but emphatically-- speaks out against the proposed cut-- in view of the program's effectiveness in "...measuring reductions in homelessness, psychiatric hospitalization and jail time in independent living and employment."

In the minds of many Californians, this proposal by Governor Schwarzenegger but be reminiscent of Ronald Reagan-- when he was governor of this state-- to move to rid the state mental hospitals of patients, out of some perverse notion of "patient's rights not to be incarcerated, life, liberty and the pursuit of happiness" (pursuant to the Lanterman Petris Short Act of 1967)-- thus dumping the bulk of the "helpless" mentally ill from the back-wards on to the alley-ways and gutters of the inner-cities (in Los Angeles particularly.) Accordingly, many others-- perhaps the majority of the California community-- may be in a state of consternation because of this -- not LIBERAL NOT CONSERVATIVE BUT JUST UNWISE instance of misplanning.

I share these sentiments, and I root for the California advocates who wish to preserve this program, but for Kentucky civic reasons: for here at the Buckle-of-the-Bible-Belt, better known for "Real:Real:Christians" who wish to save your soul for afterlife, the-hell-with-this-existence-anyway, the rule of a certain social callousness and a following-the-leader prevails. We here do not inaugurate a social program until the great crowd of exemplars has gone before. We look to states like California and Massachusetts and New York for such inspiration, and I KNOW PERFECTLY WELL that conservative Democrats here as well as the Republicans of this Commonwealth will simply "jump" on the discontinuation of AB 2034 as "proof that this-- another social program-- does not work," when in fact nothing could be further from the truth. THIS PROGRAM IS WELL-PLANNED, WELL-EXECUTED, AND BY EVERY PRE-CONCEIVED EMPIRICAL EXPECTATION (BUT THE HAPPINESS FACTOR OF PROP 63 MILLIONAIRES) HAS BEEN VALIDATED. HOW UTTERLY RAW IT WOULD BE TO ELIMINATE SUCH A WORKING PROGRAM COSTING SO LITTLE OF THE CALIFORNIA MENTAL HEALTH BUDGET!!! HOW RAW INDEED!

I have been homeless, I would argue not for fair reasons, certainly not for reasons that acknowledged the mitigating factor that I was vulnerable due to my bipolar condition. The services I got when I was homeless were utterly thread-bare-- on the order of "counsel and close" by the Coalition for the Homeless here in Louisville. But other Kentucky counties/cities lack even a homeless agency that can "counsel and close" in matters like this. MY Kentucky lacks anything approximating the social safety net of California (or the other, "progressive" states.) I am "up in arms" about this plan afoot in California because without any doubt at all it will portend horribly more drastic insults against the mentally ill of regressed regions-- like "My Ole Kaintucky Home."

So come on, Arnie, can't ya do better than this? The eyes of the nation and world-- and certainly the mental health community-- are upon you now!

---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # 350
F31.2

Telephone: 1 (502)561-5419
E-Mail: freethink@bellsouth.net

2007-07-08T04:52:00.000-07:00

What About the Mental Illness
Caused by Mentally Ill Criminals?--
A Statistical Estimate of Prevalence for This Cohort
And Some Humane Recommendations

Those who have been following this Web-log know that I have been a strong advocate for mitigating the circumstances of the mentally-ill who (so easily) get caught up in the criminal justice system in these United States-- "by use of the least restrictive alternative for the patient consistent with her/his behavior/clinical-condition." I follow a fair number of Web-sites pursuant to this goal, and have of late come upon a blog which in part had content that was a real "mind-bender." By this disconcertion I refer to a June 30, 2007 entry in "Grits for Breakfast: Welcome to Texas Justice: You Might Beat the Rap, but You Won't Beat the Ride," a site which deals with jailing and other criminal justice issues in the state of Texas.

In this entry, the author describes having gone to a workshop/seminar on "restorative justice" in Kerrville, Texas (? right state I presume, otherwise unmentioned.) There the reporter heard and passes on statistics compiled by a local Community Mental Health Center system about the "warehousing" (it seems to be an apt term in context) of chronically mentally ill prisoners in Harris County, Texas. The portion/prevalence of mental illness in this lock-up were "shocking data," yet while I found them deplorable too, they hardly seemed different than those for the rest of the "real Christian" Bible Belt-- including for Kentucky: we read that the mentally ill in this county were about 6.5 X as likely to be charged with a crime-- and 12 times more likely to be jailed-- than "normals." This figure included about 24% of those in the Harris County Jail.

But I do not wish to concentrate on this alarming set of statistics. The incarceration of the mentally ill into criminal justice facilities has always been common in the American South-- an area where Dorothy Dix' crusades-- as I understand her campaigns to rid jails and prisons of the mentally ill and put these into "asylums'-- never did "take" as well down here amidst the Believers (in Bible, slavery, and other complexities-made-pat.) What instead "made me tingle," not so much in pique but in curiosity, was the blog-writer's statement in this entry in "Grits for Breakfast" that restorative justice-- the topic of this seminar/workshop/symposium attended-- implies not just treatment for the prisoner but for the victims of crime. The writer says-- intriguingly--

"Once I learned more about the definition of restorative justice, I realized that these presentation, however interesting, really don't fit under that rubric. Neither man [speaking about jailing the mentally ill in Texas] spoke of the victims of the mentally ill's crimes, and the only 'restoration' contemplated by either was of the offenders' mental state...they're government bureaucrats trying to manage the system we have, which often doesn't work very well. That's not a beef, just an observation."

This provoked a certain amount of research, and some computation, the results of which I shall summarize now. What this author is proposing is that the crimes of the mentally ill cause damage-- psychological perhaps and otherwise. I can hardly fathom all the societal costs of the crimes of the mentally ill-- this would be complicated and subjective to a great extent-- and beyond the scale-of-modest-economy that my endeavors will permit. However, I think it possible to estimate the matter of intrigue for me-- revolving around the essentially-empirical question, What is the prevalence of PSYCHOLOGICAL disturbance expectable by the crimes of the mentally ill?

To assess the independent probability of mental illness caused by the mentally ill criminal, one needs to get prevalence figures for the rate of (especially violent) criminality in the mentally ill, and also such a figure for the rate of psychlogical/psychiatric sequelae for victims of violent crime. The intersect (one probability times the other probability) will be the independent probability for such a contingency-- an important figure because it would have to do for a baseline for all subsequent investigations of this nature. [The figures for psychiatric sequelae for the non-violent crimes do not obtain; there is some reason to think they may be -- using "thought experiment"-- lower than for violent crime-- but this is as yet unknown, as unstudied.]

Now reports have been surfacing in the media about the violence-potential of the mentally ill for a long time now-- these make "great copy" for the media, in part because the stories associated with such crime often tends to be sensational, and the context is usually still considered somewhat salacious. Hard empirical studies that would pass the muster of science are more-rare in coming. One study I found about this topic does "meet muster," a study by a Louise Arseneault, and all, entitled "Mental Disorders and Violence in a Total Birth Cohort," Archives of General Psychiatry 57:979-986, October, 2000. This study took 971 individuals, a cohort of total births in New Zealand from April 1, 1972 to March 31, 1973 and did an analysis based on self-reports + D.S.M. III-R-based diagnostic interviews to assess involvement in violent crime in the mentally ill versus controls-- 961 individuals in all. The studying considered a unique definition of mental illness, including such things as marijuana dependence-- whose psychopathological designation is perhaps somewhat controversial. Nevertheless, individuals in the schizophrenia-spectrum were found to be 2.5 times more likely to engage in violent crime than normals, bipolar-disorder patients 4.8 times more likely to be violent, and alcoholics 2.5 times more prone to violence; remarkably, the marijuana population was 8.1 times more predisposed to violent behavior. Given the number of categories involved in this study, the sample size might optimally have been bigger; otherwise these are troubling statistics for a mental health consumer and mental health advocate-- whose first concern in either case should be for reality/factuality.

An even better study-- "Major Mental Disorders and Criminal Violence in a Danish Birth Cohort," by Patricia A. Brennan, and all, Archives of General Psychiatry 57:494-500, May, 2000 -- using the a large cohort of 358,180 individuals born between January 1, 1944 and December 31, 1947 from birth and crime registries in Denmark-- obviously not a country with "Anglo" culture or values precisely, but a Western-European country with many of the characteristics of a diverse, essentially Caucasian, industrialized society. In this group, as we might expect, some individuals (the cohort included males and females), some became mentally ill and some did not, some engaged in violent crime in both sub-cohorts, and others did not. For to me somewhat mystifying reasons-- as I shall soon clarify-- this study reports that

"Approximately 2.2% of the men in the cohort were hospitalized for a major mental disorder and committed 10% of the violent crimes committed by all the men in the cohort; 2.6% of the women had been hospitalized for a major mental disorder and committed 16% of the violent crimes committed by the women in the cohort."

...But every way I compute the data tabulated in this study-- I get a higher prevalence figure for the violent propensities-- in both genders-- of the mentally ill. To wit: the total population in the cohort, the number of mentally ill men and women was 43,465 individuals. Similarly, we compute that the number of violent incidences in both the mentally ill men and mentally ill women stands at 7,962. Now the fraction 7,962/43,465 = .1832-- (in other words) 18.32%. So let us use this figure-- which seems accurate-- for the prevalence figure of violence in the cohort of the mentally ill.

What is the nature of mental/psychiatric distress among victims of (violent) crime? A study on this type of epidemiology has of late been published -- "Mental Health Needs of Crime Victims: Epidemiology and Outcomes," by Dean G. Kilpatrick and Ron Acierno, Journal of Traumatic Stress 16(2):119-132, April, 2003. Here we read that quite frequently there are psychological mishaps resulting from being the victim of violent crime: post-traumatic stress disorder (PTSD) is the most-likely psychiatric impairment resulting from such victimization [same work just cited, page 119.] Now PTSD is a malady that must be considered over both the short-span of the immediate time-frame after the index incident and for the affected individual's lifespan: with regard to PTSD in victims of violent crime-- the prevalence is 9.7% (.097) CURRENT PTSD and 25.8% (.258) LIFETIME PTSD [page 126, work cited here.]

Now we are ready to compute the expectable portion of one important psychiatric sequel to crime-by-the-mentally ill-- that is, here, for PTSD in the victims thereof. I am being generous to the "critics" and so using the "high figures" in part for this reason, in part because they seem to reflect a certain demonstrable reality. If PTSD's baseline from the victims of the crimes by the mentally ill-- we may anticipate it to be-- on the basis for computing "probability intersects" outlined procedurally above-- by multiplying .1832 X .258; the result-- and the reader may consult her/his calculator to validate what I impute here-- is .0473 (4.73%) of the total population of crime victims having PTSD as the result of violence perpetrated by a mentally ill individual.

This/these figure(s) deserve comment. It will be seen that our friend from Texas-- concerned about the restoration of justice to the PTSD victims of crime by the mentally ill is in fact talking about a small minority of the total population of crime victims. Not a few of these PTSD victims will themselves have some precursor mental illness. Nevertheless, it is only fair and right that these victims be treated with the dignity and welfare they deserve. By further implication, it is only fair and right that the victims of crime by the mentally ill receive counseling/psychotherapy/psychopharmacology commensurate with their PTSD needs. AND treatment for the victim does not diminish the burden of forensic psychiatric facilities to accomodate mentally ill prisoners with psychiatric treatment-- either kind of deficiency in service is for an advanced culture unconscionable.

In fine detail-- and in the Southern U.S.A. in another "fine"-- we are dealing with the callous and systematic disregard of the needs of a predictable part of the population-- the mentally ill criminal on the one hand -- and the mental illness caused by the crimes of the mentally ill criminal on the other. What is needed is more mental health in general and more mental health planning in particular: not less. The demagogic "beating of the rubber chicken" against "bureaucrats" does not obviate the necessity that rational bureaucracy-- to use the phraseology of social theorist Max Weber-- needs to be augmented and bolstered if these true and burning needs will be met. Such planning would include "comprehensive care" for the forensic psychiatric patient and also for victims of PTSD (as well as any other psychological or social mishap) of victims of crime by the mentally ill.

I for one will aspire to keep an ethical "seamless garment" in these Web-logs I keep: I shall not knowingly perpetrate either falsehood or inequity. So I shall not conscion the serious crimes-- or any other crimes-- by the mentally ill, for they are irresponsible behavior (with the possible exception of "crimes" of civil disobedience.) From the "systems" end, I shall try to recommend fairness to all parties, as we see espoused in A Theory of Justice by John Rawls, Harvard University Press, Cambridge, Massachusetts, 1999 (1971.) This predisposition to fairness would include accommodation for the victims-- in mental health services or otherwise-- for victims of the crimes of the mentally ill (as well as the victims of other types of crime, the vast vast majority.)

Fair is just fair. That is not only "restorative justice" but simple justice, for the mentally ill and for the unfortunates who occasionally are wronged by them.

---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # 350
F31.2
Telephone: 1 (502) 561-5419
E-Mail: freethink@bellsouth.net

2007-06-27T14:19:00.000-07:00

Shelter-Plus-Care (S+C) and the Mental Health Consumer:
When Housing is Good Psychiatry

A report in the June 25, 2007 Tuscaloosa News describes how mental patients in that Alabama city are benefited by a small (in the sense of subjects-served, not exactly in terms of expense) rent-subsidy program which is commonly known as Shelter-Plus-Care (S+C). This program is new in Tuscaloosa-- inaugurated with but ten people in 2005, but is said to cause a definite impact in the social disruption associated with homelessness among the mentally ill in that city. Speaking to the general social worth of S+C in her metropolis, a Debbie Williams, Salvation Army service coordinator and member of the Tuscaloosa community planning committee for public housing/shelter is quoted in this article as saying: "Housing is health. People need a stable place to live. Otherwise, everything becomes in jeopardy."

It should be noted that S+C is a national program-- functioning throughout this country-- I suppose in every state and territory of the Union. We have it in Louisville here, as a function of Seven County services, an undersung, under-touted redemption for many a mental health consumer in a "housing fix." It behooved me to write -- i.e. to "sing" and to "tout"-- what S+C does -- and perforce of social/fiscal limitation cannot do. Accordingly, in this article, I want to describe S+C both in the context in which I live-- backward Kentucky--as well as in the United States in general -- which program for some is a life-saver. The program is funded by the United States Department of Housing and Urban Development upon the mandate of the McKinney-Vento Homeless Assistance Act, 1992. The provisions of this program apply to "hard to reach" homeless or potentially-homeless cohorts, including not just the mentally ill, but the physically disabled, chronic substance abusers, and AIDS patients. [See "History and Goals of the Shelter Plus Care Program," at the HUD site linked here. ] By law/policy, not less than 50% of S+C monies are to go for the provision of housing with financing from HUD for the chronically mentally ill, through programs of state or local government or certain private organizations (such as Community Mental Health Centers.) Only a few hundred less than 29,000 people-- i.e. we may suppose this program serves around 14,000 of the estimable 700,000 chronically mentally ill in this go-to-hell-nut country. [ See: "Homelessness: Recent Statistics, Targeted Federal Programs, and Recent Legislation," by the Library of Congress Congressional Research Service, updated May 31, 2005.]

First of all, we might ask: what's the rub here? Why should the mentally ill (and other societally-marginal folk) be attended with a program of this sort? The answer comes that the mentally ill and their "kind" -- for substantial and insubstantial reasons-- have a hard time "finding a place to stay." Often-times potential landlords are not wont to lease to "crazies," for as we know the stigma against mental illness abides, and can be a real, lethal, yet unspoken issue in the rental contract-arrangement. Another factor is money: mental patients typically either are on SSDI, SSI, or are not "drawing a check" of any kind, and numbers of us have difficulty getting and keeping employment. There again, the landlord who knows of these circumstances may "pass" on renting to "one of us." And I think it is true-- knowing my own sometimes taxing behavior-- I think it must be added that the mental health client is often "her/his very worst enemy" by making noise, causing disruption, and barracading their doors on occasion for sundry wildly emotional or delusional reasons. The mental patient is thus among the least desirable of least desirable rentees.

On the other hand, by becoming homeless, the mental health consumer is likely to get herself/himself in all kinds of trouble, and conversely to trouble the community at large. Sometimes homeless mentally ill people do vandalism, ill-schemed burglaries, and can start fires through carelessness or pique. And this has spin-offs such that jails are flush with such unfortunate criminals, to the extent that lock-ups like this have become one of the types of back-wards of the "new" mental health so-called system (the other type of back-ward including -- if the consumer in a tail-spin is fortunate-- a mental health personal care home.) What is more, the mental health consumer on the streets often does not "take care" of herself/himself, and consequently runs a real risk of contracting one of the hepatitises, STDs (including HIV/AIDS), and the highly-contagious but incurable new form of tuberculosis. In other words, it is smart for a community's leaders to provide for the hapless-- and may-be homeless-- mentally ill.

In "my Ole Kentucky Home," the problem of the homeless mentally ill is known. One report, "Homeless Prevention Plan," by the Kentucky Council on Homeless Policy, Frankfort, Kentucky, 2003, it is reported that 161 people (only!) are in "...existing state mental health facilities without housing placement." This should not be taken as the figure for the homeless mentally ill population or the population of mentally at risk for homeless: what this report utters is probably the "hardest" statistic the group could derive about this cohort-at-risk. In truth and in fine, all the general factors I identified as impacting the lot of a mental health consumer in finding placement come to bear on us in Kentucky, with the extra disadvantage that in general-- depending on venue-- Kentucky is not known to have robust prevention for homelessness for the psychiatric population-- the "safety net is rotten and full of holes." In truth, nobody seems to know how many homeless mentally ill folks there are here-- although with my naked eye minimal discernment I can see the wretches sleeping in gutters and eating garbage and dressed for winter in dirty clothing in our terrible Dog Days of August-- all to know that the true portion of the homeless mentally ill is substantial in Louisville-- in excess of 161 just on our streets, back allies, and jails.

The precise quantitative prevalence of homelessness among the mentally ill for the whole of this country is likewise unknown, and is even the subject of contention. For example, in the article "Homelessness in the United States," in Wikipedia: The Free Encyclopedia on this very date (June 27, 2007), we read "The neutrality and factual accuracy of this article or section are disputed." We also read: "This article may require cleanup to meet Wikipedia's quality standards." This article's report that 22% of the homeless population here is mentally ill seems plausible intuitively-- but my acknowledging Wikipedia's problems with this page only highlights the general condition that hard statistics on homelessness-- including the homelessness of the mentally ill-- are in a relatively inchoate state at present. There is much that is unknown-- and much to be learned-- on this important subject. Suffice it to say that S+C recipients are-- by agency definition-- either homeless or otherwise problematic for placement-in-domicile.

