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.

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.

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.

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.

The investment firm Fidelity recently surveyed employees at various companies who had opted for a high-deductible health plan linked to a health savings account. About half of those workers said they or a family member had chosen not to seek medical care for minor ailments as many as four times in the last year to avoid paying the out-of-pocket expenses.

As any doctor will tell you, small health problems left untreated can become big problems, warns Kathleen Stoll, director of health policy at the health care advocacy group Families USA. “This is just one of the many high-deductible pitfalls consumers need to watch out for,” Ms. Stoll said.

Patient Money: The Many Hidden Costs of High-Deductible Health Insurance

Explanation:

A package of bills sponsored by Senate President Richard J. Codey that are designed to protect patient safety and improve employee training and oversight at state psychiatric hospitals was approved yesterday by the Senate Health, Human Services and Senior Citizens Committee. … Sen. Codey worked closely with the Public Advocate’s office in drafting these bills, in part, to address a number of injuries and deaths that had arisen recently at state facilities such as Ancora Psychiatric Hospital.
Bill S2492, would require the Department of Human Services (DHS) to establish a training program for staff members who work directly with patients at state psychiatric hospitals in order to ensure the delivery of safe, secure, and therapeutic care.  Utilizing best practices in patient treatment, the curriculum would include topics such as state and federal reporting requirements, patient safety, disease prevention, health wellness activities, anger management, skilled decision-making and how to deal effectively with life-threatening emergencies. … The bill would require DHS to establish an on-site educational assessment and remedial instruction program at each state psychiatric hospital in order to evaluate the proficiency of all staff members who work directly with patients.

The bill would also require the commissioner of DHS to establish minimum educational standards for staff members at a hospital who work or will work directly with patients. … Employees already working directly with patients at the time of the bill’s enactment would be required to undergo an evaluation to determine if they meet the educational standards or require remedial instruction through the on-site education program.Any employee that refuses to participate in the training program or fails to meet the educational standards and refuses to participate in remedial instruction, would be terminated from employment at the hospital. …

The second bill, S2493, would require current and future employees of state psychiatric hospitals, developmental centers and veterans’ memorial homes to undergo drug testing for controlled dangerous substances as a condition of employment.

The last bill in the package, S2494, would require DHS to report the number of physical assaults and deaths that occur at state psychiatric hospitals. The report would be a public record, posted on the official DHS website, and updated quarterly, but would not contain any identifying information about patients or staff members.

As a longtime fan of Sen. Codey’s commitment to mental health matters, I do think it’s a good move. But is it transformative? As an astute TTWS reader notes:

It’s hard to see how these three bills alone will transform patient care at New Jersey’s state psychiatric hospitals which includes Ancora, let alone insure the care long required by law, New Jersey Statutes Annotated 30:4-27.1(c), It is the policy of this State that persons in the public mental health system receive inpatient treatment and rehabilitation services in accordance with the highest professional standards and which will enable those hospitalized persons to return to their community as soon as it is clinically appropriate.

Too often words and deeds fail to intersect at our nation’s psychiatric hospitals. Transform and its variants are now used so frequently that any change is considered transformative. More recently at another New Jersey state psychiatric hospital where a new building was going to lead to transformation (click here, paragraph 5), the reality belied the representations, ex. Developing therapeutic alliances between patients and staff remains a challenge, with differences in race, ethnicity, social class and education creating a ‘them versus us’ scenario.

“When I use a word it means just what I choose it to mean — neither more nor less.” Humpty Dumpty

Don’t answer that. I got an email from Maiken Scott, behavioral health reporter for WHYY, the PBS affiliate in Philly. She wrote:

Last year, I met with Dr. John O’Reardon, a U Penn scientist who invited me to cover a new treatment for severe depression as it develops and undergoes scientific testing. This approach is called DBS, or Deep Brain Stimulation. It is already being used successfully in the treatment of symptoms associated with Parkinson’s Disease. Dr. O’Reardon is passionate about helping people with treatment-resistant depression, and he cares deeply about his patients. Yesterday, I was in the OR at Pennsylvania Hospital, and watched the procedure. I had previously met with the patient. Her name is Tara, she is 50 and has suffered with depression for almost 40 years – we spoke at length before her surgery. I have started to file stories and we’re covering this as it develops both on air and on the web. I plan to follow her for the rest of the year, as she recovers and as scientists learn whether this treatment will bring her relief.

