Wednesday, March 12, 2014

Pardon the Interruption


I've mentioned it before, but Clink and I are working on a new book.  Today, it the book-to-be is titled is "Committed: The Battle Over Forced Psychiatric Care."  I've started the process of meeting with people, interviewing, shadowing -- it's my mid-career crisis of being part-Shrink/ part-journalist.  Blogging, in the coming months, may be a bit less frequent, and may be more focused on involuntary treatments, because that's what I've been thinking about.  

So for yesterday's headlines here in Maryland, do read "Legislation Pushes Involuntary Mental Health Treatment" from yesterday's Baltimore Sun.  I went to listen to one of the Senate Committee hearings on some of the legislation -- the hearing room was packed with dozens of people there to give testimony and emotions running high. 

16 comments:

Anonymous said...

The article states, "Some mental health advocates back mandatory outpatient care as a way to ensure consistent care and fewer hospital visits. Many patients learn to manipulate the system, adhering to treatment while institutionalized but going back to their old ways once released, advocates said."

And, many patients will understandably learn that what they need to do to avoid AOT is to move. Kind of hard to force it if the patient is no where to be found. Interestingly, I never hear any data on how many of the patients under AOT turn up missing (i.e. leaving the state, etc). Surely that data is being collected somewhere?

Pseudo-Kristen

Anonymous said...

This seems like an interesting viewpoint and the legislation will probably have an equal number of supporters as opposers. But then ethically there is a lot to consider before this is brought to action.

Anonymous said...

Are you guys just focusing on the patient point of view or are you also interviewing psychiatrists who focus on in-patient care? I just found out someone I have become friends with is about to finish his residency at John Hopkins in Baltimore and wants to continue to work with patients in the in-patient setting. Would you guys want to maybe interview up and coming psychiatrists who are about to enter that world as providers? I could send him your gmail address or email you his contact info if he is interested.

J

Dinah said...

P-K: I'm not aware that there is any collection of such data, but the programs are very expensive and resource-consuming, and these are for patients who are repeatedly becoming dangerous and needing hospitalization, so I'm thinking the politicians would be glad them move to any other state.
-----
Anon 1: yes the debate is heated and I watched one set of hearings in Annapolis and both sides were there. 45 States already have legislation allowing for outpatient commitment, but my sense is that not that many actually use it.
---
J: Sure, give him our email, that would be great, would love a resident's point of view. Lots of Hopkins in the book.

Susan Inman said...

Your book project sounds very useful.

I hope you'll consider including interviews/discussions with people in British Columbia. I know many families who have had experiences like ours - we pursued involuntary treatment for our psychotic daughter. When she became well, she gradually understood how ill she'd been and is grateful that she received the care she needed.

There are several factors that contribute to this kind of positive outcome here:

> We have early psychosis intervention programs that provide intensive outpatient services. These services include psycho-education programs that teach people about their illnesses, including information about the lack of awareness of being ill which creates such havoc for so many. I witnessed the impact of this education in helping people start to understand, accept, and learn to manage their illnesses.

> Families are also offered education in early psychosis intervention programs. The U of Maryland research on NAMI's Family to Family program demonstrated better outcomes when families receive intensive education.

The national consumer organizations that have seized the right to represent all people with mental illnesses are fiercely opposed to any involuntary treatment. Since they don't believe that psychotic illnesses are brain disorders, they also end up opposing any 'not criminally responsible' defences. And their responses to the burgeoning population of the incarcerated mental ill seems to be that these are people who chose to do their crimes and may also have some kind of mental health condition.

Here's a link to blogs by Erin Hawkes who lives with schizophrenia and believes she'd be sea without involuntary treatment:
www.huffingtonpost.ca/erin-hawkes/

I'd be happy to connect you with Erin who also lives in Vancouver.

Susan Inman

Susan Inman said...

Your book project sounds very useful.

I hope you'll consider including interviews/discussions with people in British Columbia. I know many families who have had experiences like ours - we pursued involuntary treatment for our psychotic daughter. When she became well, she gradually understood how ill she'd been and is grateful that she received the care she needed.

There are several factors that contribute to this kind of positive outcome here:

> We have early psychosis intervention programs that provide intensive outpatient services. These services include psycho-education programs that teach people about their illnesses, including information about the lack of awareness of being ill which creates such havoc for so many. I witnessed the impact of this education in helping people start to understand, accept, and learn to manage their illnesses.

> Families are also offered education in early psychosis intervention programs. The U of Maryland research on NAMI's Family to Family program demonstrated better outcomes when families receive intensive education.

The national consumer organizations that have seized the right to represent all people with mental illnesses are fiercely opposed to any involuntary treatment. Since they don't believe that psychotic illnesses are brain disorders, they also end up opposing any 'not criminally responsible' defences. And their responses to the burgeoning population of the incarcerated mental ill seems to be that these are people who chose to do their crimes and may also have some kind of mental health condition.

