“Dying with their rights on”

October 7, 2014 by

A reader used that phrase with me.  She felt like that was the primary attack Murphy made on his critics.  “They don’t really care about people who need help.  They want them to die with their rights on….”  I think the fear of being labeled that way is also a tool they use to pressure legislators.

It reinforces the need for positive options.  We need to be able to explain how Murphy is not really effective care and to be able to say there are better options.  We can’t let Murphy “own” care.  If we do everything we do or say sounds like people making excuses and makes Murphy look right.

We need to help people see if they buy the idea that the government can refuse to respect people’s rights “for their own good” we are opening the door to very dangerous places and that treating someone like they are less than a person helps no one. 

We need to let our legislators know we expect a system of care that really helps those that need help and it is not necessary to violate the fundamental values of this country to do so.

We don’t want people “to die with their rights on.”

We don’t want them to die.

Talking points

October 5, 2014 by

Like the last post this one is also in part an answer to some of the feedback and questions that readers have asked me.

Many of the last posts have been about the need to be for something and many people have asked very simply:  What are you for?  What would be your talking points?  This is my attempt to answer that question. 

One belief, one assumption guides everything.  People in need, people in distress should have access to services that help them to deal with that distress and need and gives them the best chance to live lives of purpose, success and connection.  Everything I believe comes from unpacking that one statement.

People in distress-  Distress is a human phenomenon.  It is part of living for everyone.  People in distress are no less people, no less deserving of being treated with dignity or respect.  They are not broken or deficient and no diagnosis, label or name they are given makes them so.  Our distress may make us more or less capable to adequately meet the demands of our life but it does not make us less deserving of being treated like a human being.

The term distress is used to convey the idea that misery or unhappiness is a human issue.  It may have physiological aspects.  It may have interpersonal aspects.  It may have emotional or cognitive aspects.  It may have spiritual aspects.  But the important thing about any of these aspects is how they effect us as human beings.  This is a distinction largely lost by those who have a vested interest in believing that the aspects of human life that concern them are more important than anything else and the determinant of other aspects of life.  It is much more convenient and much easier to cut people up into pieces and somehow believe those pieces are the real reality of those people.  People are much more than the description people give of them.

Should have access-  To have access means you have a choice.  You can either say yes or no, but you can say.  What you choose matters. 

Part of access means having the ability to say yes.  One of the major things that means is having the resources, the insurance or whatever you need to use the services you need. I live in a state that has not expanded Medicaid and statistics say over 80,000 people with mental health issues, needs or whatever term you prefer to use have no access to the services they need for help.  They cant say yes even if they want to.  In terms of impact I believe health care reform, meaning access to services, is the most fundamental mental health care reform there is.  It literally astounds me the Rep.  Murphy preaches about the need for more services in one and then in the next breath is against medicaid expansion.  It is hypocrisy of the worst sort.  Anyone who blames someone for not making use of some service and who would deny that person the ability to access that service is simply wrong. 

Another part of access is the things you want to say yes to must exist.  Another great hypocrisy of Murphy is that he makes no mention of the fact that over the last years in this country that state after state has drastically cut their spending on mental health services.  Available services for many are skeletal at best and in some cases less than that.  To try to explain  the current problems in the mental health system without any reference to that is simply stupid and unrealistic.  Murphy’s idea that somehow the “worried well” use too many resources that people with “real problems” need is a cheap effort to blame the people who seek help for the unwillingness of state and federal governments to provide the adequate help they need.  It is like telling starving people that their greatest problem is that the person sitting next to them is eating too much. 

People should have the ability to say yes, something to say yes to and finally they should be encouraged and empowered to make those choices.  A well functioning system would encourage people to move towards as much independence as possible.  At some points that might not be very much.  People’s needs vary at different points in their lives.  But still it is theirs to chose.