This is not to say that S+C (and other social programs) do not have an empirical track record. In 1997, there pressed a "National Evaluation of the Shelter Plus Care Program," by an organization calling itself "HUD User." The general finding was that S+C did reach the target population of the mentally ill (and such others at-risk), but that its success with the most-chronic homeless people had to be coupled with social services like case-management and counseling. Most significantly for the purposes of the discussion here, though, was the acknowledgement that "[m]ore than one-half of participants reported improvement in their physical and mental health, their ability to care for themselves, and mending frayed social and familial ties" as a result of participation in S+C. This illustrates-- in keeping with the utterance of the Tuscaloosa Salvation Army service coordinator-- and with the clinical wisdom inherent in the discipline of social psychiatry-- that having shelter-from-the-storm is good mental health treatment.

However, as the wily reader may suspect, there has not been completely smooth sailing for S+C. This program is 100% dependent on renewal by Congress on a year-per-year basis. [See Library of Congress Congressional Research Service report, cited above.] And not too long ago, and to a certain and real extent now, "tight pursestrings" gave us the ilk of "The Deficit Reduction Act of 2005" ( S. 1932) could now/later/at-any-fiscal-moment throw this program (and all enlightened social legislation) into outer darkness. The mental health consumer should assume that nothing is permanent that depends on (federal or other) government for sustenance: WHAT UNCLE SAM GIVETH, UNCLE SAM CAN TAKETH AWAY!

So here we have it: the fine print: S+C is a good program, well-intended, well-designed, effective within its own limits. But it is small : it is tiny by reference to the urban reality of the homeless mentally ill as a social phenomenon. And it can vanish whenever politicians who are sufficiently callous wish to pull the rug from under this program-- perhaps to start another war, on another front than Afganistan or Iraq or Kosovo or Bosnia or Somalia.

One superb way to prevent catastrophe in this regard would be for mental health consumers to raise consciousness in the community, just as the community may be in a state of delusion or hysterical denial about the searing reality of the problem. Notice that what I am proposing is not any kind of militancy or even demonstration, but the quiet presentation of the living facts of our situation to an un-knowing world. I write these blogs [ for the sister blog to this is regarding my bipolar condition, see "Bipolar in Louisville," http://www.bipolarlouisville.blogspot.com ]; other people may wish to write Congresspeople, or phone them, or to attend political meetings/discussions/rallies to discuss mental health issues. The point is: TELL THEM WHAT YOU'RE GOING TO TELL THEM ABOUT MENTAL ILLNESS, THEN TELL THEM, THEN TELL THEM WHAT YOU'VE TOLD THEM-- ALL ALL ALL TO CLARIFY IN THE UNWITTING THE CRABBED REALITY OF LIVING "IN OUR SHOES," PARTICULARLY IF-- LIKE JESUS OF OLD-- WE HAVE NO PLACE TO MAKE OUR BED.

...And this gambit just might save S+C for us in times-to-come.

---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # 350
F31.2
Telephone: 1 (502) 561-5419
E-Mail: freethink@bellsouth.net

2007-05-18T18:42:00.000-07:00

Mental Illness and Sexual-Abuse/Rape:
A Mental Health Advocate/Consumer
Makes Reckonings on Necessarily Discomforting Realities
And Potential Solutions for "Sexuality-Gone-Crazy"

Today from the Internet I read of:

-- A mental patient, sometimes homeless, frequently arrested for crime-- sexually assaulting a woman praying in a New York City Roman Catholic Church. [See "Former Homeless Man Charged with Attacking Woman inside Church," WSTM.com, http://www.wstm.com/global/story.asp?s=6536308&ClientType=Printable .]

-- Again in New York, a psychologist reports testing that a rapist who posed as a fireman to gain entry to a woman's apartment, then to molest her for 13 hours-- was mentally ill (according to this psychometric testing) albeit not schizophrenic as his defense lawyer holds. [See "Psychologist Says 'Fake Firefighter' Has Mental Problems," 1010 WINS .]

-- A psychologist somewhat defensively pleads for sympathy for Seung-Hui Cho-- who on April 16 because of a sexual fixation from deranged (possibly schizoprenic or bipolar) reaction to being jilted-- slew 32 innocent people at Virginia Tech, on grounds of Cho's mental illness and his adverse position as an Asian in alien American society. [ See "Mental Illness, Racial Identity and the Virginia Tech Shooting," The Seattle Times, Friday, May 18, 2007. ]

-- A Canadian schizophrenic is held accountable for the homophobic murder of two gay men in Nova Scotia, and for another man's murder (gender-orientation unspecified) in Mooers, New York. [ See: "Family of Man in Canadian Gay, US Murders Frustrated by Limited Treatment He Has Received," in 365 Gay, http://www.365gay.com/Newscon07/05/051807canfamily.htm .]

-- And all of this was suggestively-- and bitingly-- corroborated by empirical evidence-- from meticulous case-control study from Sweden using thousands of subject and more-thousands of controls-- that male sexual offenders are 4.8 times more-likely to have schizophrenia and 3.4 times more likely to have bipolar disorder than normals. DAMNING! HORRIBLE TO ME AS A MENTAL HEALTH ADVOCATE/CONSUMER! [ But, see abstract from Entrez PubMed: "Severe Mental Illness and Risk of Sexual Offending in Men: A Case-Control Study Based on Swedish National Registers," Journal of Clinical Psychiatry 68(4):588-596, April, 2007 .]

Important Considerations for All of the Above (Troubling) Data:

This Web-log is a journalistic endeavor: I must at all costs strive to present the facts as facts-- no glossing-over or varnishing-up "saying-it-like-it-is." Many criminal justice workers would feel vindicated by all these reports above-- whereas perhaps many mental health advocates would be deflated, even demoralized from such an array of problematic information. Having worked in forensic-psychiatry, general-psychiatry, and corrections-- I do not think I "straddle the fence" by conceding much truth to the charge that numerous sexual offenders have mental illness, but also weigh "in the mix" mitigating and alternative findings, which in no wise defend/justify a rapist whether-or-not deranged, but add what may be considered as "dimension" to these troubles. To wit, balancing all this "bad news," it is fair to say:

The mentally ill do have a tendency to engage in crime at a higher rate than normals-- but this rate is slight-- statistically-significant only by virtue of the Law-of-Large-Numbers/Central-Limit-Theorem. [ See, "Walking Time Bombs: Violence and the Mentally Ill," in Out of the Shadows: Confronting America's Mental Illness Crisis, by E. Fuller Torrey, M.D. (a notable advocate for the mentally ill), John Wiley & Sons, Inc., New York, New York, 1997, pages 43-60.]
The mentally ill in jails/prisons do not TEND to be incarcerated for "violent" crimes. [Source: U.S. Bureau of Justice statistics as reported in "Root Causes of Violent Behavior Remain Elusive," Kansas City Star, May 6, 2007, found on Internet at KansasCity.com, http://www.kansascity.com/105/v-print/story/95876.html .]
Numerous times mentally ill men are incarcerated for sexual offenses when later found certainly (by DNA testing, etc.) to be INNOCENT. [For a case-report of one such incident recently, read: "Son's Arrest Leads Mother on a 22-Year Journey of Faith," in USA Today, May 13, 2007.]
The mentally ill (in the case of women, at least) appear to be significantly MORE LIKELY TO BE VICTIMS of rape/sexual-abuse than normals. [See: "Preventive Health Care for Mentally Ill Women," by Jeanne L. Steiner, D.O. et al., in Psychiatric Services 49:696-698, May 1998, http://psychservices.psychiatryonline.org/cgi/content/full/49/5/696 .]

Options for Intervention:

I feel no sympathy-- in view of my experience and the above information-- in "excusing" anyone who resorts to forcing sex from another person, male-or-female, female-or-male, whether or not such a person has organic brain syndrome, mental retardation, schizophrenia or even bipolar disorder (which happens to be the malady from which I suffer)... nor for any other psychiatrically-definable condition or rationalization. Clearly, for those who cannot abide sexually appropriate limits AND who are mentally-ill-- great in number according to the recent Swedish study-- something robust and effective needs to be done.

Clearly what "needs to be done" is not to put such mentally-ill malefactors into "regular" mental hospitals on any form of involuntary mental health commitment; I am in complete accord with the National Alliance on Mental Illness of New York, the American Civil Liberties and (apparently) Fox Media -- strange "fellows," here!-- on this topic. [See: "Critics Look for Alternative to Sex Offender Civil Commitments," Fox News, http://www.foxnews.com/printer_friendly_story/0,3566,202874,00.html .] The reality is that every state-- and most other venues -- as far as I know, have a lock-up for mentally ill people who run afowl of the law. These are variously called institutions for "forensic psychiatry," "criminal insanity," or "correctional psychiatry." If everything was going as designs would indicate, these places offer best-- and LIFETIME -- confinement possibilities for anyone mentally-ill/mentally-retarded who has been sexually aggressive! That for some PECULIAR reason such people as mentally ill rapists and child molesters sometimes "serve out" or-- much worse-- get parole when in such a habitual and proven state-- is an INDICTMENT OF THE SYSTEM. Clearly, however, placing such people in (state, etc.) mental hospitals-- where the security is inevitably more lax than in a jail/prison-- is BY NO MEANS a solution even if hypothetical lifelong "sentences" can be arranged.

But-- say-- someone in "infinite wisdom" decides to place a mentally ill sexual aggressor in some community or another-- a contingency which also happens more frequently than the public knows. In such an event, there are still contingencies. Just today, it was announced that technology has been developed to put "LifeShirts"-- monitoring devices that assay psychiatric symptomatology-- to mental patients in the community-- intervention which augurs to be effective but expensive. [See: "Wearable Technology Helps Monitor Mental Illness," in ScienceDaily, May 18, 2007, http://www.sciencedaily.com/releases/2007/05/070518160743.htm .] A more-cost-effective-- and proven technology might simply be "radio monitoring" with sensors on the bodies of sex offenders who are mentally ill (or any other type of sex offender.) According to a fiscal analysis done by the State of Iowa not-too-long-ago, this intervention is the second-most-inexpensive form of "high-tech" monitoring of sex offenders, beneath which is the simple "call-in" system, and above which are -- in order of cost-- video display (VB), video display radio frequency (VBR), global positioning satellite (GPS), and "advanced" GPS. [ See: "Iowa Legislative Services Agency: Fiscal Services: Electronic Monitoring of Sex Offenders," Des Moines, Iowa, December 15, 2005.] This last-cited report says that -- at prevailing costs at the time of the white-paper, radio monitoring (RF) would cost $2.87 per diem.

One might question whether I am properly functioning as a "mental health advocate" by enouncing such a "permanent lock-up policy" for sexually aggressive mental patients. But any advocacy I might do is HOLLOW if I should not in each instance promote and abet what I know or believe to be JUST. As my information above indicates, the "harmless" mentally ill are in no wise benefitted by the mayhem and sociopathy of any of those who are aggressive, sexually in this instance. Government is designed to "promote the general welfare" [ see "Preamble," United States Constitution], and one may safely predict that the mentally ill in general-- and all hapless and more-or-less disenfranchised in society-- will be first to be "wounded" by the (crazy-or-not) aggressors. For this reason, here I "hang tough"!!!

---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # 350
F31.2
Telephone:1 (502) 561-5419
E-Mail: freethink@bellsouth.net

2007-05-16T21:05:00.000-07:00

Out-of-One-Hole-and-into-Another:
A Case-Study of the Current New Jersey Predicament
That Psychiatric Patients Are Bedded in Emergency Rooms

On Tuesday, May 15 of this year the Kaiser Foundation pressed an analysis-- "Mental Health Patients Overwhelming New Jersey EDs, Officials Say," . As the title suggests, this story reports on the phenomenal overuse of emergency-department beds by psychiatric patients in recent times. This article aspires to use the New Jersey experience in mental health over the past decades-- using "case study" methodology on the basis of Internet reports-- to fathom why this misappropriation of services might occur.

New Jersey is no "backward" state-- unlike the Kentucky from which this piece is being written. The state has a high per-captita income, hosts several major-- and Ivy League-- universities, and is known to have an enlightened populace with governance that is historically known to be solid, even progressive. I read that New Jersey once had twelve public psychiatric hospitals-- six run by the state and six by the county, with 90% of expenditure for hospitalization coming from the state [Source: "Profile of Public Psychiatric Hospitals in New Jersey," SAMHSA: National Mental Health Information Center.] Like every other state-- New Jersey is in the process known as "deinstitutionalization"-- but in this case pursued with prudent deliberation -- the state has been in the process of winnowing down the public psychiatric hospitals, and building up community mental health in its preventative, screening, and treatment aspects beginning under the Governorship of Thomas Kean (Republican) in 1987-1988 [from "Profile...New Jersey," work just cited], yet continuing under all governors-- a timespan marked mostly by Republican governors (and legislature) in the 1990s yet Democratic governors in the 2000s followed this diaspora-from-asylum as well [ see, "Profile...New Jersey," same source. ]

A major state psychiatric hospital, Marlboro, was slated for complete closure; I understand ["Profile...New Jersey," again] that this 780-bed hospital stopped taking patients in June, 1998. This was a key component of a state initiative begun in 1995, under the governance of (Republican and fiscally-conservative) Christine Todd Whitman, wherein-- with the closure and curtailing of state/county psychiatric hospital admissions-- there was increased vigor for deinstitutionalization/community-mental-health, formulated under a doctrine known as "Redirection." And shortly thereafter, Governor Whitman announced that another large state psychiatric hospital-- Greystone-- would be scaled back from 538 beds to 400, and subsequent savings obtained funnelled into community mental health. In making this announcement in her budget speech before the New Jersey Legislature, Governor Whitman said, "For our one family to truly thrive, we must do our best to ensure that everyone lives and works as part of the community, not apart from the community...improving our system of care for people with mental illness. This budget allows us to begin building a smaller facility on the grounds of Greystone Park Hospital. Ultimately, scaling down Greystone will save us money that we can dedicate to more community mental health programs. In the meantime, this budget provides $22 million for those services" [from: "Remarks of Governor Christine Todd Whitman-- Fiscal Year 2002 Budget Address, Tuesday, January 23, 2001," http://www.state.nj.us/budget02/bmsgfy2002.html ]; this appears to have been the heralding of a state thrust known as "Redirection II."

We know that Governor Whitman took a prominent position-- head of the Enviornmental Protection Agency-- in the administration of George W. Bush; this left several "caretaker" governors for an inter-regnum period, three Republicans, one Democrat, until the election of James ("Jim") McGreevey-- a Democrat-- in 2002. McGreevey essentially supported much of mental health funding that the Republicans had inaugurated (as does McGreevey's Democratic sucessor, Jon S. Corzine.) This is true despite budget shortfalls and a recession, at which New Jersey-- industrially a "rust-belt" state-- was in the center, and despite the generally conservative timbre of the times. [See, "Mental Health Advocates Win BIG in Trenton," in Mental Health Notes: The Mental Health Association in Southwestern New Jersey, http://www.raphaelwebscapes.com/mha/newsletterfall03.php ; also "Governor Signs New Jersey Legislature's Recommendations for the FY '04," in The Cutting Edge: A Monthly Mental Health Advocacy Update, 2(7): July/August, 2003, http://www.mhanj.org/Resources/edgev2i7.htm -- this last-mentioned document-- in addition to thanking Governor McGreevey-- gives kudos to 16 state senators (8 Democrats, 8 Republicans) and 15 Assemblypersons (10 Democrats, 5 Republicans)-- the skew 18:13 resulting is at a cumulative binomial probability of but .247-- which mostly demonstrates that this less-than-significant result favors neither Democrats nor Republicans in New Jersey.]

In an unfortunate scandal, McGreevey was forced to resign in 2004, to be replaced by an inter-regnum Governor (Democrat), and then in 2006 came the elected Governor Jon S. Corzine (Democrat), whose austerities -- as well as his progressive tendencies were remarkably consistent with the fiscal politics of all U.S. governors at the time-- of either party. This caused disability-rights advocates some concern, but it is reported by New Jersey Protection & Advocacy,Inc., in a story "FY 2007 State Budget," http://www.njpanda.org/legislative.htm , that as of 2006, "The budget funds numerous recommendations from the Mental Health Task Force. These include: mental health screening centers, self help services, psychiatric services, supprtive housing, and jail diversion programs in Atlantic, Essex, and Union Counties." Corzine's steady-state approach initially-- perhaps not now after the known incident of his driving while intoxicated-- won him the tacit, grudging favor of the (predicably conservative) New Jersey Chamber of Commerce in the first part of 2007. [ See: "FY 2008 Budget Update," New Jersey Chamber of Commerce, http://www.njchamber.com/media/budget08/feb%2022%2007%20budget08.htm .]

Here, New Jersey, is a state that did not resort to drastic budget cuts in mental health, overall, and which with the closure of state hospitals still found that alternative facilities take the brunt of "exiled" chronically mentally ill-- the report here is of the emergency wards of hospitals-- but I have little doubts from hints in the Kaiser Foundation story yesterday that there are problems with mental patients going to jail-- and to the "skids" after shutting down the long-term facilities as well. This Kaiser report voices the speculation of mental health experts in New Jersey that this reverse-of-events there comes about through:

"lack of psychiatric beds"
"failure to hold and treat clients in a safe and secure location"
"planned downsizing of available beds in the state mental hospital system"
"challenges in moving patients with legal charges or violent histories to appropriate state facilities"

[Same Kaiser story, cited.]

Of course, it is an inevitable human tendency to begin a "blame-game" when such a massive social disruption occurs. In one place [ "Hospitals as Scapegoats," Treatment Advocacy Center, March 1, 2007, http://psychlaws.blogspot.com/search/label/hospital%20closures ], an irritated blogger-- apparently of New Jersey-- writes, "New Jersey already closed one hospital and 'reinvested' the money in the community. Yet the psychiatric hospitals are overcrowded because community mental health providers can't-- or won't-- do what is necessary to keep patients out of the hospital. Thus tragedies among this very vulnerable population are inevitable both in and out of hospitals...Community mental health must step up and do more for hospital patients than just take their money."

As we may expect, this is not the view of community mental health workers in New Jersey, for we read in "Grassroots Advocacy Newsletter," of the New Jersey Association of Mental Health Agencies, Winter (meaning this past winter) 2007, "Community mental health workers earn 20 to 30 percent lower salaries with similar jobs. This situation leads to high turnover and vacancy rates, undermining the stability that individuals with mental illness need...Since 1997, the consumer price index has risen 32%. In the same time-frame, the state has only provided a total increase of 15%...Medicaid only reimburses organizations 11-15% of the actual amount these services cost."

