On getting past a normal life

November 19, 2015 by

It is so easy to forget that what becomes normal for us so often isn’t.  It got to the point for me that sometimes I wondered if anything could happen good enough to make a difference.  Nothing held water.   Life was floods and dry land more like something in a long ago dream rather than something that was real and possible.

Loneliness seemed normal and unhappiness part of being realistic.   I was never far enough past trauma to have post anything.   Tragedy was not something that happened.   It was just the way it was.

The moving has mattered.   Some prisons can only be seen best in the rear view mirror.  You lose the bars after a while. You don’t see them anymore. They become part of you….. and only later  you wonder if you have been lost too.  

We do what we are used to doing. We live the way we are used to living. We forget normal and usual are not the same thing. We try to accept what we can’t change instead of as one writer wrote “try to change the things we can’t stand.”

Much is still hard, very hard… and maybe always will be. But I have moved and 3 miles away is a million miles closer than 25.

Hurt and loss are very real and cannot be willed or wished away. But perhaps life can be more than usual. I think so… I hope so…. I pray so.

For the first time in a long time perhaps tomorrow may really be a new day.

We Need REAL Change in Mental Health Policy, Not the Illusion of Reform

November 18, 2015 by


Tennessee Justice Center: Counting the cost… The Final Report

November 17, 2015 by


Upon request : a Murphy option

November 15, 2015 by

This is a repost of an earlier post upon request from a friend who asked me what I  wished the Murphy Bill was about.   It is not a bill.   Some of the ideas probably would not fit in any  bill but it is what I think is important.

If the mental health system was sane……

There would be a range of services availible reflecting the human needs of those it serves.

Those services would be availible to those that need them.

Those services would be based on what works, not what makes money, reflects any particular philosphy or interest, and not because it is what we are used to doing.

Asking for help would not label someone, brand them, be a cause of shame, a source of discrimination.  Asking for help should not be a problem.

It would realize that lack of a place to live, lack of food, lack of adequate clothing, lack of a job are frequently barriers and problems for the people they serve and address them in a direct and effective manner.

It would know that inadequate health and inadequate health care are common problems for the people they serve and be part of an effort to serve the entire person in an integrated fashion.

The goal would be to empower, educate, and support people towards gaining control over their lives so as to maximize their chances of leading happy, meaningful and successful lives.

This would not be empty words, but a passionate conviction that fuels and structures everything done in the system.

It would not mistake the people it serves for the labels it places upon them.

It would know that the most important thing about help is that it is what you do with people and not what you do to them. It would see itself as partnering with the people it serves.

It would know that people can say no and that not be a symptom of illness or distress.

It would view peoples values, hopes, thoughts, and aspirations as a source of strength and not a symptom of illness.

It would take substance abuse ultimately seriously. Drinking and drugging are the two primary ways people with mental health issues try to treat themselves.

It would make sure that one of the core experiences that someone seeking help has is contact and interactions with others who have dealt with similiar issues. It would treat seriously the idea that you can learn from the experience of others and them from you.

It would not tell people who have hard times or more problems they have failed or are failures.

It would take the issue of trauma seriously. Knowing how people have been hurt and not being part of hurting them further should be cornerstones of the system.

It would treat the issue of what happens in jails and prisons to people with mental health issues as a moral outrage and the impulse to do something about it as a moral necessity.

It would be honest about the risks and benefits of psychotropic medication. Help people to make real and informed choices.

It would treat families as important and not as irrelevant or a threat to what it is doing.

It would treat justice as a driving force and value in everything it does.

It would be honest with the people it serves about what it doesnt know if it wants them to have trust in what it does know.

It would attack the issue of suicide with passion. No one should ever feel like death is the best solution to life.

It would tell people that no problems make you less human,

It would view hope as realistic and know that when they dont they do more harm than good.

Towards better days

November 15, 2015 by

Sorrow.  I will always have a great deal of sorrow for what is lost.  But sorrow need not always be in front of me.  I think there is a sorrow for what is left behind that doesnt have to define what is ahead.  I will deeply miss what is lost.  But that sorrow need not define what it is possible to find.

Despite.  I can go on despite bad things.  The sun still shines.  The world has not stopped.  The things that are still important are still important.  The things I care about are still worth my care.  It is not annihilation.   The reality of the hurt need not define the reality of  the world.  The things that make me laugh still make me laugh.  There is still song and melody.

