From one of my most beloved organizations, MindFreedom, comes an effort to challenge notions of normalcy as the American Psychiatric Association meets to unveil the DSM-5. From MindFreedom.org:
Free thinkers unite in an international campaign to question how psychiatric corporations try to control us and our democracy through their misguided idea of “normal.”
Be part of peaceful protest of the American Psychiatric Association, everywhere, especially Philadelphia, on 5 May 2012.
Occupy the American Psychiatric Association!
MFI calls on mental health consumers, psychiatric survivors and allies to Boycott Normal in response to the American Psychiatric Association’s preparation for a fifth edition of Diagnostic and Statistical Manual of Mental Disorders.
DSM-5 would be the latest edition of what is widely known as psychiatry’s “label bible,” used to determine if people can be diagnosed with mental ‘disorders’ or ‘illness.’
Today, we challenge normality and celebrate creativity and diversity. Please join us!
Want to get involved? If you’re in Philly, email Susan Rogers at email@example.com. She’s the nicest person on earth, so you won’t be sorry. Also, click HERE.
The Chicago News Cooperative takes up the problem of Mayor Rahm Emanuel’s decision to cut six of Chicago’s 12 mental health centers. In Philly, that would be devastating, so I can’t imagine it’s any different there. Of course the government is saying that people will be taken care of somehow, but that’s the kind of thing they always say, right? They say they patients from the other centers can just go to the ones that will stay open. But, um, that would mean a 71 percent increase in patients for the remaining clinics and a 0 percent increase in resources. Sounds like a plan.
Go here to read the stories of the people whose lives will be impacted by the cuts. Interestingly, though you’d imagine they’re depressing, they’re actually stories of hope. People with these illnesses are so strong, they are such survivors. They’re remarkable, and they deserve better.
A combination of service cuts and recession job losses is flooding hospital ERs with people suffering from psychological crises. This is in addition to the people who already rely on ERs for psych services and who are already taxing the system because there is a lack of alternatives. People who use crisis centers are not being given the appropriate tools to manage crisis on their own or to minimize crisis in their lives. People who use the ER because they’re uninsured are victims of a negligent healthcare system that forces people to wait until things turn dire. Then there are people who are homeless who are seeking food and shelter and have nowhere else to go. If you want to see how massively this country fails its citizens, a few nights at your local ER will do it. The new population is an added problem.
“These are people without a previous psychiatric history who are coming in and telling us they’ve lost their jobs, they’ve lost sometimes their homes, they can’t provide for their families, and they are becoming severely depressed,” said Dr. Felicia Smith, director of the acute psychiatric service at Massachusetts General Hospital in Boston.
Visits to the hospital’s psychiatric emergency department have climbed 20 percent in the past three years.
“We’ve seen actually more very serious suicide attempts in that population than we had in the past as well,” she said.
Perhaps most disturbing is that people who come for care often don’t get it:
And many hospitals are not prepared for the increased caseload of psychiatric patients, says Randall Hagar, director of government affairs for the California Psychiatric Association.
California cut $587 million in state-funded mental health services in the past two years, the most of any state, according to the National Alliance on Mental Illness, a patient advocacy group.
“They don’t have secure holding rooms. They don’t have quiet spaces. They don’t have a lot of things you need to help calm down a person in an acute psychiatric crisis,” Hagar said.
“Often you have a patient strapped to a gurney in a hallway outside of the emergency department where social workers are desperately trying to find an inpatient bed,” he said.
My emphasis. Can you imagine anything more troubling than going for help and then getting restrained instead?
The reader who brought this article to my attention said:
I fear for too long the mental health system has been considered infinitely elastic. Sadly, my peers and I are not. I wish the general population was more familiar with the nature, timing, and extent of the services our nation’s mental health system provides and the outcomes it fosters. I fear a great many have come to believe with the advent of “safer and effective medications” consumers need little more then a pill. If this was true the system could be viewed as infinitely elastic. As you know, things are not so simple.
Though he was able to get media coverage for this issue in 2009, admissions in the county hospital in his area continue to increase, from 4,639 in 2009 to 5,693 in 2011. And from what we’re reading, the trend seems likely to continue.