To services that help-  The quality of services is just as important as the quantity of them.  We do too many things because we are used to doing them or because people who do them have a vested interest in continuing to have them done.  The mental health system should be honest.  It should not be about territory or status.  If it works it should be done regardless of whose sensibility or philosophy it offends.  If it doesnt work it should not be done regardless of whose territory or status is threatened by the prospect of change.

Every person should be informed by that honesty.  They should know a realistic appraisal of the risks and the benefits of anything that is recommended to them.  Again choice means little if it is not informed.

Them to deal with that distress and move towards living a life of purpose, success and connection. It is about life getting better. All of us live with a reality we will not surpass but it doesnt mean life cant get better. Part of being human means having a sense of purpose. It means feeling like who we are and what we do matter. Part of being human means enjoying some sense of success or effectiveness in living. It means developing the skills that enable us to make life a better thing. And finally part of life means connecting to others. Caring and being cared for, knowing that we matter to others and that others matter to you and no difficulty or problem we have need of necessity make that impossible. Life is not just a matter of survival but of the opportunity to thrive. My thriving and your thriving may not be the same. But that is okay. The testimony of the lived experience of thousands and thousands of people living with the most severe distress and hard circumstances is that life can and does get better.

The Murphy Bill violates all of that. It reduces people to diagnostic labels and removes long standing protection of their rights and welfare. It doesn’t take the issue of access seriously. Instead it substitutes coercion and blames the victim. And finally it doesnt take the issue of independence and transformation seriously instead believing that for people in distress realism means accepting they will never move past that distress, It replaces the notion of recovery and transformation with one of management and dependence. It would deny people choice and try to make that denial a foundation of what the mental health system should be based on.

It bills itself as a fundamental reform and reforms nothing. It preaches about evidence based practice and then offers us psychiatric hospitalization. It criticises the mental health system and says it is based on unsound principles and then in one of its major provisions says that forcing people to be part of the very system it tears down can help them to solve their problems. It preaches about removing federal authority and then seeks to provide more of it. It talks about hundreds of thousands of mentally ill in the jails and then proposes solutions that cant even begin to address the needs of the amount of people left in the cracks. It is dishonest and fraudulent and in the end betrays the people it says it is trying to help.

It is a collection of bad ideas supported by other bad ideas. It is time for our voice to be heard. You have heard what I would like to say. What would you add?

On figuring what we are for: defeating Murphy

October 5, 2014 by

I have gotten a lot of comments on the last two posts I have made.  My point was basically that the Murphy Bill could best be defeated by our articulation of better options.  It was fine to say he was wrong but it was better to say he was wrong because something else was better.

Virtually everyone who responded agreed.  They all felt like saying no was not enough and wouldn’t be effective in the long term.  The best way to say no was to say yes to a better option.

Past that though feedback varied.  Many people thought it unlikely that any agreement would ever be found that most people could support.  They felt like many people would simply not compromise on what they thought and anything approaching unity was impossible.  Because of that they were doubtful of what we might accomplish.

Others were encouraging.  They were hopeful of finding common ground especially if people realized that lack of a common ground might result in a Murphy Bill becoming a Murphy Law. 

Another 10-15 people saw things a little differently.  What follows is my understanding of their position.  There were differences among them so this is not exactly what anyone said.

“It is important to advocate for a better option and it is important to have talking points that clearly explain that option.  But some people simply will not agree and that is okay.  There are different ways to get to the same place.  What is important is that a lot of people share their opinion on the Murphy Bill.  Legislators will in the end make their own judgements about the options presented to them.  Some people’s opinions may be dismissed as irrelevant or unrealistic.  Others may touch a cord and move someone to action.  Don’t worry about trying to control what you can’t control.  Build the common alliances and positions you can.  There is strength and impact in unity but in the end everyone has a right to their own opinions.  Wish everyone well that opposes this Bill rather they see things as you do or not.  You don’t need everyone to agree with you and because of that those who disagree with you can never hold veto power over your position or actions.  Invite others to act with you but respect those who choose to go their own way.  As many voices as possible need to be heard.”