Okay.  It is okay to feel bad because it is okay to feel.  Be open to all feelings.  Worship not one.  And dont believe you are being disloyal to the hurt when you feel good.  Feelings tell you they are all that is true, but that is not so.  Have your feelings, but do not be had by them.

Because.  Even the worst of times, the times that no one would ever want or ever like, have something to offer.  Because of the injury you can discover things about yourself, about others, and about life that may be invaluable to the way you live today, tomorrow and the day after..

Grateful.  Sometimes it is the loss of big things that teach you the importance of small things.  Be excessively grateful.  Treasure each gift, however small, however slight.  It is the beginning of your rebellion against the trauma.

Share.  Share your life with other people.  Pain tells you are alone.  Forever and forever alone.  You are not.  It is easier to find the gifts of people when you are a gift to people.  Share.

Patience.  Today is not forever.  Neither is yesterday.  There is a season of life.  Sometimes waiting for better days is the hardest battle.

Honesty.  Sometimes you just cant.  Dont try to be what you cant or who you cant be.  Do what you can.  But be honest about what you cant.

Surprise.  Sometimes good things come out of the worst things.  Be open to surprise.  It is not foolishness.

Recognize.  Recognize better days.  Everything does not stay the same.  Figure out what makes things better and do them on purpose.

Strength.  Fill your days with things good for you.  Strength and capability make a difference.  Trauma tells you that you are weak and at the mercy of cruelty and meanness.  Find ways to increase your ability.  Capability matters.  Even when it doesnt make a difference now the time is coming when it will.

New.  Sometimes hope dies and you must find new hope.  Hope is more than anyone thing.  It  is more than anyone person.  It is waiting to be found but it means you must look.

Doubt.  Dont doubt your ability to make a difference for other people.  Nothing has happened to make you less of a person.  Perhaps your circumstances have been changed, maybe in awful ways.  But you have no fewer gifts, no fewer worth than you did before.

Look.  Look around.  Lots of people are hurting.  Some worse than you.  Sometimes in seeing what others will never be able to do again you see what you are still able to do.  Perspective is okay.

Have a great day.

The danger to the Murphy Bill

November 15, 2015 by


The post above is written by the president of Mental Health America and details his reasons why he thinks opposition to the Murphy Bill is “short sighted.”

Rightly or wrongly this is my take on the significance of his post and the current state of affairs.

1. The mark up showed that on purely partisan numbers the votes probably exist right now to pass the Murphy Bill in the House. Any organization that would repeal the ACA over 50 times could easily pass the Murphy Bill once. The votes are there. That is reality .

2. There is growing recognition that although it is possible the passage of the Murphy Bill as a partisan measure does not make it more but less likely to become the Murphy Law.

3. The opposition at the markup was heard and did have an impact. Deep divisions were evident. Substantial disagreement was evident. Many of the points made by the Democrats were those made by advocates in opposition to the bill. It may not have been Murphy’s biggest nightmare but it was not a great day for Chairman Upton .

4. There remains much talk about addressing “bipartisan concerns.” There is growing recognition that not addressing those concerns before the bill is passed leaves them, in effect, at risk of “repealing the ACA” again and being left with another in a long line of partisan House bills that have little or no effect on reality.

5. If it is simply a question of Republican vs Democrats and nothing else the Murphy Bill can and will pass. The crucial question in moving forward is how it passes.

6. This concern is at least part of the reason for the MHA post. His argument, if I understand it, is that those concerns are already addressed and there is no need for continued opposition.

7. There is some level of recognition if disagreement is not addressed in the House bill those disagreements will be raised to a fever pitch in the Senate and may impact the substance of anything they agree to. Neither Rep. Murphy or the Torrey guys are likely to have the kind of control or influence they have had in the House. In effect if the House does not pass a Senate friendly bill they may be less than pleased with whatever the Senate passes.

8. There is massive pressure on many fronts to pass something . Many organizations that feel like mental health has never been heard at Capital Hill feel like the opportunity is now and fear walking away with nothing. There is a lot of pressure to “pick a team” and, I believe, growing recognition that picking the wrong team may in the end damage the brand of their organization. The organizations that have picked Murphy can’t in a very real and substantial way afford to lose.

