A question I dont want to ask.

January 30, 2016 by

Everybody has things they hope are not true.  Everybody has questions they don’t want to ask.  This is mine.

Before I start I want to say that I really don’t know the answer, but my hope is that some people reading this post may.

Is male violence, manipulation, and abuse of females a  problem in this movement?

In the last couple of weeks I have talked to several people who say it is.  One person in particular who I have good reason to trust told a harrowing tale and essentially said her involvement in this movement in a very real sense put her life in danger.

It is wrong.  Wrong.  Wrong.  One time is one time too many.  If you have been put in danger or know people who have been put in danger I hope you will speak up.

To know this and ignore it, to know this and rationalize it, to know this and say “well it isn’t that bad of a problem” forfeit any moral standing this movement has.

Maybe I am over-reacting.  I certainly hope so and no one will hurt my feelings by saying so.

But the question still remains.  Is it a problem and if it is should it not be time to address it and confront it where ever we see it?

The fight for Insure Tennessee…. One perspective

January 29, 2016 by

Many thanks to Justin Jones.  Much of today has been conversation with him and much of what follows below has to do with questions he asked or issues he raised.  He made it a good day.

 

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  1. Upwards of 280,000 people in Tennessee lack any basic health insurance.  Basically they are just too poor to qualify for anything.
  2. The moral, financial, political, social and personal impacts of this in Tennessee are immense.
  3. People get sick who with access to medical care would not get sick.  People who should not have to suffer do.  Individuals, families, and communities are all impacted.  Live are ruined simply because people are poor or they don’t fit into one of the categories that give people access to health care.  And people die.  People die tragically, unnecessarily and unjustly.  Some studies have indicated that 2-4 people a day in Tennessee die from lack of insurance, from lack of access to even the most basic care.
  4. Insure Tennessee was Governor Haslam’s plan to deal with the issue.  It promised care to people, financial help to struggling hospitals, jobs for Tennesseans, Tennessee tax dollars back in Tennessee at no cost to Tennesssee.  All costs would be born by the federal government and the Tennessee Hospital Association.
  5. Virtually everybody in the state was in favor of the plan.  The sickness and death of a portion of its population should never be the policy of a decent state.  People know it.  I know it.  You know it.  Virtually every newspaper in the state came out in favor of it.  Every civic organization, every business organization, every health organization….every, every everything came out in favor of it.  Polls said the Tennessee people favored it by a large margin.
  6. Governor Haslam presented in a special session. It didn’t just lose.  It was slaughtered.
  7. A second try later in the session gave the same result.
  8. And so the wait began for the second season of Insure Tennessee
The second season of Insure Tennessee is here.
Senator Ramsey has notified everyone that Insure Tennessee is dead.  In his eyes dead and buried.  He thinks that if we get a Republican president they might give Tennessee a block grant to develop their own Medicaid program independent of any federal rules or expectations.  And he is willing to wait.  No matter how unlikely it is he is willing to wait.  And most importantly regardless of the cost to those who suffer and badly need access to medical care he is willing to wait.
The legislature I think really does want it to go away. It is election year.  Nobody wants to face a primary challenger accusing them of being soft on “Obamacare.”
Governor Haslam has given them all a free pass.  He thinks it is a ‘good idea” still he says, but it would be a hard fight with no assurance of victory and he has decided not to fight, not to try.  Political convenience wins out.
Nobody has to worry about where they stand because no one is going to ask them to stand.
And now the Tennessee Hospital Association has given Governor Haslam a free pass.  They are still for it and plan a big push to get it adopted.  They are they say going to spend $400,000……Next year.  5 days before his state of the state address they tell him not to worry.  They aren’t going to raise a fuss.  Everyone is safe…..
Except everyone is not safe.  Tomorrow 2 more Tennesseans will die from lack of insurance.  Two more will follow the next day.  Who knows how many people will suffer who shouldn’t have to?  Who knows how many lives will be touched in one way or another?
The people who should really count are not safe.  Not one bit safe.
Smart money says be realistic.  Insure Tennessee will not happen this year.  The cards are stacked against it.  Don’t get your hopes up.  The election is just in the way this year.  Next year will be a better year.
So what do you say?
I am one of the 280,000 and much of my perspective is borne of that.  My hope for Bill Haslam (and for that matter every legislator) is not that they win the battle of Insure Tennessee.  My expectation is that they will fight the battle of Insure Tennessee.
I care about what Bill Haslam says to the legislature.  I care more about what he says to me.
I understand that politicians don’t want to risk their futures on an uncertain cause.  I risk my future every day.  They worry about their safety.  I wish they worried about mine.
They worry about the right times to deal with things.  Moral choices have no season I think.  Justice deferred is not justice.
I am 64 years old and have seen much change in my life time.  Much of it was change not supposed to happen according to the smart money.  The strong, in the end, lose to the persistent.  Battles are not wars.
The question before us is not simply whether or not Insure Tennessee will win this year.  It might not.  In the end we only control what we do and can only try with others.  The question before is given the situation is  how will the situation define us and how will it define Tennessee?  It is not simply what are we to do.  It is also who are we to be.  I have been without insurance for about 8 years now and until I lost it I never really  realized what it meant to try to live without it.  I hope I will survive another year if I have to.  But I hope never to survive a day where what I do is dictated by what suits the ambitions of those around me, where political interests substitute for moral reality, where the right thing is subject to the demands of convenience.
This  challenge is as much about the fight before us as it is the victory in any one of its battles.  I think in all we do we need to strive to insure justice.  It starts with I matter, you matter…..everyone matters and no label or term, no political agenda or ambition that implies otherwise should ever be tolerated, believed or left unchallenged.
When faced with the odds against you and faced with gross injustice before you the challenge is not whether or not you win.  The challenge is whether or not you choose to fight.
This is a challenge I think we should take.  I hope it is a challenge you will take.  Speak loudly and often.  Your voice matters.  The legislature in the end will do what it does.  Governors do what governors do.  Smart people may do what the smart money dictates.  But please let none of this happen in our absence, in our quiet and with our acquiescence.
 It is time.  It is the right time.  Insure Tennessee now.