There is merit with both positions stated just-above, but my experienced sympathies lie with the community mental health workers, and with community mental health as a concept. The basic problem-- and one that is less-often voiced as "charges" get raised-- that chronic mental illness is a bio-psycho-social phenomenon in each instance of its occurrence, and there is only so much that social intervention can do to mitigate against the "sting" of these terrible disorders-- which to date -- with a "total-systems" approach can be managed-- but only liars and tom-fools boast of a cure. The fact remains that community interventions are the-more and not the-less needed when patients are getting themselves in "pickles" and thus winding up in decidedly non-psychiatric places-- dead or barely alive. If the governors-- I am speaking of magistrates-in-general-- do not take into consideration that the mental patient has such complex malady, then we may anticipate that these prophetics-- taken from the none-too-liberal BusinessWeek Online, in an Internet story posted March 24, 2003, http://www.businessweek.com/bwdaily/dnflash/mar2003/nf20030324_3888_db038.htm -- precisely when New Jersey and practically all other states were slashing mental health due to "the budget crunch":

"About 10% of state health-care spending-- a nationwide total of $ 20 billion-- goes to treatingmental disorders, according to the National Institutes of Health. And since the mentally ill aren't a particularly powerful constituency, cutting funds that are earmarked for them is a politically expedient decision. As well as hurting patients, the cuts could have an unintended negative effect on the states themselves. Many of the mentally ill could end up in jail, on the streets, or in hospital emergency rooms...[S]omeone on a simple charge, say panhandling or stealing a cup of coffee, can cost several thousand dollars-- about as much as what's needed to provide outpatient mental-health care for a year, including counseling and medication...The money needed for their treatment will come out of the budgets of departments of correction and the states' general health-care budgets...Adding the mentally ill to their load will put a bigger strain on those other budgets, which are being trimmed as well...The long-term costs of too little care are more tangible, in part because shortcuts taken now can lead to longer and more intensive treatment later-- and increase the lifetime cost of care for a disabled person."

...There is, in my estimation, great merit in what this writer in BusinessWeek had to say. The problem is-- as the New Jersey case reveals-- money is only partly the solution to this crisis of treatment-malapropism for the mentally ill. Programs and jobs designed at custody-- about at the level that the old state "asylums" used to have-- are just a way to "sweep dust under the carpet," whether-- to Dorothy Dix's rage if she knew-- this occurs (again) with the mass-jailing of mental patients, the cramming of schizophrenics and bipolars into ER beds, or -- as I think will en masse happen in my "gentle" Louisville-- for "consumers" to just die in the gutters, the victim of crime, malnourishment, exposure-to-the-elements, and no medicine. The investment should not be considered a matter of budgeting money but in biopsychosocially-astute programming.

This is not "rocket science." Mental health professionals of all types-- psychiatrists, psychologists, psychiatric nurses, mental health social workers, case-managers, expressive therapists, pastoral counselors, yea even aides-- will all tell with little variance approximately what is requisite for an optimum treatment program in mental health. Inpatient and outpatient treatment are both needed, and both types should consider the whole person-- as a complex cluster of events focalizing around the event of personhood-- to be dealt with biologically, psychologically and socially-- with savoir faire as well as the recognition that sometimes-- maybe 10-20% of the time-- there will be setbacks. Budgeting and programming in mental health-- which like it or not is here to stay-- will be so much "wheel-spinning" until these biopsychosocial realities are accomodated.

---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # 350
F31.2
Telephone: 1 (502) 561-5419
E-Mail: freethink@bellsouth.net

2007-05-14T23:46:00.000-07:00

A "Blood Test" to Identify Schizophrenia/Bipolar-Disorder:
Psychiatric Recycling, for Good-and-not-so-Good

Just yesterday, Sys-Con Media announced that a company in Britain-- Curidium-- has developed a serum (blood) test for determining: 1. whether a person is schizophrenic or bipolar; 2. whether she/he has one of several sub-types of these disorders. The accuracy of this test is stated to be 94% for selectivity-- the ability of a test to determine "true negatives" from "false negatives" -- meaning that the test robustly will eliminate cases where the patient is assessed not to have a condition although in actuality she/he does have the condition. This is impressive: but the finding that the test is effective in detecting "true positives"--its sensitivity-- only stands at 78%-- which means that over one fifth of the time the test will detect a patient as having a condition when in fact she/he does not.

This is hardly better information-quality than what one would get by using the interview-skills of a psychiatrist or panel of psychiatrists or other mental health professionals-- sans psychological testing-- for the diagnostic work-up alone. The literature on this subject mostly has to do with reliability-- the ability to consistently get the same diagnosis in the same type of situation-- yet another questions focuses on validity-- "the best available approximation to the truth of a given inference, proposition or conclusion" [see "Reliability and Validity: What's the Difference?", http://www.socialresearchmethods.net/tutorial/Colosi/lcolosi2.htm .] But from my trove of information, the file cabinet, I do have an article about the reliability of diagnosis with pschiatrists using case material: here we read that two qualified and fitly skilled doctors agree with a diagnosis of psychosis 49% of the time, with "psychoneurosis" (a diagnosis which has gone by the wayside, but to me signifies something real) at 57%, organic brain syndrome at 72%, mental deficiency at 57%, sociopathy (antisocial personality) at 80%, psychophysiological disorder at 83% and "special symptom reactions" at 91%; indeed the only mostly-unreliable showing was in the area was for the assessment of "personality disorder," which registered at 14% [see Table 12-19 of "Reliability of Psychiatrists' Ratings in Community Case Findings," American Journal of Public Health 57(1):94-106, 1967]-- I have not read statistics that the more-recent assessments for these conditions-- while they do imply something different semantically-- is any more reliable.

Now reliability is not the same as validity-- as I say-- but it would be required for a valid diagnosis. Therefore, reliability is a necessary criterion (always shows) but not a sufficient criterion (one that must show) to demonstrate an underlying cause. One could argue that the doctors of behavioral medicine lack such validity in assessments-- but clearly what a psychiatrist assays is real and therefore does constitute measurement.

On the other hand, there is some possibility that the Curidium folks have on hand a reliable test which measures something different than causality. It is known, for example, that this is not the first effort to make psychiatric diagnosis of the psychoses from blood-work: in the 1950s in Saskatchewan, Canada, Doctors Abram Hoffer and Humphrey Osmond claimed to have found a "mauve factor" -- adrenochrome-- in the blood of schizophrenics-- which if rarefied made the investigators to injected this factor by way of self experiment were said to feel alienated from society, and hallucinatory; subsequent evaluative results were mixed, with most psychiatrists-- the most-respected ones at any rate-- tending to think this hematological finding was an artifact (accident.) But for a contrary opinion, read "Orthomolecular Psychiatry," by Junius Adams, reprinted from Cosmopolitan, at the http://www.schizophrenia.org/ortho.html Website.

I do not wish to be too firm in commiting myself to the position that the Curidium test is also an artifact-- likely it is not-- and the difference between the empirical quality of biochemical studies in psychiatry is several orders-of-magnitude better than was the case in 1967-- when the anecdote was the dominant from of research-exchange-- and certainly that is not the case now. However, I just read an article which reflects the view that genetics and environment and the interplay between the two-- epigenesis-- precipitates (at least) major depression (which could include manic-depression.) See "Molecular Studies of Major Depressive Disorder: The Epigenetic Perspective," a feature review by J. Mill and A. Petronis, in Molecular Psychiatry 1-16, 2007, http://www.nature.com/mp/journal/vaop/ncurrent/pdf/4001992a.pdf . If this theory of epigenesis is the most-correct model of major depression-- if not all serious mental disorder-- then a test which only measures the impact of genetics-- read here the Curidium test-- then we are likely to suspect a problem in construct validity-- which is the concern for answering, "...is there a relationship between how I operationalized my concepts in this study to the actual causal relationship I'm trying to study?" [see again, "Reliability and Validity," article cited above.]

So here we have it, in a nutshell and "to the rub": the rate at which this test actually discriminates between schizophrenics and manic-depressives is hardly better than conventional-- all-too-conventional-- psychiatry, and as well we may readily anticipate that for the time being at any rate this test will be quite expensive!!! The main use of the test properly should fall under the balliwick of "research," i.e. to open up new pathways for treatment-- based on genomics. There the concern for expense is less than would be the case in work-a-day mental health, where medical economics has always been a factor-- always working counter to poor saps like me-- on psych disability, etc.

And it would be different if there were not medications already on-line for the treatment of the kind of malady I and other mental health consumers have. Mental illness is a highly treatable condition! But in the same way that one can cut butter with a table knife or a laser, one can be treated nowadays with viable and cheaper psychotropics or by the new medicine -- expensive as well as modern-- which no doubt will derive from work like that being done at the Curidium entrepreneurship. The "old stuff" -- like ECT and phenobarbital-- still have a niche in psychiatry, and may be applied in (economically and clinically) fitting cases.

There is one more factor I'd like to put in here, before I put "this one to-bed." The expensive stuff of today gets cheaper, and then dirt-cheap, as time goes on. Patents on medications, for example, strictly speaking run out in seven years: to wit, the expensive name-brand of risperadone-- check it out-- will expire in just a couple of weeks-- opening the door for some generic-drug manufacturer to begin distribution of a risperadone-clone for orders-of-magnitude less than the hundreds for which this medication now sells. [See "...RISPERDAL ," DrugPatent Watch.com , from my search dated May 7, 2007.

Consequently, if I live that long, within the next ten years, I expect some lab techy person to swab-me-well to get saliva/blood/any-tissue for my DNA, and then to get a "real fix" on my genomic information for clinical purposes. Then, just later, will come real genetically-engineered drugs to treat my condition-- but admittedly this may take some time. But that time IS a-coming! The Curidium news seems to be on the avant-garde of this coming tsunami-like front!

---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # 350
F31.2
Telephone: 1(502) 561-5419
E-Mail: freethink@bellsouth.net

2007-05-12T10:51:00.000-07:00

Shortcheated:
The Tax Relief and Health Care Act of 2006 (H.R. 6111, Congress 109)
And the Deficit Reduction Act of 2005 (S. 1932, Congress 108)
Work to Slash Medicare and Medicaid to Mental Health Consumers (and Others!)

In December, 2006, I happened to read a feature "Psychiatrists Face 7% Pay Cut Unless Congress Steps In," in Clinical Psychiatry News, December, 2006, pages 1 and 59. This is a scary headline to a mental health consumer like me, and while I do not profess to be expert in the outs-and-ins of federal budgetary policy-- about which in reference to the Medcare/Medicaid budget this article pertained, but what the article assuredly said was that Congress had recently moved to -- in time-- pare back funding for these healthcare services, with greater impact on psychiatry than other health disciplines.

Having many "irons in the fire," I did not try to cross-validate this claim until quite recently-- albeit if the charge were true that these slashes would occur in times to come-- just as numerous "Baby Boomers" will be both reaching retirement-age and be-times ( commensurate with advancing age) going onto disability-- this would be a scathing indictment of the (Ancien- Regime- , G.O.P.-led) representatives we had and (in minority) remain in Congress. But as per usual when I try to balance-off reports in the media against one another, I did of late make a concerted effort to verify the substance of the charges in the Clinical Psychiatry News to which I have alluded. To my consternation, with only minor qualification, I found the implication for Medicare/Medicaid/SCHIP programs -- which includes a lot of good people who DID often-as-not work hard for a toe-hold in this Cowboy Country-- and so will the coming horde of "Baby-Boomers" who have in longtitudinal time been "booped-out" of society from crowded-kindergarten, jammed-job-market, yea now unto shortcheated-retirement.

Here are my particulars: the Congressional Budget Office report, "Cost Estimate December 28, 2006 H.R. 6111 Tax Relief and Health Care Act of 2006...," http://www.cbo.gov/ftpdoc.cfm?index=7714&type=0&sequence=0 , plainly indicates that the effect on premiums-- the amount paid-out for Medicare A (hospitalization) and B (doctor's visits and 'therapy') will be a net reduction of $ 1.7 billion between 2007-2016-- although it must be admitted that integrity of Medicare fiscally will be maintained in F.Y. 2007. All the while-- as one upon a microsecond's reflection will assess-- the costs of medicine-- including mental health will go up in an inflationary spiral far in excess of the rest of the economy. This presents a real dilemma for doctors, who do like to get paid, and many of whom also -- as keepers of a kind of public trust-- like to do Medicare work (and Medicaid and SCHIP work, as well.) To get a clear grasp of this predicament-- I know of no better graphic on the "Web" than the AMA's one-page PDF document entitled, "Future Bleak for Seniors, Baby Boomers. Medicare to Cut Payments as Boomers Enter the Program," http://www.ama-assn.org/ama1/pub/upload/mm/399/nac_costs.pdf , dated February, 2007. Here we see the dollar-value of two variables-- "practice costs" (to the medical professionals) and "Medicare costs," in a time-series projection between 2001 and 2015, with the first variable mentioned making a wide "V" with the second-- really scary stuff for the average sap-- probably you, Reader, and certainly me (one who worked a career and then got inadvertantly saddled with disability, Medicare, and such issues as my unchosen lot-in-life.)

This is not the only "woe" to note: this sharp and untimely reduction in Medicare just at the time a lot of folks may be anticipated to need services, and the additional problem of medical-cost-inflation-- is to be compounded with a prior bill called the "Deficit Reduction Act" (S. 1932, Congress 108), which mandated cuts of - $ 22 Billion for Medicare for the period between 2006-2015 and - $ 26 Billion for Medicare/SCHIP programs for the same period [see Congressional Budget Office, "Cost Estimate: S. 1932: Deficit Reduction Act of 2005," page 2, January 27, 2006, http://www.cbo.gov/ftpdocs/70xx/doc7028/s1932conf.pdf .] While this bill barely passed Congress-- surviving only by the one gainful vote of Vice-President Dick Cheney-- with most Congresspersons voting along "party lines" -- so given a Republican Congress, the bill passed from legislature on December 21, 2005, and was signed into law by President George W. Bush on February 8, 2006. In his comments on the passage of the bill-- at which signing Kentucky Senator Mitch McConnell was in attendance, President Bush said, "This important piece of legislation restrains federal spending-- and it will leave more money in the pockets of those who know how to use it best, the American people...The Deficit Reduction Act is estimated to reduce the growth in Medicare spending by more than $6 Billion over the next five years. " Somewhat paradoxically, or even inconsistently, the President adds, "With this bill, we're showing that we can keep the promise of Medicare and be good stewards of the taxpayer's money at the same time."

OK. I worked virtually a career before losing my mind at the loss of my wife: I paid all the taxes of a working-man then, and now I still pay federal taxes-- e.g. on my telephone bill, and gasoline, and the myriad other ways the feds have of getting money out of folks who draw a disability check. It is not the case that I ever fretted more over the pittance I would save in paying-out a few-less dollars to care for the sick, the injured, or dependent children: I have always thought that kind of "tax" to be completely acceptable, provided the service were not "second-class" by comparison with the "worried well." NOW, I want my taxes and my government to live up to this very same expectation I had of government for deserving others when I managed a career. For, to paraphrase Ronald Reagan, who said that "all work enobles," I rejoin that "humanity enobles," and those who profess such a right/value-to-human-life had better show me how there is quality-of-life-after-birth!

The President's Press Secretary issued a "Fact Sheet.." upon the signing of the "Tax Relief and Health Care Act of 2006," upon President Bush's signing of the bill on December 20, last year [see http://www.whitehouse.gov/news/releases/2006/12/print/20061220.html .] This played much "the same music" as was enounced at the signing of the "Deficit Reduction Act of 2005," as we read, "This Act will extend tax relief for millions of American families and small businesses, and add momentum to our growing economy. It will maintain key tax reforms, expand our commitment to small business." On the crucial matter of healthcare, this notice touts a provision of the bill which would facilitate "Health Savings Accounts" hypothetically for lower-income Americans-- although I have heard through N.P.R. and other sources that these accounts are an arcane source of benefit-- for the few-- historically the haven of the wealthy-- and not readily used by the "nitty-gritty poor." Nothing is said in defense of the cuts that the Congressional Budget office reported -- as well as the December issue of Clinical Psychiatry News just cited-- that substantial cuts in Medicare/Medicaid/SCHIP will occur as a result of this bill.

HEY! I do vote, and so do most of the people who read this blog. You Congresspeople who did this number on those who depend on Medicare, etc., ultimately the great majority in this nation, will hold YOU accountable-- just as I was held accountable when I was a social worker by Nixon's -- and then Reagan's lackies-- and just as I must not as a disability recipient waste the taxpayer's money now-- I SHALL REMEMBER ALL THIS WHEN I GET TO THE POLLS, AT THE PROPER TIME, IN THAT COMING "JUDGMENT DAY" FOR THE MALEFACTORS BEHIND THIS FISCAL MYOPIA, AND LACK OF SOCIAL CONSCIENCE!

---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # 350
F31.2
...with 20+ involuntary mental hospitalizations behind me!
...with death-in-the-gutter without medical treatment ahead of me!

Telephone: 1 (502)561-5419
E-Mail: freethink@bellsouth.net

2007-05-10T09:24:00.000-07:00

"Don't Expect to Live Long if You're a Nut":
A Sad Comment by a Mental Health Consumer
On the Finding of Foreshortened Life-Expectancy for Psychiatric Patients

A media report that was uttered on or about May 3, 2007 [see "Mental Illness Linked to Shortened Life Span," by Katie Allison Granju, http://www.wbir.com/printfullstory.aspx?storyid=44809 ], presents survey result to the effect that the average life-expectancy of a mental health consumer is about 25 years less than other Americans. This compares with the already-sad finding of the early 1990s when it was found in a survey that mental health consumers live on the average 10-15 years less than Americans as a whole.

This article suggests that modern "atypical antipsychotics" are substantially to blame for these short life-expectancies, as these medications cause weight-gain in excess of the traditional antipsychotics and thus contribute to the development of diabetes, hypertension (high blood pressure), other cardiovascular problems, and all else-- which is a lot-- that is associated with obesity.

OK. I buy that thesis, in part. But every death, like every life, is the summed result of all inputs and outputs, the warp-and-woof of experience in the totality of being. In statistical terms, it is appropriate to speak of "subcomponential analysis" in such contingencies, and of course-- while we can parse off part of the variance related to short lifetimes in mental patients as due in some way to meds, it is likewise true that many other variables "feed" into the thanatological picture. This report is honest enough to cite the fact that mental patients are more-likely to succumb to "other" medical diseases and accidents which lead to death. But I do feel that we need to consider the overall curtailing of (community-based- and hospital- ) mental-health services as being in the "mix" here, too.

In the 1990s-- due to the impulse of the Reagan Administration but carried unto its zenith in the Clinton Administration-- community mental health for the indigent (and most who become mentally ill will become quite indigent!) reached a kind of low "hill-top" from which it has nothing but descend. Once-available community services from (visiting) case-managers was the rule, not the exception, and -- here in Louisville, at least-- the norm was for a psychotherapist to see a "client" (we are not called "patients" by this crew, although I am not offended in the least by being "patient"!) around once per fortnight. One could see a psychiatrist once per month, more-often if necessary. One went to a state hospital when it came time for inpatient mental health care, and the absolute rule there was that no patient (we were called "patient" at Central State--"our" hospital) would go out of the hospital without a proper "placement" (meaning shelter with the opportunity to obtain food, and care.)