Here's a link to blogs by Erin Hawkes who lives with schizophrenia and believes she'd be sea without involuntary treatment:
www.huffingtonpost.ca/erin-hawkes/

I'd be happy to connect you with Erin who also lives in Vancouver.

Susan Inman

Anonymous said...

Dinah, my state doesn't require that the patient is dangerous to qualify for AOT, you just pretty much need to have a mental illness. But, I don't doubt that legislators would be glad to shift financial burden to other states which is likely what happens when the patient flees to avoid AOT.

P-K

Anonymous said...

Dinah,

Here is a great column by someone who used to work as an inpatient counselor as to why the current system doesn't work.

http://www.madinamerica.com/2014/03/hospitalization-crisis-crisis-care/

It is just too bad that his column isn't required reading by every state legislature considering passing involuntary commitment laws.

AA

Simple Citizen said...

I worked at a state Involuntary Psych hospital for 3 years.

I now work at an adolescent Residential Treatment Center - 90 days minimum in a locked facility.

I've started thinking more and more about what it must feel like to be one of the kids I treat - locked up, against your will, for months on end.

Last month I started reading the books they're reading - Crank, Glass, Fallout, Impulse, etc...

Then this month I decided to spend just one day as a patient - 14 hours in their shoes.
Here's how my day as a patient turned out:
http://thoughtsofasimplecitizen.blogspot.com/2014/03/my-day-as-patient.html

Anonymous said...

Sent to you via email, sent here in "pieces" because of character limits with typo edits.

PART 1

Dinah,

Well known promoter of psychiatric abuse, Pete Earley -with whom corresponded in the past-, mentions that you are asking for perspectives of people who have been victims of the practice, so I thought I would send you my story. Here it is (comment by cannotsay2013),

Here is my story (comment by cannotsay2013)

While I wish I could give you more details about me, the reason I have to share this anonymously is precisely the evilness associated with involuntary commitment. Note that I do not use the description "psychiatric abuse" lightly. The practices he openly advocates for are, in my view and that of the overwhelming majority of people who have been victimized by psychiatry, psychiatric abuse. To give an analogy, we would all agree that the practice in many Muslim countries that allows men to "marry" young girls with the sole objective of forcing them into sex that few people would describe as truly "consensual" is abusive, yet this practice is legal in those countries. The Muslim men (and women!) that condone the practice consider forcing a 10 year old girl into sex with a much older man a rite of passage to adulthood.

Now, if you find my story unbelievable, here is a documented case along the lines,

The UK steals child from "bipolar" Italian woman

" A pregnant woman has had her baby forcibly removed by caesarean section prior to the child being taken into care.

Mid-Essex NHS Trust obtained a Court of Protection order against the woman that allowed her to be forcibly sedated and her child to be taken from her womb. Essex social services obtained an interim care order as soon as the baby was born.

The council said it was acting in the best interests of the woman, an Italian who was in Britain on a work trip, because she had suffered a mental breakdown. "

Anonymous said...

PART 2 (of 3),

Note that psychiatric abusers always, regardless of the extend that laws allow them to abuse, excuse themselves in "the best interests of the so called patient". My commitment order also said that they were acting on "my best interests" :-).

In the US, while we have higher protections against that type of abuse (more later), existing law has a de facto "need for treatment" standard against the most vulnerable among us: children and seniors. It is well known that children "protection" agencies drug children in foster care to oblivion. The case of Justina Pelletier (in case you live in a different planet here is the latest news on the case) shows that psychiatrists go even further: they are willing to take the unprecedented step of stealing a child from her loving parents to have the child committed EVEN when an alternative and valid biological explanation is present that explains the child's medical issues. I said "de facto" because the legal trick used to commit Justina was to steal the custody from the parents, and then have the state of Massachusetts ask for a "voluntary
commitment".

Here is an equivalent case on a 84 old man in Texas

"A North Texas man says he can't get out of a local hospital.

But what's happening may involve Adult Protective Services, and no one may be able to help him now."

With respect to the "higher protections" for non vulnerable adults in the US (ie, emancipated adults that the state deems autonomous), they are real, but as E Fuller Torrey explains here

"It would probably be difficult to find any American Psychiatrist working with the mentally ill who has not, at a minimum, exaggerated the dangerousness of a mentally ill person's behavior to obtain a judicial order for commitment."

This practice of lying and exaggerating was in full display in the recent "Imminent Danger" 60 minutes special that presented as "medical facts" things that are pure conjecture, such as that so called "schizophrenia" is a brain disease. Don't believe me? Listen to Tom Insel,

"It appears that what we currently call “schizophrenia” may comprise disorders with quite different trajectories. For some people, remaining on medication long-term might impede a full return to wellness. For others, discontinuing medication can be disastrous. "

Anonymous said...