The capacity for advocacy

January 27, 2016 by

To many efforts fail not because of the action proposed or what people want to accomplish.  They fail because organizations assume they have the capacity for action rather than realizing that capacity must be developed and grown.  Capacity must be planted and nurtured as if a flower worthy of bloom.  Many great ideas die from the inability to do, from the lack of capacity for effective action.  The development of capacity is one of our prime goals.  One definition of capacity would be to have enough people to act who believe that things can get better if their ask, their cause becomes reality, who believe that what they do makes a difference in service of that goal, who believes they have the ability, knowledge or skill to do what matters, who feel supported in their efforts and who feel like the whole effort has meaning and purpose…”

-from an earlier post on advocacy

This post might be considered a companion piece to an earlier post on “building a movement”.  In the next couple of weeks there will be a series of posts that in one way or another deal with advocacy.  We are facing times of challenge and test.  Like never before it is important that the people who want to make a difference with issues surrounding mental health are able to do so.  I claim no special knowledge or wisdom on the subject.  Much of what I think I know comes simply from watching and listening to people who I have been lucky enough to know and watch who have been able to be effective advocates.

More than one person has described much of mental health advocacy as a circular firing squad.  The goal is to straighten the line and hit targets that matter.

Advocacy doesn’t just happen.  It is more than passion and moral fervor.  It is more than wanting things to be different and committing to trying to make that difference happen.  For the most part advocacy is always a competitive sport.  Someone always loses.  There are many passionate and committed people who lost.  Despite their efforts change never happens.  They never make the difference they hoped to make.

Language matters.  The important thing is not simply how well you say things.  How well things are heard is more important and not the same thing.  You must use language that resonates with the people you are talking to.  Tying your message to values that are important to the person you are talking to makes a difference.  If your opponent “owns” important values it is hard to make the impact you want.  For example…. No politician will ever say he doesn’t want to help the “mentally ill.”  Tim Murphy tried to identify his bill with “helping the mentally ill” and any  opposition to him as just not caring and opposing him for their own selfish reason.  It is important not to let Murphy make his proposals the vehicle for core values of legislators but a proposal that should be evaluated like all proposals on how well it will work and the consequences of adopting it.  Basically something like…..”Everybody cares but lets look and see what will really work and what will really help…”

Sometimes passionate and committed people say things in ways not very likely to be heard.  If your message is only likely to be agreed to by people who already agree with you things may not go well.  You have one of two options.  Work to change what people are likely to hear knowing that may be a longer term task and in the short run you may not win very many battles or deliver your message in terms likely to be heard.

Language matters.  Speak with the intention to be heard.

Past language how do advocates develop the ability to be effective in their efforts?  How does a movement or an organization increase its capacity for effective action?  How do ordinary people come to make a difference?

Encourage- people must come to believe things can get better.  People don’t tend to get involved in things that have, in their eyes, have little hope of success.  This is perhaps the biggest problem.  We live in a cultural context that paints so many problems as inevitable and not amenable to change.

Empower- you must convince people that what they do makes a difference.  Again this is a major problem.  Sometimes people believe something might be able to be changed they just believe nothing they do is likely to help make it happen.

Educate- people must be convinced that not only can they make a difference but that either they know how to make a difference or that they can learn how to make a difference.  They can learn, they can be educated, they can develop the skills that make a difference in them making a difference.

Support-  people must know that they will be supported and encouraged in their efforts to make a difference.  That means the people around them care and can be counted upon.

Confirm- people must experience confirmation.  They need to feel like things are getting better and still can get better, they indeed can make a difference, they know how and are learning even more ways to make a difference, and that they matter to the people with them and those people will support and encourage them regardless of the difficulty of the circumstances and how they are doing.

Movements that make a difference do these things.  Everything is a matter of degree and perhaps sometimes they do them better than others.  Making a difference is so much more than the motivation to make a difference.  It is a capacity for action that must be grown, refined and expanded.

It is the way to be a difference that makes a difference.

On building a movement…..

January 26, 2016 by

Do we have a movement?  I hear people talk about “the movement” all the time.  Is “the movement” reality or wishful thinking?

Here is what I think a movement needs in order to prosper, grow and make anywhere close to the impact it hopes to make.

None of these things need to be a result of some kind of formal process, but the extent to which they exist and operate, I think, at least in part, define the chances that the movement will be persist and make progress towards the goals it holds dear.  None of these things are either or.  They are all a matter of degree and they may ebb and flow depending on the circumstances.  As you read these consider “the movement.”

    1.  There should be a consensus about the ethics of being a movement.  There should be an ethics of what it means to be part of the same effort that includes first and foremost how we are to treat each other.  Movements that lack that become cannibalistic and dissolve into competing factions that over time come to believe that the people who supposedly are about same thing you are about,  the people who care about addressing the issues you care about are in fact the real enemy.  Movements that cannot tolerate disagreement without attacking those disagreeing usually end up with some kind of demand that its followers hold to some kind of true belief.  In the end the movement implodes and becomes irrelevant to any impact on the goals it was originally formed around.  On a scale of 1-10 with 1 being not at all and 10 being a major strength where are we.  The old phrase I have heard a thousand times still rings true.  How can people who cant stand each other stand for anything that really matters??
    2. The movement should be about something important enough that the people in it place their conflicts and disagreements with others below it.  The most important thing about any movement is what connects people.  What brings them together?  There should be a momentum towards cohesion.  On a scale of 1-10 where are we?
    3. People should feel like the movement “has something for them.”  Their should be some sense that their involvement, their identity as part of the movement means something to them.  It isn’t what the movement demands or takes from their lives but what it adds.  The  movement should represent an opportunity they don’t want to miss. On a scale of 1-10 where do we stand?
    4. People should feel like they have something to give to the movement that matters.  They must feel like they contribute, that what they do matters.  They need to feel more than spectators.  They must feel like the movement is better for them being there.  On a scale of 1-10 where do we stand?

