Foster Youths Meet Psychiatry: A Wickedly Sticky Wicket

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Morning Zen Guest Blog Post ~ Wayne Munchel ~

When a foster youth encounters a Psychiatrist, chances are high that s/he will get medicated. Traumatized foster youth are often prescribed powerful psychotropics due to exhibiting a wide variety of “normal reactions to abnormal events”, such as despair, agitation, anxiety and self-harm. The practice has been well documented; foster children are prescribed psychotropics at a 2.7 to 4.5 times higher rate than non-foster youth[1]. The National Center for Youth Law aptly summarizes the problem as; too many (25% of foster youth medicated), too soon (300 children under the age of 5 in California are given psychotropics annually) too much (adult dosages) and for too long[2] (no planning or reviews for possible discontinuation). Many foster youth don’t even get placed on the category of medications that corresponds to their assigned diagnosis. According to a recent analysis[3], 40% of foster children diagnosed with ADHD and Disruptive Behaviors were prescribed anti-psychotics. Still others are medicated without even the pretense of treating a documented illness. This pattern suggests that medications are being expressly used for behavioral control. Foster youth are at risk for being placed in chemical strait-jackets.  

In California, belated progress is being made in effort to curb the egregious over-medication and under-treatment of foster youth. Several key pieces of legislation have been passed with widespread support[4]. An ongoing workgroup has been convened to develop data collection methods to identify who is prescribing what to whom, as well as implementing prior authorization and second opinion mechanisms. Attention is also being focused on building up the trauma informed care capacity to ensure that foster youth are offered “1st line” psychosocial treatments and make medications the last resort. Funding for Public Health Nurses to monitor medicated foster children and youth for metabolic complications is also being requested. 

But there is an unacknowledged conundrum waiting in the weeds. Workgroup participants are discussing ways to distinguish between trauma impacts and true “mental illness”. As if there is some way to sort through the many “symptoms” (trauma adaptations) and assign them to discrete categories of disease vs. distress. The DSM 5 largely ignores issues of causation and context. (Let’s stipulate that virtually all foster youth and children have some form of traumatic stress reactions.) When viewed through the distorting prism of the DSM 5, foster youth’s many understandably disturbed behaviors are seen as pathological indicators of an incipient brain disease. “Psychiatric Bible” thumpers cast an ever expanding net that entangles most foster youth experiencing problems in thinking, feeling and behaving – the kinds of problems that most of them have in spades. 

Perceptions of anguished foster youth are so shaped by the dominant bio-reductionist disease model that some have suggested that perhaps foster youth suffer from co-existing disorders - both trauma and a “co-occuring” brain disease. This seems to violate the Law of Parsimony – explaining things in the simplest way, while making the fewest possible assumptions. For example, let’s say someone’s lip bleeds due to being punched in the mouth. From a biopsychiatry viewpoint, someone’s lip bleeds due to a genetically predisposed lip disease that was triggered when they got punched. Poor Occam would throw away his trusty razor in disgust.

Developing trauma informed, (First – Do No pHarm?) alternatives will be key to the efforts focused on decreasing the high rates of psychotropic medications for foster youth and children. But it won’t be easy and it won’t be cheap. (Perhaps some of the $226 million that California spends annually on medicating foster youth can be redirected?) American culture has a long standing love affair for technological solutions in the form of pills. Pills that can tamp down and suppress the howls of pain and anger brought on by chronic abuse and neglect. (“Zombify” in the words of many foster youth.)  The experience of trauma at early, vulnerable ages often results in grievous wounds that can take a life-time to heal. Dr. Bruce Perry, author and Director of the ChildTrauma Academy, argues that most current treatments for these kinds of developmental traumas are inadequate. That much trauma informed care is delivered for too short a time, at too low a ”dosage”/frequency,  and are misdirected at “too high” of a neurodevelopmental stage (focused on cognitive and language processing, rather than more somatic interventions) Clearly much work remains.

