Perverse incentives

August 16, 2015 by

People have an incentive to find what they are looking for when finding that whatever it is increases their control,  their power, their social status. It is even a larger incentive when finding what they are looking for means money in their pocket.   People have an incentive to see things that make them matter or that lead to them getting things that matter.   If what they are looking to find is the distress of other people and the way that distress is framed or explained results in some type of positive payoff for them then you might say they have a perverse incentive to profit from the misery or unhappiness of other people.

All this was triggered by a phone conversation.   I was part of a group call and listened to some people from New York  discuss their experience with AOT.   What stood out for me was that if those people had lived in Tennessee none of this would have happened.   It is not just that there is no AOT. I have never heard a professional in Tennessee bemoan the fate of all the poor people with anosognosia.   If  someone did not buy into treatment that would be viewed as their decision and if anything happened it would be some kind of effort to connect with the person they thought needed help in a more effective manner.   I wonder if anosognosia is not less of an issue in Tennessee because their is less incentive to see people in that way.

I wonder in particular if perverse incentives don’t operate at their strongest when what must be justified is the coercion or forcing someone to do something they might otherwise choose not to do.   At one time it was common wisdom that drug people needed to be put in prison for a long time.   What was wise once is now seen as foolish and the cause of an epidemic of mass incarceration that has crippled this country.

The last year I could statistics about AOT in New York had one startling one.   Well over 90% of the petitions filed were judged founded.   Either New York has some extremely perceptive people filing these petitions or the courts see what they have an incentive to  see.

I can remember when it was easy to see and justify the need for long term psychiatric hospitalization and the hospitals were filled with long term patients that everyone just knew couldn’t make it in the real world. There is no longer an incentive to justify the idea that some people can’t make it in the real world ever and people who once would never be given the chance to make it in the community are regularly successful.

Follow the money.   Follow the power.   Follow the control.  Follow the status and professional standing.   Follow who is defending whose territory from what.   Follow all these and it will be much easier to see why things are the way they are and seem so resistant to change.

The tenth letter

August 14, 2015 by

From the archives for “Dear Senator Ramsey”

Dear Senator Ramsey:

This is my tenth letter to you.

The sickness and death of poor people should never be the policy of a decent people.

In Tennessee it is.

Much of the debate, the criticism, the rationale for not acting on Insure Tennessee was simply apology  and excuse for doing nothing. Absent from much of the discussion was any picture of the real life consequences of living without access to decent health care and of the struggles and trials of real life Tennesseans. Little was said about the desperation that thousands and thousands live with on a daily basis. It was a  hollow discussion about matters of great weight and substance.

You talked to the hospitals who you didn’t believe,  Tenn Care who you didn’t accept and the Beacon Center who told you what you wanted to hear.   And then you decided to do what you had already decided to do.

The notion of the moral necessity of helping 280,000 people with no where to go and no  one to turn to was absent. There was no sense that something needed to be done. There was no sense of an imperative to action.

Every no is also a yes. Your yes was a yes to passivity and to the institutionalized neglect of the poor, needy and sick.

The sickness and death of poor people should never be the policy of a decent people.

Until next time.

Yours truly,

Larry Drain

I read a post today…..

August 12, 2015 by

I read a post today on Facebook about Tracy Foster and realized I was ashamed of me…..

I met Tracy months ago.  She had no insurance and the wrong kind of cancer.   She was at the state legislature advocating for Insure Tennessee.   She was asking for her life.

At the end I remember her crying in the hallway and me hugging her and her asking me if it was over and if it meant she would die.

She found some help with care.   A hospital volunteered that.   But she still has to buy medicine.   She still has to travel over 100 miles to get there each time she goes.   She still has to live and do the 1000 million things poor people who are very sick need to do to survive.   Some of her story is in the previous post realigned from the past.

She has a gofundme account.

She needs your help. Please help. Please share.

I am so afraid she has become old news and she is so much more than that. There are 280000 people who too many would have become old news. If I am brutally honest I think Tracy became old news for me and for that I am ashamed. Do not let anyone be forgotten.