I cited Natasha Tracy’s post on AOT a few days ago, and got some intense feedback. I’d like to clarify my position. I fully understand people’s mistrust of system interventions and compelled treatments and the proverbial slippery slope they believe such treatments represent. But after working on the front lines of direct services to people with chronic mental illness, I believe you might feel differently—at least in some cases.
No one is advocating AOT for every person who has been diagnosed with a mental illness. That’s not how things work. People who are monitored under AOT have met certain criteria, like committing a criminal act. It is unfortunate that people’s illnesses do infrequently cause them to commit illegal acts, but when they do, they must—like every other person in our society—be held to account for those actions. Because we don’t want them to just be thrown in jail without considering their health problems, we find alternative ways to address issues of safety and accountability.
AOT for someone who has committed a crime is not, in my opinion, a slippery slope to someone like me—diagnosed with bipolar disorder—being forced to submit to similar conditions in my everyday life. I think the invocation of the slippery slope is a lazy rhetorical device employed by people who are afraid and angry, sometimes justifiably so. But is it borne out by facts? I don’t believe so.
A couple years ago I was the manager of a peer support program for a mental health organization. The goal of the peer support program was to reduce repeat hospital visits for “frequent flyers,” as the hospitals so sweetly called them. This reduction in hospital visits had an obvious benefit for the people we worked with. And I don’t think anyone objecting to AOT, which has the same goal in many cases, would object to peer support. There are many different tools we use to make lives better for people who have been diagnosed. Those who live in extremis due to their illness—those who are homeless, or who spend every weekend in the ER—need bold intervention.
I have a friend who runs an Assertive Community Treatment (ACT) program. Some people object to ACT for the same reasons they object to AOT. But my friend has seen people’s lives change radically—especially people living in poverty who were unable to manage their own resources. Sometimes in our zeal to protect rights in general, across the board, we forget about the individuals who are suffering on a daily basis. Should someone who lives in poverty and can’t get food because of his delusions prevent him from processing the complexity of government paperwork for food stamps be denied help so the rest of us can preserve our rights—which we only theorize are being threatened?
I am no fan of E. Fuller Torrey or TAC. I think he’s terribly destructive. He does not allow for subtlety. He has a twisted agenda. He’s a dangerous guy. I am not endorsing his positions, and I didn’t mention him—though someone affiliated my remarks with him. I do endorse careful, responsible consideration of practices that may help individuals in a system that continues to underserve them.
The town of Bend, Ore., is apparently afraid that the Crazy People are going to terrorize the neighborhoods when a teensy treatment home moves in. First there was a proposal to have all residents notified when such homes were built, thus ensuring the residents would be treated like sex offenders. The proposal was dropped, but a new proposal has been submitted by state legislators: a “safety council” will get the alert instead and then have 60 days to request changes.
I will translate that. The safety council has residents on it. Those residents will tell other residents. Throughout the 60-day period the residents will lobby, in NIMBY fashion, for the home to be in some other neighborhood. Maybe that’ll work; maybe it won’t. Either way, it’ll have negative effects on the people whose care is at stake: those with severe mental illness who are trying to leave the inpatient setting and receive community-based treatment—which is what recovery is all about, right? But if neighborhoods fight the incursion of the Crazy People, will they remain inpatient until it’s resolved? If so, who pays for that? Insurance companies?
Once they’re in the neighborhood, I’m guessing everyone will know exactly who they are and what’s wrong with them. Nothing like living in the 21st century, long after the snakepits have gone.
An incredibly eloquent submission by Joe Gutstein.
Let’s imagine for a moment that you are long into the public mental health system. You have been in the hospital multiple times, in a couple of partial hospitalization programs, and have spent years in sheltered workshops and day programs. You’ve received the Prophecy of Doom, “Too sick for too long to get any better.” You’ve heard plenty of statements beginning with “You can’t, You won’t, and You will never.” You’ve been told endlessly that something is intrinsically (genetically) wrong with you and the only thing that will truly save you is a medication yet to be discovered. You’ve also been told that the most important thing you can do is get on SSI or SSDI in light of the prolonged and persistent nature of your illness. You’ve been told to engage in meaningful activities generally limited to walking, listening to music, and reading. You’ve been told countless times to avoid any stressors which might be associated with more rewarding activities and these stressors will doubtless lead to yet another hospitalization. You’ve been told so many things.