9. That fear along with many of the “goodies” in the bill, like for example national standards for peer support and early screening for “mental illness”, make it more likely rather than less that these organizations, particularly since there is no alternative proposals, will support the Murphy Bill if the choice is Murphy or nothing .

10. The pressure to do something is very real and even if there is disagreement on what I don’t think there is disagreement on something. For that reason I think the strategy to simply oppose the bill as a whole and urge that since there are no alternatives that Congress do nothing is an uphill battle at best. I fear also, and I think this is already happening to some degree, that the attempt will be made to marginalize extremely valid criticism as coming from people who “want to just say no to everything.” I could be wrong but I fear I am not. The attempt will be made, has been made, by the Murphy group to say our criticism ignores real problems and leaves vulnerable people at risk. If this criticism resonates with and is bought into by legislators then we will lose.

11. The perspective we need to have legislators buy into is that Murphy’s statement of the problems and issues is narrow and inadequate, that his solutions not only solve little, but do significant harm to the people he says he is trying to help and that better, more comprehensive, more effective, and more ethical answers are possible and indeed called for.

12. I believe the most effective way to attack the bill is to focus on the individual provisions within it. Catalogue and explain the problems they create, the ways in which they are likely to be ineffective, and the reasons why better ideas need to be considered. Every provision of this bill is susceptible to real criticism and it is crucial that legislators see our opposition to this bill is not opposition to reform but a call for a real reform that would help to build a mental health system that would more closely met the needs and challenges of the people that use it.

13. There are people that I know who will say none of this matters. In their view no bill is likely to be passed that addresses many of their core concerns and the most important thing is to continue to press for fundamental reforms that they see as being essential. This is not my position but I view it as a legitimate position to take. Much will not be changed. No bill is likely right now to challenge the over-reliance on psychotropic medication endemic to the system. No bill will likely affect the unquestioned authority of the medical model although a bill that legitimizes and makes trauma informed care and real peer support integral parts of the system may begin to move things in that direction. Injustice and inequity will remain. Any bill passed will not be a solution to fundamental issues. At best it will only be the start of a process that may in time address them.

14. My view though is that it is important to be effective. Things will not just stay the same if a bill passes. Things may in real ways not change in ways I would like. But if the Murphy Bill passes, in anywhere close to its current form, things will get worse and in many ways a lot worse. Equally important it will start us down a path on the national level that is likely to lead to even more regressive legislation. I am less than eager to see Dr. Torrey become the de facto commissioner of Mental Health for the United States.

15. This is a long round about way to say the following :

The Murphy Bill may pass the House but the context in which it passes, if it does, matters.

A lot of organizations have a strong investment in the Murphy Bill passing.

Some of these organizations will find their influence, their credibility and name injured if Murphy loses. (They don’t realize how much they have already lost.)

The post by MHA will not be the last effort to quiet criticism.

There will be problems with any bill passed but there is a lot of pressure to pass something.

The input by advocates has mattered and helped to change the discussion.

If the Murphy Bill passes in anywhere close to its present form it will not only make things worse but will open the door to even more regressive legislation in the future.


Act today. Let your voice be heard.

Tennessee looks to change culture on childhood trauma

November 13, 2015 by


The story of Larry and Linda Drain

November 12, 2015 by


This is the story that made our story public

Originally posted on Hopeworks Community:

From Tennessean

Couple married 33 years separate so wife can keep insurance

The day Linda Drain put baby’s breath in her hair and said “I do,” she had no idea that government policies would tear her apart from her husband. But 33 years later, she and her husband, Larry Drain, separated so she could keep her health insurance. Six months into the full implementation of the Affordable Care Act, the Drains are among 162,000 Tennesseans who got caught in a coverage gap. Their household income is too little to qualify for a government subsidy to buy health insurance, and they live in a state not expanding Medicaid. Their predicament was caused by a series of legal, political and bureaucratic decisions that included the U.S. Supreme Court striking down part of the federal health law, but Larry Drain said he feels to blame.