People should feel like someone cares.  They must feel like others in the movement care for them as people, as individuals and that they can get support when needed, recognition when they deserve it and coaching and guidance when they ask for it.  They should feel, even if the movement itself is in some way a dangerous undertaking, safe as members of that movement.  On a scale of 1-10 where do we stand?

 

The movement should have a set of shared principles, values, and ideas that define the identity of that movement.  Simply it must have a reason for being that those in the movement buy into emotionally, cognitively, and behaviorally.  On a scale of 1-10 where are we?

  1. The movement should have a plan.  It should have something it is doing to accomplish something that it thinks is worth doing.  Otherwise it dissolves into complaints and bitterness.  It should have both a focus in goals and a focus in how to achieve those goals.  On a scale of 1-10 where are we?
  2. The movement should have a way to measure how it is doing.  If there is not a clearly shared measure of what constitutes success it is hard to persist through hard times.  It is important to know the difference between battles and wars and know that battles lost do not mean wars lost.  On a scale of 1-10 where are we.
  3. The movement should have a way to welcome, educate, and involve new people into it.  If it doesn’t it tends to die from lack of energy.  Few people come to believe they are doing all the work and it eventually just gets very fatiguing and people back off for their own preservation.  On a scale of 1-10 where are we?
  4. The movement should have a sense of its natural and possible allies.  Movements live and die often based on what they do in coalition with others that do not accept or value exactly what they value.  More people have more impact.  More points of concern have more impact.   A wider base of support is better than a smaller base of support.  Few groups will have the impact they desire without being in coalition with someone.  All movements have “deal breakers”, things that they feel make them unable to be in coalition with other groups or interests.  The nature of those “deal breakers” often define the stability of any coalition we may have with others.  On a scale of 1-10 where are we?
  5. A movement should have the ability to change when the circumstances that gave birth to it have in some way changed.  It is a narrow balance between preserving the historical truths that have given birth to you and changing to meet the current realities you are struggling with.  On a scale of 1-10 where are we?

What do you think?   Some of these things are obviously more important that others but taken together do they not say something about us?   What are our strengths?  What are our weaknesses?  What do we need to grow to meet the challenges we face and accomplish those things we find important?  Are we a movement?  What do you think we should do now?

This is far more than an academic question.  There will probably be a mental health reform bill of some kind come out of Congress this year.  What that bill specifically says is no where close to a closed discussion.  We have a chance to make a difference there.  We are in the midst of a presidential campaign where many of the leading candidates have essentially dismissed us loons and crazies.  If we vote our votes will matter and make a difference there.  There is a movement in this country to lay gun violence at the feet of the “mentally ill”.  We can make a difference there.  The FDA is getting ready to say that electroshock does not present a danger to those that are shocked.  We can make a difference there.  Thousands…..no probably millions….of people with mental health diagnoses either have no access to medical care at all.  We can make a difference there.  The jails are filled with people with mental health issues who are being traumatized and retraumatized and hurt in ways that will impact them for the rest of their lives.  We can make a difference there.  Way too many people in the midst of emotional crisis are deescalated by being shot with bullets by the police.  We can make a difference there.

The list above is no where close to being a total list.  The needs are extreme.  We cant probably make a difference in everything the way we would like to.  We may not even be able to make a difference in anything to the degree we would want to.  But if we have our stuff together to a functional level we can make a difference.  We can and will make things better for many, many people.

But you tell me.  What are the prospects, what are the possibilities.  On a scale of 1-10 will we make a difference?

Get into politics like your life depends on it…. It does

January 25, 2016 by

Food for thought. Important times ahead

Hopeworks Community

Get into politics like your life depends on it….. It does.  ( I think that is a quote from disability advocate Justin Dart.)

And it does. It really does.

I listened to Donald Trump make fun of a newspaper reporter with a physical disability because the reporter had criticized him. I have listened to him make comment after comment that not that long ago would have been labeled as hate speech and been political suicide applauded and hailed by crowds as being the voice of truth, the voice of real America, and their choice for president. I have listened to Republicans trying to defeat him by trying to out-Trump him.

The biggest problem is not just Trump, or Carson or Rubio or Cruz. The biggest problem is that they have obviously touched the emotions of so many people. They have made hate respectable again. They have made rage, prejudice, and violence…

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The state of the state

January 25, 2016 by

Sometime next week Tennessee governor Bill Haslam will make his annual state of the state address.

His address will be about far more than the state of the state.

It will be a lot about him.  One of the biggest productions of his stint as governor was his introduction of Insure Tennessee, his effort to insure 280,000 Tennesseans not eligible for the insurance subsidies of the ACA and not eligible for Tenn Care.  He worked really hard to make it make good sense.  He tried to extremely hard to explain to people who had a phobic reaction to the term Obamacare that it was not Obamacare.  He tried hard and was successful in making a deal with the federal government that would not cost Tennessee a penny and that would bring Tennessee tax dollars back to Tennessee and provide an economic boon more significant than the Volkswagon plant.  He did all these things.

He thought good sense mattered and it didnt.  Fear did matter and no one wanted to take a chance on facing a primary challenge and being targeted as soft on Obamacare.  People wanted it to go away and it did.  In one of the most amazing things I have ever seen in my entire life a core proposal from a sitting governor with a hugely favorable rating was massacred by his own party.  Not only did it not win.  It didnt even win a vote on the floor.

