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WMHRC's Survey #2 Public Input, Chapters 1, Section 4

The Endorsers of this letter are not in agreement with the MHTG August 1, 2006 Report Draft.  Anyone familiar with the current system would find a lot to agree with in this report, as it is steeped in the failures of the current system.  This leads one to question the assumptions the report makes.

This report contains a deep level of conflict, with old hard line psychiatric ideology of force/coercion/control clashing with new thoughts of transformation, consumer run services, consumer involvement in their own treatment and recovery. In short, whole sections of this document are in conflict with other sections. This conflict, if not adequately identified and resolved, will simply continue the strife as usual in the public mental health system.

The report manifests this conflict in many ways. For example many consumers would place a high value on 1. Consumer Driven Care, 2. Employment and 3. Housing. The lack of these 3 points in adequate forms and quantities directly traces back to psychiatric concepts of autonomy and low expectations that pervade our current system.

Why don’t consumers currently control their own treatment, the same as a cancer patient?  Why are there no voluntary treatment systems? Why are programs of coercion like PACT favored over recovery programs like Clubhouses and Soteria Houses? Why does recovery in the mental health arena not mean recovery of ones health? These would be basic questions to ask if one were trying to find out why the current system is a failure. These questions or anything similar were not asked.

This section (and report) therefore lacks the clarity of vision necessary for a clean break from the past.

It is also understood by us (WMHRC) that the majority of people reading this critique (who wrote the report) are system providers steeped in the same psychiatric ideals of the necessity of force/coercion/control and low expectations and it is asking a lot of these people to change overnight.

Anyone can come to similar conclusions that we make, if you:

1.        are not part of the psychiatric system and their training, and thereby vested in their beliefs and don’t benefit or profit from that system

2.        are willing to read books and research that is critical or contradicts mainstream mental health of today

3.        are willing to objectively look at the lack of results, i.e. lack of health and recovery in public mental health (current King County Report Cards or the now defunct 3 annual reports from the King County Recovery Ordinance)

4.        are willing to research existing, effective, non-coercive alternatives to what we have now that could be employed right now, but are not for some reason

Chapter 1: Washington's Transformation in Action

Section I: Federal Goal 1 - Americans Understand that Mental Health is Essential to Overall Health

 #1: This section identifies the important issues related to Goal 1 and offers strategies to achieve Transformation in Washington State.    Disagree

#2: This section identifies issues I feel are important for Mental Health Transformation.     Disagree

The debate over “stigma” which is the subject of this chapter is far too limited in this section. Enacting a “social marketing campaign” on the current outline would amount to a fancy propaganda campaign, on the public dime. We have been told that the marketing would not be of the current failures, but the wording of this section is vague, and it sounds like plans to initiate social marketing could  begin right now – which would be propaganda.  We do not support a redefinition of terms and a public relations campaign to citizens to accept a public mental health system that does not believe in autonomy and recovery and actually creates autonomy and recovery. Until the system does support and actually create autonomy and recovery of health no public campaign should be engaged upon....  Promotion of recovery and resiliency concepts among treatment providers should be a priority activity and is something we do support. 

Section II:
Federal Goal 2 - Mental Health Care is Consumer and Family Driven

#1: This section identifies the important issues related to Goal 2 and offers strategies to achieve Transformation in Washington State.   Agree Strongly

#2: This section identifies issues I feel are important for Mental Health Transformation.    Agree Strongly

Section III:
Federal Goal 3 - Disparities in Mental Health Services are Eliminated

#1: This section identifies the important issues related to Goal 3 and offers strategies to achieve Transformation in Washington State.    Neither Agree nor Disagree

#2: This section identifies issues I feel are important for Mental Health Transformation.    Disagree     If the true aims could be achieved with the data outlined in Section #  2 above, then disparities could be properly addressed.