Nowadays, things are much-different. Managed-care and the federal passage of the Deficit Reduction Act-- by a Republican Congress and White House with a decidedly arch-conservative slant-- one goes no more to a state hospital, but -- if service along these lines is compelled-- to the local "general" hospital, which inevitably cares not a whit if you become homeless as a result of mental hospitalization (having been cunningly evicted by shyster landlords to our general hospital and subsequently made homeless, I know well whereof I speak.) Consequently homelessness-- and the very exposure to the elements when the mental patient is left out-of-doors to his own device and judgment-- all contribute to the kind of mortality-- not painless death!-- that we could expect under such conditions.

It matters not to me whether the state government or the county government (as it was in certain venues previously) or the federal government "picks up the tab" for the care of the mentally ill-- this can all be explained as an obligation parens patriae [Latin: "the King/State is the father-of-us-all"; by inference, "when the normal social system breaks down, the state needs to intervene"] obligation of governance under wise common law. But in fine, we live in the Untied Snakes of America, a country which would much rather wage war in Iraq than take care of the dying-in-the-street at home.

And mental patients are dying-in-the-street. Here, in Metro-Louisville, Kentucky, we read in the newspaper quite often of folks who are just described as "homeless" dying of exposure to the elements; what often-as-not goes unsaid is that this person was a mental health consumer or marginalized "should-be" mental patient-- who died without insight or judgment as to how to care for herself/himself "out there." This is especially true in the winter: but one can die of the merciless heat in Kentucky summer as well, or from exposure-without-shelter to our well-known "cold Kentucky rain" of any season. Our politicians in Washington, in Frankfort, in City Hall just have "other fish to fry," and -- while we have 'paper' rights of which we are informed if when absolutely needed we can get into a psychiatric hospital-- it is also quite true that many of us are -- as the saying does go in mental health-- "dying-with-our-rights-on."

Any politician who sponsored or voted for the Deficit Reduction Act-- and I think this had great appeal to the Kentucky Congressional contingent-- does not rate her/his job as a result of this great "penny-wise-and-treasury-note-foolish" decision. The damage that has been done to the mentally ill-- and to the ill -- as a result of this shortsightedness does make us live shorter lives-- but that is not all: without our medication, and without continuing psychosocial care, the cohort of the chronically mentally ill gets into all kinds of mischief-- and we spread diseases like hepatitis, HIV, tuberculosis-- and even LICE --at rates which, if known, would shock and alarm this REDNECK NATION!

...I do NOT rest my case!

---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # 350
F31.2
Telephone: 1 (502) 561-5419
E-Mail: freethink@bellsouth.net

2007-04-29T02:31:00.000-07:00

A Mental Health Consumer and Advocate
Reads the Involuntary Commitment Petition
of Seung-Hui Cho (Poly-Murder-Suicide Perpetrator):
A Matter of Existential Dread

On April 17, 2007, the day prior to my 6oth birth anniversary, an event transpired in Virginia that is certain eventually to affect me as a mental health consumer and advocate. On that day in Blacksburg, at the university known as Virginia Tech, a "should-be" mental health consumer named Seung-Hui Cho-- a Korean immigrant apparently on a student visa-- shot-to-death 32 people with a high-powered rifle-- having been jilted by a girl whom he loved.

I deliberately-- out of penitance-- avoided listening to the news of this horrible event, except of very late to read the story of the published involuntary mental health petition taken out by an LCSW -- Kathy Godbey-- of Carilion Saint Albans Behavioral Health, New River Valley, Virginia. Then my aversion to the mass-psychological frenzy of the day was place in "the back seat," and with anguish I read these legal papers from the Christiansburg, Virginia, mental health court dated December 14, 2005-- which are public documents for which no claim of confidentiality can be raised-- "pressed" at http://www.slate.com/id/2164842/entry/2164844/ and sequence.

In places, the graphology of this document is physically hard to read on the Web-- probably because the handwriting in the original is close to a scrawl in the first place. Nevertheless, the message that comes through quite clearly is that Godby-- and apparently a psychiatrist at the Center-- thought that Cho "[p]resents an imminent danger to himself as a result of mental illness," the magic words-- or some of the words at any rate-- that get a person locked-away in an involuntary psychiatric place. This was sought, with the proviso that "court-ordered o-p [out-patient] to follow are recommended treatments." Cho had no prior psychiatric admissions, or even psychiatric treatments. He was not considered a "danger to others." Godbey wrote-- as best I can determine-- in her fairly clear but still hard-to-read calligraphics-- "Oriented X 4 [meaning that the patient knew who-he-was, when-it-was, where-it-was, and what-the-situation-was at the instant of the psychiatric-history-taking]. Affect is flat [which is usually taken as a "negative symptom" of schizoprenia-- but I know from practice that it is often applied to depressed patients, as well] and mood is depressed. He denies suicidal ideation [but! just four months later Cho killed himself with an AK-47 after killing the innocent 32 with the same gun!] He is not ... [Internet transcription of this word is not clear at this word] symptoms of a thought disorder [this almost certainly means that the mental health professional-- who had to be sufficiently qualified to put information on this petition-- did NOT believe that Cho was schizophrenic-- she does not put in a diagnosis but all this COULD HAVE BEEN diagnosed as a "schizo-affective disorder"]. His insight and judgment ... [somewhat illegible on the computer screen-- likely to be the word "decompensated," which means that insight-and-judgment-were-not-working-properly.] A "doctor of medicine" -- whose name appears to be "Roy Crowe"-- also signs the petition, which is to be expected [mental health petitions for involuntary commitment typically will permit a psychiatric social worker, psychologist, master's-level nurse or nurse-practitioner, etc. to fill out such a petition-- PROVIDED AN M.D. ALSO SIGNS THE "PAPERS"; in my experience-- inpatient and outpatient as a professional and consumer-- the "heavy lifting" in these matters is done by social workers-- at the complete behest of doctors; the work is nasty, unrewarding, yet requiring-perfection-- in all of which you can lose your social work license if/when the wrong "moves" are made.]

According to www.Slate.com -- in the article by Bonnie Goldstein posted Tuesday, April 24, 2007, at 11:26 a.m. Eastern (Daylight) Time-- in the subsequent hearing the mental health center's petition for involuntary confinement was turned down by Judge Terry W. Teel (gender uncertain and irrelevant), and Cho was referred to outpatient treatment instead. One can be certain-- in view of what did happen with this case-- that "Hell" will be paid for the eventful decision not to "commit." But -- as a former social worker who did this sort of work-- and as a mental patient who has experienced around 20 involuntaries ( all for "danger to self" of a LOUD/SCREAMING kind more than what is truly life-treatening!) I have some input here-- which a world all-too-ready to judge SOMEONE ought to "hear."

Mental Health centers for "the masses" are harried places these days. The psychiatrist tends to be a guy who gives-five-minute-medication-consults-and-writes-it-up-as-fifteen-minutes; the nurse-practitioner has nearly "eclipsed" the M.D. as the primary medical person for "these welfare people," the people who lack the resources to pay-- as being closest to "the skids" in society-- for a private psychiatrist; the social worker-- who as I say would have to have a clinical license to write-up an involuntary petition-- is the REAL HELPER in such places-- and it is thankless, undesired, and usually counter-productive to both the healing process and the ultimate success in mental health court to pursue "an involuntary," as these are called.

It is no surprise that the M.D. who was recently called to testify in Cho's "post-mortem" hearing did not show up-- she/he may have had almost zero proximic, face-to-face, interaction with the patient: this would have all been done-- really-- by the social worker. CMHCs [Community Mental Health Centers] with almost no variance do NOT with joy enter into the fray required for involuntary commitment, which is inevitably a vast expenditure of time, effort, and agency money. "Business-as-usual" seems to be the operant principle behind the apparent dearth of action in the Cho case.

But this is not all of the context necessary for understanding these events. Of late, since the 1990s the budgets for CMHCs all over the U.S.A. have been cut back and programs "shriveled" [yes! having a Democrat in the White House certainly made for better quality-of-care in those bygone days!] Instead of a good 10-15 clients in a caseload now, a social worker may see or have accountability for 50 clients; and DON'T ASK about the CMHC medical staff-- they have long since virtually been "booked-up-and-out!"

In this business the "loud and squeaky" are the ones likeliest to be EMIed [ "emergency-mental-inquested"]; the "lurkers"-- like the notorious "Son of Sam" of old-times and apparently Cho now-- tend to be shoved off to the side because they do not "make a lot of noise" about their psychopathology. Almost all of mental health service depends on talk-- what the patient says and how she/he says it, what is uttered in staffings ["treatment planning," and other case-conferences] by mental health professionals, and -- let it be known for certain that this is Truth-- by the COPS-- for the police are the last-recourse, emergency mental health professionals who-- on the front lines-- must say to their level of psychological expertise whether a person is/is-not a threat by reason of mental illness.

Like any other assay, the business of mental-health determination and of dangerousness is an empirical investigation which has TRUE POSITIVES (the person is both mentally ill and dangerous), TRUE NEGATIVES ( "patient is not dangerous + mentally ill"), as well as some certainly more-undesirable FALSE POSITIVES (the patient may/may-not be mentally ill but is NOT deemed a danger to society); yet it is exactly the case that the FALSE NEGATIVES ( when the patient IS dangerous because of mental illness and HAS NOT BEEN DETECTED AS SUCH) that cause the most problems to the entire system. Typically, the mental-health/criminal-justice complex will "miss/pass-over" the quiet types-- most of whom are men-- who scheme mayhem in silence, never breaking any laws down to the least traffic ticket, not even "uttering a peep" that would betray ill intent: THEN ONE DAY ERUPTING IN VIOLENCE THAT SHOCKS THE WORLD INTO AN OUTCRY, "WHY DON'T THEY LOCK UP ALL THOSE PEOPLE; WHY DON'T THEY DO THEIR JOBS?"

In actuality, the TRUE POSITIVE rate for all psychological assessment is much lower than anyone would like to tout: this certainly was the stuff of mental health banter as far back as the 1970s-- when courts and legislatures started demanding the involuntary commitment include and assessment of DANGEROUSNESS-- REAL AND IMMEDIATE-- as well as a psychiatric/psychological diagnosis. The System since those early days of this requirement has REALLY tended to err in the conservative direction-- TOWARD LOCKING UP PEOPLE ON SCANT SUSPICION THAT THEY MAY CAUSE HARM TO SELF/OTHERS [whom I call "FALSE POSTIVES" in this business.] I must give the mental health "pros" credit for this: the least suggestion of harmfulness in a mental health consumer will usually warrant an involuntary. BUT THAT IS MORE THE REFLECTION OF A "MOUTHY" PATIENT THAN-- FREQUENTLY-- SUICIDALITY/HOMICIDALITY BY A MENTAL PATIENT.

I -- a person who can this minute get myself hospitalized by going out as I am dressed -- in my bathrobe-- and shouting at the sky oaths and obscenities until the cops come-- I know that all you really have to do to create yourself an involuntary as a mental health consumer is to MAKE A LOT OF NOISE-- i.e. what under other circumstances is "disorderly conduct" or "disturbing the peace" becomes convincing -- unbreakable-- inexorable-- "dangerousness to self/others by reason of mental illness" to busy cops, who-- thinking that they have better things to do than this-- perfunctorily handcuff the nut with metal cuffs-- throw her/him into the back of a squadcar like any other "criminal," and off to the involuntary-mental-place. This demand of the cops on the mental health system is almost always met with compliance-- the gal/guy is kept for (on the average nowadays) less than a week, fed well, humiliated maximally, and sent out thereafter with an appointment slip to see a worker at a CMHC.

In all of this, we are dealing with human-all-too-human circumstances. No one should lock up a person who is NOT uttering mayhem, and it is the "mob" factor in society that makes a hue-and-cry/uproar/demand-for-villification when the quiet little Schlemiels fowl up a place with unspeakable violence-- SCIENTIFICALLY ONE CANNOT MAKE JUDGMENT ON INFORMATION THAT ONE IN NO WISE HAS; ALSO, ONE WHO "SHOUTS" IS AUTOMATICALLY-- RIGHTLY OR WRONGLY-- MOST-LIKELY TO BE DETERMINED A SOCIAL RISK. "SMILE, THE SITUATION IS HOPELESS!"

However, a few obvious factoids loom out for explication on this matter: 1. In terms of odds/likelihood/probability, an adequate mental health system-- with a complete complement of staff and ready/willing/able to respond when the patient "gets risky" -- will more accurately and effectively deal with "problem cases" than a service-system which has been cut-into-the-marrow-within-the-bone-- i.e. exactly the condition of the mental health system now; 2. something needs to be done to validly incarcerate the dangerous-mentally-ill for substantial periods of time (and of course-- as I can attest-- the converse-- that the "merely-shouting" mental patients do not need such "asylum" is true as well); 3. the system-- which includes all-of-the-American-social-order -- needs to recognize that assessing the suicidality/homicidality is an iffffffffffffffffffffffffy matter, far more likely to be inaccurate than accurate-- AND THAT'S "THE FACTS," AS SARGEANT FRIDAY [of the old t.v. show "Dragnet"] SAYS, "JUST THE FACTS"; [there will always be mistakes made-- FALSE POSITIVES and FALSE NEGATIVES in such matters-- and I for one have learned-- as a practical matter as a practical nut-- to just "pipe down" and not do malapropism as a way to keep the cops at bay-- and they are the real "missers-of-the-mark," both-ways, in the "street assessment" of dangerous mental illness]; 3. then it follows that SOMEBODY with real mental health savvy needs to do mental-health runs; if the police CANNOT exercise this ability then the call for increased MH training in criminal justice is all-the-more valid; if the police simply fail all-the-way-around in this, then such matters should best be turned over to people like EMS workers-- who at least have medical sensitivity by training/experience.

As the old popular song goes, "I've seen the world from both sides now, and still somehow it's life's illusions I have found: I really don't know life at all." It does inconvenience a person to lose one's liberty for mere shouting-- as is typically the case with me-- the handcuffs and the cop-stuff are a total embarrassment after nearly a career in forensic (psychiatric) work. Nevertheless, the system is only trying to do what it can to protect mentally-ill people-- and ultimately society-- from the Sons-of-Sam and Leon-Klinghoffers and Cho Seung-Huis of the world. I REALLY don't think they will ever fully "do it," will never make a clean-break with no FALSE POSTIVES or FALSE NEGATIVES in involuntarily hospitalizing the truly dangerous mentally ill. But that is by-far no excuse for abandoning psychiatry and mental health: the call instead should be

"Send in 295867348576 more mental-health battalions!!!!"

-- Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # F31.2

2007-01-05T00:02:00.000-08:00

Comment on the Shortening Period of "Youth" Psychiatric Hospitalizations:
Less "Sledgehammer" to "Kill Gnats"

Just hours ago, "EurekAlert," which is an organization which appears to devote at least part of its attention to mental health news, uttered a review ["Youth Are Receiving Shorter Inpatient Stays for Mental Health Treatment," http://www.eurekalert.org/pub_releases/2007/-01/1-yar010407.php] of an article just appearing in in January 2007 issue of Archives of General Psychiatry [AGP] documenting the steep-- even abrupt-- decline in the length of psychiatric hospitalization for children from 12.2 days a decade ago to 4.5 days now. The purpose of this article is to engage -- not in criticism of this fine piece of medical journalism by Carol L. Viera, cviera1@lifespan.org , but to analyze the general phenomenon of foreshortening trends in child psychiatric hospitalization itself, and to engage in a bit of "advocacy" which was perhaps neither anticipated nor imagined by EurekAlert.

The first article here quotes an author of the AGP article, Dr. Brady Case of Bradley Hasbro Children's Research Center, etc., as lamenting that "... driven by financial and other pressures, mental health providers are discharging severely ill youth too early in treatment." He does go on to say, however, that "... it may be that mental health providers are using hospital resources more efficiently and that children are increasingly being treated in day programs, clinics, and private offices." I would be the-more inclined to assess the variance of shortening hospitalization to the latter propostion, coming on the somewhat economically-forced-choice condition that fostered the mental health providers' "discovery" of community-based treatment.

I can remember when "state" hospitalization of youths was an even more drawn-out-affair than a stay of twelve-on-the-average days, but more like months and months and months in places like Kentucky's Children's Treatment Services (The Bingham Unit) at Central State Hospital here in the county from which I now write. Stays were -- by today's standards-- often for clinical reasons that would be "overkill," by which I mean that often the rationale was closer to a yen for providing residential services when the real problem best needed treatment in the community, and also for cases in which mental health acuity-- psychosis, suicidality, or assaultiveness was for a time a problem in a patient/client but the intrusive use of long-long-long-term hospitalization was employed. In this last case, it may be speculated that some significant portion of such prolonged institutionalization functioned to "get the brat out of the community's hair," and "to let the family off the hook" via inordinate respite.

But any form of respite psychiatric care-- while a "treat" for the family-- amounts to custody-alone, "jail," not "therapy." Such incarceration is expressly forbidden by the laws of every state, federal case-law, the Joint Commission on Accreditation of Hospitals [JCAH], and finds its way agreeably into managed care in utilization-review companies approved by URAC [which is an organization with just those initials alone, but used to stand for "Utilization Review Accreditation Committee."] Hospitalization of a mentally/behaviorally/emotionally-disturbed kid just for a "lock-up" is thus forbidden by every/all levels of state, federal, and regulatory agency.

Nowadays, there is recognition that Acute Inpatient Treatment is only occasionally necessary, and then for cases where clear psychiatric acuity or "dangerousness-to-self-or-others" can expressly be substantiated. More than a few days is hardly ever necessary at this level of care, which very often consists of intensive use of medication and even physical restraint. For states which have an adequate child psychiatry system-- and in no wise should one think that I refer to my own Kentucky-- THE PITS WE HAVE HERE !!!-- one can quickly and inexorably refer a child who has come down from such acute need to a longer-term residential program-- or the more likely to suit the client's needs, to community-based Intensive Outpatient [IOP] or Partial Hospitalization Program [PHP.]

IF-- and I mean IF-- good resources exist in the community for the disturbed child-- again not not not like in Dark and Bloody Kaintuck-- it is highly plausible that "locking the kid up and throwing away the key" will have been anything but a cruel, and counter-therapeutic, and lavishly expensive solution. In the communities, it becomes much easier to work with families in networking and problem-solving than is in all but the most-exceptional case a possibility in [especially state- ] institutions. This holds true whether one holds that strictly biological etiology is implication in mental illness, or that psychosocial genesis for such problems is at root, or whether such conditions are epigenetic/biopsychosocial [by which I mean that both biololgical and psychosocial factors interface to "make" psychopathology.]