He threw up his hands and said their was nothing he could do.  He talked about educating legislators more as if the problem was that they did not know what they were voting on and seemed unaware that the problem was that they did know what they were voting on.  In the end it was all about politics and little else.

The problem was not that he lost.  The problem was that he thought he couldnt fight and 280,000 people who depended on him, 280,000 people who thought someone cared and someone thought justice and fairness were important were left holding the bag.

He still says there is no point in trying.  He doesnt think he can make a difference.  He doesnt understand that by doing this he has put a bulls eye on every one of his legislative proposals.  Bullies are seldom content with one victory.  Any proposal that runs counter to the legislature now has an asterisk on it.  **Please pass this bill but only if you really want to.***  He blinked and backed down on Insure Tennessee and in the process not only the bill but lost a lot of his credibility and his leverage to move the state forward in a way that he wants.

He says that he still thinks Insure Tennessee is a good idea but without action does that even really matter.  Is it anything more than trying to put the blame somewhere else?

My problem is not that Insure Tennessee lost or even that it may well lose this time.  My problem is that there was no fight.  People may say he couldnt have won and was only being realistic.  Politicians who are willing to sacrifice their principles on the altar of realism are a dime a dozen.

It did matter.  It still does.  I am one of the 280,000 people and it would have mattered to me and it would have said more about the state of the state than all the speeches he will ever give.

He will talk next week.  Whether he knows it or not he is talking as much about himself as he is about Tennessee.  Will he even mention Insure Tennessee?  I dont know.  Many people hope he will.  Many people think he wont.

I hope he knows that he is talking to far more than legislators.  I hope he knows he is talking to me, talking to you….talking to 280,000 who are far more interested in whether or not he will ever talk for them.

Governor Haslam Ron Ramsey is a terrible governor.  I did not vote for him.  I voted for you.

It is time to be the Governor.  Please.  Please be the Governor.

Insure Tennessee.

NOW!!!

 

De-escalating to death

January 25, 2016 by

Denver Jail Death Puts New Light On Common Restraint Tactic – http://huff.to/1SdMLHg

A gift from friends…..

January 24, 2016 by

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On the dysfunctional communication of psychiatric labeling

January 24, 2016 by

Adapted from an earlier post….

Have you ever had anybody label you as lazy, deceitful, or some other negative personality trait and then dismiss your behavior as a symptom of the label they have placed on you? Normally you feel unfairly treated, blamed or somehow victimized. You feel unfairly judged and not listened to or valued. Normally the person labeling you feels like they are better than you and that act of labeling impacts your relationship in very real ways.

There is tons of research that say this type of communication leads to real problems in marriages and in other important relationships. Labeling leads to the other party withdrawing and putting up a stone wall. The labeler pursues and points to the withdrawal as sign that their label was correct and legitimate. At its worse the whole thing dissolves into mutual contempt.

I had a friend who was diagnosed with bipolar disorder who told me her greatest wish was that her family not see her feelings as a symptom of her “illness.” “Cant I just be mad and it just be about me…. Does everything have to be about bipolar.” I have met many people who feel the same. The great lie of psychiatric diagnosis is that life is a symptom of that illness.

I have another friend who believes that treatment works and that it works a great percentage of the time. He can point to the research showing so and makes a very convincing case. My question is always the same. If it works so well why do so many people have such trouble becoming involved in it or maintaining their involvement in it?

The answer is, I believe, what the system says to people about them. Often with not even intending to it tells them that they are flawed in fundamental ways and that they need to accept that, be realistic and not expect too much out of life.

I have another friend who according to psychiatric diagnosis is impossible. She spent 16 years in a state institution. She knew brutality on an everyday basis. The doctors told her that her problem was that she was a schizophrenic. She now owns her own home, drives and does a million everyday things that she was told she would never be able to do. Most importantly she does not define herself by the brutality done to her, but by the opportunities in life ahead of her.

Living in the psychiatric system for too many is too often like being in a bad marriage. They find themselves labeled, blamed, scapegoated and told they are deficient and will never change. Frequently they are told the problem is that they really dont want to change.

No wonder the divorce rate is so high.

The meaning of survivor….

January 24, 2016 by

A friend told me that she thought the term “psychiatric survivor” was widely misunderstood, that it was much more than a political label and that people who self identified that way were normally unfairly marginalized and dismissed as extremists who had little of value to say. “Psychiatric survivors” were she said unfairly dismissed as people who were against everything and unwilling to work with anyone who did not agree with them about everything.

She said it was more about identity than ideology and we talked for a while that night what it meant for her…. A couple of nights later I was part of a phone conversation with Sarah Knutson, Marty Felker, and Sharon Cretsinger. The same subject came up and some of the same points were made. Much of the rest of this post springs from that conversation.

I have a friend who is a remarkably good person. Life has been lucky for him. He has not known distress in the same way so many other people have.

We were talking about recovery and I read him part of something I had wrote a long time ago. “…. Do good things every day that build your strength and capability. Try to anticipate and prevent any problems you can. Cope with what you can’t prevent. Survive what you can’t cope with or control …”

He wondered why for so many people life was so hard and seemed to think people should just be more focused and try harder. I told him that he didn’t know very much about survival.

For some people life is a lot about survival. It is not about education or skills although that may be very important. It is not about motivation or support although that may be very important. As much as anything else it is about tragedy. Bad things happen to people who don’t cause those bad things to happen. Bad things happen that people have little or no control over. For many people bad things impact what they think of themselves, of others, of life and many other things.

Sometimes life is not simply changing life events but fighting like hell to survive the assault of life events on you. For some people survival is about saving themselves in circumstances that conspire to make that seem impossible. It is about trying to survive with some degree of integrity and capability the injustices that seem to determine the parameters of life.