Someone asked me about the fight to insure Tennessee. Was it really important? In a time of so many important things was it really so important.

This is what I told them :

The argument in Tennessee is not about competing models of care. Despite all the high sounding rhetoric there are no competing models. It is an argument for care versus a feverish search to make abandonment a political, financial and moral value. It is not about how to care, but rather or not to care at all. In the end it is about making turning your back on the more needy and more vulnerable amongst you a virtue and political necessity.

If it is about abandonment it is about the everyday, deep in the pit experience of terror. It is terror not just of the sickness or challenges you face, but a terror borne of the spirit killing certainty that when you are the most vulnerable, the most fragile, the most needy that no one will be there. It is in the recognition that because of your poverty, because of where you live, because of many things, most of which you have no control that for some inexplicable reason it is against the rules for you to get the help you need. 

It is about a system that says because of your financial status you will most likely die earlier than your fellow citizens.

It is about a system that says that ordinary and expected illnesses that medical science can treat or cure may go untreated for you even if it should mean your unnecessary death.

It is about a system in which any sickness may present you with financial catastrophe that you can never get past.

It is about a system that threatens your ability to keep a job and provide for your family if you cant get the medical care you need to stay healthy enough to keep that job.

It is about a system that tries to tell you that you are the cause of why it doesn’t work well rather than the victim of how it does work.

It is about a system that threatens the safety and security of your family and that in the end tells your children something is wrong with them.

It is about a system that attacks the heart and soul of its members as much as it ignores their bodies.

It is about a system that treats poverty as a crime and a moral failing.

It is about a system that in abandoning its most vulnerable would have each of us abandon something of the best of ourselves.

It is about a system long past time to change.

Your voice matters. Speak loudly and more loudly. Do not stop or turn around.


August 12, 2015 by


From the archives

Originally posted on Hopeworks Community:

I just met Tracy 3 days ago and I wish everyone of you could meet her too. She is both the face of what is wrong with Tennessee and the hope for what can be right.

Her name is Tracy Foster. She has beaten cancer once and it has come back. She may die this time. Without insurance she will.

She had Tenn Care once but lost it when her daughter turned 18. She is in pain all the time now. Her cancer is bladder cancer and that is the wrong kind. If she had cervical or breast cancer she could get help. Her sickness breaks the rules and she has none. No doctor will help.

Despite the pain she drove over a hundred miles by herself. She came to speak and other than one legislator I don’t know if anyone even gave her the time to listen. She set…

View original 246 more words

There is hope to defeat the Murphys Bills: Mr. Jaffe is speaking for them again

August 12, 2015 by

Mr. Jaffe is back on the job. After what seemed, at least to me a too brief respite, he is once again joined the fray determined to slay the dragons of mental health advocacy that so imperil the seriously mentally ill. The article linked above is more than anything else an exhortation by Mr. Jaffe to rally the troops to try harder. The nasty no good rotten mental health advocates are he says several times “…. having an effect.” With his help the odds of defeating the Bills can only go up.

Mr. Jaffe and company were as you might recall were seriously effective advocates for the original Murphy Bill. Their scorched earth advocacy campaign alienated everyone there was to alienate. They were basically the tea party of mental health reform dedicated to the proposition that personally attacking anyone who disagreed with them and questioning their motivation and character was a sure fire way to build the consensus they needed to pass major legislative reform. It didn’t quite work out.

The post above is the first major effort I have seen in a little while from him. He is, I guess, back.

He sets the tone of the post with his title: There is a chance for real mental health reform if the Mental Health Industry gets out of the way. I think that means if the people who disagree would stop disagreeing everything would be okay.

Notice the use of the term “mental health industry.” It makes things sound conspiratorial. Anytime someone says something about an “industry” advocating for itself your gut reaction is always something a little bit dirty is going on. After all what else could it be about other than people trying to get more money at the expense of the people they ostensibly serve. I may have missed it but I have never once heard Mr. Jaffe say people disagree with us because they disagree with us. Their is, according to him, always an underhanded sort of motive. The biggest weakness of his position is that he has no way to account for people who disagree with him other than to slander them or write them off as dupes of a greater conspiracy.