Maybe "money" -- filthy lucre-- the "green stuff it takes to get along"-- is the prime reason for the thrust into brevity of inpatient stays for pediatric/child psychiatric hospitalization. No matter as far as the clear virtue of-- in general and not every single time of course-- keeping intensive inpatient treatment in child psychiatry to the essentials, and thus to the minimum. The long hospitalizations which were the hallmark of the age-- not too long ago at all-- when a child who was "committed" to a state psychiatric facility could expect months and in some cases years of institutionalization, during which time many dysfunctional, iatrogenic [ "healer-caused" ], and intractable habits could be and probably were learned. This previously-common condition for the disturbed child was nothing but an affront to the dignity, human-rights and clinical conditions, for the youth may very likely come out of such glacially-slow internment in worse condition than she/he "went in."

Accordingly, provided genuine community resources in child psychiatry, I see brevity of inpatient mental health treatment for the younger members of society as naught but a positive development, which I even applaud. It is almost-- but not quite-- true that even when community resources are poor, intensive acute psychiatric treatment for a kid should be avoided. Too often in the past, psychiatric treatment of children amounted to a malapropism, like the proverbial "sledge hammer to kill a gnat": when the first need of the disturbed child is placement, or when effort needs to be made to cobble-together "real" lives for kids like these, whose social matrix is often-as-not pretty "artificial," and in order not to teach a kid bad habits [like "hospitalism" for starters], then WE BEST START "AT HOME."

--- Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # F31.2
Telephone: (502) 561-5419
E-Mail: freethink@bellsouth.net

2006-12-19T03:43:00.000-08:00

The Right of Jailed Psychiatric Patients to Appropriate Treatment:
A Lesson from Puerto Rico that Applies to Kentucky Pre-Trial Mental Health
And to the Predicament of All Psychotics Who Get Arrested

Those who have been following this web-log know that I am quite keen to promote the genuine mental health concerns that are posed by criminal incarceration. I "speak" from Kentucky, a state I know well as I have lived here all my life, and have worked in the criminal justice system myself prior to going onto psychiatric disability, where almost no stimulus could net a cop determining that your shouting-at-the-sky is more a matter of "disorderly conduct" or "disturbing the peace" than a psychiatric syndrome. There is some psychiatry for the sap like me who winds up in prison (post-convicted status)-- a contingency that is a lethally facile occurrence, whether the mental patient is guilty or innocent; and there is a tinier amount of psychiatry in the major metropolitan jails of Louisville and Lexington and Northern Kentucky and peripheral counties; but in the rural counties, the "South," the "West," and "East" of Kentucky the pre-trial mental health services do not appear to be qualitatively different than that extant in Puerto Rico some years back, which was the subject of a federal lawsuit, and subsequently the topic of this entry.

In the action Feliciano v. Barcelo, 497 F.Supp.14 (1979), the United States District Court in Puerto Rico declared the entire correctional system (pre-trial and post-convicted) to be a violation of the Constitutional prohibition (8th Amendment) against "cruel and unusual punishment." In no small measure, the issues with which this lawsuit deals pertain to mental health of inmates (rather the lack thereunto for decompensated prisoners.) Under the pre-trial Puerto-Rican system, essentially zero input from a psychiatrist or other mental health professional was involved in identifying or treating the psychotic inmates in the system; instead guards would make a "lay assessment" that an individual was loco and accordingily put her/him in dungeon-like "calabozos"-- tiny enclosures which lacked plumbing and virtually every other human amenity. The total number of psychiatric cases in the correctional system then was not known: medical records almost did not exist and contained little if any psychological information. In the resulting opinion on which I report here, Judge Perez-Gimenez wrote,

"The overcrowding, lack of sanitation, the absence of health facilities or adequate medical or psychological services, the triple bunking of young adults, the failure to protect the pretrial detainees from attack...The government's obligation to provide medical care, recognized in the legislation of Puerto Rico, if not properly met, may produce physical torture or lingering death in the worst cases and in less serious cases, may result in pain and suffering. Deliberate indifference to the serious medical needs of the inmates constitutes "unnecessary and wanton infliction of pain" prohibited by the Eighth and Fifth Amendments...The medical program or better said, the lack of it, in the institutions operated by the Puerto Rico Administration of Correction violates the Constitution." ( ibid., pp. 33-34.)

..."The failure to hospitalize known mentally ill under conditions where the penal institution personnel know that they cannot provide medical or psychiatric services constitutes cruel and unusual punishment." ( ibid., p. 35)

Accordingly, it was ordered that,

"The psychotics must be removed from the penal institutions. Nothing we have seen is more depressing than the sight of young men totally out of contact with their surroundings and reality, stripped naked and left to their delusions and hallucinations without the benefit of working toilets, toilet paper, drinking water, beds, matresses or linen, human attention, medical care or medications. The prisons cannot cope with these sick persons. All the identified psychotics or severe mentally ill must be removed forthwith and placed by the Commonwealth in proper psychiatric hospitals.

"Every incoming inmate, whether pretrial detainee or convicted prisoner must have a complete screening medical examination within one week from the date of his admission...Not only must there be a medical screening of the inmates, there must also be psychiatric screening to determine which inmates are so seriously ill as to require hospitalization in a psychiatric facility outside the Administration of Correction and to determine which require treatment and the institutions...Each inmate who enters the penal population or the pretrial detainee population of the facilities operated by the Administration of Correction is entitled to continue to receive any life-supporting medication, prescription or special diet tha he had in civilian life. Each inmate has the right to receive medications, prescriptions and diets as they have been prescribed by a physician while the inmate is incarcerated." ( ibid., pp.37-38.)

This is as much of this rather-long federal opinion on which I wish to report. What is important to note is that this is still valid case-law: I "Shepard-ized" the decision and found that while it has been cited many times, it has not been "over-ruled."

Now it is fair to say that I am getting much feed-back that in Kentucky (especially rural) jails, the conditions for mental health consumers who get "caught up in the System" would-- in a fair judge's mind -- be only a little different than those reported in this legal case from Puerto Rico. Continental Americans are accustomed to thinking of Puerto Rico virtually as a "Third World" venue: they may be surprised to learn than medical/psychiatric treatment of inmates in Kentucky jails, the South (probably), and elsewhere here resembles quite closely this "Third World" condition. [Those who would like to read a specific example of what happened when a mental health consumer from New York City -- visiting our Kentucky mountains-- ran out of gasoline-- and was arrested after "knocking on doors" -- thereupon to lose all and to be deprived indefinitely of requisite psychiatric treatment-- should read my entry on this matter in this blog, date-of-entry Saturday, September 23, 2006.]

This is a "lock-up crazy" state, this Kentucky: our hillbilly singing and culture, known to much of the world, confirms this; it corroborates with everything I knew as a pretrial forensic/correctional psychiatric worker; it corroborates with my own-- admittedly limited and "innocent" scrapes with the law; therefore I have much reason to believe that the reports I am getting of under-treatment in Kentucky jails for psychiatric cases is "the tip of the iceberg," whose body is an immense social problem.

What is more, Kentucky is last in the delivery of all the states in a recent NAMI report, "Grading the States," issued March 1, 2006. We shall drift even further and further behind with the recent cut-backs in mental health services from the local CMHCs (Community Mental Health Centers), which included the most-gracious Patient Assistance Program (PAP), affording the distribution of "samples" from psychopharmaceutical companies to mental patients. We certainly can anticipate that large numbers of mental patients will be cast-adrift. Where will they go? Why, they will often go-- if they do not die in gutters or under bridges in Kentucky-- to JAIL. This inevitability creates the rationale for my discussion of this federal case, and my lament thereafter.

I am for my part holding my own. I shall do my best to "avoid the skids." But I am angry as hell and present here a tool-- legal means, motive, and opportunity-- for all of us "grunts" to get to work and work and work and work.

--- Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # F31.2
Telephone Number: (502) 56105419
E-Mail: freethink@bellsouth.net

2006-12-05T21:06:00.000-08:00

The "Washout" Period in the Bullitt County Jail
And Other Correctional Facilities in Kentucky:
One Peril for the Psychiatric Patient Who "Winds-Up-In-Trouble"
In this "Dark and Bloody State"

From authoritative, though anonymous, sources, I have learned that the jail in Bullitt County-- situated just south of Louisville here-- has resorted to a "washout" period for drugs, including psychotropic drugs for psychiatriatric patients immediately released from the hospital. The "washout" period is a matter of eight (8) hours, and I am told by an expert in psychopharmacology that the degree of medical peril associated with the use of even the most-vital psychotropic or mood-stabilizer would have been not-too-grave. However, I happen to know of jails in Kentucky that do essentially no psychopharmacology for inmates, with Kentucky Correctional Psychiatric Center (K.C.PC.)-- which for pre-trial services is officially but a center for determining competency-to-stand-trial--as really the only place where pre-trial correctional mental health services are provided in the Commonwealth / State. This means going to K.C.P.C. in an unmedicated, probably "crazed" state for a few weeks, getting what would pass for psychiatric treatment, then back to jail where again there will be no psychtropics or mood stabilizers [!!! then most of the time to go on to prison anyway, as except for the rich, "there ain't no insanity defense"!!!]

In the counties around Louisville as well as in Louisville, jail mental health does exist in a subdued way; the same may be said generally for the Bluegrass Area ( outsiders read "top-of-the-triangle-of-Kentucky") ; but in the rurality and mountains the reverse abjectly is true: for the mental patient in such places -- even with all the "turn-key training" and regional-jail-movement and professed "sensitivity"-- Kentucky's jails are DANGEROUS and MENTALLY HAZARDOUS places.

I strive at all costs to be fair. I have not heard the "side" of the Bullitt County jail here on its policy of the "washout period." Nor do I wish to be a demogogue in my advocacy. However, this policy of depriving recently-hospitalized mental patients of prescribed medications does concern me, in particular because I feel certain that this case is one-of-the-more-benign-examples of a system that is, by all appearances, corrupt.

In this entry tonight, I shall examine two aspects of this untoward tendency not to provide proper medical and security arrangements for mental patients in jails here, the legal aspect-- for those who feel that the pre-trial correctional system in Kentucky is violative of the 8th Amendment of the U.S. Constitution (and its Kentucky Constitutional equivalent); and then the policy aspect-- for those who feel (as I) that reasonable and realistic planning, funding, and programmatics-- as well as "eternal vigilance"-- are the ultimate keys to correcting this problem of horrific proportions. My aim is not exactly to "please" anyone, although clearly my sympathies emotionally and volitionally belong with the lot of the mental health consumers who have happened into one of Kentucky's "dungeon-throwbacks."

The Eighth Amendment to the U.S. Constitution briefly reads, "Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted." All of the three clauses have been interpreted with immense latitude, and the third, on "curel and unusual punishment" is really the only "real stuff" that a lay-person like me can point to as having been the avoidant practice of wiggy jurist who have alway tried to modify and even "get out of" what the Founding Fathers actually meant in the first place (using the criterion of "common sense" if not "strict construction.") Of only very late actual practice comes the requirement that -- on pain of violating the Eighth Amendment-- jails and prisons must provide for the safety and medical needs of their inmates ( Cortes-Quinones v. Jimenez-Nettleship, 842 F 2d 556, 558.) By immediate extension, this would mandate the segregation of mental-patients from non-mental-patients, and provision of the appropriate panoply of psychiatric services for those affected ( Morales-Feliciano, 497 F. Supp. at 37-40.)

In the 1970s, the hey-day of legal involvement to obtain rights for jail and prison inmates, numerous "paper" lawsuits were sustained, but in practice, "where the rubber meets the road" in this earliest 21st century, all of that is but a memory, with tombstones-and-bones hither and yon to remind us of those heady times, when social workers thought that, at long last, we could "shake some action" into correctional psychiatry. (Fools we were!) In point fine, jails and prisons can hire the best of great lawyers, and with a sympathetic public can "roll back" even soundly-reasoned case law whose logic and analysis "cuts to the quick" of this fecal impaction called penal law. Routinely, even quite modest claims for amenities (including medical treatment) in class actions have been "turned down" on appeal ( e.g. Clark v. Armontrout 28 F. 3d 71 [1994]), and with considerable success prison and jail official have been able to claim a form of "sovereign immunity" on the basis that they as functionaries of government "can do no wrong [in this particular matter]"; the Latin legal principle on which this notion is based is phrased, exactly, "Rex non potest peccare!"-- "The King can do no wrong!"-- an utterance which is certain to raise the deepest hackles of any North American. Such qualified immunity can also be applied to prison/jail officials who fail to provide medical treatment for an inmate (Osolinski v. Kane, 92 F. 3d 934 [1996], p. 939.) In other words, we are a long, long way separate in time from the era when Class Action Lawsuits and Consent Decrees governed-- even paralyzed-- the correctional system, although in all I would have to say that by far the more good came of this legal action than would have been accomplished by utter do-nothing indifference.

But it is time to move on. We need to move on, because it always was important to remember that the goal of all this court-battle was not to have public arguments, but to speak responsibly to real condition, real need, real danger, that is inherent in the status quo of the correctional mental health system. These legal cases do have their place-- I am in no wise in favor of carte blanche tort reform-- but the really ethical and responsible and effective-- and-- dare we say it-- the HUMANE thing would be to accomodate this malignancy as though it were something besides inconvenient detritis, to be stuffed into the least-conspicuous ash-can.

I cannot call it "illegal" that the Bullitt County Jail-- or almost any rural jail in Kentucky-- has something akin to a brief or extended "washout period." I do not know what they do with "brittle" diabetics or heart patients who have to take digitalis frequently, etc., etc., but certainly in tone and spirit this refusal to give mental patients psychopharmacological agents (hardly any of which have any addictive potential, and at any rate the mildly addictive "head meds" are never administered in jail) flies in the face of cooperation with recommended medical treatment. Here I do not fault the "good faith" of correctional administrators, but their "good-will" for complying with proper medical treatment.

In a larger, prison-demographic sense, the mentally ill are a malapropism to "manage" using conventional correctional procedures. They do have some potential to be violent-- a feature of my cohort which is much-overtouted; but what is more and exactly to the point is that the mentally ill tend to be unpredictable, particularly if the "turn-keys" should do the tom-fool thing of not letting psychotics have their "chlorpromazine" or whatever it takes to mellow them out. [Chlorpromazine is the cheap, old-fashioned stuff. Really cheap. Oldest.]

Yet the risk the mental patient may be to others does not compare to the management risk she/he may pose to herself/himself. Patients "who go to pill-call" [i.e. are on psychiatric rolls] are routinely tricked, robbed, beaten, raped, mutilated and murdered. Seldom if ever is anything "done about it."

What is even more diabolical is that anti-social inmates in Kentucky are likelier than psychotic patients to "go to K.C.P.C." from jail or prison precisely because the jailers "want a breather from this guy," which is a complete violation of the letter and spirit of the Consent Decree which brought accomodation for the mentally ill at the afore-mentioned facility (housed inside of Luther Luckett Correctional Complex, in LaGrange.)

None of this is privy knowledge to me. For the general problem of dealing with the mentally ill given a correctional mandate, I would refer you to the still very fine-- if now a bit dated-- Out of the Shadows: Confronting America's Mental Illness Crisis, by E. Fuller Torrey, M.D., John Wiley & Sons, New York, New York, 1997, pp. 25-42. Clearly, Dr. Torrey illustrates that some form of segregation of the mentally ill is a desideratum, and he later goes on to persuasively argue that deinstututionalization has rather "hamstrung" police and courts into using the jail-option owing the near-impossibility of acquiring hospital bed space for psychiatric cases.

What is to be done? We no longer operate in the social milieu of the 1970s, where the "big thing" was to litigate prisoner's rights cases. However, as I have tried to outline above, these legal actions are but a "flash in the pan" and mean nothing unless policy-makers are moved to administer correctional mental health in a more-responsible manner. This will accordingly not require a lawsuit, it will require a landslide (socially.) One needs to get out and in the words of Abolitionist Frederick Douglass, "Agitate, Agitate, Agitate!"

And how do we do that? If you live in Kentucky, you: 1. will be affected in some way by mental illness-- it's a "wacky" place or; 2. will be affected by the cops, courts, and corrections-people (we have more people in lock-up percentage-wise than the Gulags of Russia.) So go out an knock on every door right now, telling them about the injustices of correctional mental health, particularly vis a vis the jails. Don't like that plan? Then research your topic, get a computer and a link with Internet, and "sound off" on a blog or Google Base. That, I promise you, will have been the magic "levelizer" of the future, for with this keyboard and knowledge and utter utter honesty, you can get our landslide.

A higher percentage than half of the American population is now "wired up" to the Web. Potentially this strategy of consciousness-raising will make for phone-calls, votes, decisions, and finally rational administration of services for the mentally ill in (Kentucky's) jails.

--- Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # F31.2
Telephone: (502) 561-5419
E-Mail: freethink@bellsouth.net

2006-10-24T15:08:00.000-07:00

The Psychiatric Sequelae of Hurricane Katrina:
Report-on-a-Report of Before/After Epidemiology

Hurricane Katrina, which was the great storm of last August affecting-and-dislocating thousands of people in Southern Alabama, Mississippi, and Louisiana, was predicted to potentiate psychiatric crisis from its inception. For a time, I collected carefully the articles that I could glean from Internet and from the newspapers about the mental-health impact of this storm, anticipating that the aftermath of the temporary near-complete degradation of the city of New Orleans and Gulfport, Mississippi would have substantive collective changes in the morale, and thus the mental health of the victimized.

Of late, epidemiological work on this topic of good-enough quality to surpass the "journalistic level" to which I had been strapped has surfaced. This day I would like to review and opine on one such report, published as a PDF document by the World Health Organization in August, 2006: i.e. "Mental Illness and Suicidality after Hurricane Katrina," by Ronald C. Kessler, et al., Bulletin of the World Health Organization ID # 06-033019, published online at http://www.who.int/bulletin/volumes/84/10/06-033019.pdf .

This may have been the first article to systematically examine the before/after effects of this "big blow", using methods that are relatively satisfactory for empirical analysis. [The "journalistic" approach-- collecting "gee-whiz" articles from newspapers, etc.-- is biased from several standpoints, including the lack of systematization, randomization-of-survey, and the inherent desire of the journalistic publication to "tell a good story."] I encountered the Kessler, et al. article just today, on a Dogpile.com search, and felt immediately that here was material that could be shared with my readership.

Essentially, this study found that the sundry dislocations of Katrina potentiated mental illness in the affected population, but not "suicidality"-- a technical term implying the presence of suicidal ideation, preoccupation, or a 'plan' to kill oneself, as well as actual suicide attempts. Whereas of the 1043 respondants screened on a brief mental health survey [the "K6"-- c.f. note #23 of this report for R.C. Kessler, et al., "Screening for Serious Mental Illness in the General Population," Archives of General Psychiatry 60:184-189, 2006] there was a 5.2% increase in "serious mental illness" and 10.2% increase in "mild-moderate mental illness," significant that is in extremis statistically; there was almost no effect in the tendency to suicide in the population, even to the point that there was a slight decrease in the rate of suicide attempts.