Like I said the last option is my summary of what many people said, but I have to admit I see a lot of things in that option I like.  Common agreement with some folks is not likely.  We have handcuffed ourselves feeling like we have to have that agreement to move forward.  Perhaps we can not act as one because we are not one.  I like the idea of seeking the widest consensus possible but accepting the idea that behind our common opposition to Murphy there are wide differences on how to move forward and leaving it to each individual what they are willing to buy into.  We can share talking points but each person in the end must make their own choices.  What is important is that as many people as possible act.

On the danger of no voice: losing to Murphy

October 3, 2014 by

My last post talked about the need to be for something that can be presented as a better alternative to the Murphy Bill.   It argued strongly that simply saying no was in the long run not going to be enough and actually played into the hands of those supporting Murphy.  You can argue against Murphy’s solutions but in the end you lose if you ignore the issues and problems he identifies.  You don’t sound like you are shedding light on the problem.  You sound like you are advocating blindness.

Since the post I have received a lot of feedback agreeing with me.  Everyone seems to realize that you really want to make a difference you must be for something better than what you argue against and be literate and compelling in your presentation of that.  Murphy is really good at caricaturizing people who can’t or don’t as obstructionists against real changes.

But the question that almost everybody asks is the same.  What if we can’t agree?  What happens if we can’t agree on our voice?  Do we not have enough differences amongst ourselves to make it unlikely if not impossible we will agree to anything.  I share the concern.  I don’t know the answer.  I would like to think that Murphy would be enough of a unifying threat as to move people past differences, but I am honestly not sure.  And I wonder what will happen.

I can think of several possible outcomes.

1.  The coalition against Murphy falls apart due to internal squabbling and ends with people reduced to pointing fingers at each other.
2.  Efforts to come up with an option to Murphy fall apart and we rely simply on being against Murphy and hope that is good enough.
3.  Murphy unifies and a common alternative is developed.  People who may have a lot of differences find enough common ground to make a unified stand.
4.  Efforts to reach common ground fall apart and several groups start their own campaigns.  The consensus is that it is okay to be against the same thing for different reasons and the hope is that the cumulative impact of different voices will make a difference.

The scary thought is not just that Murphy wins but that we help him to win.  There are many questions to be asked.  Murphy is a bad Bill and the chances to beat it are real.  But it sure seems easier to beat something when you have something you would like to win.

Being for a better mental health system: On the new Murphy Bill

October 2, 2014 by

The new Murphy Bill will soon be amongst us.  And the battle to define who is really in favor of a better mental health system will soon enter a new chapter.

The message of the supporters of the Murphy Bill is really pretty simple.   We have a terrible mental health system, many people receive inadequate services.  Many receive none at all.  We are for a better mental health system.  If you are not for us you are not for a better mental health system.  Much of their message has been to share stories of those they say are hurt by the system and to claim their proposals would help those being hurt.  They rely heavily on statistics about people with mental illness in jail.  They say those that oppose them don’t really care about the people being hurt and oppose them generally for selfish reasons and because they have a monetary reason to oppose change.  They tend to try to frame those who disagree with them as lacking integrity and honesty.  They don’t worry about opposing messages so much.  Instead  they try to destroy opposing messengers.  They portray themselves as lonely warriors fighting against a dark conspiracy.  And they are wonderful salesmen.

Their genius is in their effort to capture an issue that has relevance and emotional impact to the legislators they talk to in such a way as to identify themselves as spokesmen for those people who have watched their relatives or loved ones  fall between the cracks of a system that too often seems to have a lot of cracks.