A side note. The use of the term “mental health industry” also conjures up images of a homogeneous body speaking with one voice and one purpose. That is certainly not true. Some of the people who oppose the Murphy Bill disagree with each other only a little less than they disagree with the Murphy Bill. As a matter of fact I think you could argue if there was more common ground amongst Murphy opponents that it would never have gotten as far as it has.

His opening paragraph is a masterpiece of nonsense:

Mental-health programs received $172 billion in federal and state taxpayer funds in 2014. As a result of lobbying by the mental-health industry, however, little of it went to reducing homelessness, arrest, incarceration, and hospitalization of the 10 million who have serious mental illness such as schizophrenia and bipolar disorder. Instead, as in previous years, a vast amount went to improving the “behavioral health” of the masses. As a result, 164,000 adults with serious mental illness are homeless; 365,000 are in jails and prisons; 770,000 are on probation or parole; 95,000 who should be hospitalized can’t get a bed because of the shortage; and headlines are full of “psychotic killer on rampage” headlines.

Where to start????

1. “As a result of lobbying by the mental health industry….” Is anyone other than me confused? Again he seems to reference some sort of conspiratorial activity. Who lobbied who? How? At whose direction? Why? My hunch is that this is one of those things that you have to know the code words for. I wonder if “lobbying of the mental health industry….” doesn’t just mean “disagreeing with the Torrey gospel” in particular his infatuation with the glories of psychiatric hospitalization. I don’t know but maybe…

2. little of it went to reducing homelessness, arrest, incarceration, and hospitalization of the 10 million who have serious mental illness such as schizophrenia and bipolar disorder. Instead, as in previous years, a vast amount went to improving the “behavioral health” of the masses. It simply amazes me that some people are so gullible as to believe stuff like this. That is what the Tennessee system is about. That is the nuts and bolts prime directive. Reduce human misery. Give people a chance at a better life. This is so far off base as to not even be on the right field. I mean what is “improving the behavioral health of the masses?” Mr. Jaffe could you give some concrete specific examples of that and also some concrete examples of the “mental health industry” lobbying for these to the exclusion of things that actually improve human life. And finally and carefully explain how these specific examples you list comprise the bulk of the mental health system.

An important side note There is a central and enduring contradiction to the Torrey/Jaffe position I have never heard anyone explain. On the one hand they describe the mental health system as basically trash not meeting the needs of the seriously mentally ill but in the next breath talk about the glories of AOT, their gold standard intervention, which is basically committing people with serious mental illness to a system they say sucks. You can’t have it both ways. If the system sucks AOT must also.

3. As a result, 164,000 adults with serious mental illness are homeless; 365,000 are in jails and prisons; 770,000 are on probation or parole; 95,000 who should be hospitalized can’t get a bed because of the shortage; and headlines are full of “psychotic killer on rampage” headlines.

Look carefully at what he is saying. Because of the way the lobbyists of the mental health industry have designed services to meet the “mental health of the masses” the following things have happened: 164,000 adults with serious mental illness are homeless; 365,000 are in jails and prisons; 770,000 are on probation or parole; 95,000 who should be hospitalized can’t get a bed because of the shortage; and headlines are full of “psychotic killer on rampage” headlines. Focusing on the “mental health of the masses” (whatever that is) caused all this???? Does this not look more like a tabloid headline than serious thought? This is the reasoning behind a major effort at mental health reform? Homelessness, crime, “psychotic killers on the rampage” are fundamentally a defiency of psychiatric hospitalization, AOT, and medication. Mr. Jaffe you make no sense. I would love to see the concrete evidence base you use to make such claims.

Lord that is only the title and first paragraph of his post. This post is already much longer than I normally like. The rest of his post is filled with more goodies and I urge you to read it.

