Mental illness in Tennessee prisons and jails: a proposal

April 17, 2014 by

Dear Governor Haslam.

The plight of the mentally ill in Tennessee prisons and jails is, I believe, a human tragedy of unbelievable magnitude.  Throughout the country each day you hear more and more horrible stories of abuse, violence, and of mentally ill being further traumatized.  The story in the video above, the story of Jason Toll, is a Tennessee tragedy.  It is one that should ever have to happen to anyone in this state again.

Local jails are being flooded with the mentally ill.  Our jails have become our largest mental health centers.  It is a job they dont have the financial resources nor the people resources to deal with.  The ultimate victims are the mentally ill, their families and the communities they live in.  It is in a very real way a public health emergency.

I am asking that you appoint a committee to study exactly what we as a state are doing about this crisis and come up with a set of policy recommendations that could improve what we are doing and help us to move forward in the effective and humane treatment of the mentally ill.  That committee should include representatives from the departments of mental health and corrections, as well as sitting sheriffs, mental health professionals, family members of mentally ill in jail, advocacy organizations like Disability Law and Advocacy Center, and mental health groups like NAMI and the Tennessee Mental Health Consumers Association.

Among issues that might be addressed are:
1.  What are we doing right now that is working??  What can we build on?
2.  Diversion.  The use of things like mental health courts to keep the mentally ill out of jail.
3.  Solitiary confinement. The frequency, length and situations under which solitiary confinement can and should be used.
4.  The availibility of mental health treatment within correctional facilities.
5.  Staff training.  Are there techniques and skills staff need to be systematically trained in??
6.  Community transition.  What is being done to make sure that mentally ill inmates are being tied to the community resources they need to be successful in their communities?

I am sure there are additional areas of concern.  These are just some that come to mind.

There is every opportunity to deal with this horrible issue in a proactive manner.  I hope you will respond positively to my suggestion.  It would be a big step forward for all Tennesseans.

Yours truly,

Larry Drain.


April 16, 2014 by

This is the 3301 post on this blog.  It has went far longer than I ever planned it to go or ever thought possible.  It is impossible to thank all the people who have played a part without missing someone.  So thanks to everyone.

Bless each of you.

Life is not a symptom

April 16, 2014 by

If you think your mistakes and problems are a symptom of the kind of person you are, a measure of “what you got” then a fear of mistakes will define your life.  Everything will be about lying and denial, defensiveness and vigilance, rationalization and blaming, irritation and apathy, resentment and depression.

If you think everyone makes mistakes and it is your effort, what you do with them that matters then everything is about being open and honest, seeing mistakes as an opportunity to learn, having confidence in your ability to learn, being unafraid to ask for help,  appreciating good effort, forgiving mistakes and having hope in how things are going to turn out.

If life is about what you got, that you are who you are then your choices are few:  concentrate on what you appear to be, when you cant control appearences lie, distort and make excuses.  When all else fails find someone to blame.

If life is about what you can become then life is about resilence, using everything as a learning opportunity, getting all the support you can, and knowing what you want to become.

Mental health issues can either be viewed as a challenge or as an indictment.  They are an opportunity to learn and grow or a life long sentence of deprivation that keeps you from ever trying.

What you make of things has everything to do with what they make of you.

Life is not a disease and the way you live is not a symptom.  Never let anyone tell you different.

The consumertrocracy

April 15, 2014 by

Before you ask me what that is or even if that is a real word I have to tell you I dont know.  DJ Jaffe used the term in a recent comment on this blog and if he says its a word I guess it is.

He wrote to tell me that my recent post about the logic of E Fuller Torrey was incorrect.  He says that Torrey does not believe that mental illness is a chronic disease from which nobody recovers.

Below is his comment:

“Not sure facts matter here, but #1 and #4 are the opposite of what Torrey says and has written. From page 102 of latest edition of Surviving Schizophrenia: “…a third recover, a third are improved, a third unimproved…” My own guess is that the consumertrocracy is drawn from the first third, and attribute their recover to a whole host of the things, while faililng to admit they would have recovered anyway or acknowledging the other 2/3s.”

