Representative Murphy did you know Congress has an 8% approval rating

July 30, 2015 by

Congressman Murphy I heard last night that Congress had an 8% approval rating and I thought of you.   I remember a long time ago you used a word describing PAIMI that you don’t hear much anymore – reprehensible.   And it hit me last night that is the word that most people apply to Congress.   They lament that Congress is so dysfunctional it can’t pass needed legislation but perhaps we need to be grateful it is so dysfunctional it can’t pass bad legislation either.

Some things stand out about the new bill….

I have been told by lots of people in a position to know that you were told that as long as your bill was so partisan it would never see the outside of the committee room. I wonder if that is why Dr.  Torrey and Mr. Jaffe no longer seem to be on the front line of this bill with you.  They are the essence of partisanship and a scorched earth advocacy approach.  It seems Patrick Kennedy is your new poster child and the combination of him and Dr.  Lieberman and the new head of MHA is much more of a formidable  crew.   Dr.  Torrey I  think is a little like the Donald Trump of psychiatry: always good for a sound bite,  beloved by many and despised by many more.   I think the combination of AOT as your flagship and Torrey as the pilot of the boat was too much for anyone to overcome.

A primarily AOT bill is not going to pass.   Dr Torrey never had the influence or audience he thought he had.  You seem to finally realize that and I suppose the AOT incentive is your compromise.   You probably know more than me but I have been told that an AOT incentive is not making it through the Senate.

I  simply do not understand how, even if they have made mistakes,  you can be against the unfettered operation of an organization that protects the rights of those you claim to be for.  The mental health system,  and certainly the mental health system as you would like it to be,  has earned no blank check of trust and in a free society never should.

You seem to have a very personal gripe against Samhsa.   The best I can tell your solution to the bureaucracy of Samhsa is a bureaucracy not named Samhsa.   People I know tell me your personal animus towards Pamela Hyde is well known and it seems she feels the same about you.  The perception of Samhsa in Tennessee is largely positive and I know of no one who understands let alone agrees with your claim that it is a terminal virus on the mental health system.   This  battle seems highly partisan and I have a hard time believing a democratic president is going to sign something destroying it. I  also think this is going to be a hard sell in the Senate.

How are you going to get the increased federal bankrolling of psychiatric hospitals to be budget neutral?  I don’t think the Republicans will even vote for that.

I think you have a very hard road to hoe.   It is August and you are still not out of the committee and the Senate has not even started.   The presidential campaign is going to put a halt to a lot.   I  understand that some members of Congress are still hunting the speakers head. I  wonder how much could happen even if everyone wanted it to. Your organization just sounds like a chaotic mess and the clock is ticking.   And August is vacation time for you guys I think.

8% approval rating.  Unless you are a Republican candidate for president that is scary low.

There are no small successes

July 30, 2015 by

Survival is:

Doing as many good things as possible. Somethings make it more likely to be a good day. Do good day things.

Anticipate problems as far ahead as I can. “Getting worse” is a lot easier (and more effective) to deal with than “worse”. If you are standing out in the middle of the road cars get more dangerous the closer they get to you. From a mile off the success in getting out of the road is much higher than from a foot.

Have a plan to cope. Avoid all the unnecessary things you can. Cope with everything else. Use your plan. Change it to make it better.

Sometimes nothing works. No matter how well thought out or how hard you try things may not work. Get used to it. The things in the way are not in the way. They are the way.

Frustration feeds a desire and screaming need to be in control. You’re not. The pursuit of control feeds more problems than it starves.

Help. Give freely and receive freely. Know people that matter and let them matter. Easy to say…. hard to do.

Have a plan to survive what you cant cope with. Know how you can get past disasters. You already have many times. Make use of what you know.

Celebrate small successes. Eventually you realize there are no small successes.

There are no smooth paths. Life is not eraseable.

When a bad thing is over let it be over. Too often we don’t.

I don’t know our answers. Slowly I am beginning to realize some things don’t change. You do the best you can and try your best to be okay with it. Then you try again tomorrow.

On change…..

July 30, 2015 by

This blog has been going for years now and is approaching 4000 posts. I  spent some time in the last couple of weeks looking back at past years and although much has stayed the same much has also changed.   I’ve changed and to be honest I am not sure I like some of the changes.

I  am not as optimistic as I once was. I once thought if people could be taught the recovery skills they needed and practice those things until they became second nature life would most assuredly get better. I still see truth in that but know now that it is much more complicated than that.