I only have a couple more remarks.

I am not sure that Mr. Jaffe and company are central to Sen. Murphys bill. Their holy rhetoric makes nothing more likely to pass. The Representative can testify to that. I wish I thought he was more important but he has already criticized the Senate bill as being soft on AOT and I don’t think he is going to be in the inner circle on this one. We could use Mr. Jaffe’s help on this one. Too bad.

Mental Health and mass incarceration

August 10, 2015 by

Linda and I went to a community forum tonight hosted in part by the Knoxville Peace and Justice Center as well as other community organizations.   The subject was mass incarceration: how many people in jail just don’t need to be there and the social and moral consequences of the choices that we as a society make.

The panelists were varied.   There was someone from the sheriff’s office there,  a public defender,  clergy,  academics,  community activists and even someone who had recently got out of jail and trying to put his life back together again. 

We talked about how if you were male and black the  chances in Knoxville were sky high of you going to jail.  We talked about the role mental health issues played in people going to jail and the role they played in jail and suicide and how many people were lost to the trauma  and injury of what it meant to be locked up.   We heard about I could only call the necessary violence and injury of the experience (the things that happened even when the system was running right).

What was described was a perfect storm.   And to be honest much I heard sounded about as effective as trying to bail out the Titanic with a table spoon.

It is a mess a long time building and may be a mess a long time changing. The discussion about mental health issues really struck since so much is said about supposedly how the failure of the mental health system has resulted in so many people with mental health issues being stuck in the jail/prison system.

After listening the following seemed clear to me.

1. The issue of too many people with mental health issues in the system cannot be considered apart from the fact there are simply too many people in the system.   As long as we imprison with the frequency we imprison the issue of the mental health issues of those in jail will never be addressed.   So many people in jail have mental health issues in part because there is so many people in jail.

2.  Much of the jail system is stacked against poor people.  And people with mental health issues tend to be poor. They tend to not be able to make bail.   It  costs money to maintain contact with family.   Phone calls cost a lot.   In Knoxville there are no face to face visits anymore.   Everything is through tele-visits and that cost money too. And finally if you don’t have the money to do commissary being chronically hungry is part of being in jail.

3.  If you accept the idea that adverse experiences,  trauma,  victimization are part of the equation that fuels people to commit crimes and you accept the idea that trauma and injury are inevitable parts of jail how can anyone be surprised that for many people getting and staying out of the system are much harder than getting into the system.

4.  The guy from the Knox County jail said they were trying as hard as they could to do right by people with mental health issues and I  believe they are.   But what goes on is still indefensible.   I told him that if there was as much expected and seemingly unalterable injury at the local animal shelter as there is at the jail we would find a better and more humane option than animal shelters.

It was a piercing experience for me. The strongest thing I walked away with was little would make much much better unless we made a concerted effort to reduce our love affair with sticking people in jail.  Taking injured people and injuring them further as a consequence for their behavior does not make things safer for anyone. Without question some people deserve to be in jail.   Without question some of the people in jail don’t belong there.

Solutions that create worse problems than they solve seem in so many ways and in so many areas something we face with a committed blindness.

How Do You Get That Lonely

August 8, 2015 by

You do not treat me with respect if…

August 8, 2015 by

You cannot see despite what is hard for me or what I struggle with or how hard I struggle that what is important to me as a human being is the same thing important to other human beings as human beings.

What if we started with the idea there was nothing to prove

August 8, 2015 by

What if our default setting in life was that no one is essentially better than me, nor am I essentially better than anyone else?? 

That would be revolutionary in my life and I bet in yours.

I think of all the times I nurse a grudge or hang frantically onto an injustice done or a slight received.  I think of how many times I disregard the worth of others or just dismiss with some kind of remark about “those kind of people.”  How many times am I content to look for the truth about someone else in what I or someone else call them?  How many times I wonder are my words meant to draw blood and wound?  How hurtful am I and how blind to that hurtfulness am I?