Section IV:
Federal Goal 4 - Early Mental Health Screening, Assessment, and Referral to Services are Common Practice

#1: This section identifies the important issues related to Goal 4 and offers strategies to achieve Transformation in Washington State.      Strongly Disagree

#2: This section identifies issues I feel are important for Mental Health Transformation.   Strongly Disagree

This is a major problem. We do not agree that children and teens need be screened. Currently, screening amounts to a 50% or even 75% chance that the person will simply be placed on psychotropic drugs. Mandatory screening also represents a potential huge annual increase in expense to the state MH system by increasing those in it and increasing drug company profits by consuming more drugs – with no result to show for it. This goal of increased screening should be dropped or delayed. The line of debate that there is inadequate screening is another old psychiatric marketing line.  There are real risk factors for people that exhibit emotional distress, these are poverty, abuse, single parent households, drug abuse, etc. These are root causes and are difficult to solve. It is rather easy to say little Johnny or little Suzy is exhibiting behavior problems and so should be put onto some mind-altering drug to chemically manage them. However, simply because it is easy, and it is being done, and there is a funding stream for it, does not mean it should be condoned or even allowed, in the absence of any physical medical test that shows anything to be wrong with the brains of these children.

WMHRC's Survey #2 Public Input, Chapters 1, Sections 5 - 8 and Chapters 2 - 8

Section V:
Federal Goal 5 - Excellent Mental Health Care is Delivered and Research is Accelerated

#1: This section identifies the important issues related to Goal 5 and offers strategies to achieve Transformation in Washington State.   Strongly Disagree

#2: This section identifies issues I feel are important for Mental Health Transformation.   Strongly Disagree

The report is written so that you like the wording, but the substance does not match the goal. This is a result of the unresolved conflict of this report, old school – coercion/commitment vs new school of involvement/participation and autonomy.  This section forwards a huge psychiatric marketing myth. Research today is mostly generated by drug companies. Researchers fall into line to do research for drug companies as that is where the money is, that is where their future lies. This comprehensive report simply forwards a psychiatric wish list of what they have wanted for years – along the same lines of what produces failures today. Section 5 could have been written 10 years ago by your non-favorite psychiatrist or drug company lobbyist/representative, trolling for research money and future profits. This is not a step forward and will not forward recovery or resiliency

Research could be directed at existing recovery programs like Soteria House, PACE, CHOICES (a program started in Alaska), proper Medical Examinations to treat medical / nutritional issues that mimic psychiatric behaviors (Walker, Koran), programs that deal with the homeless (CHOICES in Florida, for example), programs that are voluntary and desirable to individuals like Clubhouses should be researched.  Unfortunately, none of these programs are in favor with drug companies and therefore will not be researched by our state under this MHTG Report Draft.  Ombudsman: Section 5 does included research & language to make the Ombudsman separate and independent, which has needed to happen for years

Research could be directed at existing recovery programs like Soteria House, PACE, CHOICES (a program started in Alaska), proper Medical Examinations to treat medical / nutritional issues that mimic psychiatric behaviors (Walker, Koran), programs that deal with the homeless (CHOICES in Florida, for example), programs that are voluntary and desirable to individuals like Clubhouses should be researched.  Unfortunately, none of these programs are in favor with drug companies and therefore will not be researched by our state under this MHTG Report Draft.  Ombudsman: Section 5 does included research & language to make the Ombudsman separate and independent, which has needed to happen for years

On the issue of Recovery.

The National Consensus Statement defines recovery as "Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential."

Daniel Fisher, who was part of the Presidents New Freedom Commission on Mental Health and who’s material on recovery is referenced by the TWG has a much different view:

When Dr. Daniel Fisher was a neurochemist working for the National Institute of Mental Health in the late 1960s, he was convinced that the key to mental illness was somewhere in the brain's messenger chemicals, which he was studying. But that was before he was hospitalized with schizophrenia and got a first-person perspective.

"I found that thinking that everything was determined by chemistry was very disempowering and very dehumanizing," he said. Fisher, 61, who turned from neuroscience to psychiatry after his own battle with mental illness, is now one of the leading proponents of a view that is about as far from the lab bench as one can get. He believes that with enough of a support system, people can recover fully from mental illness, even from disorders such as schizophrenia that are widely believed to be chronic, long-term illnesses for most people.   

Lacking effective treatment strategies, mental health systems nationally and regionally have defined mental illness to be incurable and redefined recovery to mean living with illness.  What is meaningful or real recovery? Online medical dictionaries define it just as you would expect:

"To regain health after sickness; to grow well; to be restored or cured; hence, to regain a former state or condition." 