Perhaps, one day, after many more billions of dollars in myopic research, a true biomarker or mental illness gene will be identified. (The dispassionate scientist in me, allows that it is possible). In the meantime, can the prominent pachyderm in the room be acknowledged? – that the horrific, toxic stressors that foster youth have endured can lead to many disturbances in their young lives and they will require all the care and support we can muster. It is unacceptable that after suffering so much from the collapse of their family systems, that foster youth and children are further subjected to potential abuses by misguided treatments that carry such high health risks and stigma. Understanding and compassion for “what has happened” to foster youth, rather than “what’s wrong” with them is imperative.        

[1] U.S. Government Accountability Office. (2011). Foster children: HHS guidance could help states improve oversight of psychotropic medication (Publication No. GAO-12-270T). Washington, D.C.: Author. Document Number)

2  PsychDrugs Action Campaign –

3 Crystal, S., Mackie, T., Fenton, M.C., Amin, S., Neese-Todd, S., Olfson, M. and Bilder, S., 2016. Rapid Growth Of Antipsychotic Prescriptions For Children Who Are Publicly Insured Has Ceased, But Concerns Remain.Health Affairs35(6), pp.974-982. (Abstract)

4 California Psych Meds Legislation Advances – 

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munchelWayne Munchel, LCSW is a leader in mental health programs designed for transition age youth. He was also a founding staff member of The Village, an innovative recovery program located in Long Beach, CA. Mr. Munchel provides trainings and consultations for services to young people, including trauma informed care and supported employment.

The Murphy Bill, HR 2646 — a Heinous Piece of Legislation — is Coming to a Vote. Act Now.

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Morning Zen Guest Blog Post ~ Val Marsh, MSW ~ 

This coming Wednesday, two days after the 4th of July celebration of our country’s declaration of freedom from oppression, the U.S. House of Representatives will vote on HR 2646, the Helping Families in Mental Health Crisis Act of 2016, or HR 2646. It is also known as The Murphy Bill. The ORIGINAL Murphy Bill. In truth, it has nothing to do with freedom, and everything to do with oppression.

HR 2646 is a heinous piece of legislation that has been hailed as the solution to the nation’s problems with gun violence, terrorism, and the massive influx of people with mental health conditions into the correctional system and the burgeoning ranks among the homeless. Not to mention that it will save untold hundreds of thousands of families from anguish and unwarranted pain. And it is a calculated, repulsive lie.

The National Coalition for Mental Health Recovery is calling upon all people of like minds, who care about individuals who need mental health services, to ACT. It is urgent. Please call your representative in the House of Representatives to vigorously oppose HR 2646 on Tuesday, July 5, 2016. And, call your Senator to insist that the Senate reject any amendments or changes to mental health legislation from the House by Friday, July 8, 2016. For more information about this Call to Action, please click here.

We have been fighting battles on many fronts for decades. The medical model of MH care has had the financial backing and the political power to convince the public and our Congress that people with mental health conditions must be coerced into taking psychotropic medication and into psychiatric care, for everyone else’s sake. Here is a rebuttal:

Nothing about Us without Us 
HR 2646 describes the membership and duties of the following entities:

  • The National Mental Health Policy Laboratory
  • The Center for Behavioral Health Statistics and Quality
  • Advisory Councils
  • Peer review groups that review grants, cooperative agreements or contracts related to mental illness treatment

None of these entities includes the membership of people with lived experience with mental health conditions.  We have been excluded from entities that will make important decisions about our lives.

Additionally, we are grossly underrepresented on the “Interagency Serious Mental Illness Coordinating Committee,” with only two representatives on a committee of more than twenty people.

We were thrown the proverbial bone with the following two inserts: “…increase meaningful participation of individuals with mental illness in programs and activities of the Administration,’’ and ‘‘…through policies and programs that reduce risk and promote resiliency.” Yet in the context of the bill’s relentless drive to replace recovery with the medical model of treatment and promote coercion, these two phrases have little meaning.

We are the citizens most directly impacted by the policies enacted in Congress. We bear the brunt of all things that go wrong with those policies. We are uniquely qualified to provide meaningful input, and we speak with the benefit of hindsight based on our actual lived experience. Any social policies developed without significant input from people with lived experience defy the basic tenets of democracy.