Sounds very interesting to me, and Maiken is a really good reporter. Check it out here.

What made me angry is that I know plenty of incompetent drivers who shouldn’t be on the road, and they don’t suffer from mental illness. I also know drivers who have severe mental illnesses who acquit themselves quite admirably on the roadways (myself included). It’s a violation, in my opinion, of a person’s civil rights to prevent them from applying to get a license.

One woman who did get approval was empowered by it. She failed the permit test again and again, but it never ceased to be a goal, which fit in with the messages given by the community health center: Make sure the clients set goals for themselves; it gives them hope. Perhaps it was an unrealistic goal for her. I don’t think she’ll ever drive. But it was the trying that mattered, and if she ever gets behind the wheel, I hope she drives far away into the sunset with a great song on the radio. Just for fun.

A Guy, a Car: Beyond Schizophrenia by Ronald Pies M.D.

Don't let me blow away

Bystanders at a Detroit-area flea market were stunned this weekend when high winds from a passing storm picked up a couple’s Chihuahua puppy and blew her out of sight.

After two days of searching and consulting with a pet psychic, Tinkerbell was found almost a mile away in the woods dirty but unharmed. …

“We were shocked when we found her,” Dorothy Utley, 72, told The Detroit News. “You don’t know how happy we were. We love her so much.”

It’s a Bird, It’s a Plane, It’s a … Flying Chihuahua?

Stigma watchers are not amused. In an open letter to Psycho Donuts, the National Stigma Clearinghouse’s Jean Arnold wrote:

In this bring-the-kids mecca of mega-calories, children can pose in a padded cell encased in a straitjacket. … What’s endearing about a straitjacket? Why do straitjackets, a symbol of force and humiliation, appeal to advertisers and product marketers? We can’t answer that question, but the National Stigma Clearinghouse archive shows straitjackets have been used as a marketing tool for many years. Twice in our experience, the marketers have tangled with Human Rights commissioners.

Although straitjackets are now mainly found on bondage websites and in S&M shops, for decades they caused death and suffering to untold thousands of mental institution inmates. Children are especially vulnerable, according to research by the Harvard Center for Risk Analysis in 1998, accounting for 25% of the deaths. That study brought calls for nationwide reform.

… Unlike other powerful symbols of oppression (a lynching noose for example), it is sad that psychiatric medications, straitjackets, and padded cells are still used to amuse the general public. We respectfully ask Psycho Donuts to rethink the theme of their new store.

That’s unlikely. In an article in the Silicon Valley Mercury News, the store’s owner is quoted:

“I think that the community out there has taken what we’re doing and has turned it into something that was never our intention. When we’re talking about Psycho Donuts, we’re not referring to people; we’re referring to doughnuts,” Zweigoron said. “Our intention in all of this was never to hurt anyone. It was simply as a fun type of thing, adding an interesting and unique twist to selling doughnuts.

“There’s a Psycho Mouse ride at Great America, and there’s El Pollo Loco. At what point do you cross the line?” … “I find that the community at large is not offended by what we’re doing.”

But NARSAD disagrees. Below, a letter to the owners from the esteemed organization:

The website also has really good games on it, like Asteroids, which I just wasted 15 minutes on, and a virtual Etch-a-Sketch. The gallery has “weird” art, which is a stupid idea, but some of the artists seem vaguely talented. I like this work called The Lonely Satellite by Nicolas Caesar.

Thanks to Susan for letting me know about this.