View original

November 10

November 12, 2015 by


From a year ago

Originally posted on Hopeworks Community:

View original

A year ago…. A most long long year

November 12, 2015 by

A year ago Linda and I were in Nashville getting ready to hold a demonstration to  urge the governor to expand Medicaid.   Back then there was no Insure Tennessee.   We had a petition signed by over 50,000 people asking the governor to give so many poor people a chance and expand Medicaid. 

We really thought it was a no brainer. That seems so strange to say now, but we really did. We had by then been separated almost a year because of Tenn Care not being expanded and had learned what misery was about. It just seemed so wrong that the government should be the most dangerous thing in my life. For us to be “legal” meant so many bad things…. poverty, hunger, loneliness…. walking into a trap with seemingly no exit.

But it was about so much more than even that. Linda and I had been there years before when Government Bredesen was disemboweling Tenn Care and we remembered so many people and so much suffering and the people we met who wondered if it was now their turn to die… And what it felt like when we found out someone had.

I remember writing Government Bredesen and asking him not to kill my wife. I remember testifying at the state legislature and telling them Linda was a miracle, but that she was a Tenn Care miracle and without Tenn Care there was no miracle.

I remember asking a friend who Sat-in Governor Bredesen’s office for weeks and asking him why. “Someone had to say we were people too and this was wrong…” We are people too…

Shortly after we were separated I had started writing letters to Governor Haslam asking him to expand Tenn Care. I wrote him everyday for a long time and never got any kind of response. I called and was told Governor Haslam didn’t talk to his constituents about Tenn Care. I knew that if I had money, or power, or position he would have fallen all over himself to talk to me. So we had come to Nashville to talk to him. I kept remembering long ago words… “We are people too….”

We never saw the Governor but weeks later came word about Insure Tennessee and for the first time in a long time I remember hope in every part of my body. I remember the utter desolation I felt after the special session. Not just that it had lost… But how it had lost and so much seemed a lie. I don’t know the words to describe what I felt. I remember after a while my biggest hope was to stop feeling and maybe I did. Much is a blur and I am glad I don’t remember.

Insure Tennessee got another chance at the end of the regular session and I remember coming to Nashville really hoping for hope. About 900 people were in the hallway of the legislative plaza that day and the committee was over in 15 minutes. They asked no questions, made no statements. They could have mailed in their votes. I remember Tracy Foster in the hallway and her asking me if this meant she was going to die. And I remember Michelle Fardan whose daughter had died. And I remember sadness. And I knew I would have to tell Linda and I remember such sadness.

In the weeks afterwards the lieutenant governor said there would be no Insure Tennessee until there was a Republican president and the governor said basically he would be glad to fight for Insure Tennessee when he was sure it wouldn’t be such a hard fight. And I wonder how Insure will make it during a Republican presidential campaign with everyone trying to be so fiercely Republican.

A lot of voices have been raised. And they continue to be raised. Many many people believe Tennessee can be a decent place and that the death and sickness of its citizens can never be the policy of a decent place. There is a new legislative session in January. I hope…. I pray…. But I am afraid to say I know.

Our lives became more and more about making it from the beginning of the day to the end. More than once I wondered if I would. I hoped I was the same person but I wondered. Maybe I still do.

Linda suffered. The medical stuff got worse. It still gets worse and 25 miles apart was way past torture. I don’t know the name for way past desperation. But I know the place.

Finally I have moved. I think maybe so much evil and hurt and pain was in the walls of the old place. I felt washed over and drowned. I was the frog in the pot of water and the temperature was being turned up and I was dying and didn’t know it because it just seemed so normal and so always.

I have moved. It is called a miracle.

I don’t know if Linda and I will ever live together again. I just don’t know. This is not the life I would choose but it is life and it has chosen me. It is a fresh chance I never thought I would see. We are 3 miles away and that is thousands of miles less than 25.

There are many wounds. And healing will not be soon or easy. But at long last there is life.

So many people have helped. So many people have cared. I have been so blessed and am so grateful.

I am going to see Linda. Have a great day.

Thanks to each and everyone of you.

If you think the talk about registering the “mentally ill” is much ado about nothing…..

November 12, 2015 by


The most dangerous part of the Murphy Bill no one has ever heard of….

November 11, 2015 by

I have read many criticisms of the Murphy Bill but there is one  provision I don’t think I have ever heard anyone talk about.   It sounds a little innocuous until you read it and think about the implications of it.   It is a statute calling for a “report on the state of the states in mental health and substance abuse treatment.   On the face of it that seems very appropriate and something long past due.