PAET 3 of 3,

Add to that that so called "mental health" judges are rubber stampers of psychiatrists' desires and the reality is a bit murkier. So while in theory the protections I enjoy in the US are higher than in Europe, the fact that psychiatrists regularly exaggerate or lie to get people committed and that judges rubber stamp those exaggerations, weakens those protections in a significant number of cases.

So in short, I believe that so called "involuntary psychiatric treatment" is the last form of civil rights abuse that remains in the books of the Western world. Women got the unfair treatment against them removed. So did blacks and gays (ironically the latter were abused for a long time because the APA considered them "mentally ill"). Now it is the time that the XIV-th amendment extends its protections to the rest of us. That would mean that the state SHOULD not be able to have a "separate but equal" regime against those that the APA hates by way of the DSM . This "separate but equal" is our current reality,

- If the APA deems you "normal", you cannot be incarcerated unless you commit a crime (even if that crime is making criminal threats). Incarceration requires proving the crime under the standard "beyond reasonable doubt". Criminal defendants also enjoy strong procedural protections in place. After conviction, the length of incarceration is subjected to sentencing guidelines. If you are convicted of making "criminal threats" that rarely goes beyond a few months.

- If the APA deems you "sub human" -as it is the case for yours truly :-)-, you CAN BE incarcerated EVEN if you DON'T commit a crime. A rubber stamper judge can lock you up using your APA declared "subhumanity" based solely on the testimony of lying psychiatrists that you are "dangerous", never mind that Allen Frances says here, "it is impossible to predict in advance who is likely to become violent and when". And then, incarceration lasts for as long as your lying psychiatrist thinks it is necessary.

Sorry for the length of this email, but I wanted to document my case because I would understand that you don't believe a story coming from an anonymous source. Before he developed his current hatred towards the so called "mentally ill" E Fuller Torrey cogently advocated that

"It is better that we err on the side of labeling too few, rather than too many, as brain diseased. In other words, a person should be presumed not to have a brain disease until proven otherwise on the basis of probability. This is exactly the opposite of what we do now as we blithely label everyone who behaves a little oddly “schizophrenic.” Human dignity rather demands that people be assumed to be in control of their behavior and not brain diseased unless there is strong evidence to the contrary. "

Only God knows what made him go from holding said libertarian views to being the greatest source of psychiatric stigma that currently exists in the United States.

Dinah said...

Susan and Psych Survivor, thank you for your comments. Given the overwhelming nature of the project, I'm finding that 50 states with 50 sets of laws is all I can manage! We really have to limit the book to US Psychiatry. Thank you, both, though.

Anonymous said...

Dinah,

You are welcome, but any discussion on involuntary commitment in the US needs to deal with how the current American framework compares with the frameworks of other countries, Western Europe's in particular .

If you think that the European framework is "better", then you need to put up with the fact that countries like Norway have a reality that "incidence rate for civil commitment based on "involuntary referrals", "treatment periods" and persons involved were 259, 209 and 186 per 100,000 adults/year, respectively" which means that one out of every 500 adults in Norway has been civilly committed. How was that helpful to prevent the largest civilian mass shooting of the last 20 years? And how is that Norway has one of the highest suicide rates in the Western World?

catlover said...

I have to say, beyond the fact that inpatient care is often abusive and nothing is offered nowadays except drugs (the groups are a joke in the hospitals around here, but I know that 20 years ago, groups did offer training in things like meditation etc), a MAJOR major issue I have with involuntary commitment is that it's on your record permanently, like a felony. Presumably, some people are going to have severe problems all their lives, and need help just to live (too bad that help is poorly provided with too much bureaucracy and other times abusive), but others are in a transient out of control period, and even if they don't altogether recover, they will be branded as dangerous individuals all the rest of their lives. Maybe they were bipolar and reacting to antidepressants or some other drug that made them manic (happened to me!),or maybe in a temporary crisis due to extreme life events, but there is no way to get that commitment off their record. Also, I was told that in my state, people were voluntarily agreeing to be involuntarily committed because there was no room for them at the state hospital otherwise. That was fixed years later, perhaps by a court decision, but the commitment is on their records forever. This is more of my theme of "don't put me in an FBI database - I'm a nice person and have never hurt anybody." When I was having severe behavioral problems due to prescribed drugs, a kind older psychiatrist (must have retired by now) protected me from a commitment and said this power was grossly abused by many other psychiatrists, in his STRONG opinion.

catlover said...

On rereading, I wasn't too clear - if a person has been committed, they may bad off forever, or they may recover more or less - maybe 100%, maybe not, but never again be anywhere near so bad off that they should have a commitment on their record permanently. Still, if they have a bipolar or schizophrenia label, they can't prove they aren't mentally ill anymore, since it's presumed they are mentally ill for life. So much for recovery, even if it happens.