It is not a matter of doing the right 5 things or the right 10 things.   There is no recipe.   There is no if you just try harder or if you practice more or learn something different it will all be okay.   There is no checklist to life.   Doing good things matter but life cannot be cured.   Sometimes it is just hard.    Sometimes it just sucks.   Part of life is joy but part of life is tragedy.

Some things can be changed.   Some things cannot.   Some things can only be survived.   I know many people who try hard,  who have a lot courage and a lot of character who know suffering better than anything. If you have lived and never known tragedy you are way past lucky.

I have learned that challenges are not what gets in the way.   They are the way.   I have learned that how we cope with things is  no more important than how we survive what we can’t cope with.

I  don’t feel nearly as safe as I once did and I have met more and more people who seem to feel the same way.  In the last couple of years personal tragedy has overtaken my life and I  know that is a large part for me.   There are things that for us that could be done by the government that could really make a difference and maybe the hardest thing has been to realize those things may never happen.

I  have become very unhappy and wonder every day if life really can get better when so much sadness and disappointment seems so much a given.

But it is even more than that.  Hatred and anger seem to be so much of what our culture is about.   Our political institutions seem stuck and defined more by division and partisanship than anything.   It is scary and very disheartening.   For some people our government seems more dangerous than any of the foreign enemies we worry about. And I wonder how long problems can go unsolved or even ignored before the  bills become due.   And I wonder if we are already started to pay.

I wish I could still hold on to simple optimism. I  wish hope was easier.   And I really wish unhappiness was not so familiar.  I know writing this blog used to be a lot easier.  I used to write every day and now that seems something I can’t believe I ever did.

I hope good things are ahead and am very grateful to those who continue to read. There are probably many changes yet ahead.   The company has been well appreciated.

Thanks and God bless.

Remember

July 28, 2015 by

hopeworkscommunity:

From the archives

Originally posted on Hopeworks Community:

Adapted from an earlier post

Bad things happen faster than they should and last longer than seems right.

Good things happen slower than they should and never last as long as we feel like they should.

We never have a problem coming up with good reasons to do things that are often not good ideas.

We normally think finding out whose fault it is is the best explanation for everything.

We dont appreciate the momentum of life enough.  The better things are going the more likely it is that better things will happen.

Figure out the difference between what you do on good days and what you do on bad days.  Do more good day things.

Tell people thank you for things you wish they would tell you thank you for.

Be aggressively kind.

No matter what you think the sky is seldom falling.

Dont treat unimportant things importantly.

Celebrate…

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ON serenity, courage and wisdom

July 28, 2015 by

hopeworkscommunity:

From the archives

Originally posted on Hopeworks Community:

Serenity is not the product of our actions, but rather a by product of the way we see. To have serenity means to believe in a larger truth. It means believing that the life is about more than what is happening right now. It means believing that life is about more than me. It means believing that it has a direction and purpose and trusting and believing in that purpose. When I read about people who have coped with extreme misery and disaster in their lives with serenity the one thing they all have in common is the certainity of a greater truth and greater purpose.

One of the greatest lies told to people with mental health issues is that they are incapable of living lives of purpose, that the most they can hope for is a marginal life. The idea that they can base their life on a greater…

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The Murphy Bill: Old Wine in New Bottles or Rep. Murphy, We Can Do Better than This

July 27, 2015 by

hopeworkscommunity:

Well worth reading

Originally posted on Campaign for Real Change in Mental Health Policy:

By Andrea Blanch, PhD, and David Shern, PhD

In June, the Helping Families in Mental Health Crisis Act of 2015 (H.R. 2646) was introduced by Reps. Tim Murphy (R-PA) and Eddie Bernice Johnson (D-TX).  Several groups have applauded the bill for focusing attention on the need for strengthening the nation’s mental health system.  Unfortunately, the bill proposes very little new, contains provisions that could prove harmful to the very people it is intended to help, and ignores significant scientific advances in our understanding of the causes and treatment of mental illnesses.

Others have criticized in detail the bill’s emphasis on institutional and coercive approaches to treatment rather than on effective, voluntary community-based services; the elimination or drastic reduction in important programs overseen by the Substance Abuse and Mental Health Services Administration (SAMHSA); provisions that would curtail or limit enforcement of civil and privacy rights; and structural problems with proposed changes…

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Hatred is not a mental illness

July 27, 2015 by

Explaining murder without talking about hatred is like talking about fish without the notion of water. Rather it is a an individual hatred or hatred tied to a larger cause much of murder is about making a statement, teaching someone a lesson or making sure others suffer as they deserve. And hatred is not a mental illness. If it is then we are all sick.