The authors conject that something about the elan-of-crisis in these communities, through the mediating effects of enhanced ties to family/loved-ones, faith in the ability to rebuild [one's] life, spirituality and increased interest in religion, and deepening sense of inner strength-- all contributed to this surprising reduction in suicidal preoccupation. This was consistent with a finding of a WHO study from Lebanon during the Lebanon-Israel war [of some several years ago] where it was found that while depression [ ? and other psychopathology ? ] increased during this social upheaval, suicide and suicidal ideation were comparatively less-common.

I for one can identify, on the level of my individual experience, the main features of the conclusions the authors in this report reach. I have been uprooted-- as a mental health consumer on psychiatric disability-- about four (4) times by eviction (some of which I must say were defensible on the part of landlords but unforgiving of my bipolar condition and others of which were strictly high-handed, done for no other reason, it would appear, than to "give me a hard way to go.") I have kept a record of both the hospitalizations during these periods in a time-series with other factors, and in graphic form -- in a way that is clearly significant clinically and statistically-- being dislocated-from-domicile is associated with psychiatric institutionalization. Yet suicide was not a part of my bipolarity at that time: instead I was suicidal only in stresses associated with an unpleasant divorce and incipient vocational/occupational difficulties. The crazy times of being homeless are nonetheless exhilarating, not per se conducive to the thought-processes accompanying suicidality: it's the situation that is deformed when you "get homeless," and not you-yourself.

This is not to say that perils-to-life are absent when one is homeless/dislocated: you can freeze to death in wintertime in most of North America, and here in Kentucky the presence of rain can beget hypothermia, which is in its way even more pervasively lethal to the homeless than a "solid freeze" ( which inevitably betokens a time when the extant missions and (sometimes) the jails and healing-places will let you come in and "warm up.") But what you want more than all else at such homeless times as a mental health consumer is to be comfortable physically; therefore it is not surprising to me that even those predisposed to mental illness would not resort to suicide at such times. In fact, one's morale, given such vital problems, may "perk up" during such a tail-spin; many folks reach out to "help," and "you feel like putting up the good fight." Yes, there can be a " + " side to homelessness!

The study I report on this day is a "macro" view of what becomes quite personal per individual living for the mental health consumer: suicide and suicidality is the product of another existential mode-- frequently-- than being uprooted by homelessness or other socio-economic crisis; other psychiatric sequelae do occur in such hard times, and these need to be treated accordingly.

Thus, I recommend this study to the reader's rapt attention, for it "speaks to my condition" as it will to many affected and concerned about mental illness.

--- Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # F31.2
E-Mail: freethink@bellsouth.net

2006-10-12T03:08:00.000-07:00

"What is to Be Done?":
A Mental Health Advocate-Blogger Reports-on-Reports
Of Rough Treatment at the Hands of the "Power-That-Be"

Those who know me well will, I think, find me to have been a fair person, considering myself fit as mediator if and only if I can hear both sides of a story. The business of issuing this web-log has presented a challenge to this sense of fairness, yet not without an abiding sense that there would be no real way to pursue getting a "balance" that would fit the requirements of journalism and truth.

In point fine, I am getting a substantial number of reports of "manhandlings" of mental health consumers in such places as Kentucky correctional facilities and during involuntary mental hospitalizations: as I am a "nut" myself, it makes a quick "thought experiment" to run down the possibility that any investigation/inquiry I do toward verification of such stories with the pertinent agencies-- who generally go unnamed by my sources-- would be met with "stonewalling," "the run-around," scorn, and other counter-production suggestive that this type of journalism-- "hearing both sides out" -- is simply not a possibility for what I do.

On the other hand, the reports I get of abuses of privilege in Kentucky institutions dealing -- all in all-- with the mentally ill is quite pervasive. It is hard to contradict a caller who claims to have been-- as a mental patient in jail-- "beaten unmercifully" when I myself have encountered very nearly the same treatment a couple of times by cops on such things as an EMS-mental-health "run." Here, verification is in the usual sense not feasible, and almost theoretically not-possible, but the corroboration of these abuse stories jibing with my story strongly suggests that something needs to be done "to clear the air."

Accordingly, I shall now enounce a policy, good until I am utterly humiliated in my efforts to present the truth, the whole truth, and nothing but the truth: when hence I get reports of abuse by the mental-health-accomodating agencies I shall here-and-there "pass it along," always with the open invitation of the implicated institutions to respond to these plaints-of-violation, ultimately affronts to the sense of human dignity and even human rights.

Insofar as the "criminalization of the mentally ill" is concerned, Kentucky has the worst reputation in the nation-- dressed up with a few in-service programs for "turn-keys" and cops in mental health-- dressed up with federal money to construct "regional jails" with easier access to mental health services-- but all in all abusive, amounting to insult. The plight of those experiencing involuntary mental hospitalization is only by degrees better: it is generally a "nice jail" to go to a psychiatric ward and lose all amenities, but "it is still jail." And in fact, I have known of able lawyers who are astonished and appalled at the non-utility of all the "paper-rights" that case-law established in the 1970s and 1980s as far as "the right to treatment," and "the right to the least-restrictive treatment" are concerned. I do not think it is "the same way" in other venues: from what I can tell, in places like Massachusetts, Connecticut, and New York, the dignity of the mental patient is held in substantially higher esteem. In this "korn-likker crazy" state, we seem to have a kind of "mental-health hell-hole."

All of these factors would tend to invoke the need for a special kind of journalism. While I do not intend to be any kind of "muck-raker," I shall open my mind, ears, and keyboard to those who feel a need to report to me about "the raw deal they got" from some or another mental-health intervention or its parllel in criminal justice. My "travel advisory/warning" to mental health consumers wishing to cross into this Kentucky, this "Dark-and-Bloody-Land" as the Native Americans called it, will have to stand: here we are in a hard place psychiatrically, and just as Kentucky will have to work-like-hell to get a "D-" from its grade of "F" on the delivery on mental health, for the mental patient in Kentucky to feel safe walking the streets-- not always because of the "robbers" but because of the "cops" in the "cops-and-robbers game," big changes requiring big consciousness-raising will be required.

So here, with this blog and its sister, "Bipolar in Louisville," www.bipolarlouisville.blogspot.com/, I come in to be a voice for what I hear and feel: I shall not ever lie in these presents, in what I feel the least, and in what I hear for how it sounds; and inviting "the other side" to speak up in its defense if indeed the reports of injustice are untrue. But on the wisdom that "where there's smoke, there's fire," I shall go right on reporting abuse which seems real and an affront to mental health values.

--- Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # F31.2
E-Mail: freethink@bellsouth.net

2006-09-23T08:03:00.000-07:00

Vacationing New York Mental Health Consumer Jailed in Kentucky 5 Months,
Loses Car, Valuables, Deprived of Psychiatric Treatment and Decent Care Substantially:
The Lot that Befalls the Hapless Mental Patient Who Comes Here !!!

I got a telephone call last night from New York, from the sister of a mental health consumer who appears exactly to have been the victim of Kentucky's Abu-Graib-style manner of "criminalizing" the mentally ill. I feel compelled to help this cause along, because I feel the story must be true, so consistent is it with what I know to be the state of "jail mental health" in this "Korn-Likker State," better at playing college basketball, racing horsies, and manufacturing whiskey than in serving the real needs of real people. The specifics of this story of high-handed jailing and lapse of mental health treatment in correctional facilities violative of human and civ il rights will be the topic of this web-log entry this day.

I have been strident with cause about the state of mental health services in Kentucky, particularly with regard to the bleak conditions that exist-- with some "window dressing" that was done after negative publicity about ten years ago-- with regard to what is variously known as "forensic psychiatry," "correctional psychiatry," "criminalization of the mentally ill"; I prefer to call it "going-to-jail-instead-of-a-hospital-when-you-are-mentally-ill."

On this kind of service, Kentucky is really in horrible shape-- despite the fact that in response to work by the National Alliance for the Mentally Ill (NAMI) pressing a damning "white paper" whose title was something like 'The Criminalization of the Mentally Ill,' a report which graded all states and counties on the variable of how frequently they jailed mental patients instead of seeking psychiatric institutions for them. In this report, Kentucky came in very last in the nation for the "criminalization" problem here, and was likewise the state with the county with the worst problem for incarcerating the mentally ill-- Barren County, Glasgow, Kentucky. Now this report came out about 1988 or 1989-- I no longer have access to it-- it is Saturday when I write this and NAMI is closed-- and the libraries including the Library of Congress do not seem to have this work in their holdings. I say there was a "flurry"-- meaning a few snowflakes-- of interest to remedy this problem-- grant money allocated to train criminal justice staff in identifying mentally ill subjects in their populations and in accomodating their needs, some impetus toward moving subjects into "regional jails," which of course provided somewhat better medical (and semi-psychiatric) care for subjects as well as having enhanced ability to refer to MH facilities given need.

But fool not thyself! The values of this state are only in a limited way, and only to certain sub-sets of the populace focused on psychiatric-care/mental-health, and whereas a mental patient finds himself/herself in trouble with "the law" -- the William-Faulknerian term much used in Kentucky too-- the automatic tendency of many here to to is to say "just desserts, out-of-sight, out-of-mind, lock-the-bastard-up!" Because of this value-orientation, as all social orientations tend to be, this does not change with a few newspaper articles, white-papers, or hundreds-of-thousands of dollars "thrown" at a situational problem. The problem is ethnic, engrained, goes deeper than all to which I have alluded here.

In the case of our friend from New York, a prominent professional with real skills who just happened into our beautiful mountains also happened against our often not-too-beautiful criminal justice system when he-- perhaps indeed in a psychologically decompensated state-- ran out of gasoline in his automobile and knocked on doors to get help in an excited state. This began an ordeal in which he was incarcerated by local police, had his car impounded and sold, his ring (which was said to be worth a lot of money) taken and never returned (? thus stolen?), placed in solitary confinement without medical treatment of any significant type until he could be transferred after many months to Kentucky Correctional Psychiatric Center (KCPC) hundreds of miles away briefly, where he was assessed-- properly-- as being "incompetent to stand trial." And from there, with almost nothing like a nod to the constitutional "right to a speedy trial," he was released to return to New York City, where eventually, as now, he has resumed a life as sucessful practitioner of orthotics.

I know as reliable the story as presented above-- second hand but from whom appeared to have been an extremely reliable source-- his sister phoning me from NYC-- this corroborates well with my own personal experiences both as a professional psychiatric social worker at Forensic Psychiatry and KCPC and Glasgow, as well as my experiences with "the cops" here in Louisville-- "the nicest town with which to deal with the police on a mental bust in Kentucky," and DO find me sarcastic in what I just said! In my wallet-- to give the reader an idea as to how bad things are in this redneck state for "nuts" like me and the hapless guy who is the subject of this report today-- MAY JUSTICE BE DONE FOR HIM !!! --I myself have through Seven Counties Services (with the help/approval of my therapist, her boss, and all the bosses on up to the CEO I suppose) a card in my wallet which reads: "To Whom it May Concern: Vernon Stephens is a psychiatric patient of Seven Counties Services subject to mental decompensation with impaired insight at times. On such occasions, please send him to an appropriate mental health facility using the least restrictive physical restraint consistent with his condition." The intent of this is to avoid being beaten up by the cops, a contingency that has been a very-near-miss on a couple of occasions when I have gone "bonkers," yea when the cops have come with EMS to cart me off to the psychiatric hospital. Another factor is handcuffs and man-handling/shoving, etc. which are almost never ever ever ever ever under any circumstances necessary for me when I get psychiatrically hospitalized, as for the longest time that I can recall since these involuntary mental hospitalizations have begun, I always go limp every time the cops come. In the end, it just depends, as I have tried to suggest, on character: a good cop will not beat you up if you are merely psychiatrically decompensated, but a sadistic cop-- sensing that he will in no wise have to "answer" for his misdeeds-- might be prompted to beat, beat, beat, beat and beat for JOLLIES !!!

The situation is dangerous enough that I -- as a person who has had both professional and personal experience with the interface between the criminal justice system and mental health consumers, would like to issue a TRAVEL ADVISORY (ALMOST A 'TRAVEL WARNING'): THE MENTAL PATIENT WHO VISITS KENTUCKY FROM WITHOUT WHEN ENCOUNTERING LOCAL LAW ENFORCEMENT OFFICIALS VERY WELL MAY RECEIVE "HIGH-HANDED" AND "ROUGH" TREATMENT INDEED, THE KIND OF AFFRONT WHICH IN MORE-ENLIGHTED PARTS OF THE WORLD AND COUNTRY WOULD BE CONSIDERED INJUSTICE AND VIOLATIVE OF HUMAN RIGHTS AND OUR U.S. CONSTITUTION !!!

Do consider this, mental health consumers, should you plan to visit Kentucky! I for one try not to travel at all, staying as close to home as possible.

--- Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV F31.2
E-Mail: freethink@bellsouth.net

2006-09-16T05:31:00.000-07:00

Nice Jails:
The Ultra-Use of Psychiatric Facilities for Custody
Under the Rubric of Scientific and Humane Medical Treatment

I had coffee with a woman not too many days ago who had been hospitalized for what by contemporary standards would be considered an exceptionally long time. She went into the hospital "breathing fire," as it were, and came out submissive, and-- as is most-often fortunate-- compliant with both her medications and her psychosocial therapies. But she wanted me-- whom I suppose she thought to be a kind of mental health advocate or even a "reporter" on my web-logs-- about HER PERCEPTIONS of hospital life.

I am "savvy" to mental health, particularly on the services provided residentially, inasmuch as I did about 3/4 of a vocational career in psychiatric social work before bipolar disorder and then a bitterly-experienced divorce flipped me onto the the rolls of the disabled. In my lifetime, I have been psychiatrically hospitalized 22 times (all but four of which were involuntary in nature), and I have probably dealt with 1000+ psychiatric patients on a professional basis in my work-a-day pre-existence. I have formed ideas about what inpatient psychiatry is all-about in my time, how much of it has changed, how much of it has remained the same. I would like, therefore, to do a kind of "Vernon-tells-all" entry in this case. I want to tell the "story" my mental-health consumer friend-- who was voluntary in this series of hospitalizations/transfers-from-one-mental-health-facility-to-another. The two-fold story, put together, may by way of corroboration "megaphone" onto the Web our "Message," for there was remarkable consistency between what my friend with whom I had coffee told me and my total array of experiences, professional and personal.

First of all, let's not get NASTY. Anyone who lives in Metropolitan Louisville could figure out which hospitals to which I refer by context, and those from outside the community will simply sufficiently satisfy their curiousity to know that for indigent people, the primary inpatient psychiatric care facility for acute needs is the teaching hospital essentially under the auspices of a great medical school; the long-term psychiatric needs are met in a state psychiatric hospital. My friend who had just gotten out of the mental hospital first spent a longish time in the teaching hospital psychiatric ward said the level of dignity afforded her and other patients-- by which she meant her utter credibility/acceptance-of-her-good-word was about NIL, a finding that is completely consistent with my inpatient experience. I have had occasion when I have been beaten in my own apartment by my property manager, and drug in to the teaching hospital on an involuntary mental warrant, and taken to mental inquest court because I was alleged to have been assaulting myself. On another occasion, an aide "picked an argument" with me because I -- lacking glasses-- could not fill out a menu as required-- and was then strapped on my back-- sleep apnea and all -- in "time out" for what seemed like an interminable number of hours. On another occasion, a "Tarasoff" warning-- you know, what-the-therapist-is-supposed-to-give-a-contemplated-victim-when-a-person-in-therapy-says-he/she-is-thinking-about-hurting-somebody -- for absolutely no reason. THESE ABUSES CAN GO ON AND WILL GO ON: 1. BECAUSE PEOPLE LIKE ME ARE INDIGENT; 2. BECAUSE A TEACHING HOSPITAL PSYCHIATRIC WARD IS "MORE IMPORTANT" THAN A "CRAPPO" HOSPITAL LIKE A STATE ASYLUM; 3. FOR THE PREVENTION OF THE REAL PHENOMENON KNOWN AS "HOSPITALISM/THE-REVOLVING-DOOR-SYNDROME."

I spoke of the "changes" over time: I see two, as a "real" person, with "real" eyes and ears on the "receiving end" of all this goodness. In the first instance, human interaction-- particularly on a 1 X 1 level-- even though it is ABSOLUTELY REQUIRED BY ALL THESE HOTSHOT UR/MANAGED-CARE-CONCERNS-- is essentially imaginary during inpatient psychiatric treatment for the indigent. What does the staff do? About what they did when I was a psychiatric social worker-- WRITE WRITE WRITE WRITE ILLEGIBLE LITTLE NOTES ALL ALL ALL DAY-- except I think nowadays they do more of this scribbling. And in the "cute" places, the occasional nurse will ask you "on a scale of one-to-ten, was-this/was-this-not a GREAT service??" Which is supposed to MEASURE SOMETHING, I think. But on the onld cybernetic principle of GIGO ( Garbage-In-Garbage-Out ) I don't think this measures anything whatsoever.

I advocate a truly reasonable approach to the planning, administration, and evaluation of services for the mentally ill: using logic, whatever a hospital provides should be no more and no less than the sufficient remedy based on a comprehensive review of relevant inputs/outputs. This is nothing but a "total systems approach" to psychiatry that is being recommended, yet instead it seems so clear to me that the essentials of what a psychiatric hospital really offers is a place to take psychotropic medication in a confined setting. The "needs assessment" and "treatment planning" and the "checklists" that no doubt are all that remain of charting-- call it ERRONEOUSLY -- the biopsychosocial model !!! But on the receiving end, you mental health types do not seem to give a DAMN about me or any other inpatient.

One good thing about it, though, if you don't mind my saying so: I hate yer ole psychiatry with a purple passion! FOR SPITE I will do my utmost to stay out of your lousy hospital. I suppose that does sorta cure my, hospitalism, but since you-guys work in those ole hospitals and as far as psychiatric patients are concered EQUAL HOSPITALS, what are YOU gonna do about your HOSPITALISM?

---Vernon Lynn Stephens
freethink@bellsouth.net

2006-07-10T01:58:00.000-07:00

Jailing Mental Patients in Jail-Crazy Kentucky:
An Effort to Resurrect an Old Issue [Not Gone-Away] from a So-Deigned "New" Issue

In the Louisville Courier-Journal yesterday, July 9, 2006, there ran a story "More State Felons Held in Jails," by Andrew Wolfson, awolfson@courier-journal.com . The gist of this article was that jails in Kentucky are horribly overcrowded, lacking basic amenities for human dignity, and are the utter shame of this state, a back-handed sequel to the War on Crime, which has increased the prison population in Kentucky 700% since 1970. And I -- a former psychiatric social worker who managed part of a career in a maximum-security correctional-psychiatric facility-- do not take issue with these contentions: rather, what I would like the world-- especially the journalists-- to know, is that an exceedingly high percentage of both the pre-trial and post-conviction institutional population is mentally ill!!! Psychotic people are being held in these inhumane conditions, to the detriment of the social stability of the lock-up facility as well as (especially!) to the mental patients themselves.