Several things stood out about this comment to me.  The first was the use of the term “consumertrocracy” which I assume he means, in effect, some type of elitist group that exercises undue influence over the mental health system to the detriment of the people who seek help there (some people might describe that as The Treatment Advocacy Center).  But let me come back to that.

What really caught my attention more than anything else was one phrase, “…while failing to admit they would have recovered anyway….”  That is a truly remarkable comment if you think about it.

In one phrase Jaffe invalidates the lives, the struggles, the problems, the pain and hurt of thousands and thousands of people: “they would have recovered anyway.” He expouses a kind of weird psychological form of predestination. It doesnt matter what you do, how you live… nothing matters. It matters “what you got.”

The people who struggle and struggle with very real issues shouldnt pat themselves on the back too much because “they were probably going to get better anyway.” Does anybody else see where this nonsense leads to?? People with lived experience have nothing to offer, nothing to say because what they believe is superstitious nonsense. “They were going to get better anyway.”

He simply defines away anyone who disagrees with him.

The consumertrocracy is I guess the deluded efforts of those “who were going to get better anyway” to control mental health policy. Again what a bunch of nonsense. It almost sounds like something someone trained as an advertising executive would cook up as part of a pr campaign.

There is no consumertrocracy. In Tennessee, where I live, it is simply laughable to believe that their is a consumertrocracy that dictates or controls anything. It is a stupid notion not attached to any reality I am aware of. Mental health policy is set by mental health professionals. The whole mental health consumers are taking over the mental health system conspiracy idea is just astounding to me. It shows the level of skill and what great salesman that Jaffe and Torrey are that so many people swallow this line.

By and large the people that Jaffe would place in the “consumer movement” dont agree with each other well enough or often enough to have any kind of “…trocracy…”

Read Jaffe’s comment again. There are a lot of unanswered questions there and much to ask about. Some of it I may revisit later. It does appear that my perception of Dr. Torreys position is wrong. He only believes that one third of the mentally ill will never get better. He does believe, if Jaffe’s comment is correct and I understand it correctly, that we spend far too much time and money on those who are going to get better anyway– “the worried well.” It sounds like the bottom line for the mentally ill is “cheer up if you are supposed to get better you will and if you are not you wont….but dont worry we are trying to find a nice place to put you.”

Through the looking glass: the weird logic of E Fuller Torrey and the rise of the “worried well”

April 14, 2014 by
  1. Mental illness is a chronic illness that never really gets better.
  2. The fact that so many people have found some sort of recovery, some sort of better life proves they were never that really bad off to begin with.
  3. Because the mental health system serves so many people who were never that really bad off to begin with (“the worried well”) it neglects the needs of those who really need help because as you might know…
  4. Mental illness is a chronic illness that never really gets better.




Anyone feeling a little bit confused?????



The Many Problems with the Helping Families in Mental Health Crisis Act

April 14, 2014 by

The Many Problems with the Helping Families in Mental Health Crisis Act | World of Psychology
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“People with mental illness are 10 times more likely to be in a jail than in a psychiatric hospital”– What does that actually not mean??

April 14, 2014 by

Newspapers trumpet the news:

“People with mental illness 10 times more likely to be in a jail than a pschiatric hospital.”

Before we assume this is saying something it is not, what does this statement not mean?

1. It does not mean that criminal behavior is caused by a defiency in psychiatric hospitalization. It may or may not be correlated, but that is no proof of causation. I dont know, but would be willing to bet, that many of the “mentally ill” in jail have a previous history of psychiatric hospitalization.

2. It also ignores other correlations like poverty, ability to get and hold a job, family history, past history of abuse and other adverse events, race, age, history of substance abuse, and past criminal behavior among other things.

3. For example, the previous post talks about adverse childhood experiences and the research around that concept and how it affects everything in life. It isnt “what you got” but “what happened”.