Dr. Courtney Harding, a researcher who has spent decades investigating recovery from schizophrenia defines it this way:

"No current signs and symptoms of any mental illness, no current medications, working, relating well to family and friends, integrated  into the community and behaving in such a way as to not being able to detect having ever been hospitalized for any kind of psychiatric problems."

So, are outcomes recovery outcomes without recovery? Or are outcomes health outcomes? There are way to many system outcomes in this report.

Section VI:
Federal Goal 6 - Technology is Used to Access Mental health Care and Information

#1: This section identifies the important issues related to Goal 6 and offers strategies to achieve Transformation in Washington State.   Neither Agree nor Disagree

#2: This section identifies issues I feel are important for Mental Health Transformation.   Neither Agree nor Disagree

This section is rather neutral, except for the fact it will be used against individuals and make it even harder for them to escape psychiatric treatment. Until recovery means recovery, access to MH information will be used against one.  It is a bit odd that there is no mention in the report of psychiatric advanced directives (PAD). The statewide database of PAD is going ahead, but this document should include it. If it is there, we did not see it.

Section VII:
State Goal 7 – Employment

#1: This section identifies the important issues related to Goal 7 and offers strategies to achieve Transformation in Washington State.   Agree Strongly

#2: This section identifies issues I feel are important for Mental Health Transformation.   Agree Strongly

(NOTE -  The index says section 7 is employment, while the file I downloaded has section 7 as housing) 

We have seen Clubhouses fill a very vital and needed role with employment. I think the problem with PACT programs is that they maintain a level of disability in so many of their program members it limits its chances of success, of gaining employment and working their way out of the PACT program. According to the Clark County Analysis of employment, very few ever become employed and no one graduates.  Employment is very therapeutic and can go a long way to recover self-esteem, and autonomy and hope for a brighter future.  Implementing effective employment programs is a must should be one of the MHTG’S priorities.

Section VIII:
State Goal 8 - Housing

#1: This section identifies the important issues related to Goal 8 and offers strategies to achieve Transformation in Washington State.   Agree Strongly

#2: This section identifies issues I feel are important for Mental Health Transformation.   Agree Strongly

Stable Housing is essential as without housing availability, individuals have little hope of becoming stable. The lack of availability is strained by the tremendous effort put into drug delivery and drug maintenance (treatment compliance to MH providers). Add to the mix the lack of medical / nutritional screening which would limit the number of individuals entering the system and the lack of anyone leaving the system through recovery and you have an ever expanding group of people dependent on services like housing.

Chapter 2: Governance and Organizational Structure

#1: The explanation of Governance and Organizational Structure is clear and understandable.   Disagree

“In Washington State, a broad consensus has developed among the mental health community stakeholders about the need to transform the mental health system. At the state level, both the legislative and executive branches have demonstrated a firm and lasting commitment to this effort.” 

                                                                                                                                                                                                            As covered in the introduction, the need for change is agreed upon, the form of that change is in conflict with itself. A house divided will be weak, and will falter – similar to what we have today.  The goal of public mental health needs to be health. If the goal of public mental health is to manage disability and make the disability comfortable, it will fail the majority of individuals which his where we are at today. Here is a key line in this report:

The outcomes and strategies presented to the TWG provide the direction and form the vision underlying this CMHP. The responsibility of converting these visionary action plans into reality rests with the transformation partners. (Chapter 2 pg 113, full document)

As stated throughout this analysis, the vision of the TWG is conflicted throughout this report and there is a large failure to reconcile the vision between the past and the future. If this is truly a bridging document, then there must be more specificity on how autonomy and participation in consumer run services is going to occur when this is not the dominant agreement today among the “transformation partners.”  The system as we know it will change, the question is how long it will take, based on the courage level and understanding of our current transformation leaders and elected officials.

Chapter 3: Mental Health Transformation in Indian Country

#1: Tribal concerns and potential solutions are represented well.   Disagree

 “There needs to be intensive efforts developed to address cultural competency issues and problems.” 