And I truly wonder how much of that would be true if I really lived as if all human beings were human beings.  What if there was nothing to prove, nothing to win, nothing to protect?  What if there was nothing to get because I already had what I needed?  What if life was neither proof or argument about our value but celebration of it?  What if I knew that there being a me meant there had to be a you?

It would unravel much of what troubles me.  It would leave fear a memory and discouragement not the result of the next events.  It would be the most profound step of recovery I can take and the greatest gift I could give those for whom I care.

It would not make hard times go away.  It would not make some people be less hateful.  It would not make everything fair.

It would just mean those things would no longer define the context of my living.

I think it is the most poisonous and killing illusion in life that it is all about what you prove or keep others from proving. 

Stand up for peer support now… Put your name on the line.

August 5, 2015 by

The National Mental Health Consumers Self – Help Clearinghouse was founded in 1986 by Joseph Rogers. It has played a substantial role in the development of the notion of peer support in this country. It has helped to develop the vision that recovery is real and possible. It has helped to make hope common sense in a field that tried to tell people despair and resignation were the only realistic responses to “scientific truth.” It has a proud history, an effective and important contemporary role in broadening the notion and reality of recovery for thousands of people and promises to continue to make a difference in the future.

It matters. In a world where so many things just make things worse it matters.

Its future is in grave danger. Samhsa has indicated it may no longer offer support. There are only 3 other programs in the entire country that serve the same function. Only 3.

Please read and sign the petition. Please make your voice heard. Then share with everyone you know. If you sign and get only 3 people to sign and each of those 3 get 3 who get 3 and so on in a matter of days thousands will have signed. Please help. Act today.


Larry Drain

Page 163, line 13

August 4, 2015 by

This is the second post tonight on basically the same subject.   The Murphy Bill is  not just bad mental health policy.   It is bad government.

Page 163, line 13 is the place where it says that every single mental health grant proposal made by the federal government must be reviewed by congressional committees 6 months before it is awarded.   The activities of the federal agency charged with improving the mental health system in this country is to basically be micromanaged by congressional committees.   Can anyone say control issues?  The practical reality of this would be to give Tim Murphy extraordinary influence over whether or not specific grants are approved or not.

Again let me say again this bill is not just bad policy.   It is really bad government.  Murphy says he wants mental health policy to be based on sound research and “scientific truth”.   Given the Congressional record on global warming is this really who we want in charge of “scientific truth”?

Don’t you think the legislative branch needs a little more work on how to be the legislative branch before it tries to take over the executive branch too?

Do we still need to make Pamela Hyde illegal: The Murphy Bill as personal vendetta

August 4, 2015 by

The Murphy Bill is many different things.   It is in a major way an attempt to fire SAMHSHA administrator Pamela Hyde by passing a law making her illegal. It is an attempt by the legislative branch to control the management of an agency of the executive branch they don’t like by basically disemboweling that agency and creating another agency with a different name to do the same thing. It is a bizarre management theory and creates a precedent of an extremely dangerous sort for the next time someone in Congress gets mad at someone else.   It  really asks the question is personal antagonism a sufficient reason for legislative action and if it is have we not opened an incredible Pandora’s Box?

But today a solution has appeared.   Pamela Hyde is leaving.   Rather she was asked or she chose she is leaving.   And assuming someone is appointed that is either a psychiatrist or a psychologist do we still need  a law to make someone illegal who is no longer there?  I have seen nothing in the rationale for all these changes that says that Pamela Hyde leaving doesn’t destroy the reason to junk the agency she heads.

Better life is possible

August 4, 2015 by

Manage bad times... Recognize.

Be honest.

See them coming. Maintain perspective.
Don’t  make them bigger than what they  are. They are already big enough.

   Don’t make them longer  than what they are.   They are long enough.

Don’t make them about more than they are. They are about enough right now.

Prevent what you can prevent.   Avoid what you can avoid. Cope with what you can’t.   Survive what  you  can’t cope with.   Learn from it all.

Know that injury  may last longer than the circumstances that bring it. Be patient. 