4. The headline also omits a critical fact. Everyone with mental health issues is 10 times, 20 times, 30 times less likely to be in a psychiatric hospital. Psychiatric hospitalization is not as they like to say “an evidence based practice”. It doesnt even help people to stay out of psychiatric hospitals let alone jail. Just as a point of logic: if (A) psychiatric hospitalization is (B) not used by many people with “mental illness” who dont go to jail and (C) not used with people with “mental illness” who do go to jail then (D) it can not be used as an explanation in and of itself why some people with “mental illness” go to jail and some dont.

5. It doesnt mean that everyone with “mental illness” in jail belongs in a psychiatric hospital. It doesnt mean they are commitable or not commitable. It is not a diagnostic statement. If you look at what the insurance companies who pay the bills say less and less people “need” psychiatric hospitalization.

6. It does not say that everyone with “mental illness” in jail meet the criteria of “severe and persistent mental illness”. It is an assumption they do. Many of them in all likelihood fall into what Dr. Torrey likes to call the “worried well” who according to him steal money and services from the people who really need help anyway.

7. What it at least implies (and I think even the Torrey/Murphy people would agree with this) is the real problem is not “what they got” as much as “where they are at.” At least part of the solution to “mental illness” in the jails is to not send so many people with “mental illness” to jails. Diversion programs are essential. It is so utterly cruel, senseless, mean and (dare I say it) insane to send one of the most vulnerable and traumatized populations in our society into the cruelest and most traumatizing environments possible. And it is criminal negligence to expect it to be anything else other than a disaster.

8. The headline omits another crucial fact. In the last years state mental health budgets have been slashed to below the bone. Read the Nami report. It is horrifying. I really think this is as much an explanation as any single factor. It explains a lot more than any lack of psychiatric beds in my opinion.

9. The headline does not mean the only or even primary solution to the issue of “mental illness” in jails is more psychiatric beds. That is not an honest or realistic depiction of the facts. I am 100% sure in Tennessee there will be no more state psychiatric beds. That ship has sailed. If for no other reason the cost is prohibitive. It would involve totally disemboweling the community mental health system for funds which would only create more customers for both jails and psychiatric hospitals. Try as they might, and they are trying, Dr Torrey is not going to be able to put that genie back in the bottle.

Let me be clear. The placement and treatment of those with “mental illness” in jails is a crime itself and a total abomination. We can argue forever rather or not the statistics themselves are correct or not. The fact remains it is a killing reality for many people. The testimonies of untold families deserve to be heard. It is, I believe, the single greatest civil and human rights issue in our society. It is the source of much of the passion supporting the Murphy bill. It is the single greatest failure of the “recovery movement.” They have let Dr. Torrey define it as his issue and the vision they believe in be defined as irrelevant to the lives, the pain, and the hopes of hundreds of thousands of people.

But it is an issue that will never be solved by fancy or distorted headlines or political manipulations. For many it is about living and dying. Lord…help us to pick life.

The secret to better care: It really is all in your head

April 14, 2014 by

The fundamental failure of the mental health system

April 13, 2014 by

From the archives.

In a fundamental way the mental health system fails to serve those in need.   This failure has in some sense been responsible for the deaths of many people, the ruined health of many more, and the ruined lives of countless others.  It has not been because of a lack of skill, commitment or effort of  those who provide mental health services.  It has not been because of some lack of motivation, insight or unwillingness to change on the part of those receiving services.  It is not the result of financial challenges or lack of availible services although both of these have drastic effects.  It is, instead, the result of the ordinary way the mental health system does everyday business.


The effects of untreated mental health issues are common knowledge.  30,000 people a year commit suicide.  Probably 10 times that amount make an attempt.  Unaddressed mental health issues have a role in virtually every form of human misery from drug addiction, lost jobs, family struggles, lost relationships, homelessness, and virtually every other problem you can think of.  It destroys not only those with problems, but countless others they know, that they love, and who love them.  It is an equal opportunity destroyer.  It does not respect status, power, age, or any other variable.