The Bill Expands Grant Funding and the Timeframes for Assisted Outpatient Treatment 
Robert Bernstein, executive director for the Judge David L. Bazelon Center for Mental Health Law, provided testimony to Congress regarding Assisted Outpatient Treatment (AOT) several years ago, which began with the following: “The term ‘assisted outpatient treatment’ (AOT) is like calling robbery ‘assisted wealth redistribution’ and is more appropriately called involuntary outpatient treatment.” Indeed, the term robs the layperson of reality before the description of this abrogation of rights even begins.

HR 2646 extends and enhances existing federal grants that encourage states to expand coercive, court-ordered outpatient treatment programs. These programs of forced treatment do not help people get better. Further, AOT inserts the court system into decisions that should be between individuals and their treatment providers, while adding unnecessary costs. Ultimately, AOT discourages people from voluntarily seeking help using services that work for them.

It is unacceptable to fund AOT when humane, voluntary services have not been adequately funded for the past five decades. It is a waste of taxpayer dollars and it unfairly jeopardizes civil liberties.  For more information, download the NCMHR Fact Sheet on Involuntary Commitment and Real Mental Health Change's "A Psychiatrist Opposes HR 2646, Here's Why."

HR 2646 Significantly Weakens the Substance Abuse and Mental Health Services Administration 
HR 2646 provides a blueprint for the systematic disempowering of the Substance Abuse and Mental Health Services Administration (SAMHSA).  The bill creates the new position of Assistant Secretary for Mental Health and Substance Use, which requires either an MD or a PhD in psychology. The insertion of medical authority over SAMHSA would be a huge step backward to institutional policies and models.

One of SAMHSA’s greatest achievements is its instrumental role in promoting recovery in ways that have helped thousands people across the country. SAMHSA has promoted and funded major innovations such as peer support, trauma-informed care, recovery oriented systems of care, and state consumer and family networks, all of which have yielded positive outcomes while being extremely cost-effective. These programs would be jeopardized by HR 2646.

Representative Murphy’s continued focus on disempowering SAMHSA is deeply troubling. Though HR 2646 may have been penned by Representative Murphy, it is clearly the bidding of Dr. E. Fuller Torrey, a longtime proponent of involuntary inpatient commitment, outpatient commitment and forced medication. Despite the criticisms of Rep. Murphy and Dr. Torrey that SAMHSA promotes activities that are not evidence-based, SAMHSA has published on its website a compilation of no fewer than 31 resources and links to evidence-based programs and practices.

HR 2646 punishes SAMHSA for partnering with and respecting the dignity of people with lived experience. We reject this attempt to undermine the very entity within the federal government that has provided leadership in actualizing the most fundamental, core belief of mental health consumers – recovery.

HR 2646 uses “anosognosia” as a rationale to relax confidentiality issues and promote forced treatment 
To be honest, this issue IS A DRAG. I have received a great deal of pushback on this, because anosognosia is impossible to pronounce, much less explain. But it is vital. Please, push through your revulsion, for the sake of untold thousands of others who need you. Make yourself understand this important piece of information.

Section 401 of the HR 2646 would establish a “Sense of Congress” using a definition of anosognosia to study how best to wiggle around HIPAA in order to violate the confidentiality of people with mental health conditions. It is described as a condition in which individuals “lack the awareness they even have a mental illness.” Anosognosia can be found in the literature associated with people who have had strokes and brain injuries. It basically describes a condition in which a person is unaware that they have paralysis in parts of their body. It is a TEMPORARY condition, and it clears up without the use of medication. Further, according to Dr. Danica Mijovic-Prelec, a researcher in neuroscience, "patients with anosognosia, or denial of illness, are [still] able to process information about their condition."

Anosognosia is highly controversial because it was “borrowed” into the MH field specifically to justify forced treatment. But how can the above condition described for stroke patients be remotely the same for individuals with mental health conditions? The “science” is a sham. Can neuroscientists attest to this application to people with “mental illness”? No. There is no actual scientific evidence to support the existence of anosognosia in mental health populations. But Congress is not comprised of experts in research. And they have been convinced to rely on phony research by experts in public relations, not science.

HR 2646 suggests that people with mental health conditions have worse “compliance with treatment” than others. In fact, there is substantial research showing that people diagnosed with mental illness are able to make reasonable decisions about their care, on par with others who have chronic health conditions.