Thoughtful people in Kentucky have known for some time that our jails have large numbers of the mentally ill as inmates; my experiences-- to be presented after I have summarized what else is known on this subject-- only corroborates this elephant-in-the-closet that correctional administrators are not wont to address publicly. Occasionally a progressive paper like the C-J will press an article on the subject as it did with "Locked in Suffering: Kentucky's Jails and the Mentally Ill; State Acts to Improve Care," which story by Jim Adams and Sara Shipley appeared on March 3, 2002. The article mentions that in the 30-month period prior to this publication, seventeen (17) people had committed suicide in Kentucky jails. The number taking psychotropic medication (mood-stabilizers or anti-psychotics) is also an empirically-quantifiable statistic, which in prison in this state was estimated by the Cincinnati Enquirer to be about 15%-- about 1000% higher than in the community-at-large. On February 24, 2002, the C-J ("Jail System Fails Mentally Ill: Many Troubled Inmates Untreated and Forgotten," again by Jim Adams and Sara Shipley) flatly stated, "No one knows how many times in the course of a year Kentucky jails book mentally ill inmates. A conservative figure, The Courier Journal [sic] concluded, may be around 25,000" [emphasis mine.]

Now let me go back in time a little, to permit older, yet corroborating research to augment this finding, before marshalling the data from my own vita. Sometime around 1990, the National Alliance for Mental Illness (NAMI) published a 'grading-the-states' monograph on the criminalization-of-the-mentally-ill, and of the 50 states, Kentucky came in exactly last for its propensity to incarcerate people with chronic mental conditions, and correspondingly, Barren County (Glasgow, Kentucky) came in exactly last in the entire nation for its facile tendency to put mental patients in the local jail instead of referring them to proper mental health treatment. Then, much further back, in the 1970s, Dr. Dale Farabee, Commissioner of Mental Health, and others investigated health conditions in jails in this state, part of which included mental-health history and screening of inmates. This document confirmed what is still the case-- that the mentally ill in Kentucky are over-jailed.

The people who are in jail with mental illness would largely have been taken off to "asylum" [somehow the term is getting better 'press' of late than in the second-half of the 20th century!!!] at Central State Hospital, where they would have faced "kind-and-usual" [as Jessica Mitford put it] treatment of interminable duration, "out-of-sight, out-of-mind" of society. I have said it previously, but the 19th-century mental health crusader Dorothy Dix would simply reel in her etheral abode of the grave if she knew that -- by some savage round-robin-- again the mentally ill are drifting back into jails as the mainstay of placement/'therapy'/maintenance. This process, however, has been inexorably going on in tandem with the "diaspora from the asylum" after the advent of rather effective medications for treating mental illness (chlorpromazine and amitriptyline in the old days; now such as risperadone and divalporate sodium), the "liberalization" of mental health law making involuntary hospitalization a short-term affair, and-- where it hurts The System the most-- the hyper-expense of maintaining psychiatric hospitals and treating the mentally ill. [Not that it is really any "cheaper" to lock people who are mentally ill up and give them a few anti-pscychotic medications at "pill-call." The actual expense of correctional incarceration rivals-- if one would check this out-- tuition at any ivy-league college.] For a good discussion of this phenomenon, the reader is referred to Henry J. Steadman's The Mentally Ill In Jail: Planning for Essential Services, Guilford Press, New York, New York, 1989; this is an older publication, yet the problems it enounces are up-to-the-minute with Kentucky's needs.

The mentally ill in jail tend to become "problem inmates": they both cause trouble due to their fantastic preoccupations and are the cause of mischief against them. In Jefferson County, Kentucky, there is some mitigation of the bulge of mental patients in pre-trial lock-up by virtue of the Criminal Justice Liason Unit of Seven Counties Services, and to a lesser-extent by the presence of the Behavioral Unit of Seven Counties at 1512 Crums Lane. This does not obviate the fact that many schizophrenics, schizo-affectives and bipolar-disorder patients manage to get themselves -- for justifiable and unjustifiable reasons-- in jail.

As a person who used to have a hand in doing pre-trial competency evaluations at the old Forensic Psychiatry Services, Grauman Unit, Central State Hospital, I saw a lot of clients who would come into our unit who had mental problems: I am of course aware that a wide gulf in time separates the situation now from the situation then, but I feel confident that -- given all the indicators lined up just as I have now-- and given the intractable nature of mental illness and of American/Kentucky society for dealing with social issues in a head-on way-- I know that the stories of exploitation and under-treatment which abounded among my patients then from local jails must be replicated over and over again today. In those days, almost no patient who was manifestly and floridly psychotice would be likely to get psychiatric treatment: instead the circuitous route of referring a client for pre-trial competency evaluation would often be attempted, and as was almost-never-the-case, the occasional client would be decared incompetent-to-stand trial and channeled to a mental instituion, etc. The main advantage, in the social sense, of referring a mental patient in pretrial to competency-evaluation would be that such a person could receive TREATMENT including psychotropics and some psychotherapy. This was all-to-the-better for the actual sociological function of pre-trial competency evaluation-- I believe-- IN PREPARING THE MENTAL HEALTH CONSUMER CAUGHT UP IN CRIMINAL JUSTICE TO GO TO PRISON!!!

The typical mental health consumer, you see, tends to be empty-of-wallet, unable to get a "good" lawyer (i.e. one who will really advocate, and not just plea-bargain), and whether innocent or guilty will be pressed into saying-- most of the time-- that she/he did some lesser charge in order not to get "maximum time." Do not worry about the "insanity defense" in this instance: that is the plea of those-with-money-caught-red-handed. The sap who like I do from time to time occasionally gets charged with a crime -- mine tends to be "disorderly conduct" but the cops would love to find a pocket-knife on me-- which therefore I never tote-- to bring a "carrying a concealed and deadly weapon" charge. But you do not have to even do that as a mental patient: you can be walking down the street, and suddenly surrounded by police swarming around you trying to get "confessions" from you that you started every unsolved arson case in Metro Louisville. [That is what I call "being a person of many convictions!!!"]

There are, of course, mentally ill people who commit crimes, and for these the correctional-psychiatric/forensic-psychiatric facilities should be employed. Nevertheless, old K.C.P.C. (Kentucky Correctional Psychiatric Center)-- whatever its new name may be-- was and probably still is in the business overweeningly of treating conduct disorder people, and those whom the wardens believe are likely to cause fights and other law-suit generating disturbances. The mentally ill, instead of being treated in mental health facilities specifically for their needs, were and no doubt still are shuffled off to "the yard" with other inmates-- often to come back naked and abused and intimidated by the thugs who have exploited them in prison-proper.

But the condition in jail is even worse. There one factually has no right whatsoever to a "speedy trial"; but what is more damning is that they are unlikely to get the barest of medical necessities, including treatment for mental problems. This is a violation of human rights, exactly in contradiction to the "Universal Declaration of Human Rights" -- unratified by our U.S. Senate but persuasive authority indeed for the country holding itself up as the human rights exemplar of the world.

In summary, therefore, we may say that the Courier-Journal and the world needs to look at the phenomenon of jailing the mentally ill in Kentucky and everywhere. It presents miseries to the jail administrators, the non-psychotic jail inmates, and the mentally ill in jail themselves to be subject to this living lie and malapropism of social services. Dig a little deeper, World, and find out just what an affront to human dignity are the things to which I refer.

--- Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # F31.2
E-Mail: freethink@bellsouth.net

2006-07-07T18:48:00.000-07:00

Manics and Schizophrenics Tend to Lose 20 Years of Average Life-Expectancy
Due to Incautious Use of Medication: Co-Morbid "Metabolic Syndrome" with Psychotropic Rx Compliance

The worthy publication Psychiatric News (online) today-- Friday, July 7, 2006-- pressed a feature which should disturb any mental health consumer who is compliant-- i.e. "takes as prescribed"-- psychotropic medication for manic-depression or schizophrenia (and I think we can include schizoaffective disorder and the other maladies which begin with the praenomen "schizo- ".) The feature to which I refer by Jim Rosack is entitled, "Clinicians Urged to Better Monitor Drug-Related Side Effects," and its gist is that a patient who has been compliant with (especially) the newer, second-generation antipsychotics (SGAs) run the risk of cardiovascular disease as a condition comorbid to their mental condition, to the degree that the Centers for Disease Control estimates that such individuals will have a shorter life-expectancy by a factor of 20 years.

The research points up a new clinically-definable condition, metabolic syndrome, which is confirmed by a positive finding of three of the following five criteria:

1. Obesity as measured by a waistline exceeding 40 inches for males or 35 inches for females.
2. Fasting serum triglyceride levels above 150 mg per deciliter.
3. Serum high density lipoprotein (HDL) levels below 40 mg per deciliter for males or 50 mg per deciliter for females.
4. Hypertension defined by an increase in systolic, diastolic blood pressure, or both, above 130/85.
5.Hyperglycemia defined by elevated fasting serum glucose levels greater than 110 mg per deciliter (some use glucose levels above 100 mg/dL).
[Source: "Clinical and Research News," Psychiatric News 41:1-34, 2006.]

The article cites research from the National Institute of Mental Health's Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) which shows that-- depending on which SGA is used -- compliant patients are more-or-less vulnerable to obesity, hypertension ("high blood pressure"), diabetes, and hyperlipidosis (excess fat in the fluids and blood.) These all complicate the general health picture of the compliant mental health consumer, compounded by the fact that her/his confounding medical conditions going along with medication-usage are less-likely-than-usual to receive the kind of treatment that is known to be beneficial in treating these extremely undesirable medical (what doctors call "iatrogenic" --- from Greek roots meaning "doctor-caused") disturbances.

Weight-gain seems deeply implicated in the overall process of developing the co-morbid conditions. Not every antipsychotic, indeed not every SGA, has the effect of making a client obese, though. The author of this article cites a research project called zODIAC-- the ziprasidone Observational Study of Cardiac Outcomes comparing ziprasidone (Geodon) with a variety of other antipsychotics to determine their potential for cardiac complications associated with these medications. At baseline, of the more than 17,000 patients enrolled in this program, 19 % of patients had hypertension, 16 % had hyperlipidemia, yet less than 3% were taking statins or other antihypertensive medication.

Most in jeopardy are schizophrenics, according to CATIE findings: they run a high risk for cardiovascular disease yet at the same time are not getting "appropriate and necessary treatment." Henry Nasrallah, University of Cincinnati professor of psychiatry involved in this research, cautions that psychiatrists need to "measure and follow their patients' obesity, their hypertension, their hyperglycemia and hyperlipidemia."

This all comes full circle now, to the mental health consumer who -- following "doctor's orders"-- and sometimes a court-order-- takes these "head meds." I think almost all of us who take these chemicals realize that weight gain will come as a result of "being good" and compliant. Fewer would know-- as I now believe from my own medical history-- that these medications predispose the "consumer" to health problems as serious as diabetes, or a heart condition, or a stroke. Most of us are still trying to make some cognitive adjustment to our new, "fatso" bodies, which to the public's eye and mind are eyesores leaving you "high, dry, and dateless." If it really gets out that -- almost through carelessness-- taking these medications like SGAs will foreshorten one's life by some 20 years, then I think the "average stabilized psychotic" (whoever that is) if not the general public will simply flip out!

And why not? From what I read in Psychiatric News this day, the "side effects" of diabetes and cardiovascular disease in mental health clients taking psychotropics is essentially preventable. We can thank our clinicians for kindness and genuine help, but for "burying the dust under the carpet" goes no thanks at all.

I give my healers fair grades on trying to keep me bolted down to reality with my meds., yet at the same time paying attention to my blood-sugar level and obesity and hyperlipidosis-- all of which are problems for me. In the past, my beloved psychiatrist would weigh me, and give me good counsel about what sorts of foods to eat-- healthy yet befitting a "tight purse." Nevertheless, to be on the safe side, I think I shall get bloodwork to ascertain whether I have this metabolic syndrome described in Psychiatric News today, with a view toward making whatever corrections I can.

You-- and yours-- are encouraged to do the same!

--- Vernon Lynn Stephens
E-Mail: freethink@bellsouth.net

2006-07-06T19:09:00.000-07:00

More Words on the Insanity Defense:
All the Justice a Mental Health Consumer (Or Criminal Caught Red-Handed) Can Buy

I write tonight of the insanity defense, however it gets defined in any of the 51 jurisdicitions of the USA; my reference-point, however, is decidedly of a former professional-- now a mental health consumer-- who worked in the bleak application of psychiatry known as forensic psychiatry as it is practised in Kentucky-- part of which includes pretrial evaluations to determine whether individuals with criminal charges are competent to stand trial, as well as whether they are to be regarded as not-guilty-by-reason-of-insanity for a charge.

I say that this sub-discipline of psychiatry was "bleak"; the following reasons point to my sense of bleakness with regard to forensic psychiatry. First of all, only the very rare case would ever be considered too-psychotic-to-be-held-responsible-for-their-crime (the gist of the "Durham Rule.") Practically speaking, such an 'insanity plea' is the privilege of the rich, who indeed may profess all manner of psychiatric exotica to avoid going to jail. This is all done with "good lawyers" (i.e. attorneys who will "fight" for you like a gladiator or hired-gun in court, and by the expenditure of tall tall tall money.)

But the average mental health consumer specifically lacks money, "the green stuff," "what it takes to get along" in these United States. Over and over I saw quite deranged people compelled to go to prison through the workings of "usual justice," i.e. plea bargaining, being declared guilty after a botched trial wherein the jury-- seeing naught but a crazy person in the defendant's chair-- being declared "guilty."

Nor are services up-to-snuff once the psychiatric client reaches prison. In Kentucky, the mental patient is most-likely to serve her/his time "on the yard," in the general prison population in other words, whereas precious psychiatric beds tend to go for antisocial-personalities, psychopathic-deviates, and behavior-problems that the prison administrators would prefer to see apart from the general prison population, in order to prevent fights and mayhem.

All of this means, as a social process, that the social reforms which were the thrust of Dorothy Dix in the asylum movement during the mid-19th century is becoming completely undone. Jails are filling up with patients who should be in mental hospitals, for whom a real insanity defense was obviated decades ago. Occasionally, we read of this in "progressive" newspapers, such as our local Louisville Courier-Journal, which on March 3, 2002 published an article by Jim Adams and Sara Shipley entitled "Locked in Suffering; Kentucky's Jails and the Mentally Ill; State Acts to Improve Care." This article focuses on jails, not on prisons-- but you can take my word as a former mental health professional who worked in the prison system for a time-- many of the matters affecting the jail (pre-trial) mental health consumer also apply to the mentally ill convict.

I would say that in the application of this kind of "justice," as is so true of everything American, the services one tends to get are predisposed by one's income. Situated at the very bottom of the income-pyramid, the typical mental health consumer finds it: 1. easy to get into trouble with "the law"; 2. prone to go to prison if in any way insinuated in a criminal charge; 3. given essentially sub-standard and horrifically-expensive institutional treatment in the midst of ordinary criminals once she/he gets to prison. The rich defendant, on the other hand may use the insanity defense as his sole way to "get out of it" when she/he has been caught "red-handed." The successful effecting of an insanity defense with a jury is inevitably an indication that the defendant had a first-class advocate, not the kind that mental health consumers are likely to receive.

Therefore, I am somewhat jaded in all talk about the insanity defense. When the paranoid schizophrenic man who killed the police officer in Arizona lost his bid for an this plea by the Supreme Court of the United States recently, I was only a little perturbed. Knowing something about the kind of case this likely was-- a "celebrity" case invoking much yea-and-nay controversy in the community, I know in my heart of hearts that here is an instance of violence that does nothing to rectify the rabid social injustice of locking-up mental patients in correctional facilities with almost no sense that they are violent or dangerous or anything that should not really require a good, old-fashioned "asylum," or a new-fashioned "personal-care-home" to contain! The existence of the insanity defense "on the books" is like the presence of an unused fire-alarm in a high-fire-risk-zone. It is so much "sound and fury" about mental illness, essentially meaning nothing.

This is why I rather "refuse" to take-up-arms about the insanity-defense, preferring instead to promote realistic services for the mentally ill, and a reversal of the trend-- still going on with great vigor-- of putting the mentally ill in correctional facilities. All my experience and all my sense of justice say that these are the real issues, and not the demogogery of some speculative insanity defense, always for the very, very, few.

--- Vernon Lynn Stephens
E-Mail: freethink@bellsouth.net

2006-07-04T19:34:00.000-07:00

"Life, Liberty and the Pursuit of Happiness" for the Mental Health Consumer:
Some Fourth-of-July Thoughts about Our Precarious Freedoms

According to the Declaration of Independence, signed unanimously by Congress on this date in 1776, "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness." Now these are fine words, apart from the sexist rendering of men-only which would never be permitted today, and the fact that they were unintended apparently at the time for slaves, who could not be equal under the Constitution and would not be so for numerous decades... it taking a Civil War to ascertain that equality! In this piece tonight, with fireworks going off here and there like in the original revolution which set this country toward its process-of-liberating-itself, I would like to devote some time to the real liberties that mental patients have acquired -- historically just in the blink-of-an-eye!!!-- and the very real exigencies which countervene against consumer "Life, Liberty and the pursuit of Happiness."

Not very long ago at all a diagnosis of schizophrenia, schizoaffective-disorder, or manic-depression implied institutional confinement, usually a "life-sentence," in a lock-up hardly any more clement than a prison, which was usually given some euphemistic name like "asylum." Indeed, one was just a little better off in one sense by going to prison for a crime, for sentences by and large were precise: one knew exactly when one would "serve out" and go home from jail, having hypothetically "served one's debt to society." The mental patient, on the other hand, had and has but one gambit to which to resort in "getting out," and that is the route of submission and cooperation. And actually, even for the most-cooperative mental patients, "freedom" even as it lamely existed for the ex-convict was not a possibility in the deepest days of the asylum movement. From such a place, there was, practically speaking, NO WAY OUT!!!

I do not attribute the kindness of human spirit or a charitable elan in society for the great depopulation of mental hospitals, but the advent of medications that offered a real hope -- albeit imperfect-- of controlling the symptomatology of mental illness. I am referring of course to the first applications of the antihistimine chlorpromazine-- which had been synthesized in the 1940s but first used in psychiatry about 1956-- and thereafter the derivation of amitriptyline (closely related to chlorpromazine chemically) for depression-- as well as a host of other chemicals ushering in a genuine age of psychopharmacology. These drugs, and in my opinion these drugs almost exclusively, set the stage for depopulating mental hospitals, the phenomenon generally called "Deinstitutionalization."