Yet with all this being commonly known a curious fact remains.  Depending on what study you read somewhere between 40-70% of the people who could possibly profit from some type of help from mental health services do not seek them.  Many more enter the mental health system but leave without following through or buying into the explanations or services they recieve there.  Why?


One obvious issue is that of accessibility of services.  For some they neither have the financial resources they need to access services or else the services they need no longer exist.  Ample evidence exists that this is a major issue.


Some lay the problem at the feet of those seeking help.  They are “unmotivated.”  “They dont really want to change….”  Or in its most radical version-  “They have brain damage and dont even realize they have a problem.”  Some people are not motivated.  Some people dont want to change.  And some people show little insight.  But none of that has anything to do with mental health issues.  It has to do with being people.  In virtually every area of human conduct the same criticisms can be made.  In fact, many people believe the greatest problem in all medicine (not just mental health) is lack of patient compliance.  In her book, “Join the Club”, Tina Rosenberg makes the following observations, ” Poor patient adherence is a serious problem; dozens of studies have shown this.  Only a fourth of  people on blood pressure drugs in one study took their medication properly.  Only 13 percent of  diabetes patients taking certain drugs complied with their regimens for a year….50% of patients with chronic illnesses dropped out of treatment within  year….poor adherence is responsible for an increase in bacteria resistant to antibiotics, millions of hospitalizations, hundreds of billions of dollars in wasted health care and immeasurable patient suffering.”    NO- blaming the victim- assuming that because people have mental health issues that they are incapable of seeing their need for help or that they have some strange need to hang on to the misery in their lives because of their issues is simply wrong.  They are simply human and have the same difficulties as anybody else.  They may be no better, but they are no worse.


In the last few years I have gotten to know hundreds, maybe thousands of people who have been identified either by themselves or professionals as having serious emotional health issues.  They apply or have had a wide variety of  labels attached to them: mentally ill, having a mental illness, consumer, patient, client, person receiving services, survivor and many others.  Many have told me that the services they have received in the mental health system have been of immeasurable help.  Others have told me he services they received were of little help or even made things worse.


After talking and listening to many people, looking at my own experience and the experience of many I care about I have come to what I believe is an accurate conclusion.Many people find the mental health system intolerable or even useless because of what  they believe it says about the kind of people they are.  The mental health system makes sense of mental health issues in such a way that it speaks predominantly about the “judgement of mental illness.”  It tells them the most they can expect is a diminished life dealing with a life long affliction that will probably only get worse.  It tells them they will be forever dependent on professional treatment and often that they will have to take medication for the rest of their life.  The medication helps many, but for many others doesnt work nearly as well as advertised and in fact has side effects that are dangerous and drastically affect the quality of daily life.  The disease concept is justified as a way to tell people it isnt their fault, but fault or not, leaves  many feeling that their lot in life is to be forever left out of good things and marked as somehow deficient and not as really human as other people.  If they accept this “judgement” for many it also means they are in danger of being treated with prejudice by those around them and perhaps excluded from relationships and groups they formerly were part of.  They also find that many of the people who try to help them are suspicious of their commitment to making a better life.  They tend to believe that “mental patients” cant be trusted and really dont want to change.  They talk about some people as “frequent flyers” and often dont believe the people they are trying to tell to change are likely in the end to do the things necessary to change.


Many of the people I know  tell me that the mental health system uses a cookie cutter “one size fits all approach.”  They object to being told the most fundamental thing about them is their diagnosis and that because of that diagnosis the things they value and care about are not quite as real or relevant as they are to people without a mental health diagnosis.  They are astounded that their diagnosis is often more an artifact of the particular doctor they see than anything else.  They see doctors who assure them that medications are necessary and safe, but yet read the constant reports of pharmaceutical companies who lie, cheat and manipulate to sell these “necessary and safe” medications.  And they wonder who and what they can believe.Many people decide they are not the kind of people the mental health system tells them they are and that their life need not be limited to the experience the mental health system provides.  They opt out of the system or never enter.  And when mental health issues are real, when they are life destroying or life altering that decision to opt out can be and is often catastrophic.  Treatment can and does help, but when receiving it means accepting an identity and prospectus for life that is untenable and horrible many people choose not to accept the treatment.  In the book by Tina Rosenberg quoted earlier she spends a lot of time talking about patients with diseases like AIDS who refuse to take the medicines that might keep them alive.  She makes the same point.  When getting treatment means accepting a “reality” you cant accept you often refuse treatment.