Allowing such language into a “Sense of Congress” legitimizes junk science and provides a rationale for violating confidentiality and the deprivation of civil rights. It also sets a dangerous precedent for future legislation that will promote forced treatment measures.  This must be struck from the bill.

For more information about anosognosia and people who appear to lack insight, please click on the following links: Anosognosia: How Conjecture Becomes Medical “Fact”, "The Issue of Insight", and Call to Action: HR 2646 Markup This Week

The Bill is Hostile to Programs and Concepts of Recovery 
In writing and promoting this bill, Representative Murphy has relied heavily upon the work of Dr. Torrey. HR 2646 is steeped in language that attempts to justify coercion and the stripping of rights of people with mental health conditions. Over the course of the past four decades, Dr. Torrey has established a reputation as an extremist and an ideologue. He does not believe in recovery. He wants Congress to believe that people who “deserve” mental health services are “too sick to know they are sick…” and those who do not exhibit the most severe behaviors associated with “illness” are a waste of money. It is a warped, binary vision bereft of hope – those who need to be coerced, and those who neither deserve help nor a place at the table of policy decisions.

There is no support for recovery-based programs in HR 2646. It is strikingly absent from the bill. In fact, the bill calls for the “DIRECTOR OF THE CENTER FOR SUBSTANCE ABUSE TREATMENT … [to] work with States, providers, and individuals in recovery, and their families, to promote the expansion of recovery support services and systems of care oriented towards recovery.” 

There is no similar language for mental health. We must ask why the principle of recovery in mental health is not supported in HR 2646, especially in light of unfettered support for recovery among individuals with substance use disorders.

Why is it impossible to believe that people can actually get better? A better question would be to ask why our members of Congress have bought this ugly deception.

Inpatient care cannot and should not replace preventive care in the community 
We do not support the expansion of Medicaid funding for Institutions for Mental Diseases (IMDs) or other inpatient settings. This is often referred to as “loosening the IMD exclusion.” Increased funds for hospital care means continuing to support the unacceptable status quo, and advances the agenda of forced treatment in the absence of decent voluntary care.

The current lack of adequate community support has created a mental health system that is crisis-driven. It provides too few services that are too late and that result in unnecessary and coercive means of treatment. In addition to causing needless suffering, continued/increased funding for inpatient settings ultimately supports the most expensive form of care possible at the far end of the continuum of care. The inevitable result is rationing. Thus the cycle of crises continues unabated. It is the equivalent of offering intensive care as the sole treatment of choice for people with heart conditions.

Since the 1990’s, state after state has attempted to close psychiatric hospital beds and “reinvest” the funding into community care. And yet, once the funds were transferred to the community, they became vulnerable to funding cuts, especially in the face of economic downturns. We have lost more than $4 billion alone to the Great Recession of 2008. OF COURSE PEOPLE HAVE GONE INTO CRISIS.  It is outrageous that we have an entire nation that blames the victims of such shameless public policy with more of the same.

The mental health crisis that the United States is currently experiencing is directly related to a collective lack of will to fund and sustain decent community care, at both the state and federal levels. Beds were closed, yet hospitals remained open for business as usual for decades. Later on, beds were closed with tremendous efforts among advocates to create community care, yet the money evaporated with each economic downturn.

There is no right to community care. There is only a “right” to “treatment” once you have lost your liberty. Who is not thinking clearly here?

Critics argue that too many beds were closed, that inpatient care will always be needed, that HR 2646 is merely codifying recent regulatory changes made by CMS, and that we must address this urgent crisis now. But in relaxing the IMD exclusion to allow for 15 days each month of inpatient care, we will lose vital dollars that we will never get back for community care. Never. The proposed federal funding for IMDs is “de facto” replacement money for lost state dollars that will be relocated to the wrong end of the system.

One consistent theme of our opponents is that psychiatric hospitals are better than jails, prisons or the streets. This is a false choice that should be revolting to millions of us throughout the country. Why isn’t community care seen as a better option over all of the above? The message is one of deep disrespect and discrimination for people who need mental health services. People of good conscience have been misled. Those who have misled them have a mighty war chest and wear a deceptive mantle of “truth-i-ness,” as Stephen Colbert might have said.