You’ve lived through several successive Eras: Psychosocial Rehabilitation, Evidence Based Practices, Transformation, Recovery and now Recovery and Wellness but the only thing that actually changed was your medication. You’ve been referred to as a patient, a recipient, a client, a consumer, a prosumer, a self advocate and now a “person with ….” but everything is the same at the hospitals, the sheltered workshops, the partial hospitalization programs and the very day program you now attend. You are now told pursuant to the Recovery model that you are suddenly empowered but what evidences your empowerment? What is it in your life that is now different? When did you last hold a meaningful job, live in decent housing, go on a date, attend to a party which wasn’t held at 3 pm or have friends over to your place? Has your health improved? Has your circle of friends and acquaintances changed? Has your income increased to provide for more options? What activities do you now engage in which you wouldn’t have before you were empowered?
Are you empowered? Not really, nothing has changed in your existence. What you do have is a familiar long standing delusion in which you are empowered. You imagine, it is part of your symptomatology, that you can provide anyone anything and everything with a CGI script. This is an empowering belief within your disempowering reality and among all the other folks at the day program it gives you a unique identity, a unique story where being unique in other areas might not be highly regarded. Fortunately, there is no impact on your role as a person in the day program unless you chatter away about it. (No more so than your peer who believes he is being watched by friends on another planet. After all, he is no longer alone all the time. Someone is watching over him where no one else might otherwise care about him.)
What is going to replace this powerful delusion and that which accrues to you by virtue of it? Let’s consider your options and the system of supports and services which will assist you in replacing it. Knowing that it is best not to ask for anything specific which might fall beyond the groups found at the day program, You say, “I want to be empowered.” The reply is “Of course, we can help you with this. Did you know that the day program has an Empowerment Group?” (You knew there was an Empowerment Group.) Consequently, you are signed up for the day program’s Empowerment Group. It meets in the same room as the Socialization Group which was going to help you get a date on Saturday night and the Pre-Vocational Group which was going to help you get a meaningful job. But you know the folks in the Empowerment Group. Not a one has become empowered. (The group meets weekly and all the chairs are in a therapeutic arrangement. There are handouts and members of the group so inclined read aloud from the handouts.)
So in the final analysis, you have the delusion and the Empowerment Group. The delusion is empowering but the Empowerment Group isn’t. Sadly, no one asked you the right question in the Era of Wellness & Recovery. Now – for the first time – the very question he or she would want to be asked in the same circumstances is being asked, “What do you need to thrive?” What is it that would lead you to hope for a life where the delusion has no value and might be patently detrimental. And for once you truly know that your answer shouldn’t be limited to something that happens in another group but involves real skills, fostered and facilitated in the real world with services and supports which promote a life. And just maybe you’ll now believe in the possibility of that date on Saturday night and a meaningful job for this new reality is more satisfying and empowering then any long held delusion.
Hoo boy, that shit is powerful. I’ve been having trouble sleeping due to anxiety and my doctor prescribed an antihistimine, Atarax. I like it because it sounds like a planet dreamed up by L. Ron Hubbard. I also like it because I slept, slept, slept — until right now. My dog has been loving this unemployment thing. We just bask in the nap-ness of life. Here’s a little something from a dedicated reader who has a finger on the pulse of the Ancora mess, especially in the context of accreditation:
Despite the Dept. of Justice’s [scathing] report on Ancora it maintains full Joint Commission on the Accreditation of Healthcare Organizations accreditation . The kick in the head is that JCAHO did its site inspection on January 9, 2009 and the DOJ did its inspection from January 12 to January 15, 2009. Apparently JCAHO perceived a completely different institution. Kings County Hospital’s Behavioral Health Department maintained full JCAHO accreditation despite the death of Esmin Green, its 2009 DOJ report, and a lawsuit filed in 2007 . Connecticut Valley Hospital similarly maintained full accreditation despite its August 2007 DOJ report .
Someday a reporter will consider what JCAHO accreditation means when it comes to mental hospitals and whose interests JCAHO is putting first, i.e. the hospitals who pay for the accreditation or the patients whose misfortune it is to be in these institutions.
All the below is about this show.
Madigan: They didn’t flatter you with that lighting.