But when you read the provision several questions come to mind. (A portion of that section of the bill is reposted below.   For the full flavor of the provision read the whole text in the bill.)

(c) Report on the state of the States in mental health and substance use treatment.—

(1) IN GENERAL.—Not later than 1 year after the date of enactment of this Act, and not less than every 2 years thereafter, the Assistant Secretary shall submit to the Congress and make available to the public a report on the state of the States in mental health and substance use treatment, including the following:

(A) A detailed report on how Federal mental health and substance use treatment funds are used in each State including:

(i) The numbers of individuals with serious mental illness or substance use disorders who are served with Federal funds.

(ii) The types of programs made available to individuals with serious mental illness or substance use disorders.

(B) A summary of best practice models in the States highlighting programs that are cost effective, provide evidence-based care, increase access to care, integrate physical, psychiatric, psychological, and behavioral medicine, and improve outcomes for individuals with mental illness or substance use disorders.

(C) A statistical report of outcome measures in each State, including—

(i) rates of suicide, suicide attempts, substance abuse, overdose, overdose deaths, emergency psychiatric hospitalizations, and emergency room boarding; and

(ii) for those with mental illness, arrests, incarcerations, victimization, homelessness, joblessness, employment, and enrollment in educational or vocational programs.

(D) Outcome measures on State-assisted outpatient treatment programs, including—

(i) rates of keeping treatment appointments and compliance with prescribed medications;

(ii) participants’ perceived effectiveness of the program;

(iii) rates of the programs helping those with serious mental illness gain control over their lives;

(iv) alcohol and drug abuse rates;

(v) incarceration and arrest rates;

(vi) violence against persons or property;

(vii) homelessness; and

(viii) total treatment costs for compliance with the program.

(E) STATE AND COUNTIES WITH ASSISTED OUTPATIENT TREATMENT PROGRAMS.—For States and counties with assisted outpatient treatment programs, the information reported under this subsection shall include a comparison of the outcomes of individuals with serious mental illness who participated in the programs versus the outcomes of individuals who did not participate but were eligible to do so by nature of their history.

(F) STATES AND COUNTIES WITHOUT AOT PROGRAMS.—For States and counties without assisted outpatient treatment programs, the information reported under this subsection shall include data on individuals with mental illness who—

(i) have a history of violence, incarceration, and arrests;

(ii) have a history of emergency psychiatric hospitalizations;

(iii) are substantially unlikely to participate in treatment on their own;

(iv) may be unable for reasons other than indigence, to provide for any of their basic needs such as food, clothing, shelter, health or safety;

(v) have a history of mental illness or condition that is likely to substantially deteriorate if the individual is not provided with timely treatment; and

(vi) due to their mental illness, have a lack of capacity to fully understand or lack judgment, or diminished capacity to make informed decisions, regarding their need for treatment, care, or supervision

What stands out about this provision?

1. This provision basically says that it is the policy of the United States Government to find justification for Assisted Outpatient Treatment and by implication for the expansion of AOT past its current level.

2. If you strip away the wordiness away the report asks for a description of AOT working and an accounting of how many people not served by AOT who could be. The report is due within a year after the act takes effect and every 2 years after that.

3. It is important to realize the significance of this. It means that while AOT provisions in the House bill may, by all accounts, not make it through the Senate bill this report basically is an end run around any vote that gives the federal government a basically permanent role in the promotion and expansion of AOT. Even if the final legislative decision is resoundingly against AOT (and I think it might be) the commitment to AOT is made through the back door. Does anyone not think Rep. Murphy and friends will not be back in a year preaching once again the expansion of AOT?

4. It is important to realize this provision rewrites the rules. It is not simply a decision to use “evidence based practices.” It is the decision by the federal government to spend the money and effort on proving a specific practice is “evidence based” and promoting that practice even though many people have extreme reservations about its effectiveness and moral standing. It is governmental overreach at its worst. It is bad government, bad choice, and a terrible precedent to set.