  Life sometimes sucks but know that doesn’t mean everything in it sucks or that it must suck forever.

Promote good times…. Somethings make it better. Become an expert in those things.

Plan for them.

Do  them on purpose with commitment and  perseverance. 

What you cannot make good make better. Value coping.  Don’t dismiss it lightly.

Value  success and celebrate it.  The more you do things good for you the better you will do. Life is often a matter of momentum  and  good momentum matters.

Value becoming the kind of person you want to be.

Much of what we do is tied up in who we think we are.

   As much as you can, as often as you can practice being the person you want to be.   It is never a destination but a process. Even small steps are steps.

Care about other people and allow them to care about you.

Life is what we do with others.  

Connection matters. Believe you can.

Beware accomplices.  Things are already hard enough.  

Part of the meaning of life is in the meaning of the people in our life. Seek the opportunity of others even in a sea of deprivation.  Be honest in what is and open to what  can be.

Find meaning and purpose in who you are and what you do

Live like it matters. The biggest lie and deepest hurt is that it doesn’t. 

  Human beings  are incredibly strong and resilent creatures.   We can cope with much when we believe it matters to do so.

Meaning gives energy and direction to life. Sometimes we must find it. Often we must nurture it.   But always,  always prize and value it.

The conviction of recovery is that better life is possible.   It is not just a special process that challenges some people but a common  challenge  facing us all

It is not about the cost of living but the cost of the way we live

August 3, 2015 by


From the archives

Originally posted on Hopeworks Community:

“It is not about the cost of living but the cost of the way we live.”  Those words were uttered by my wife in a speech she gave in November at the “Listen to the people” rally in Nashville.

In one sentence she summarized the entire debate about Insure Tennessee.

Legislators, fueled by political partisanship and in a frenzy of ideological purity, have argued and postured about what they fear the effect of Insure Tennessee will be on the cost of living.  They have spent a mountain of energy and effort trying to uncover the dark side of free but have totally missed the boat.  Although vitally important Insure Tennessee is about so much more than the cost of living.  It is about the cost of the way we live.  It is about the real cost.

Over 800 people in the halls outside the committee room knew exactly.  They knew…

View original 30 more words


August 2, 2015 by

I do not understand affliction. I had a friend once who told me that life “was nothing but beans and hard times.” Him and his wife had given birth to two deaf-blind children because of a recessive gene they both had…. the odds were incredible against that happening. I forget the numerical odds exactly but something similar to the odds of getting hit by lightning. He didn’t understand affliction either.

Things happen. To you…. To me… To everyone. Adverse life events they call them. Science even is beginning to believe that “what happened?” actually has something to do with the way we lead our lives and the people we become.

Pain counts. There are many things hard to find in this life. Tragedy is not one.

I have talked often in this blog about the tragedies I have known. I have met many who have known far worse things than me and am in continual awe of the human capacity to meet terror and pain with courage and quiet faith.

For me, at its worst, the most difficult thing is the tenaciousness of tragedy. It never wants to leave. Its footprint too easily is seen in each new day. Coping sometimes seems a miracle, but it seems sometimes a miracle that has to be redone each day.

Feeling bad makes me feel like a failure and I often feel bad. Trauma often feels new and alive even when it is neither. It is not that it was once where I was as much as it seems like where I still am or where I am about to go.

Things do get better with time sometimes. Life sometimes captures our hurts and puts it on the back burner of a busy stove. Things that once felt like everything are dissipated by perspective. And things are more than what they make of us. We can also make of them.

Someone today told me a wise thing. “Sometimes we are hurt and hurt badly. Sometimes we are changed and sometimes in ways we hate with a passion. Trauma though even when it changes us doesn’t condemn us. We can find restoration, sometimes in small and slow steps. It doesn’t mean things are not hard or that we don’t take steps backward. It means we can take steps and what we do matters. ”

” Adverse life events” tell us many things about ourselves, other people and life in general. But no matter how compelling, how loud or how emphatic they are not the final verdict. That is always on us.


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