For some people mental health issues and their exposure to the mental health system is about survival more than anything else.

Distress and difficulty are very real. Many things may seem out of control or very difficult. The “treatment” they are offered may add to injury. The short term side effects of many drugs and their long term consequences may be life altering and impossible to live with. Even if you can live with them they often don’t make it easier to live. For many people they don’t help nearly as well as advertised or hoped for. For many people the experience of inpatient treatment is demeaning and traumatic. They are asked to accept a definition of themselves that says life will never be better, that their “disease” will be chronic and life long. They are told they can never have, will never have what others have. And they are told to be “realistic” and accept a life always limited.

But the issue of survival goes far past these things. It is not just the experience of distress or treatments that may make things worse that must be survived but the social experience of what all that means. The labels attached to you matter. They have impact. Discrimination and prejudice are real. Psychiatric diagnosis is not a simple morally neutral medical act. It consigns you to a social group and standing. If you belong to that group you are more likely than other people to:

Be poor…
Be unemployed…
Face issues of homelessness…
Lack access to the help you need or want….
Have a history of lousy medical care…..
Die considerably earlier than the larger population….
Have your civil rights be abridged or denied….
Plus many other things…..

To survive what it means to be “mentally ill” in this society with any kind of integrity, belief in themselves, hope for the future, and recognition of their own strengths and abilities requires a daily courage and commitment that even survivors don’t always know they have or give themselves credit for.

“Psychiatric survivors ” are often dismissed as people chronically complaining about what the system has done to them. It is so much more than that. It is about courage and victory and making real better life. It is about, in a very real sense something good happening.

Many people know what it means for life to be about survival. In tragedy sometimes we find the capacity to reach out to others and to support and be supported and to find out even in the worst of circumstances more is possible, that we can survive and find better life.

(Psychiatric survivor is also a political term but that is the subject for another post.)

“Talking Wheelchair Blues”

January 19, 2016 by

My southern heritage…

January 18, 2016 by

This is post after the Charleston shootings.   It seems to fit the day…

I spent a lot of time as a child in Charleston.   My dad was in the Air Force, but my mother was from Charleston and it was as much home as anywhere else.   I have listened to people talk about their  “southern heritage” and how taking down the Confederate flag threatens that heritage.   I also had a southern heritage…

I remember when I was 6 or 7 going to a store with my mom in Charleston.   I remember 3 doors:  white men,  white women,  and colored.   I remember asking her why.   I could not imagine her being mean to anyone.   She stammered for a minute.   “It is just the way things are….  ”   Those doors were part of my Southern heritage.

I remember my uncle telling me how bad blacks smelled and how lazy they were with his black maid working in the next room. The word he used started with an N.   That conversation and that word was part of my Southern heritage.

I remember being told when the civil rights workers in Mississippi were being searched for being told to be happy.    “They were getting what they deserved.”   That was part of my Southern heritage.

I lived on an Air Force Base in Colorado and my next door neighbor and best friend was black.   I remember the day I realized that if we both lived in Charleston we could not be friends and he couldn’t come to my house any more.   That was part of my Southern heritage.

I remember the day my uncle laughed and clapped and said God had answered his prayers.   Martin Luther King had been shot.   That was part of my Southern heritage.

I remember church after church after church where all God’s people were white and no one ever talked about black people other than to be glad they weren’t there.   That was part of my Southern heritage.

I remember the first time I  was told the Bible mandated the inferiority of black people. That was part of my Southern heritage.

I remember in a high school class shortly after we moved to Tennessee listening as the senior class president proclaimed loudly “I don’t even like chocolate ice cream… I don’t like nothing black…”  That was part of my Southern heritage.

I remember when a Klu Klux Klan newspaper was brought to my high school by someone who got it from his parents and how fervently it was discussed and applauded.   That was part of my Southern heritage.

I have a Southern heritage and the flag has been symbolic but not of bravery or virtue or any historical truth.   It was about the systematic,  deliberate  and horrible attempt to enslave,  brutalize and murder a people… An attempt to cover that crime up as cultural diversity and to make excuses for the fact that freedom, opportunity and justice have been dependent on your skin color.

A couple of days after Charleston a black church was burnt in Knoxville.  Linda and I were there today and listened to people talk about the need for a new heritage to be formed and the journey ahead and the transformative power of love and forgiveness taught in Charleston.

A flag has been brought down.  Perhaps a door has been opened.   There is another place to be, a better place for all,  a place of welcome and opportunity. The last days, the last weeks have been some steps.

I liked a phrase I heard there.   “If it happens to you it happens to me…”

Maybe a start… Maybe

Against violence…. Martin Luther King day

January 17, 2016 by

Tomorrow is Martin Luther King Day.   This post is in honor of that day….

I am against violence…

I am against the violence of poverty.   I am against the assault on the soul,  on the mind, on the body of people who know life is about doing without what they need.  I am against the terror of those who must live with their children’s hunger. I am against the fear of  those who must worry if they can pay the rent this month.   I am against the violence of culture which dismisses the poor as lazy and getting what they deserve while the gap between the rich and poor gets greater and greater.   

I am against the violence of health care injustice. I am against people dying for lack of medical care simply because they are poor. I am against the unnecessary suffering of those who suffer from illness and sickness we can cure or treat simply because we lack the political will or integrity to make that care available to those who need it.

I am against the violence of politicians who proclaim hatred and fear as common sense and civic virtue. I am against the violence of the politics of division and suspicion. I am against the violence of politicians who in the service of their own personal ambitions tell us the solution to our problems is in who we need to attack and the walls we build to separate us from each other.

I am against the violence of hunger in a land of life, liberty and the pursuit of happiness. I am against the violence of politicians who would protect us from the danger of poor people eating too much.

I am against the violence of homelessness. I am against the violence of believing people bring it on themselves and that homelessness is an index of measure of someone’s character.