When people criticize their proposals as being coercive and not respecting the legitimate rights of people receiving services they caricaturize those criticisms as being given by people wanting to weaken the power of professionals and being totally out of touch with the reality and enormity of the problems thousands and thousands of people face.  And to the degree the caricatures hold the people who support the Murphy Bill are able to use the complaints about coercion as evidence they are being opposed by dangerous people who don’t really want to change a flawed system.  And, as I said before, they are positively gifted salesman.  The real question is to what degree enough legislators will buy their argument.

The weakness of those who oppose the Murphy Bill is that they are not nearly as clear about what they support as they are about what they oppose.  I have written about this before but it is so crucial.  The Murphy folks would use that as evidence that critics are not for real change and would leave crucial changes ignored.  And they try to use that as further proof they own the issue.  They are for real change.

The solution is simple.  Those against the Murphy Bill must present themselves, not as being against change, but for better change.  They can not let the Murphy people own the issue.  They must have a better option and that option must be presented in such a way that it is credible and compelling to legislators who in the end will make the decision.  I think you could make a strong argument that in the end Murphy will be defeated by an alternative Bill or he will not be defeated at all.

The same old Murphy Bill may or may not be the new Murphy Bill.  And it may pass.  I may be very wrong and hope I am but I really question rather or not the same old opposition will be enough.  Historically opponents of the bill have had a hard time agreeing on anything but their opposition to the bill. It will be hard to find legislators to agree with them if they don’t find a way to agree with each other.

Tennessee ahead: The coming of mental health season

October 2, 2014 by

The early projections are not good.  Tennessee governor Bill Haslam is, asking for budgets to be prepared with a 7% cut from last year.  We should know in the next couple of weeks what is likely to happen.  Peer support centers are near the top of the cut list I would imagine from the little bit I have been told.  Whatever is ahead is not good news.

There is a major battle to expand Medicaid in Tennessee.  A peculiar form of chaos would be to substantially increase the amount of people people eligible for services at the same time you sure substantially cut services.

Mental health season in Tennessee approaches.

What makes life better

September 30, 2014 by

If life is about momentum then two sets of factors are important.

What are the risk factors (behaviors, situations, relationships, emotions, attitudes, and ideas) that tend to be precursors to things going worse? What predicts bad times coming? What makes bad times and problems more likely?

What are the protective factors? What (behaviors, situations, relationships, emotions, attitudes, and ideas) build capability? What makes positive outcomes more likely? What builds resiliency in difficult times?

Do what you do when life is going better. Things that make you stronger increase your chances of living successfullly in life and more likely to coping when you are not.

Doing things that are good for you won’t prevent life from having problems. Nothing does that. Much is beyond control. But it may make it less like likely and more likely if there are problems you will deal well with them.

You may or may not be able to control whether or not you have problems in life. But everything is better if you do all you can to build solutions into the fabric of daily life.

Recovery vs. Disease Management: The Core of the Argument

September 29, 2014 by


rom the archives

Originally posted on Hopeworks Community:

  •  Recovery  believes that individuals matter.  No degree of impairment or difficulty makes them matter less.
  •   Disease management believes that the disease or diagnostic label is the most important thing about anybody.
  • Recovery believes that if an individual is important then what is important to him is important: his thoughts, feelings, goals, aspirations, interests, hopes and dreams.  No amount of impairment or difficulty makes this less true.
  •  Disease management believes that many things that an individual values are a creation or result of his disease.  It believes that these things do not have as much validity as they do for people without a diagnosis.  It believes the most important thing is symptom management.  What is most important is not that people are people, but that they are “diseased.”
  •  Recovery believes that if an individual is important then what is most important is what he chooses for himself and not what…

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What I believe

September 29, 2014 by

These are some of the fundamental ideas and values that have guided Hopeworks Community over the last years.  Most of them have been the subject of multiple posts.

People should be able to make their own choices about their own life.

They should have choices that matter.

They should have access to the knowledge, skills, and support that enable them to make the best choices they can for their own life.

They should have the ability to change those choices as life dictates or circumstances change.

