I listened to Brian Stettin speak to a group in Tennessee tonight. For those of you who dont know Brian is the policy director for the Treatment Advocacy Center and probably the point person in the effort to bring Assisted Outpatient Treatment to Tennessee this year. The conventional wisdom is that it doesnt have a chance of passing if there is a fiscal note of any measure attached to it. That indeed may be true (I hope that is true), but much of what he said really did suprise me and I wanted to share it. unintentionally he gave one of the best criticisms of AOT I have heard. I did not hear his entire presentation so I am trying to take some care so as to not distort what was said.
What I expected to hear was some version of “…AOT is the cornerstone of effective treatment of the mentally ill….It will save us from the violent emotionally disturbed people who dont realze they are really disturbed…..It has a track record of unbridled success…..It is the best way to meet the needs of the mentally ill… Let me tell you some horror stories about what will happen if you dont do this…..And by the way let me tell you what the research in New York has proved about AOT.” There is a blog called “Its Time to Change Tennessee Mental Health Laws” that has advocated in favor of AOT and this has basically been the argument it has made. If you get the Treatment Advocacy Center Newsletter you hear a lot of these type of things said. They will tell you that AOT is the “best thing since sliced bread” and that anyone who is not is in denial of the real needs of the “mentally ill.”
The argument I heard tonight was different:
- The proposed law in Tennessee should be supported because it is unambitious. It doesnt propose any new services. The answer to the question “what do you commit people to….” is simple. Just the same old services that didnt work to begin with. He went through this part fairly rapidly but it just struck me. I have never heard anyone say the best thing about a proposed law is that it doesnt do much.
- It wont affect many people. He spent a lot more time talking about who wouldnt qualify than who would. Part of this was his effort to defuse the coercion issue. But basically you had him describe a law that didnt do much, but would only do it for a few people.
- Nothing bad would happen to someone if they refused to comply with the commitment. He said the way this law was written there was no contempt of court. He relied on what he called the “black robe effect.” He said people tended to do what judges said to do. Maybe people in Tennessee are different, but an awful lot of people here dont do what judges say. But basically you have a law that wont do much but will do it only to a few people that we wont make them do anyway.
- And it really wont cost anything to do. He said previous attempts had an exorbitant price tag and that was what had killed them. What he didnt explain that last year they also didnt propose any new services. But if the state pays for people with no insurance (a major problem in Tennessee) and only had 30 indigent people on it the costs came out to about $24,000 a person. No one I know seriously believes that only 30 indigent people will be affected. He also neglected to talk about the fact we had a $1.2 billion dollar deficit in TennCare this year that was averted by the hospital tax and how much extra would come out of TennCare for his program that didnt do much, but did it for only a few people. He also went very fast through this part of his talk.
So his basic argument for AOT was: It was a bill that didnt do much, but did it only for a few people, that we wouldnt really make take part in it and it wouldnt cost too much to do all this.
Wow….. I wonder why I didnt walk away overwhelmed. Given the situation in Tennessee I still dont see how we can even think of taking away a penny of money from people desperately searching for help and give it to someone who has decided he doesnt need or want the services. The problem is not in convincing people they need help. It is in providing a sufficient number and array of services to be helpful. Mr. Stettin was very good in his argument. He tried to tell people what he thought they wanted to hear. He ignored the things that made him look bad and hurried through the bad things he had to say. He made an argument for passing a law unlike any I have ever heard. I dont know if he understands that he made it sound like a law that wasnt worth the time we spent on it.
Hopeworks Community 
Larry, for the record this is the second time you have mischaracterized my arguments. Last time you quoted something I wrote out of context. This time you twisted my statements to the point of absurdity. I will resist the temptation to get into the substance with you here. Frankly, I don’t see the point because I doubt that anyone with an open mind on the issue reads this blog. But I must say I think it is very sad that you did not speak up and challenge me on anything during the NAMI call. It was basically a Q+A session. You could have exposed me for the con artist you think I am. But on neutral ground, you chose silence. Apparently you are only comfortable shooting spitballs from the safety of your Amen corner. That’s not advocacy, my friend, it’s an ego trip. You are basically playing the same game as Rush Limbaugh and Glenn Beck. Good luck with that.
Larry, for the record this is the second time you have mischaracterized my arguments. Last time you quoted something I wrote out of context. This time you twisted my statements to the point of absurdity. I will resist the temptation to get into the substance with you here. Frankly, I don’t see the point because I doubt that anyone with an open mind on the issue reads this blog. But I must say I think it is very sad that you did not speak up and challenge me on anything during the NAMI call. It was basically a Q+A session. You could have exposed me for the con artist you think I am. But on neutral ground, you chose silence. Apparently you are only comfortable shooting spitballs from the safety of your Amen corner. That’s not advocacy, my friend, it’s an ego trip. You are bas playing the same game as Rush Limbaugh and Glenn Beck. Good luck with that.
Brian
Thanks for your comments. I am encouraged that you responded to my post. I have asked several times for any response from someone from the TAC for a long time. For the record, I did not hear all of your remarks. I had not thought I would be there at all, but found time to get a small break at work and hear the gist off your remarks. I had to go back before you completely finished. That is what I tried to say at the beginning of the post. I thought my name was announced when I came on but several people were coming on or leaving at about that time and perhaps not. I do think you understand the problem in Tennessee. I have really only asked two questions the whole time. What do you commit people to? Resources are the problem. If you live in a rural county like I do it is extraordinarily the problem. We have about 6-8 therapists that deal with a load of about 4000 people. Our reality is not the same as New York. Many people fall through the cracks and it is far more than personal blindness. My other question was who pays and where does it come from. You cant take money from existing services. I think in the end it will come down to the fiscal note. If there is little or none I think you have an excellent chance. You are right in the scheme of things this blog is unimportant. I am only one person. The stats say about 3000 people a day look at it though. You seem to read it occasionally. I would be willing to post something from you unedited by me stating your position if you would like to. I at least owe you that opportunity. You are a big national thing and if it is not worth your time I certainly understand. But thanks for your time. Thanks for your response.
Larry, The only reason Mr. Stettin was made aware of the unfound statements you made on this post is due to an unsolicited email you sent to me and several others shortly after the NAMI Policy members finished their conference call. Mr. Stettin does not read your blog. I do not read your blog. But yesterday you really crossed the line by your “remarks” so I’m sure he felt he had to respond. BTW, it’s not very professional or ethical to disclose “your version” of what you “partially” heard in a NAMI Policy committee meeting on a personal blog.