I am against the violence of a system that tells us that the verdict of our life is in the labels placed on us. I am against a system that our life is but a symptom of my deficiencies and that the things that are important to me are of less value or importance than the same things are for other people.

I am against the violence of those who would treat others as less because of their race, their faith, their gender or living situation. They are a cancer on this planet.

I am against the violence of pharmaceutical companies who would have us believe that the pursuit of their bottom lines are motivated by a desire for scientific truth.

I am against the violence of a society in which we routinely shoot our neighbors and friends at a rate unheard of in other developed countries and then explain it away as the threat of the “mentally ill.”

I am against the violence of those who would justify the death or injury of others as a duty given to them by God.

I am against the violence of those believe that maintaining the health of this planet must come without economic inconvenience. I am against the violence of those who ignore the facts in front of them or try to explain them away in the service of political ideology or economic privilege.

The lesson of Martin Luther King is that you matter and I matter. The lesson of Martin Luther King is that justice is possible and the pursuit of it matters all the time.

I hope tomorrow is a good day for you and you will stand for so many who are unheard and unnoticed. You matter. I matter. We matter. Let’s make tomorrow matter.

God bless!

Murphy Math

January 16, 2016 by

Murphy just doesn’t add up.   Below are a couple of older posts on the Murphy math.   His proposals don’t even succeed on their own terms.

https://hopeworkscommunity.wordpress.com/2014/08/27/murphys-free-ride/

Murphys free ride….

Without intending to or even being aware we are doing it we have given the Murphy Bill a free ride on an extremely critical core question:  leaving aside for a moment all questions of values and moral issues the bill touches upon– can it work.  Are the solutions they propose of a magnitude and type likely to effectively address the issues they cite on anywhere close to the level they say those issues need to be dealt with?  The answer I believe is resoundly no.  The Murphy Bill is a fraud.  It is a bridge in Brooklyn or swamp land in Arizona being sold to people desperate for a solution.

The argument on Murphy in one sense has been very simple. It has been an arguments about morals and doing the right thing. Murphy, Torrey, and Jaffe have framed their bill as a valiant uphill battle against overwhelming odds to do the right thing for people who cant help themselves and need help very badly. The battle against the Murphy Bill has also been about doing the right thing: respecting people’s rights to make their own choice in life and saving people from the specter of coercive treatment. What you conclude depends on what you think the right thing is.

But what if it was about more than that. What if it was about what works, what really solves problems and makes lives better. What if it was just a discussion based on honesty and not protecting or advancing turf or power or status or whatever. What if the question was, “Does the vehicle you have designed actually work. Can it do what you say it does? Can it do what needs to be done?

A major Murphy issue is the travesty of “mental illness” being criminalized… I think he is right. It is an atrocity. Something close to 300,000 or so people are in jails or prisons who have some sort of mental health issues or diagnosis severely impacting their life. His solution is two fold if I understand him correctly. He touts assisted outpatient treatment (aot) as a major part of the solution. He says the problem is that they dont know they have a mental illness and they need to go to treatment rather they want to or not. If that happens not nearly so many people with mental illness will commit crimes or be put in jail or so he seems to believe. Before anyone makes a remark about the simple minded and naive faith he has in the efficacy of outpatient treatment lets look at a couple of other variables.

Remember the number 300,000. That is an important number. The New York state mental health system for example serves about 675,000 people. A little more than twice as many as are in prison. The New York state mental health system is also the holy site of AOT. It is the largest program and according to the people who believe in AOT what they believe is the model for how it should be done. But this largest, best done model of AOT only serves about 2000 people– about 1/3 of 1%. It spends about $32,000,000 a year. If you assume that indeed New York is indeed how it should be done and it really AOT at its optimum and should serve as the model of how AOT can keep people out of jail you are looking at a yearly cost of $4,800,000,000 (billion with a b) if you use AOT on all 300,000 or so residents of our correctional system to save them from themselves. Obviously you may not have to use AOT on 100% of the people…. Say you only needed to do it on 10% of the correctional population. The cost then would be $960,000,000 (million with an m). What happens to the idea of AOT to “cost effective and saving money.” What states could even begin to pay for their portions of this bill. The federal grants attached to the law dont even begin to foot the bill. That money must come from somewhere and if it was the law then money would likely have to be taken from community services which would create more people who get into trouble who need AOT which needs more money which creates more people in trouble etc. etc. etc.

Obviously I have created a straw man and the truth is much more complex than I described it here. But two important points need to be considered. To blindly assume a program that serves 1/3 of 1% of a population in its biggest incarnation can be increased to serve about 50% of that population is a really big assumption. Secondly the question of cost is a real one with real impacts. Buying a car may be a real bargain. Buying a thousand cars at the same price may not be the same bargain.

Making AOT in New York the measure of all things as Murphy, Torrey, and Jaffe basically do is also a strawman. AOT is not a new thing. It is in 44 states. In most of those states it lays unused, and basically irrelevant to the operation of the wider system.

On many different levels (ignoring the very real moral questions) AOT is simply not what it is advertised to be. The biggest reason is that the problem is not what it says it is. There are not anosognosiacs running around unattended everywhere. Again if you accept the Murphy notions as truth and do the math you just get nonsense. If about 4% of the population is seriously mentally ill and about 50% of them have anosognosia as Murphy claims then about 370,000 people in New York have anosognosia. AOT in New York deals with 2000 (granting the rather large assumption that all of them have anosognosia). There are 368000 anosognosiacs missing. Come on. Does anyone really drink this kool aid?

AOT (even if you believe in it and worship it and think it is the best thing since sliced bread) is a pop-gun trying to bring down thousands of herds of elephants. It just doesnt deliver. Way too little bang for way too many bucks.
Whatever it is “a fundamental reform of a broken system” is not it.