Nothing that anyone is called or limits makes them less of a human being, broken or deficient in some fundamental way.

All of us have limits.  There are some things that will not change and some things we will not be, but the capacity for change, for life getting better…..for hope is real and not based on groundless wishing or pollyannish thinking.

People can and do thrive under the  most challenging of circumstances.  Dont give up on anyone.

People who live difficult lives can be successful in their endeavors…..connected in their relationships…..and live a life of purpose and meaning.

Man is a biological, social, emotional, historical, cognitive, spiritual and relational being.  Any system of  thought that reduces man to one of this dimensions or that tries to say that one of these dimensions is more fundamental or the cause of others distorts what people are.

A biological, social, emotional, historical, cognitive, spiritual, or relational fact is most important in the way it manifests itself as a human issue and the misunderstanding of this causes great harm.

Life is largely a matter of momentum.  Things that are more likely to happen, all other things being equal, tend to happen more often.  A major secret to being in control of your life is understanding how to control the momentum of it.  Bad things can and will always happen.  That is what it means to be alive.  But we can affect the difficulty with which they occur.

People learn.  Experiences have the opportunity to teach us important things that make the experiences after them better.

Meaning matters.  In choosing what we make of things we make likely what they make of us.

Many people are ordinary people dealing with extraordinary circumstances and we so often do not acknowledge their courage or give them the credit due.

In any circumstance some people are doing better and some people are doing worse.  The people doing worse can learn from the people doing better.  Lived experience matters.

Every person has times where they are doing better and times when they are doing worse.  As much as you can do better things on purpose.

Support is essential.  People who dont support others normally find it hard to find people who support them.

Taking care of yourself does not mean living like you are the only important thing in the world.

Accepting what you cant control gives you the capacity to control the things you can.

“What happened” is the most important question you can ask anyone.  Helping people to cope with injury is more often than not the key to really caring.

Feelings lie.  It is often not as bad as it feels.  It is often not as good as it feels.

There is no real explanation for tragedy.  It just is.

What do you advocate for?

September 24, 2014 by

In a preceding post I talked about an essential, suprisingly often forgotten, step in advocacy. Before anyone can respond to what you ask you must be clear about what you are asking.  If people are not sure what you are selling they probably arent buying.

I also talked about the importance of being for something.  It is a lot easier to convince someone not to buy something if you give them a better alternative.

I have listened to a lot of ideas about change.  Some seem very important and very doable. Some dont seem relevant to current reality.  They just arent going to happen.  No one other than a small group is for them and it is unclear if hopes for legislative support are even realistic.  Some dont seem like they are very true. They are not what they are advertised to be. Some seem important. Some seem not so important.

The questions below are adapted from a previous post. They are one way, certainly not the only and probably not the best way to look at proposed mental health reform. How much would a proposal actually change things? Does it address important problems? Does it address what you want addressed? Does it leave important questions unaddressed?

What does the proposal have to do with:

The issue of access to services. There is no help if you cant get it. Lack of access is a major issue for many many people. Health care reform and adequate funding for mental health services are both essential.

The issue of effective services. Many things we do dont work very well. Some things may even do more harm than good. We do too much because that is what we are used to doing or because someone has a vested interest in continuing to see it done.

The issue of making sure those who seek help are treated with dignity and respect. For too many the most difficult thing is not the issues they deal with but the system they turn to for help. Those who help you should not be a source of trauma in your life.

The issue of making sure that people have access to correct information to enable them to make decisions about their own lives. The mental health system should be accurate and honest.

The issue of supporting people in making those decisions. Empowering people to be in charge of their lives.

The issue of enabling people to acquire the skills and tools that really make a difference in their lives. Learning makes a difference and the mental health system should make possible learning that makes a differerence.

Addressing issues of homelessness, joblessness, and poverty that are so often part of what it means to  be labeled with a mental illness in this country.