When I talk to the people who have been helped by the mental health system they tell me about another identity they have found.  For them what is important is not the judgement or sentence of mental illness, but the promise of recovery.  They have bought in, not to the terminal sentence of less life, but to the promise of more and better life.  They identify less with professionals and more with others who have walked in the same shoes as them.  The idea that those with lived experience can be of a help that professionals perhaps cant be is an idea that is growing in importance and acceptance.  In many areas though it has yet to be integrated into a prime part of the experience of someone who seeks help in the mental health system.  Rather it is because professionals are threatened by it, dont understand it, or because no one has really figured out how to make a service based on what is right with people rather than what is wrong something that financially pays I dont know.  I suspect there is some truth in all of it.


The sentence of mental illness is too often a sentence to despair and diminished life.  The medical model has a prime liability.  Anything that tells people they are chronically ill and will probably be so for most of their life is not likely to find many people easily accepting its findings.  For most people their problems with mental health issues are a matter of degree and frequently episodic.  To be told life as you know may well be gone is not likely to find many takers.  It just doesnt seem true.The recovery model, the use of peer support, does talk about the possibility of hope.  It give you a peer group to identify with that says that you can share the experiences and successes of others and they can share yours.  It says you matter and can make a difference.  It tells you life matters and is much more than anything that bothers you or troubles you.


The mental health system all too often tells those it serves that deprivation is all that awaits.  It is not necessarily a message it intends to give.  Many very dedicated and skilled people  try very hard to say anything but that.  But perhaps if the message of recovery and more life were to  take center stage more people would believe them and avail themselves of the help they offer.It seems so wrong that people should die of thirst in the presence of what may be the water they need.

On swimming in peanut butter: more on depression

April 12, 2014 by

Somedays I swim in peanut butter.  In the worst of days I fear I live there.

Sometimes things are sticky and heavy.  The more I move the stickier things seem sometimes.  You try to keep your head up.  Submerged all is dark.  No hint of light or surface.  Motion is exhausting.  Each stroke harder than the one before.  You try to move but the place you are at looks and feels like the one you left.  There is no end to obstacle. You feel like the more you move the more you are stuck.  And you want to quit.

You want someone to know but how do you explain to people?  Words seem like drama and posture and you wish there was a map or something you could give them.  You dont understand how people can look and not see, hear and not listen. 

Initially the terror suprises you and you dont know what happened and you let people tell you it can be wished away.  Then you figure out who to blame but pointing fingers bring no relief and change nothing.  Finally you figure maybe it is you and vow to try harder.  You discover trying harder doesnt work like you hope and pray nobody else knows it is you.  And then you dont care anymore.  It is no longer where you are passing through but where you live.

A friend was joking around but maybe told me at least part of the answer:  Why dont you just get out and walk around.  Maybe its not the sea, but just a puddle.

I am trying more to walk around. I think my friend is right.  Life has more than enough mud and more than enough puddles.  Some take more time to leave than others but it doesnt mean they are more than a puddle. 

I am learning more what it means to walk as if there is dry ground.  Sometimes it seems little more than an act of faith, but it is the most important faith.  I am learning falling does not mean I will drown.  Nor does it mean I cant walk.

A friend once told me life was nothing but “beans and hard times.”  There are “beans and hard times” but the important thing to remember is that they need not always be the main course.  And life can still taste good.

Depression is….

April 12, 2014 by

Depression is a peculiar form of blindness.  Its cruelty is in convincing you that finally you have sight.