Murphy’s other fundamental reform of a broken system is psychiatric hospitalizations. It is a little like a tank commander saying the problem with the army is that there is not enough horse calvary. The time is past. The ship is sailed.

If you listen to Murphy talk sometimes it seems like what he is saying is illegal, criminal activity is due to a defiency in psychiatric hospitalization. He speaks romantically about the thrill of “evidence based practices” and then touts perhaps the least evidence based practice in the world. Perhaps there is a place for psychiatric hospitals for crisis stabilization (although many people would even disagree with that) but that is in no way a fundamental reform of a broken system.

And again remember the 300000 figure. A hospital bed in Tennessee costs can depending on the level of care cost as much as $350,000 a year. Care to guess how many new beds they are going to open to serve the 300,000 (even if there is no IMD exclusion). Try zero.

The claims of the Murphy Bill are not examined nearly close enough. Too often we lose ourselves in outrage and dont take enough time to look closely and see it just isnt very good. It isnt a fundamental reform of a broken anything. His gun makes a lot of noise. It just doesnt have any bullets.

https://hopeworkscommunity.wordpress.com/2014/09/11/old-hospitals-new-hospitals-aot-and-the-murphy-illusion/

The Murphy Illusion

Our jails we are told are the new psychiatric hospitals.  They are packed with people they are not equipped to deal with and with whom they don’t do well.  If anything they make things a lot worse and help leave an entire population of people stuck in an ever entrenched pattern of repeat incarceration.  We seem to solve problems by diminishing the people who have them.

If you listen to Murphy it is simple:

1. People are in jail with “mental illness” are there because they have not had effective treatment for their “illness.”

2. Many of them do not even accept that they are “ill.” They refuse to accept the treatment they need.

3. We feed into the problem by allowing people who don’t have the capacity to make informed decisions control over the decisions that affect their lives.

4. The answer is to force them to accept treatment rather they want it or not for the long term good of all of us.

5. This coercive treatment would come in two forms: Assisted outpatient training and psychiatric hospitalization.

There are only about a million problems with this view. Chief among them:

1. The assumption that criminal behavior is the result of a lack of effective treatment is naive to the max. It ignores things like poverty, homelessness, drugs, gang affiliations, racism, unemployment, past history of trauma, poor education and other things. It makes crime a medical issue instead of a human one. It makes it a response to illness instead of a response to life. And it drastically overestimates the effect of treatment far past anything there is proof of. The best way to address the choices of desperate people in the long run is to address the factors that make life desperate.

2. Murphy says that 5% of the population has a serious mental illness and that 50% of them don’t know it. This is a major part of his justification for the need for coercive treatment. If this is not true the case he makes for coercive treatment is suspect on the very grounds he chooses to argue on. These figures are sacred myth supposedly well grounded in scientific truth according to the Treatment Advocacy Center. It literally astonished me the gullibility with which so many people accept them. If you do the math in Tennessee there are 162,399 people with severe mental illness who don’t know they have it, who need treatment because of the negative life impacting symptoms of their illness. They also seem to be invisible since no one seems to know they exist. You would think 162,399 disruptive people would make somewhat of a splash but there seems to be none. There is a pilot AOT program in East Tennessee I guess to find as many of the 162,399 as possible. They served one person last year.

3. People according to Murphy can’t make informed decisions because they don’t know they need help. And again he is not talking about a few people although he sometimes tries to soften criticism by saying he is. 50% of 5% is what he is talking about. A lot of people. If you could find the missing 162,399 people in Tennessee and add them to the mental health system you would increase the people served by 50%. In New York if you do the math 368,000 anosognesiacs are running around missing somewhere. (Many of the numerical claims Murphy makes are just not given close enough scrutiny. He gets a free ride on way too many things.) This is a critical point of argument. If Murphy can’t prove that a large substantial group of people can’t make decisions then his argument for coercion as an integral part of major mental health reform falls according to his own terms.

4. The phrase “accept treatment” implies that there is widespread agreement about what effective treatment is. That is not even close to the truth. The medical model supported by Murphy with a heavy emphasis on the use of psychotropic medication is hotly debated and criticised. Many techniques that are increasingly used and found effective by many providers are regarded by Murphy as being fraudulent. When he uses the term “accept treatment” he means treatment according to his criteria. And if that treatment is still widely debated on the professional level how can there be a law dictating that people must accept a treatment even professionals can’t agree on.

5. Psychotropic medication may help some people and it may help some people a lot but it without question is ineffective for some people, harmful to some people and poses risks to maybe all people. To make it illegal to refuse medication that may cause harm and even life threatening consequences to you seems to me to be a basic violation of human rights. If you start by saying we don’t have the right to question the decisions of our doctors where does it end and who draws the limits. Whatever else doctors are they are not God and to legally have to treat them as they are is an assault on all of us.

6. AOT is portrayed as a basic service for large groups of people. Again remember 50% of 5%. It is already a nationwide program and it’s track record just doesn’t support that. In most state’s it lays unused and irrelevant. Not enough people talk about this. Again Murphy gets a free ride on many numerical claims. In New York were it is supposedly a huge success it serves 1/3 of 1% of the population served by the mental health system (I don’t know what happened to 50% of 5 %). Does the magnitude of the solution match the magnitude of the problem? Not even close.

7. The Murphy Bill in part would have us replace the new hospitals with the old hospitals.  And somehow that would solve the problem.  It is a fraud and a cruel fraud.  Ask a simple question.  Does the magnitude of the problem match the magnitude of the proposed solution?  The figure normally thrown out is about 300,000 people with mental illness in jail.  There are a lot of questions:

A.   How many of these people are supposed to be served in psychiatric hospitals?  50%….25%….maybe just 10%.  Most state hospital beds run about $150,000  a year.  Many run more than that.  At 10% hospitalization you are talking an expense of $4,500,000,000 a year.  Who is paying?