I would say the "new accomodation" of the mental patient with the community is going about as smoothly as could be expected, which is to say one would have to consider the initial expectations of society, and in fact, the nature of mental illness itelf. Given that there is a super-abundance of "Halloween," mad-slasher, mental-patient-gets-out-of-the-asylum-and-commits-mayhem media prevailing, and given that landlords are not wont to rent to "crazies" because neighbors are not wont to live next to "crazies," the housing market for the mental health consumer can be "iffy" and challenging. If she/he for any reason decides not to make use of outpatient treatment resources-- in this town being the Community Mental Health Center (CMHC) Seven Counties Services, especially if self-medication or no medication is attempted instead of cooperation with "the system"-- which after all is only in place to help in such cases-- then I think it likely that conditions are rife for losing-Life-Liberty-the-pursuit-of-Happiness so dear to the mental health client.

Here follow a few cases to illustrate my point. According to a Washington Times story by Matthew Cella and Gary Emerling, datelined May 12, 2006, "Gunman Was Free to Escape Therapy," http://www.washingtontimes.com/functions/print.php?StoryID=20060511-110539-6536r, a mental health consumer Potomac Ridge Behavioral Health Center at Rockville in Virginia was permitted to sign himself out without restraint, whereupon he went out, reportedly operating under the delusion that he was Jesus Christ and that the world is being invaded by zombies, and then carjacked a sport utility vehicle, and had a gunfire-fight with Fairfax County (Virginia) police. According to the previously treating behavioral health facility, the client did not meet the prior-restraint criteria for involuntary hospitalization.

More recently, the United States Supreme Court-- see "Court Upholds Law Limiting Insanity Defense," by James Vicini, Reuters, Thursday, June 29, 2006, http://today.reuters.com/-- has upheld curtailment of the insanity-defense rights of a man -- a paranoid schizophrenic who had on June 21, 2000, slain a Flagstaff, Arizona police officer-- apparently blaring a "boom-box" in a truck from some logic having connection with the belief that the town had been taken over by space aliens and that he was being tortured. Arizona is one of several states which have placed restrictions on the insanity defense; others, including Kentucky, have responded by adding an option of "Guilty-but-Mentally-Ill" to the options available in a crimial trial. Clearly, though, "the public," if there is such a thing, singly, is fed-up with outrages against the civil dignity which occur when mental patients -- invariably unmedicated or medicating themselves with "street drugs" or alcohol, do mayhem. I suppose the sort of crime that a mental health consumer does at such a time is likely to be more-bizarre than that of the typical criminal, and at any rate, for a reporter interested in a "story," this would inevitably seem to make better "copy" than a usual fray-with-the-law-by-a-thug.

But on this July 4, the day of freedom, it is well to note that in certain quarters there are those who definitely would like to see more in the way of total-institutionalization of the mentally ill. On Tuesday, June 27, 2006, the Kennebec Journal Online of Augusta, Maine, issued an editorial "Civil Liberties Must Not Block Mental Treatment," http://kennebecjournal.mainetoday.com/view/columns/2875185.shtml; in this position-piece, the editor argues that while in general it is to the good that mental patients have the liberty to live in the community these days, there are times when the needs of the patient -- and the needs of the community-- require that the mental health consumer receive (involuntary) institutionalization. This position reminds me of that of the renowned psychiatrist-mental-patient-advocate E. Fuller Torrey, who in his Out of the Shadows (John Wiley & Sons, Inc., New York, New York, 1997, pp.81-90) delimns the need for occasional use of involuntary hospitalization and long-term 'asylum' for mental patients who truly need such service. Torrey is of the opinion-- and he justifies his opinion with solid research-- that a substantial fraction of the mentally ill are dangerous-- at least toward others-- and need to be confined.

To me, this is not, by any stretch of the imagination, a recipe for "going back to the old days," with each-and-every mental health client in confinement. The actual percentage of violent and self-violent mental patients-- from what I have read-- subtends about one-part-in-one-hundred-of-the-total-mix-of-mental-health-consumers. If this small fraction needs an "asylum," then the Fathers of this Society/Community need to get their heads together to see such a lock-up exist. For the great bulk-and-main of the mental-patient-populace, however, simple outpatient treatment-- by which I mean maintenance chemotherapy + psychotherapy + occasional social supports --- should do ably to see that such an individual -- without the stigma that she/he "has some horrible affliction" might prosper.

I do not see the "Fathers" to whom I allude in the last paragraph making even that preliminary step toward institution-building. In all candor, I doubt that what has not happen readily will happen even if it is very necessary for the decorum of the community. What I see, instead, is a tendency to tighten the purse-strings in all of governance and health-care, to the extent that what the mental patient living in the community is now expected to do is rather to treat-herself/himself with minimum recourse to "the system." This laissez-faire approach in the end can only imply that a lot of mental patients will die-- not in "asylums," not in jails, but in the "gutter," on "skid-row."

"Life, Liberty, and the pursuit of Happiness" are only imperfectly obtainable for the mental health consumer, therefore. The mental hospital itself affords almost none of these things, and one entering even the "nicest" mental hospital should anticipate humiliations unlike those other patients in other hospital settings have to experience. One's shoelaces and belts and-- if one is a man of girth-- one's suspenders-- are taken-- leaving to initial nudity and submission the client for "care." All activities, of course, are supervised, particularly things that may involve "sharps" as for example is the case in shaving. Treatment-- even when it is boring and silly-- can be enforced by court order and thus have the force-of-law. Yet there are some folks who without such humiliating places to make their decisions would be out having gunfights with police.

The mental health consumer needs to recognize that liberty is precious, but not everyone in our cohort can "handle" liberty. For the one-percent who need total institutionalization, provably, the truth-based mental health advocate should take no quarrel. But for the rest of us-- the overweening large majority of mental patients who can live in the community and take "meds." and pay-the-rent and even be-times hold-down-a-job and yea!!! be leaders in town, such "jail" definitely is not the answer. For these, "let freedom ring!"

--- Vernon Lynn Stephens
E-Mail: freethink@bellsouth.net

2006-06-30T02:11:00.000-07:00

Congress Investigates "Mental Illness and Brain Disease":
Talk of "Research and Education" Where Simple Civility Take Precedence and Priority

On Thursday, June 29, the House Energy and Commerce Subcommittee on Health conducted an airing of mental health issues entitled "Mental Illness and Brain Disease: Dispelling Myths and Promoting Recovery Through Awareness and Treatment," which was notable in that both Republicans and Democrats spoke up for the kinds of issues that mental health advocates and associated service agencies have been supporting-- to a degree-- for some time. A major point of the discussion in the Subcommittee seemed to be that program-money needs to be increased for research and education re mental health issues. While I am not in favor of turning-off the "spicket" of money that goes into mental health investments like these, I would like to present the case-- as does psychiatrist Dr. E. Fuller Torrey-- in Out of the Shadows: Confronting America's Mental Illness Crisis, John Wiley & Sons, Inc., New York, New York, 1997, p. 195 et seq. -- that such "research and training" money is often spent on psychological/behavioral exotica and not on genuine chronic mental illnesses like schizophrenia, schizo-affective disorder, bipolar disorder, or manic-depression.

I would even argue that while basic research needs to be done on the chronic mental illnesses, what is really needed is enhanced courtesy, decency, and credibility of the mentally ill, as meted on an individual-per-individual case. Clearly, the threshold of public awareness about mental illness is clearer and more-accurate than it has ever been previously; all that needs to go in tandem with this enhanced awareness is good-manners and equity and fair-dealing such as it may be deserved.

To me, a public-relations campaign is in-order to clear up the misconceptions surrounding the overweening characteristics of the greatest portion of the mentally ill, many of whom, now with improved psychotropic medication and a modicum of support in the "social safety net," are able to re-enter the communities in which they live quite successfully, even hold-down responsible jobs and act as "pillars" and leaders in the neighborhoods in which they live. This tends to go unspoken, unpressed, thus "unsung," due to the culture-of-silence surrounding mental illness and the fact of being mentally ill.

Instead, and I do not hesitate to say that this minority of the mentally-ill-cohort is not a distinct part of our motley presence in society, we have the mentally ill who present a danger, particularly a danger to others... the "bad apples" and "bad actors" who tend to get all the "press" about the mentally ill and thus color the public impression of what "we" are like. It is therefore of utmost importance that the mental health consumer-- who might as well call herself/himself a "mental patient" as having to be so so so "patient"--consider her/his behavior to be a kind of ambassadorship, in an "asylum" that has been granted by the society in which we live in lieu of the old "asylum" which meant life-confinement, hardly any different from imprisonment, now a by-gone aspect of mental hospital deinstitutionalization.

It might even be that such a public-awareness campaign could take place "from the grass-roots," without the fiscal investment of the Energy and Commerce Subcommittee on Health-- and from what I can read from press releases that tightness-of-money in any event seems in the offing. If what I am proposing can take hold, mental health consumers en masse can turn out to lobby, blog, "bulletin-board," "spread-word-of-mouth advertisements," with hardly more federal investment than what took place yesterday (Thursday) in Congress, talk, talk, talk, in solemn assemblies which has the great advantage of creating press releases.

But I read that these days, blogs are the hottest source of "news," op-ed, and plain editorials: to establish a blog, a mental health consumer need do no more than I, which would be to do the proper steps with "Blogger.com," http://www.blogger.com. Alternately, she/he could make "comment" to this blog, or to its companion web-log "Bipolar in Louisville," http://www.bipolarlouisville.blogspot.com; barring that -- in the interest of short time or PC skills-- one could contribute to an online Internet mental health discussion group, like the exemplary "HealthyPlace.com," http://www.healthyplace.com. None of these "Web-solutions" cost any money per se, for if one cannot afford a computer in these United States, one can-- as a well-behaved mental health consumer or well-behaved anyone-- go to a public library and do all/any of these things.

There is a certain wisdom-- whether I or anyone would hesitate to admit it -- to the Conservative ideology of self-reliance in this country, for this country's "favors" and "charities" have often been back-handed at best. The mental health consumer who senses that services-will-be-cut-and-will-dry-up is not being delusional or morbid; she/he is almost-certainly being reality-centered. It is therefore mentally healthy for "us" to assume that we shall have to manage on our own, with less, and with more cost to ourselves, as an aspect of the new requirements of living independently as a mental patient in the community. To some extent, we shall have to be on our best behavior, and also to an extent, we shall have to take care of mental health consumers who cannot take care of themselves as those better-functioning; and to the least extent, we shall support the irresponsible mental patients who commit mayhem and cause the great commotions which blight the image of "mental patient" in the public's eye.

An "all-fronts-attack" seems strategic for the general goal of raising-consciousness about mental illness and the value of the mentally ill in American society. At the same time, the mental health consumer movement needs to show real social cohesion, and real discipline, and real responsibility, all the while adhering to what Mohandas Gandhi called "The Truth-Force," i.e. the Truth, the Whole Truth, and Nothing-But-the-Truth, as the basis for its social action. I would say that to date, the mental health consumer movement has lived far from these goals, more abiding in the realm of lick-and-promise to the genuine moral responsibilities of leadership, as well as ignoring unpleasant realities. This web-log will strive to make leadership in the mental health consumer advocacy movement a lived fact!

--- Vernon Lynn Stephens
E-Mail: freethink@bellsouth.net

2006-06-27T16:11:00.002-07:00

In Dubious Battle:
A Louisville MH Consumer Voices her Right to Refuse Anti-Psychotic Medication in a Voluntary Psychiatric Hospitalization

I am a Louisville-local mental health advocate. Folks call me about mental health issues, especially about mental health social justice, in which I write and am keenly interested. Today, just as I had gotten back from my individual psychotherapy session at Seven Counties Services, a woman called me from the psychiatric ward of University Hospital on her cellular telephone wanting to know everything she could about the "right" (such as it is and gets practiced!) to refuse psychotropic medication, in this case on religious grounds.

Mental patiients in Kentucky have-- on "paper" at least-- the right-to-refuse-psychotropic medication. As a former mental health professional who believed in psychotherapy-first, and as a mental patient-patient, I often learned that in the pragmatic sense this right almost does not exist, as much as hospitals like to beautify the deeply-unpleasant but often necessary task of convincing a psychotic client-- sometimes by manpower and by brute-force-- to curtail this right-to-refuse in the face of an imminent danger to oneself or to others.

For me, the forced decision to medicate me at Our Lady of Peace Hospital could have been -- as I look back on my life-- the very best thing that ever happened to me. It was done without the intervention of a court, and there probably were laws and court-decisions strong enough at the time to get some hell-bent, winnings-oriented lawyer to help me undo part of the humiliation of getting a shot of some major tranquilizer in the rear when I was insisting that my psychological problems-- during this first mania-- be handled by psychosocial interventions only. But that was in 1977, and in point of fact I came to appreciate that I had been inaugurated on my long career as a mental health consumer.

I am not very sympathetic with any schizophrenic or schizoaffective client or bipolar-with-psychosis who wishes either to refuse medication initially or to desist from maintenance psychopharmacotherapy without the cooperation of a supervising clinician or team-of-clinicians. Nor is the general public-- I trow-- a whit more inclined to validate the claims of a seriously psychotic individual who happens to want "no head-meds.," even invoking the Most Sacred Name of Jesus to justify this refusal. The science supporting the use of anti-psychotic medication and mood-stabilizers is whelming in the conclusion that these chemicals are effective (and essentially safe) in treating acutre and chronic mental illness; I do not wish to argue with what seem well-established facts.

Nevertheless, mental patients do have basic rights, some of which are in international accords, others in federal case-law and regulations, and some in state statutes. Here is what Kentucky Revised Statutes has to say about the red-hot "right-to-refuse treatment":

KRS 202A.191(1)-- "Each and every patient hospitalized under this chapter shall have the following rights...(c) The right to refuse treatment subject to the provisions of KRS 202A.196... (g) The right to refuse intrusive treatment subject to the provisions of KRS 202A.196.

KRS 202.A.196(2)-- "Upon the refusal of an involuntary patient to participate in any or all aspects of his treatment plan, the review committee shall examine the appropriateness of the patient's individual treatment plan. Within three (3) days of the refusal, the review committee shall meet with the patient and his counsel or other representatives to discuss its recommendations.

KRS 202A.196(3)-- "If the patient still refuses to participate in any or all aspects of his individual treatment plan, the hospital may petition the District Court for a de novo determination of the appropriateness of the proposed treatment. Within seven (7) days, the court shall conduct a hearing, consistent with the patient's rights to due process of law..."

I should hasten to say that, like so much in America, these are-- from my experience-- "paper rights." The mental patient who challenges the mental health staff in any way is likely to get some exceedingly rough treatment, and this is especially so where the all-too-familiar problem of the patient-refusing-psychotropic-medication is concerned. I know not at all whether my friend calling me today, who for religious reasons wanted not to take psychotropics, was afforded the letter-dot-and-tittle of the statutes just cited, but this is about par for the course. Hospitals are extremely high-handed in abusing patient's rights, and the whole process of mental hospitalization is inexorably humiliating, not the first place to go looking for shining examples of respect of human-dignity.

In the case of the woman who called me, I have but her report to give. Fairness would require that I also give the hospital's side, which in any event I do not expect to come so I shall not name the hospital or otherwise identify it. But in my experience, mental hospitals do lie about what they have done vis a vis respecting a patient's rights. They lie and lie and lie -- apparently when they think they are in a weak legal position. What the patient who called me said was that she refused medication, was forcibly medicated, then a mental-inquest petition to the Jefferson District Court was written on her. If this is true, in my experience, the hospital is in some legal jeopardy and thus will utter every kind of fiction to exonerate themselves on the matter. I SPEAK FROM BITTER EXPERIENCE, OF WHICH I SHALL CONVEY, EITHER IN THIS BLOG OR IN "BIPOLAR IN LOUISVILLE," http://www.bipolarlouisville.blogspot.com , the companion to this page, that one concerned with issues related to bipolar disorder.

My advice to people like the woman who called me today is to cooperate!!! Taking the medication can be considered a moral an ethical obligation, like obeying the law-of-the-land or the prudent instructions of a police officer or fireman. Simply put, society does have the obligation to curtail the practice of many of our rights, particularly where we in the free exercise of liberties may harm ourselves or others. We mental patients are social animals, and to live fairly we should be expected to "play by the rules." As a practical matter, additionally, this same society has no patience and almost no understanding of the febrile issues of the deranged individual, who feels that Jesus/Buddha/Allah does not want her/him to take Thorazine/Mellaril/lithium/Zyprexa/Risperdal; the public instead would rather be rid of the mental health problem according to the old adage, "Out-of-sight, out-of-mind!"

The American Civil Liberties Union (ACLU) as a practical matter has quit taking mental health cases: this I knew and this the friend who called me to found out, painfully. The panoply of rights that were laid out in such federal case-law as Wyatt v. Stickney and Donaldson v. O'Connor from the 1970s and early 1980s have either been checked, altered, or-- as I am trying to suggest now-- ignored by baldface insincerity whenever investigators from Licensure, JCAH, or the state poke-around to find the basis of a charge that a patient's rights were violated. There are winner-take-all lawyers, who will work hard on a private basis to "win" a case, only to take almost all of the patient's monetary settlement. In point-fine, nobody seems to care very much if a mental patient's rights are even quite seriously violated, out-of-sight-out-of-mind it is, it is.

This is a mental health advocacy web-log. At the same time, practicing was Mohandas Gandhi called Satyagraha [Sanskrit: "Truth-Force"], we shall endeavor to be balanced and present "the truth, the whole truth, and nothing but the truth"... even when it hurts!!! I cannot say much in favor of a psychotic mental patient's right to refuse anti-psychotic medication, even when the motivation derives from the pure teachings of Jesus-of-Nazareth. While it in fact is difficult for me personally to make a strong connection between Jesus' didache [Greek" "doctrine"] and the refusal of psychotropics by a patient in the mental hospital, it is nonetheless true that a patient exactly does have such rights, procedures for the abrogation of which require strict adherance to legal procedure. Let us hope that the psychiatric ward -- contrary to the report I am getting-- really has followed these procedures. Know the reality! We have to almost out-of-hand acknowledge that Kentucky, got an "F" on the delivery of mental health services, dead-last in the nation, on NAMI's "Grading the States" report which came out in March, http://www.nami.org/gtstemplate.cfm?section=grading_the_states&lstid=679 . All other niceties about services for the mentally ill, including the accomodation for their civil liberties and rights, needs to be seen through this "optical" filter.

In other words, I think I am "in the belly of the beast" as a mental patient in Louisville. I am neither sympathetic with mental patients who expect the outlandish or with agencies who give outlandish services with the pretense of civility. Truly, the fray for betterment of the lot of mental patients is a "dubious battle."

--- Vernon Lynn Stephens,
Consciousness-Raiser

2006-06-27T16:11:00.001-07:00

2006-06-27T16:11:00.000-07:00