On AOT and human rights

Assisted outpatient treatment (AOT) is the psychiatric version of ocean front property in Arizona.  Even more than the assault on the PAIMI program written about in the previous post it is one of the crown jewels of the Murphy Bill,  a bill Rep Murphy tells us will rescue us from an unhealthy obsession with mental health and create a system based on mental illness,  which, he says,  is the only kind of system that will truly meet the needs of those with “severe mental illness.”

There are AOT laws in virtually every state now and I am honestly not sure why Rep Murphy thought there needed to be a national law but he did.   Initially the drive to national AOT looked irresistible but it looks now to face a very difficult path to becoming reality.   The original idea was to financially punish states that did not have AOT and force them to adopt a state statute.   The involuntary commitment of states to AOT did not exactly go over real well.  Rep Murphy did not help things by claiming that anyone who was against his proposals was so because of a personal stake or possibility of personal gain in defending a corrupt system that really didn’t care about the people it claimed to serve.   He burned every bridge and then seemed shocked that no one had come to stand with him.

The second version of the bill decided that perhaps a big stick might have been a little over the top and substituted a big carrot.   They would not punish those who did not have AOT.   They would pay those that did extra.   This version has gotten a little more support.   Some organizations have jumped on board since the overt nastiness was somewhat muted but for many people the coercive passage of a coercive Bill has not went well.  

I live in Tennessee which does not have AOT.   As much as I object to Tennesseans being committed I also object to Tennessee being committed.

AOT is based on a central irony I have never heard anyone even begin to explain.   Rep Murphy will explain to you in great details how the current mental health system really sucks.   He will tell you it does not in any way meet the needs of the “severely mentally ill”.   Then in the next breath he will tell you how important it is to pass a law that allows you to commit people,  force them to accept treatment in this awful system.  I  still don’t get it.   Is he saying that the system sucks (His rhetoric goes into overkill on this point) or is he saying that choice sucks.   He seems to have a great affinity for coercion as long as he is doing the coercion.

AOT is a little answer to big problems and the volume that Rep Murphy presents it at does not make it any bigger.   He throws out huge numbers of “severely mentally ill”  in jails and prisons and then tells you they are there because they were not coerced into mental health treatment.   Forget for a moment the remarkably simple minded nature of his reasoning.   Forget for a moment his seemingly endless faith in the power of coercive mental health treatment. Forget for a moment that he ignores the affects of poverty,  racism,  trauma,  homelessness,  drugs and many other social determinants of human behavior on crime.   Forget all that and look at AOT.

In most states it is far from a bustling success.   The numbers served in comparison to the numbers served in the entire system are miniscule.  New York,  which is the promised land of AOT serves last I checked about 2000 people… about 1/3 of 1%.  Perhaps if this is true in the state which tries harder than any other to commit people then there is not the widespread need for committal that Rep Murphy says underlies our current crisis.

They tell you that medical facts provide the foundation for the operation of AOT yet one study says that if you are black you are 5 times more likely to be committed than if you are white.  – http://huff.to/1qf7m49

There are just many problems with the whole thing and more and more they are coming to roost.   Right now it looks doubtful that the Senate will drink the AOL kool-aid.   Even in the House there seems to be some reluctance to move forward on a bill that as written is so different than the Senate version.   They want a “bipartisan” bill to emerge but seem to be struggling with the idea that a bill based on the casual acceptance of coercion as a building block of the mental health system is going to have some problems with getting Democratic approval.   It is becoming more obvious that if Rep Murphy must have his way that there may not be any way.

Rep Murphy is going uphill right now.   That is obvious perhaps even to him.   But he is a true believer and is not going to stop.   And this is not a done deal.   As dangerous as AOT is and as dangerous as other aspects of the Murphy Bill are Rep Murphy is also dangerous.   There is no promise about what kind of deals people eager for some kind of deal might make in a conference committee.

Talk to your legislators.   Tell them you want mental health reform that actually addresses problems and not ideology.   Tell them that coercion is not part of any solution and that you do not believe justice and a respect for human rights are incompatible with helping troubled people build a better life.   Tell them to vote for you if they want you to continue to vote for them.

Rep. Murphy would have us have faith in a psychiatric vision and a system that has proven dangerous to too many people it had served.   He  asks us to have faith and trust in the good will and judgement of something less and less people have faith in.   He defends the power of a role that has progressively lost power and says the solution to the problems of the way things are now is to go back to the way things were.

If Dr Torrey and company are defeated here rest assured they will be back with the next shooting,  the next tragedy.   If they don’t make it on a national level they will be back at your state legislature asking for more power.   In some states they are already there.   Be vigilant.   Your voice matters but only if you use it.

I close this post with the words I started the previous post about PAIMI with.   They still apply perhaps even more on this issue than on PAIMI.

Thanks for your time.   Be well.

Only people with power believe that the
human rights of vulnerable people are not worthy of protection.   Only people with power would have us believe that the protection of those rights prevents them from the lawful and appropriate use of their power.   Only people with power would have us believe that those who would protect those rights are more dangerous and more trouble than those who would threaten those rights.   Only those with power would have us believe that the role of government is to get out of their way and not be concerned with how they would treat vulnerable people.   Only those with power would have us believe that they need to be protected from the people who would protect the vulnerable from them.


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