B. The repeal of the IMD exclusion which is floated as one way to pay for all this has its own questions.  Medicaid reimbursement of anything largely never pays the full cost of anything.  Are the state’s to be stuck with the remaining cost?  Even if you make Medicaid funds available it simply means state’s can pay….not that they must.  I find it highly unlikely that in Tennessee for example which is counting every Medicaid penny 4 times before they spend it that they will agree to a huge new expense for something that shows so little evidence that it is effective.  This is particularly true when the Dept of Mental Health and Substance Abuse shows little support for increasing psychiatric hospital beds.

C.   And related again to the IMD exclusion what about the state’s that have not expanded Medicaid. (I find it extraordinary that Rep Murphy would be for increasing the use of Medicaid funds but would vote innumerable times against increasing people’s access to Medicaid).  Does that not mean that for over 20 state’s the entire cost of increased hospitalization for individuals that would be covered in other states be borne by the state’s.  Again where is the money coming from if not from community based programs and if you reduce community programs are you not creating the very problem you claim to be solving?

D.   There is no particular reason that I am aware of to assume that all these people in jail meet the criteria for hospitalization.  That is a huge assumption Murphy makes.  In Tennessee there are no voluntary admissions into state hospitals.  The criteria is danger to self or others and then most people only stay a maximum of 8-10 days.  I don’t see any of this changing.  The ship on psychiatric hospitalization has simply sailed and it isn’t coming back. Murphy, Torrey, and Jaffe just missed the boat. When Tennessee had a psychiatric hospital going full steam in East Tennessee it served about 90-100 people at a time (hardly an answer to jail overcrowding).  When they closed the hospital those funds stayed in the community and served 10 times the amount of people they had before.  When they looked at the “chronically mentally ill” that had been about half the population they found the defining characteristic was not severe mental illness but severe poverty. They had no where to go. They helped find them places to go. In the 2 years since the hospital closed only 2 of the so called “chronic patients” have been rehospitalized.

This is only a very small slice of ways in which the Murphy Bill misses the boat. It probably should be called the Murphy-Torrey-Jaffe- Treatment Advocacy Center Bill since it is just basically a long fax of things the TAC has been saying for years. It is probably, in the end, less about what is done in the mental health system and more about who is in control of what is done. The common thread throughout the Bill is to make anyone who would question TAC influence impotent in opposing It….all the way from dismantling Samsha, disemboweling paimi to changing hippa requirements to institutionalizing coercion as the basic value of the mental health system.

The political skills of TAC are well tooled and effective. They sell and sell well. Considering the suspect quality of what they sell they are master salesmen.

It is a simple 3 step plan:

1. Identify the problem in dramatic, emotional terms and clearly outline the catastrophe the problem is leading to.
2. Offer deliverance. Offer a plan that will take us from the edge of the cliff, that will restore goodness and justice to a situation lacking both.
3. Deliver up a boogeyman. Make sure people understand that the boogeyman has a personal stake in keeping the problem going. Explain that anyone who disagrees with you has fallen under the influence of evil forces and that anything critical they say is proof of the power of the boogeyman. Anything critical is proof of how bad the problem is and the length evil people will go to prevent it from being solved.

A key element is the boogeyman. And the boogeyman for TAC has been the “psychiatric survivor” movement or at least their caricature of it. They actually have tried to sell the Murphy Bill as an effort to rescue the mental health system from the grips of “psychiatric survivors” and to put it back in the hands of professionals. The total stupidity of that claim has never stopped them from making it loudly. It is called megalomania when you have delusions of your grandeur. I dont know what it called when you have delusions of someone elses grandeur.

The Murphy Bill is a bad thing that will do much damage to people already damaged. Their is no difference that people who oppose this Bill should have between themseves that should or would stop them from working together to defeat this Bill. It is that important.

The First Letter to the Governor

January 15, 2016 by

http://wp.me/p77IQV

The link above is the first post in a new blog “Letters to Governor Haslam”. I hope you will read it and tell others about it.

And I hope you will write your own letters to Governor Haslam.

Insure Tennessee now

Dear Governor Haslam :

This is the first of a series of letters I intend to write you. I am confused by your decision to abstain from the battle for Insure Tennessee. I do not understand why. I really don’t understand. These letters are not an attempt to blast you. They are not about being angry or rageful. They are my attempt to hold you accountable for your decision, to encourage you to step up and to help begin the process of making Insure Tennessee real.

I have never seen any politician, especially one in a senior leadership position like you, have such a good, potentially great idea, just simply abandon it and walk away. You say it still is a good idea. What you would for 280,000 people is far more than a good idea. You have the potential to have a greater impact than all the doctors in Tennessee. A “good idea”????

You say nothing has changed. You say the legislature hasn’t changed their mind… You say it will be hard. You seem to be afraid of the consequences of trying. What is lost if you don’t try? Or maybe a better question is who.

You backed down at the end of the last session. You said it was hopeless and you were helpless to make a difference. I don’t know how to say this in a way you would like to hear. Governor Haslam I really fear what hasn’t changed is you.

I have heard the legislators aren’t educated enough. More facts and figures are what is needed.

I have heard they don’t really understand what it means to live in the gap and need to talk to more people who live with no coverage.

Maybe both are true to some degree. But that is a bigger and more passionate truth. Fear. People are afraid if they step out they will face primary challengers. They fear they will be charged with the crime of being soft on Obamacare and they want you to keep them from being a tea party target.

I hope many people write letters. I hope many people hold you accountable. Your support is important to any chance of success and I hope no one gives you a free pass. Political convenience is not the answer to the needs of 280,000 Tennesseans who deserve a lot more.

Yours truly,

Larry Drain


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