Hatred begats anger.

Anger fed begats rage.

Rage begats violence.

Violence begats murder.

Murder confirms hatred.

Hatred confirmed starts the cycle again.

HATRED
We have made hatred easy. Problems are about who to blame and how to get them back. We are divided by what we call each other and that distinction is seen as the most real thing there is. There are people like us and people not like us and the people not like us are why things are so hard and so messed up.

ANGER
We live constantly provoked. Anger is what we take out of a situation and there is no shortage of offense to pick from. The people we hate seem constantly to confirm we have reason to hate them.

RAGE
After awhile we no longer get angry. Anger is simply what we are. Rage is not what we get from a situation. It is what we bring to the situation. The rageful person lives at war. It becomes not what we see in life but the means by which we see or make sense of life.

VIOLENCE
We worship violence. The rhetoric of violence is celebrated in political discourse, social media and popular culture. There are serious arguments made that the problem with church, with movies, in parks, with grocery stores and other public places is that not enough people carry guns. There are people who believe it is silly to go anywhere not prepared to shoot back. For the rageful violence is one of the few things that make sense.

MURDER
A lot of people get shot. The amount of gun casualties in this culture dwarfs that of most wars. We live in a cowboy culture that judges violence not by its frequency but by rather or not the right people get shot.

HATRED
We always find good reason for the most horrible things. We may suffer from lack of justice but we have no lack of justification. Hatred justifies almost anything.

The pattern described above does not describe everyone. I hope it is an all the time description of very few people in fact. But it describes enough people enough of the time to leave us with the periodic horrors that seem almost a daily occurrence.

I think we make a large mistake when we try to psychiatrize violent and murderous behavior. It ignores the context we live in and gives social, historical, political and philosophical variables short importance. People kill people because they are people and sometimes being a person is a scary thing. Though not in fashion to believe, I think there is such a thing as evil and hatred unquestioned and hatred clothed as common sense is the door to that evil.

Far too often, far too easily it seems the only door open.

204 mass shootings in 204 days: What is going on?????

July 24, 2015 by

http://www.washingtonpost.com/blogs/wonkblog/wp/2015/07/24/there-have-been-204-mass-shootings-and-204-days-in-2015-so-far/

The most recent tragedy in Louisiana has took front and center stage in the most recent chapter of the mass murder marathon that is the United States. Louisiana is no stranger to mass murder. The latest tragedy was the 10th episode of mass murder in Louisiana this year. In the first 204 days of 2015 there have been 204 episodes of mass murder in the United States. 204 mass murders in 204 days. If anything is insane that is. 204.

You will not hear much about 204. You will hear more about his family seeking an order of protection and a psychiatric commitment and a bipolar diagnosis than anything else. Many people will see that as the cut and dried truth and tell you this was a failure of the mental health system and that tougher laws are needed to avert tragedy. The only thing more predictable than tomorrow’s tragedy is that someone will tell you if we had just listened to them it wouldn’t have happened.

I don’t know if this man had bipolar disorder or not and the people who will confidently tell you he did and that was the cause of this tragedy don’t know either. What seems sure is he had a lot of hate. And I think the first case of hate and racism being cured might be the first.

The problem with the no fault mental illness hypothesis is that it ignores the context that people live in. It makes the things he believes in, the values he holds, his political positions irrelevant or even a symptom of some supposed disease. Not only does it in a real way let him off the hook, it leaves us, society and culture off the hook. And we don’t deserve that.

Before bigotry can have wide commerce it must be clothed as somehow common sense. There are perhaps millions of people, thousands and thousands for sure, that believe that what this man believed was just common sense for anyone who can see and had the courage to speak up. And the thing about hateful violent things is that when those sentiments achieve a degree of “common sense” the likelihood of the being acted on go way up.

When you combine the likelihood of action with the tools necessary for that action the recipe for tragedy is real. Guns don’t kill people. People don’t kill people. People with guns kill people. Angry, rageful people with what they see as righteous or justified anger with guns are even more likely to kill people. I understand he got the gun legally. He didn’t even have to break the law to commit mass murder. It is so sad.

204. By the time you read this 205 may be upon us. Unless you live nearby you may not even immediately hear about this. It is close to normal now and further away from news.

I don’t believe we can cure murder. The Bible somewhere says you will, “know them by their fruits.” We have made it easy and even likely that we will hate those different than us. The ways people can credibly address their differences with others are seen as ineffective. We prize strength and not letting others push us around. We have a cowboy culture with no Wyatt Earp to insist we check our guns. And guns… Easy and everywhere.