Conflating gun violence with mental health conditions 
HR 2646 is a direct result of the Sandy Hook tragedy. It was a tragedy so horrendous that the entire nation was traumatized… except, of course, for the NRA and the proponents of coerced MH treatment, who were gleeful to find an opportunity to spread their poison. Since that horrible day, and with each subsequent mass shooting, people have struggled to find an answer; something, ANYthing that will keep us, especially our children, safe.

Despite research that consistently shows that only 4% of all violence in this country is related to mental illness, people with mental health conditions have been scapegoated. The truth is merely a distraction. Japanese Americans were interned during WWII because the government and the public KNEW they were a dangerous population. We now know better. But in the frenzy to react to tragedies of historic magnitude, it is easy and predictable that vulnerable people will be blamed and have their rights violated. The Japanese Americans were ultimately freed. Can we say the same about people who will be forced into hospitals? For more information about violence and mental illness, click on Mental Illness is the Wrong Scapegoat After Mass Shootings and Untangling Gun Violence from Mental Illness.

The Myth of Hospitals Being the Answer 
Deinstitutionalization came to pass, in part, with the sobering recognition of a national shame. Psychiatric hospitals are inherently coercive. Period. Conditions in psychiatric hospitals easily devolve into egregious snake pits. It is as true today as it was in the 1950’s. Erving Gottman wrote a seminal book about conditions in psychiatric hospitals, entitled Asylums: Essays on the Social Situation of Mental Patients and Other Inmates

The Department of Justice is still investigating hospitals and legal action is still needed too often to remedy abuse, neglect and unnatural deaths. Additionally, increasing hospital beds flies in the face of the The Supreme Court’s Olmstead decision. It is unwarranted segregation, not integration.

The following link to an investigation of a Florida hospital is merely one example of how sadistic and shocking inpatient hospitals can become. It is a damning statement of the medical model.

The Failure of Deinstitutionalization 
Deinstitutionalization was passed into federal policy in 1963, at a time when the United States was the Land of Camelot. This landmark legislation was driven by the civil rights movement, the advent of psychotropic medication, which was thought to be the magic bullet for treating mental illness, and the exposure of egregious conditions and the warehousing of hundreds of thousands of citizens. In 1961,

The Community Mental Health Act was passed by the 88th Congress. It was never adequately funded. This landmark legislation represented the beginning of deinstitutionalization. However, states saw it as an opportunity to close beds without having to relocate the funds in the community – quite a windfall for state budgets, for a period of time. In fact, over 90% of all state hospitals were closed as a result of deinstitutionalization.

This is the true crux of the problem we face with mental health care in the United States. It is not a problem of “undeserved” rights; it is a problem of inadequate resources that are poorly allocated.  It is not only illogical and inhumane, but is also a very poor investment of public dollars. Hospitals represent the most expensive form of mental health care. It makes no sense to create a system around inpatient care. 

We, the people with lived experiences that are SPECIFIC to the policies of deinstitutionalization, have made significant discoveries about how to help people with mental health conditions. And, we have found that those with lived experiences, much like those of people who have struggled with addictions, can have a profoundly positive impact upon people who need mental health supports. People who have been there understand what it is like for people who ARE there.

We have developed peer-run respites that help divert people in crisis from inpatient care. We have developed peer support specialists, forensic peer specialists, recovery coaches, self-education programs and more. We have found models that facilitate open communication among individuals, families and providers from other countries that are highly successful, such as Open Dialogue. Housing First models show clearly that mandating “treatment” before housing is folly.

These are troubling times for people with lived experience in mental health care. More than 50 years after deinstitutionalization, mental health systems across the country are still unable to provide the appropriate care in the community that was promised long ago. We must ask ourselves why this is so, and we come back to the fundamental issues of stigma and discrimination.  We are different. Yes, we know. But does that justify withholding help in the face of massive suffering? Does it justify a punitive, coercive system of care that dictates without listening? Does it really justify violating the rights guaranteed to all citizens of the United States under our Constitution?

Time and again, research has proven that the public perception of the relative “dangerousness” of people with mental health conditions is unfounded. Sensationalized, distorted media coverage has fueled arguments for forced treatment and an overly medicalized system of care.  The march toward re-institutionalization and coercive care is abhorrent to us. Having a mental health condition does not constitute a life sentence to poverty, marginalization, aberrant behavior or an inability to become a fully functioning citizen who can contribute meaningfully to his/her community. We know that recovery is possible because we are the evidence.