Mom blames improper meds for son’s condition

Oh, and as for that headline? That’s the Courier-Post’s way of covering its ass, legally speaking. But after this article, I hope the state — not just “Mom” — blames the hospital for starting her son’s miserable trajectory.

Yet people with multiple health problems — a condition known as multimorbidity — are largely overlooked both in medical research and in the nation’s clinics and hospitals. The default position is to treat complicated patients as collections of malfunctioning body parts rather than as whole human beings.

“Very often, there is nobody looking at the big picture or recognizing that what is best for the disease may not be best for the patient,” said Dr. Mary E. Tinetti, a geriatrician at the Yale School of Medicine.

And treating one disease in isolation, she added, can make another disease worse. In controlling diabetes, for example, doctors often seek to reduce levels of a blood-sugar marker called hemoglobin A1C. “But we know that for some people with complicated diseases, that’s not always the best move,” Dr. Tinetti said.

Treating an Illness Is One Thing. What About a Patient With Many?

There’s an interesting piece over at The Huffington Post today, which talks about waterboarding’s secret history as a “treatment” for the insane in the 1800s. As it turns out, much of what we know about the practice in those days centers around a Philly businessman of the day named Ebenezer Haskell, who worked in Old City and was institutionalized numerous times.

And here’s an excerpt from Dan Agin’s HuffPo entry:

There are many sources that document conditions in 19th century insane asylums, but one passage in Haskell’s little book about a specific treatment is revealing. In 1867, they called it the spread-eagle cure, but these days we call it water-boarding. Ebenezer Haskell tells us the term “spread-eagle cure” was common in his time in “all asylums and prisons.” Note the conflating of asylums and prisons. More than seventy years after Benjamin Rush pushed through reforms to have mental patients kept in more humane conditions, asylums were essentially still prisons for the insane. Recall that Haskell, after each of his escapes from the Pennsylvania Hospital for the Insane, was “arrested” and returned to the asylum.

The spread-eagle cure, common in 1867, reveals a few things about public attitudes towards madness. The “cure” was no cure at all, simply a procedure applied to terrorize patients–especially when they were disorderly. The patient was stripped naked, thrown on the floor on his back, and then his arms and legs each gripped by one of a team of four men. The patient’s limbs were stretched out to keep him immobilized. A fifth man, a “doctor” (more often an orderly), would then stand on a chair or table at the head of the patient and pour a series of buckets of cold water on the patient’s face until the patient nearly drowned. After the treatment, the patient was returned to his dungeon supposedly “cured” of all disease, including lunacy.

According to Haskell, the shock of the treatment often caused the death of the patient. Haskell points out (five generations before our own current familiarity with this procedure) that if a steady stream of water seven or eight feet in height falls down directly on the face of a patient, the water will have the same effect as if the patient was held under water the same number of feet for the same time, since no one can breathe when water is falling directly on the nose and mouth. “It is a shock to the nervous system,” Haskell says. He knew it, the other patients knew it, and the people who managed the asylum knew it. In 19th century American asylums and prisons, they all knew the spread-eagle cure as essentially a method of terrorizing lunatics.

Proud Moments: Philly Once Led The Charge To Waterboard The Mentally Ill

How It Was: Terror and Water-Boarding the Insane in Philadelphia

They’re going to appeal. Unbelieveable.

On the mental health tip, in the spirit of injustice, Joe sent me the following:

Under the heading of “Beyond Belief.” Having grossly violated the trust of consumers, GA’s DHR is being permitted to monitor the operation of its state hospitals under the terms of a DOJ settlement,  “The Department of Human Resources —- the agency that operates the seven state hospitals —- will monitor its own compliance with a settlement agreement reached last week with the U.S. Justice Department. The agreement calls for the state to correct deficiencies that caused hundreds of injuries and illnesses and dozens of deaths among psychiatric patients, spending as much money as is necessary.”

DHR to monitor itself in mental hospital settlement