The problem is not that we made the Louisiana shooter. We didn’t. But neither did we make him less likely.

204. 205 is next.

.

The core of the change process

July 22, 2015 by

hopeworkscommunity:

From the archives

Originally posted on Hopeworks Community:

Why do some folks absolutely refuse to do things that are in their obvious best interest?  Why do other folks absolutely refuse to do stop doing things that are not in their best interest?  The mystery of mysteries….

Years ago I remember reading about something called the theory of inadequate justification.  The basic idea was really simple.  All of us are constantly trying to make sense of what we do.  We are always trying to find the ground to justify our behavior as sensible, or at worst, at least as necessary.  This theory says that people first look at external justification.  They did it because it paid money.  They did it because it got them something or prevented them from losing something.  In some way we try to justify our behavior by the consequences it brings.  We do things, or so we would like to believe, “because they make sense.”

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“The obstacles in the path are not obstacles…They are the path.”

July 22, 2015 by

hopeworkscommunity:

From the archives….

Originally posted on Hopeworks Community:

“May you always remember the obstacles in the path are not obstacles…They are the path.”

Jane Lotter

The quote above ended the article I linked to a couple posts ago  “The nine essential habits of mentally strong people.”   It was an article with a lot of punch and a lot of wisdom.  If you havent read it I urge you to do so.  But for me the quote at the end really hit me between the eyes.

Much of our time is spent comparing how we are doing with how others are doing and one of the things we always compare are the obstacles in front of us and how they reflect on us.  We want our obstacles to be big enough to testify to our heroism and integrity, but not so big that they reflect poorly on us.  We like it best when our obstacles are out of…

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hippa… It ain’t what they say it is

July 18, 2015 by

http://mobile.nytimes.com/2015/07/21/health/hipaas-use-as-code-of-silence-often-misinterprets-the-law.html?referrer=

Murder as self expression

July 18, 2015 by

I have watched the events of the past days in Chattanooga in horror.   I used to live there and the shooting sites were not far from my house.

It is hard to be surprised anymore.   Each atrocity,  each horror is new and jarring and unbelievable but after a couple of days it begins to feel like a place you have been before and the real horror is not simply that it happened but that increasingly it is harder and harder to  see this as a country where it might stop happening.

Murder seems for too many to almost about self expression. It is about who they are, what they stand for and how much they matter. Guns seem increasingly an extension of self, as much political or philosophical statement as anything. It is about making a point, a claim, somehow about being more than one of those people who just put up with things. When guns become how you make your point and everyone wants to make a point people die. Even Wyatt Earp knew to have people check their guns when they came to town.

Nobody makes evil people do evil things. That is not what I am saying. What I am saying is that the American experience with guns is unlike that of any other country. The things we make easier to happen tend to happen more often. Guns don’t kill people. People with guns kill people. And Wyatt Earp is long since gone. No one checks their guns anymore.

What if….

July 17, 2015 by

What if….

Our relationships with others were a celebration of their worth and not a demand for their proof of it….

We believed that justice denied one was justice denied all…

Guns were not expressions of personal identity or political philosophy….

Kind was the most powerful way to deal with other people…

Politicians believed in uniting us rather than helping us to defeat those we are scared or jealous of.

Decisions were based on doing better rather than looking better….

Ordinary people realized when they showed extraordinary courage.

Everyone knew small steps were still steps.

The things we couldn’t solve we were content to make a little better….

The kind of person we wanted to be had more influence on the kind of things we decided to do….

We knew life was an invitation to learn if we would only accept it….

Many things are bearable if we only find reason to persist….

We knew the most important thing to know was what we didn’t know….

Everyone knew they had something worthwhile to give…

We could be as generous with others as we wish they could be with us….

We didn’t try to understand people by figuring out what was wrong with them….

We knew when we felt bad it wasn’t forever or about everything.

We knew sometimes things don’t make sense and they don’t have to.

We knew the greatest courage was not to be afraid of being afraid.

Every one had something that mattered and it mattered they did.

Violence was not a solution to the problem but a symptom of it.

Justice was a fact and not a demand….

We knew sometimes things were better and sometimes they were worse and we made sure not to forget what made things better….

We knew things being better for me did not mean they had to be worse for you….

We knew that one of God’s best ideas was not to make either one of us God.