As covered in the introduction and in other sections, the solutions being given to the Indian tribes across the state are currently failed and failing. If real change occurs, then the Indian communities will certainly benefit. 

“There is not enough emphasis on the impact of the K-12 educational system and its role in mental health. This relates to the issues associated with school personnel to respond to mental health issues and administrative issues on how they operate educational programs.” 

This is an incorrect summary of the problem schools face today, as schools have been a heavy target of psychiatric labeling and drugging. Teachers in many instances are mental health counselors and mental health clinics are in the schools themselves in many cases. This approach has not resolved the problems these students face. Studies show that most of these youth are:  simply not properly/adequately taught in school. Too many students drop out and remain functionally illiterate for many reasons. Yet many attend community college when they are interested/motivated and they do get their GED and succeed in life. What does not work are assembly line schools where one size fits all. Some students need additional assistance or alternative learning environments, not drugs. 

School solutions or educational solutions are ignored, in favor of escalating behavior issues into mental illness labels and drugging the kids. Discipline is a foreign word at school. Drugs mask the very real problems of illiteracy, poor schooling, drug use by parents, abuse and family break-ups.. Giving a child a psychotropic drug solves none of these problems, but gives the appearance of a manageable child. The TRUE product of a school is not a manageable child; it is an educated child who can succeed in life because they have the basic tools.

Survey Wrap-Up

#1: I am satisfied with the overall quality of the Comprehensive Mental Health Plan.

  Strongly Disagree

 “In our quest to raise the bar regarding improving the health of all citizens, we must broaden our philosophical approach to include mental health as an essential component of overall health.” 

This is a vast oversimplification of what we are facing. Transformation of public mental health does not depend on what people external to the system think. The system is designed and built and run by individuals who are now creating the current transformation. The fox is really guarding the chickens at this point. If the MH Comprehensive Plan was actually created in response to the input, what we would be discussing would all be in the context of chapter 1 sections 2, 7 and 8.  Instead we have a mammoth document that is much larger in scope than the Omnibus SB 5763.

There seems to be recognition in the idea that the system should move away from system desires for treatment to one where “consumers and family members have choices, utilize self-directed care and are sponsors, mentors and guides.” If fully implemented, this would transform the whole system.

However, the rest of the CMHP report does not reflect nor adequately support this new premise.

It is really the task of the TWG to broaden their look at why our current system is a failure, because it is readily apparent that they have not grasped real reasons, and are simply creating a report listing out their desires, as if choosing gifts from a wonderful new catalog.

The writers of the CMHP itself have not grasped the concept of autonomy and how essential this is to recovery of health. It is a dramatic shift from the current model of drugged disability to one where you help someone recover from an emotional crises by following their treatment decisions.

 “We cannot continue the traditional piecemeal approach in which partial services are rationed to those in most desperate need, and expect peak results.”

 “The Mental Health Transformation Project leadership agrees with the vision of making Washington state the Healthiest State in the Nation and we believe that the state must place much more emphasis on prevention and early intervention as well as cross system planning if we expect to improve the health of our residents. Improved health of citizens will in the long run result in less demand on publicly funded health and mental health care systems.”

Again, this part of the report misses the mark and is simply parroting back an often heard justification for the poor results the system is experiencing. The basic question of why are people who are or have been hooked into treatment in such desperate need? No one is talking about the obvious and basic answer which is the drug treatments they are receiving does not produce health or recovery. We have requested information from every RSN in the state, the MHD, the Health Department etc. and no one even tracks the physical health of individuals in the public mental health system today. A few years ago King County did track the health of individuals based on a novel ordinance – the Wellness Ordinance. The statistics are horrifying – 5 out of 9,300 recover in a year, only 5% progressed and 95% worsened. These are people who received their designated “treatment.” What was the response to these horrible results?  King County MH responded by “watering down” the ordinance and doing away with the tracking of health of those in their mental health system!

A true paradigm shift will only occur when those working in the system, and managing the system realize that recovery of health is possible and attainable and treatments are voluntary and effective. This is within reach, if you are willing to study outside the current mainstream psychiatric box, and question the authorities that have made our current mental health system the failure that it is.

End