Addressing the dismal state of health care that so many people with mental health diagnosis receive. It is a crime and disgrace that people with psychiatric diagnosis die much earlier than those without. Everyone with a diagnosis knows what it is like to be treated like real medical issues are “in their head.”

Addressing the very real issues of discrimination and prejudice that is a core element in the life of everyone who has a mental health diagnosis.

Addressing the benefits, risks and side effects of medication. Making sure that choices about medication are informed choices.

Addressing the national disgrace of the treatment of those with mental health issues in the jails and prisons of this country.

Addressing the national calamity of suicide. 

Addressing the growing issue of trauma.  Moving mental health from a whats wrong system to a what happened system.

Addressing the issue of peer support. It is clear and overwhelming that the voice of lived experience matters. What role should it play in an optimal system?

There are many more issues to be considered, Some issues translate easily into proposed legislation. Some may not translate at all and other advocacy may be called for. The important thing is to know what you are asking, ask something worth asking and have a plan how to effectively get the answer you want.

If you dont know what you’re selling the odds are no one is buying: The need for consensus

September 22, 2014 by

If you dont know what you’re selling the  odds are pretty strong no one is buying.  If the people selling are always arguing about who is selling the right thing, are they selling to the right person, and are they selling in the right way the likelihood is even higher that no one is buying. When there is a competition amongst brands the quality of each brand is important, but often the most important thing is which brand is sold the most effectively. Advocacy is many things, but it is very importantly about selling and selling well.

The strength of the Murphy Bill is not the bill itself but the skill with which it is sold. There are a lot of serious problems with the bill. Many of the posts I have written talk about them. Others have also written exhaustively on the subject. Some have argued because of its faults it is unlikely to be passed. I hope that is true but am reminded this is the United States Congress and ask myself when was the last time anyone went broke betting against the ability of the Congress to make poor, narrowly based partisan decisions.

I have a friend who believes when all is said and done the Murphy Bill will pass. He thinks it is an awful bunch of ideas but his opinion is simple. “The mental health system is terrible. If the Murphy Bill is the only option on the table, if it is the only option for change and the choice is between changing the system or letting it be many people, even if they have misgivings, will vote for change simply because they think doing nothing is a worse option.”

I think the most important task between now and the next Murphy Bill is reach some sort of consensus about the options we are putting on the table. It is to recognize that unless we agree, to a meaningful degree, about what we are selling, we decrease our chances of success. It is to agree that we cant argue against change, but must argue for a better change in order to be successful in the long run. The wider the consensus, the larger the tent the more likely it is to be successful.

There is widespread disagreement about how to proceed among many. Trying to find what connects us seems much harder than to find what divides us. The Treatment Advocacy Center has shown in state after state the power of its ability to sell its vision. If they were baseball players they would be far above 300 hitters. If we cant find a way to stand together I am afraid we will find what we stand for not as impactful as we would like.

Murphy will work harder to broaden the coalition that supports his bill. He will try to increase the amount of people willing to sign on despite their misgivings. What will be our coalition? What ideas, what vision, what positions do we share well enough and strong enough to propel ourselves forward?

During things like the Alternatives Conference and in other meetings and interactions and forums over the next months we will answer that question. Some people may decide they cant be part of any coalition at all broadly defined. They may feel like it somehow violates fundamental values they have and that is okay. But unless we find enough people willing to get on the same boat together the odds for Murphy to be successful increase. I really think they count on us to self destruct and get stuck in endless squabbling amongst ourselves.

I dont know what the consensus should be. I dont know if anyone knows. Maybe the biggest change is in deciding we vitally and importantly need to build one.

The new Murphy Bill will soon be upon us.

A culture of recovery

September 22, 2014 by


From the archives

Originally posted on Hopeworks Community:

From the archives.