To Linda…..Courage and beauty

July 17, 2015 by

hopeworkscommunity:

I miss you tonight

Originally posted on Hopeworks Community:

Beauty has its own strength

strength its own beauty

and in you

the harvest of both

you are human

in the best sense

not an excuse for

things undone

or love disappointed

but the  possibility

of triumph over distress

of restoration

and flower and blossom

When things are hard

you remain and offer

harbor to those

who find life a hurricane

and terrible wind

In times of worse

pain and stress

you offer hope and sun

to dark days

May each day be new

and breeze mild

and sun friendly and warming.

know you are loved

with all breath and hope and heart.

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An open letter to the Tennessee state congressional delegation: In opposition to HR 2646 “The Helping Families in Mental Health Crisis Act of 2015

July 17, 2015 by

Dear legislators:

I write to you today in opposition to HR 2646 “The Helping Families in Mental Health Crisis Act”. I believe this act as written is bad for Tennessee. It makes promises it doesn’t deliver on, lacks understanding of the mental health system in Tennessee and in fact would impose ineffective programs in Tennessee and put in danger some of the most promising and effective initiatives we have.

The bill promises states a 2% increase in block grant funding for states that have assisted outpatient programs (AOT). AOT is a program that mandates that an individual agree to take part in outpatient treatment. Tennessee tried a pilot AOT program the past two years. In two years it served one person at the cost of 20,000 dollars a person. Proponents insisted that the program would fulfill an important role in the Tennessee mental health system but the reality never matched the hype.

The problem in Tennessee, the challenge facing the system, has not been in forcing people to get help they may not believe they need or want. It has been in developing an adequate array of effective services that people needing help can access as needed. The problem in Tennessee has not been people not wanting help. It has been people not finding help or not being able to access the help that is there.

Under the leadership of Commissioner Doug Varney the Tennessee Dept of Mental Health and Substance Abuse Services has done a great job in using limited resources in innovative ways. The last thing it needs is to be told that a program already failed in Tennessee is going to be imposed on it to get needed funding. If bonuses are to be given I can think of several innovative programs in Tennessee that should more than qualify for any bonus given. For example, Crisis Stabilization Units for the first time serve as many people as state psychiatric hospitals at a fraction of the cost and with greater effect. Crisis Stabilization Units (CSU) are small voluntary programs set up to serve people in emotional crisis and tie them to needed community resources to maintain stability and coping in their communities. Many of them would have been hospitalized without the CSU’s. Tennessee deserves any bonus. AOT should not be a requirement to get it.

This bill would drastically and at great expense on both the state and federal level increase the amount of psychiatric hospitals beds by repealing the IMD exclusion. I urge you to contact Commissioner Varney directly and ask him if Tennessee needs more psychiatric beds. What Tennessee has found is that without adequate community services you can’t build enough psychiatric hospitals and that psychiatric hospitals eat up the funding needed for community services.

Tennessee is a leader in developing options to hospitalization which is by far the most expensive way and one of the least effective ways to help people with mental health needs. The CSU’S are only one initiative. This fall Tennessee will unveil a “Peer Engagement Program” that will target everyone in the state hospital system and try to decrease the tendency of too many people who are hospitalized to end up returning to the hospital. Aside from being the right and kind thing to do it promises to be a much better use of the financial resources in the system. The answer is not more resources to separate people but more resources to allow them to be successful members of their community.

SAMHSA is a major villain in the story this bill tells. Before accepting what you are told I urge you to contact Commissioner Varney and ask him about what SAMHSA has brought to the Tennessee mental health system. Many innovative and effective services have been implemented with SAMHSA help. It can certainly do a better job but be careful. It always costs more to fix things not broken.

There are a lot of problematic provisions in this bill. There is not space here to adequately even mention them let alone discuss them in depth. The proposal to eviscerate the protection and advocacy programs like PAIMI (Protection and Advocacy for Individuals with Mental Illness) is the last one I will mention. That program in Tennessee was primarily responsible for tremendous improvement in the Adult Group Homes system in Tennessee. They uncovered a whole realm of problems that under this bill would not have even been legal for them to even talk about. Contact Lisa Primm at Disability Rights Tennessee to hear more about this.

This letter scratches the surface of this bill. It is not good for Tennessee. Before you make a decision to support it I hope you will, as I have suggested talk first hand with people who know mental health in Tennessee and both what has been accomplished and what is needed. This is too important to be decided by political rhetoric.

We need a bill that matters and addresses the needs of Tennesseans. This is not it.

I would love to talk further with anyone who would like further information.

Yours truly,

Larry Drain
Maryvillle, Tennessee


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