David Oaks: You’re looking so handsome! I had no idea. Your eyebrows are very sexy. (I’m completely sincere.)
“But critics worry …” That’s journalism-speak for “We don’t have any specific sources who say this, but we’ll generalize it so we have reason to focus on …”
… violence. That’s what they’re focusing on. Why am I not surprised?
So of all the things they could talk about related to Mad Pride — and related to mental health — this is what they’ve come up with: criminals and violent crime. Ugh. TV is so predictable and depressing.
Okay, so now we’re telling the story of a kid with hallucinations and delusions (the CIA, yadda yadda) who KILLS HIS MOTHER? Does the average American viewer understand how fucking rare this kind of thing is? That it’s not the necessary result of deciding not to take meds?
On to the withdrawal story: Clearly, the program wasn’t looking for a success story. This poor woman who decided to do the show so they could feed off her misery — I knew that’s what they wanted. Is she doing the withdrawal in conjunction with a doctor? Who the hell knows? The show doesn’t tell you. It hardly tells you her name. And …
Oh! There it is again: “Critics worry … ” (that she’s going to be “a time bomb” without her meds). Who are these critics worrying about this girl? Frank Rich? David Denby? I’d love to know.
“Violence is unpredictable with or without drugs.” Brilliant script.
Blurry homeless images. Madigan cello-ing. … This show is so bad, it’s like a joke. I guess it all goes back to what producer Ia Robinson told me, when we discussed my being on the show: She doesn’t have any friends or family who have mental problems, so the whole topic was like “walking on the moon.” Yes, that’s the phrase she used. The show should’ve been blasted out to Mars.
Except Joey P. He’s delightful and a voice of reason.
liz | 9:34 PM | SCHIZOPHRENIA, alternative treatments, bipolar disorder, celebrities, criminal justice system, depression, hospitals / hospitalization, meds, philadelphia, side effects, stigma, suicide, violence
I’m always complaining about writing yet another post on Ancora, but what’s funny about its name is that it means “again” in Italian. Dovrei dire, “Ancora parlo di Ancora? E ridicolo.”
Of course, it’s not funny at all for people who are trapped there. The most recent news comes in a report on the psych hospital’s operations in 2008, and of course, it’s nothing we didn’t know already. It’s just depressing. From the Courier-Post Online:
Ancora Psychiatric Hospital remained a dangerous place in 2008, with patients there subject to “serious, frequent and recurrent harm,” according to details of a U.S. Department of Justice investigation released on Monday.
A letter to Gov. Jon S. Corzine from acting Assistant Attorney General Loretta King was sharply critical of practices at Ancora, the Winslow Township hospital that is the state’s largest psychiatric facility.
Staff at Ancora frequently used excessive restraint to control patients, failed to appropriately monitor patients who were engaged in aggressive or self-destructive behavior, and did not provide adequate mental health treatment for those hospitalized there, the letter states.
Click here for more. But not while you’re eating.
liz | 2:37 PM | hospitals / hospitalization
After a long battle with cancer, PW staff writer, Guardian columnist, punk-rock novelist, NME gadfly, gender-twisting rebel comedian and poet Steven Wells has gone on to other things. Well, not really. According to Steven, there’s no such thing as the afterlife, and if there is, I guarantee he’s really, really pissed off right now. I can just picture him at St. Peter’s Gates, saying, “Fuck me! This shit actually exists?”
We’ll all miss Steven so much, and I’ll say more about that later. For now, I’m wishing the best to all family and friends who are hurting. That’s what Steven really cared about in the end, though he was very passionately annoyed by knitting, as well.
Steven was often told he was anti-American. I loved his passion, and he cracked us the fuck up every day. This video was part of a series he did for PW called Steven Wells’ America, in which he took sacred cows and basically grilled them for dinner. Below, he reflects on the religiosity of an America that voted for Bush a second time (Steven was a staunch atheist). Toward the end he smiles a bit, so you know that he knows he’s being ridiculous. And that’s part of what was so cute about Steven — he’d rant, but then laugh at himself.
liz | 10:41 AM | BIG PHARMA, Funny or Offensive?, GLBT, Song of the Day, alternative treatments, anxiety, celebrities, children, cute fix, depression, hospitals / hospitalization, media, meds, military, philadelphia, phobias, politics, random, religion, suicide, violence