We seldom see more than we expect to see. More and more people talk about a recovery model. The consensus that the medical model is limited and so often part of the problem is growing stronger and stronger. Yet how does this impact what is real? We dont just need a recovery model. Those who become involved in the mental health system need to experience a culture of recovery. The need to experience a way of seeing things, a way of doing things that affirms their worth as people and treats the idea of flourishing in life as real and possible. The message sadly that many get from their exposure to the mental health is not this. They learn they are damaged, deficient and that being realistic means accepting that defiency. They learn that a lifetime of psychotropic medication is something to be expected and that the…

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Paimi rocks: bringing light to the dark side of the mental health system

September 22, 2014 by

In Tennessee the Disability Law and Advocacy Center is the home of the Paimi program.  I have been a member of the Paimi council for several years.  Below is a post a couple of years old that shows the importance of the paimi program Murphy is trying to destroy.

From the archives
There are many, many real and important criticisms of the mental health system.  One of the ones that affects many mental health consumers is rarely made.  When it is made it is seldom afforded the importance it merits.

That is on the subject of adult group homes  ( or whatever they are called in your state) for those with mental illness.  Recent reports on the system in Florida reveal a system ripe with abuse, neglect, and abuse.  Some programs described there are little more than criminal activities victimizing the mentally ill.  Other states report similiar problems.  It seems to be a widely known secret in virtually every state.  But it does not seem known enough or compelling enough to motivate much action for improvement.

The Disability Law and Advocacy Center recently  released its report on the group home system in Tennessee.  Quoting from the report:  “

The following report is presented to address unacceptable operating practices of licensed board and care homes (supportive living facilities) for persons with mental illness in Tennessee. Issues and recommended solutions found within are drawn from numerous monitoring visits, policy reviews, and dialogue with residents and owners/operators. The current lack of  compliance with licensure rules and oversight create a
risk of potentially dangerous consequences for some of Tennessee’s most vulnerable citizens – persons with mental illness residing in board and care homes. Occurrences of physical and emotional abuse, neglect, and financial exploitation may remain undetected due to inadequate supervision and monitoring and failure to take actionwhen compliance is lacking.
Residents may feel disempowered to change these situations or self advocate under such circumstances. Many lack the ability to protect themselves while others believe that they have no choices or options. All too often, residents’only alternatives to board and care homes include institutions, hospitals, shelters, jails, prisons, and even homelessness. Limited financial resources, lack of supportive family, few safe alternative living arrangements, and insufficient community resources frequently result in helplessness and passivity.”

Later on the paper adds, “Overall, the provision of services in board and care homes was found to be an illusion with many issues representing an alarming potential for harm, including abuse, neglect, and financial exploitation. During DLAC’s monitoring visits, investigators observed that persons with mental illness (residents) living in board and care homes
experience poor living conditions, lack of oversight, and greater opportunities for exploitation.”

One of the most alarming things to me is that many of these people are the same people being served in Tennessee’s peer support centers during the day.  Considerable work, planning, and effort has gone into trying to make sure that these centers met the needs of their clients.  The state puts a lot of effort into oversight and regulation to at least try to insure that programs work for the clients they serve.  If we are trying to serve the needs of people and insure their safety and chances for a better life how can we manage their days without giving the same kind of care to the places where they live?  As the report states many of these folks feel like they have no choice or options about where to live and are afraid to speak up or dont know who to speak up to.  How in the world can we let this happen?


When life is hard: recovery and tragedy

September 21, 2014 by


From the archives

Originally posted on Hopeworks Community:

I know people who hate talk of recovery.  Often they have a long history of mental health issues. Professionals have told them in many ways, not all spoken, that they lack the motivation and ability to make changes. Often for them treatment seems increasingly irrelevant to the conduct of their daily lives.

  Everything is hard for them.  It doesnt seem to matter how hard they try or what they try.  They hear recovery and wonder why it aint so for them.  They hear tales of how good it can be as an indictment of how bad it is for them.  The promise of joy seems hollow when your only constant companion is misery and distress.