5. This may not be the most dangerous feature of this provision, as hard as that is to believe.

6. Look at the information the bill would require states to present.

7. No state that I am aware of has anywhere close to the level of information required by this provision. To get a sense of the task and the expense of the task consider this as you read below. The mental health system in Tennessee serves over 400,000 people. New York state I think is close to 700,000.

8. Rates of suicides, suicide attempts, overdose, overdose deaths , emergency psychiatric hospitalizations, emergency room boarding,
arrests, incarceration, victimization, homelessness, joblessness, employment, school, rates of keeping appointments are some of the data required. These are only some of the data required. Go back and read the list. It is not the requirement for data per se that is the problem. It is what that data requirement means.

9. For Tennessee (and I think virtually every other state I believe) it would mean they would need to develop a data base of virtually every person in the state with a mental health diagnosis with real time tracking of significant events in his life. In effect, the “mentally ill” would need to be registered so that the state could prove to the federal government that funds are being spent effectively.

10. It is hard to know what to begin screaming about first. A country that will not register guns thinks it is appropriate, needed, and indeed good business to register those with psychiatric labels. And all of this in the name of evidence based practice. Who is really mad?

This should fill you with both a sense of dread and a powerful sense of rage. I promise you your representatives have never closely looked or questioned what this provision means or what its ultimate dangers are. Please speak loudly and share this post with others.

The danger is real. Please act.

The shortest possible course in mental health reform

November 9, 2015 by

Ask these questions about any mental health reform proposal you hear:

1.  Does it do no harm?
2.  Does it increase access to helpful things? 
3.  Does it increase things that matter?  Does it make help more helpful?
4.  Does it treat distress,  pain,  and misery as more than a matter of mental  health?   Does it address the conditions of misery as well as the experience of misery? Does it treat trauma, and injury as serious?   Does it assume the dignity and worth of the people it serves as a starting point?
5.  Does it promote honesty as a foundational principle of the mental health system?
6.  Who does this proposal leave in charge of the people served by the system?
7.  If the person you loved more than anyone else needed help would a system based on these reforms be more or less likely to help them?

Is the Murphy Bill just another repeal of the ACA

November 8, 2015 by

The Republicans in the House of Representatives have repealed the ACA over 50 times.   They didn’t do it because it mattered. They did it because they could.   They had the numbers.   It didn’t matter what the Democrats said.   It didn’t change anything then and still hasn’t. It confirmed for many people how much time the House spent doing things that didn’t matter simply because they could.

The Murphy Bill made it out of the subcommittee not because of any great consensus.   It made it out because it could.   There were more Republicans than Democrats and if that was the way they wanted to win it was a dead sure certainty they would.   The Democrats who felt they were never heard in the development of the bill and  tried to make sure they were heard in the markup.   I think 37 amendments were proposed.   Maybe 1 was agreed to. I am not sure. The Republicans won because they could.

Rep. Pallone was very eloquent.   “Why pass a bill that won’t matter?”   If you don’t address the concerns likely to be voiced in the Senate or in the White House what have you really done?

The challenge facing the Republicans is not to pass the Murphy Bill.   Barring something really strange they can if they want to.   If they want a bill they can probably have a bill.   The real issue is in passing that bill they do more than simply repeal the ACA.

Their real challenge is how not to listen to people they don’t want to listen to say things they don’t want to hear and have it not matter. Rep. Upton has said he hopes Democratic concerns will be listened to before the bill goes to the full committee. He can make them be listened to. He schedules both when the bill goes to the committee and probably also when it would go to the full House.

Contact him again. Tell him you want more than partisanship. Tell him you want all voices to be heard and all voices to matter. Tell him you want your voice to matter.

Tell him we have a broken system that needs change and repealing the ACA one more time is just not good enough.

A last Murphy piece

November 5, 2015 by

Barring major events or incredible news this is my last Murphy post I hope for a long time.   I realized how much time and energy I had put into this late last night.   It had captured me to an extent I had not realized and I  need to go visit the rest of my life.

My summary of the mark-up is simple:

Murphy said it was not about Republicans and Democrats.

The mark-up showed that was all it was about.

The only question is can a bill about Republicans and Democrats on such an important subject become a law given the way the Senate normally functions and the current resident of the White House.

I don’t think so but I honestly don’t know.

I heard many of the points I have heard from countless advocates in the points the Democrats made.   You mattered.  Keep up the good work.


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