It leaves you afraid to get up in the morning for fear of a day you can neither stop or survive..

It tells you the only important thing is how you feel.  Finally you hope you dont feel.

It leaves you alone in a crowd.  You know that no one knows.  Theirs is a language of a different world.   It is a room in which you live but never enter.

It is a lie… the ultimate seduction.  It would have you forget what can be and forget what has been.  It would keep you in the hole until you become convinced you are the hole.

You can leave.  It doesnt want you to know.  Perhaps in slow steps but in steps.  Journey is an option.  You have to decide to go even when decisions seem hard and without power.  Things change.  Even bad days can plant seeds of better times.

Life is a journey best not taken alone.  Bad times can be so real and so everything.  But they are not the end of travel, just a place on the road.

Never stop going.  The solution to this place is in the next one you find.

Depression tells you life is what you used to do.

Its not. 

Have a great day.  Have a better day.  Have another day.  Have life..

Betty’s daughter

April 11, 2014 by

My sister in law Betty died over 15 years ago.

She was sitting around with her family watching a movie one night.  She excused herself to the bathroom and took enough pills to kill 3 or 4 people and then went back to watch the movie.  After a few minutes she told them what she had done.  There was nothing the hospital could do.  It wasnt her first attempt and she had gotten better with practice.  Over 3 or 4 days her organ systems shut down one after another.  They finally pulled the plug and let her go.

I dont know if anyone really ever knew why.  She had been and out of the hospital more times than you could count.  She had medication, lots of medication and and she had medication for her medication.  Somehow in “getting well” she got lost. Finally I think she gave up hope there was anything left to look for.  She was gone long before she died and none of us even realized it.

She lived in a terrifying space and finally she moved to a space that even terror could no longer move her.  She was a quiet person, and very shy.  She was one of the kindest people I knew.  Her death was one of the sorrows of my life.

I spent yesterday with her daughter.  She is 30 now with a daughter of her own.  She lacks her mother’s torment although the growing up has not left her unscarred or unhurt.  When she sits quietly you can kind of sense the deep hurt she still carries with her.  But she is in many ways her mom.  Kind and loving. So alive.  Devoted to a daughter who she is determined will know a different growing up than what she knew.

She was an intense kindness to me in what has been a very bad few days. And I am so grateful. Her mom would have been very proud of her.

The last days have been swimming in peanut butter. One close friend nears death in an induced coma in one hospital. Another, near 80 years old, is losing himself to age he has always seemed to forever defeat. Linda remains without answer and everything seems so hard.

So Jenny thank you for your kindness, your care and just for you. It was a good, very good day. Love really matters. Sometimes I just need to hear it again.

Evidence based practices

April 11, 2014 by

In the course of writing this blog I have made contacts with many people who disagree with basically everything I write.  Many of them are supporters of the Murphy Bill.  This post is directed most directly to them.

One of the pet phrases that I hear Murphy folks use is that they rely on evidence based practices.  That is part of their special claim to validity in their eyes.

My question is simple.  Specifically what evidence practices are you talking about??  I went looking on some of the lists of evidence based practices that I could find and came up empty for you guys.  SAMSHA lists over 400 and I didnt see anything Murphy like on it.  I did see WRAP, the Clubhouse model, a Nami program, many programs related to trauma informed care and just a wide variety of other things. SAMSHA is not the only list and I may have used inadequate search terms so please help me out. What specifically are you talking about when you use the term evidence based???

If you do look at the lists though you will find out that your claims to be evidence based (assuming they are true) dont really give you any exclusive status (you have a lot of company) and many of the types of programs you deride as “hocus pocus” are evidenced based.

So before you throw your chest out too far check the whole list and….. what evidenced based practices did you say you supported again??

Violence is about anger… not mental illness

April 10, 2014 by

What Everyone Gets Wrong About Mental Illness –

Recidivism: Reducing Non-Compliance or Victim Blaming?

April 10, 2014 by

Recidivism: Reducing Non-Compliance or Victim Blaming? | Social Work Helper
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