They try to be what other people expect them to be, but are cautious about ever letting anyone else see them as they are.   One lady told me straight up.  “I dont need to…

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Getting ready for the new Murphy Bill

September 19, 2014 by

Congress has left for the election.  A lame duck session will occupy the remainder of the year.  The Murphy Bill didn’t make it over the hump.  With the new Congress will come the new Murphy Bill and with the next Congress an even newer Murphy Bill and so on. 

Several things seem obvious to me:

1.  Unless another Bill of some kind is passed there will be a Murphy Bill each year until he leaves Congress.  It will be a perpetual battle. 

2.  Perpetual battles wear people out and the odds favor him in the long run. Dr. Torrey, Mr. Jaffe and company will not wear out.  They live for stuff like this and anything that gives them a chance to get some press and some attention will find them endlessly motivated.

3.  It is essential to articulate the changes we are for, and not rely on opposing what we find objectionable.  We are much more effective if we have a viable, concrete option that we can point to as an alternative answer.  Give people something to vote for.  Give them a vision of what the mental health system can be.  Murphy portrays anyone who is against him as being against mental health reform.  We need to say we are for a better reform.

4.  This means people who are against Murphy must find some common ground from which to proceed from.  Murphy’s greatest strength is our lack of that common ground.  I think there are a lot of common agreements.  Part of the problem is that the people who seek common ground are not as verbal as those who think their way is the only real way.

5.  Murphy’s greatest strength is the stories he marshalls to prove his points.  We need to develop and share stories that show he misses the point.  In some ways it will be a competition of anecdotes.

6.  We need to ruthlessly fact check his claims.  As I have tried to show in several posts his claims just don’t pan out.  His Bill is not a fundamental reform of the system.  It is just a rewind of strategies already tried and largely discarded.

7.  Particular attention needs to be paid to the cost of his proposals.  AOT and psychiatric hospitalization in particular are big ticket items and must necessarily subtract from spending elsewhere.  The dollars matter and they will really matter in Congress.

8.  It will not be enough for us to say we want the mental health system to operate in a more ethical fashion.  We must say we want it to be more effective.  Murphy will try to dismiss the ethical argument as people who are against real change.  We have to be for “real change”.

9.  There is not nearly enough attention to the fact that state mental health budgets in last year’s have been cut past the bone.  Every state is struggling to hold its head above water.  Murphy never mentions that.  Instead he tries to blame the “worried well” and say we are trying to help people who don’t need help.  It is a classic attempt to blame the victim.  We could do a lot more to highlight the utter absurdity of his position and his immense distortion of reality.

10.  The issues he talks about like “mental illness and the jails” resonate with legislators because those issues resonate with their constituents.  To not address or to not treat them as real leaves the debate to Murphy and gives him leverage we don’t want to give him.

11.  We need to do a better and louder job articulating the vital role of Paimi.  In Tennessee it plays a vital role in the system.  Again confront the distortions of reality that Murphy makes time after time.

12.  Murphy is a political opportunist.  Confront him every time he shamelessly uses a tragedy to glorify himself or his Bill. He seems to be chronically first in line to proclaim how his Bill would have saved the lives of people tragically lost.

13.  Dr. Torrey is a ventriloquist.  Every time Murphy opens his mouth Dr. Torrey talks.  More attention needs to be given to how little professional backing Dr. Torrey has.  He is not exactly in the forefront of psychiatric thought.  And the Treatment Advocacy Center has certainly shown no reluctance to impose its vision in state after state.

14.  Murphy continually talks about AOT as if every state is New York.  It is basically dead or irrelevant in most states. It is time he be asked to explain that irrelevancy.  It is time more legislators are aware of it.

15.  Seek allies.  There are many people who agree with you about Murphy that may disagree on many other things.  Murphy is trying to seek allies.  In the end bigger tents normally beat smaller tents.

Just some thoughts.


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