It has been 53 years since deinstitutionalization began. We are still waiting.

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valmarshValerie L. Marsh, MSW, is Executive Director of the National Coalition for Mental Health Recovery (NCMHR). Marsh received both her bachelor’s and master’s degrees in social work from Virginia Commonwealth University in Richmond (VCU), Virginia, where her graduate studies focused on mental health policy, administration and planning. She served as an adjunct faculty member at VCU, teaching policy, advocacy and human behavior to graduate and undergraduate students in social work. As the Executive Director of NAMI-Virginia from 1994-2004, Marsh shown a spotlight on abuse, neglect, and unnatural deaths in Virginia’s public psychiatric hospitals.

This post originally appeared on the Mad in America website, July 5, 2016

Martin Rafferty Defines 'Next Generation Advocacy' Leadership for Mental Health Reform

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Morning Zen Blog Post ~ Scott Bryant-Comstock ~ 

Is the time right for Next Generation Advocacy?
Currently, there are several mental health reform bill proposals in the House and Senate working their way toward merger into a bill that, increasingly, looks like it might pass. The conversation about mental health reform in Washington, DC has been driven primarily by advocacy leaders inside the beltway. These leaders are undeniably well versed in the inner workings of the legislative process, understanding the nuances and give and take of compromise. Their influence with congressional leaders carries significant weight in deciding what gets included in a particular mental health bill and what does not.

If you look closely at the current mental health bill that just passed the House (H.R. 2646), it is clear that mental health reform models only your grandfather could love (reliance on hospitalization, focus on “after-the-fact” treatment), still rule the day. There is an active component of the advocacy community that seems to want to “Make America Great Again”, wistfully remembering how the national mental health service delivery system was 40 or 50 years ago. Only one problem – resuscitating old models from a time when there were only three television networks, models that really should have a D.N.R. tag on them, ultimately won’t work in an American landscape that is vastly different in the year 2016. 

Why is it that so many national advocacy leaders choose not to address the antiquated mental health reform approaches being touted by the architects of current legislation proposals in Congress? Is it because they, too, rely on mental health reform models of the past? Do they lack vision and innovation?

The answer, as is often the case, is not an easy one. Some of our most prominent advocacy leaders will be wildly inspirational and innovative until they are ready to pass on to that great mental health reform cosmic discussion in the sky. Others, however, seem to have taken a different path, holding on tighter and tighter to beliefs and approaches that served them well in their prime, but are increasingly becoming out of touch with the realities of today.

As old leadership passes on, vacuums are created, just waiting to be filled by innovators who bring fresh, new ideas to help stimulate or replace old and tired approaches to mental health reform. I am convinced that we are on the precipice of a radical change in what advocacy leadership looks like for the future. There is much innovation taking place in communities across America right now. These innovative activities may not get the press that older, more traditional efforts do, and certainly are not getting attention or notice in legislative language. However, make no mistake, they are happening, they are making an impact, and they are setting the stage for what comes next.

It is time for an infusion of Next Generation Advocacy.

Martin Rafferty – Next Generation Advocacy leadership personified 
martinOne of the most exciting examples of a Next Generation Advocacy leader is a young twenty-something CEO by the name of Martin Rafferty. Martin is the CEO and founder of an organization called Youth M.O.V.E. Oregon (YMO). This dynamic organization utilizes numerous evidence-based practices in their service delivery model. Their work is solely focused on working with emerging adults. Martin and his team of innovators at YMO are rewriting the playbook when it comes to addressing trauma, understanding the needs of emerging adults, and moving forward with cutting edge technology to reach youth in ways that most national mental health advocacy leaders haven’t even begun to grasp. Here is how Martin and his team are doing this.

Next Generation Advocacy leadership in action – School Shootings 
On June 10, 2014, at Reynolds High School in Troutdale, Oregon, a 15-year old student, armed with an AR-15 rifle, shot and killed a 14-year old freshman, and wounded a teacher before turning the gun on himself and taking his life. The shooting occurred on the second-to-last day of the school year.

After the initial wave of community response, attention to the shooting and its aftermath quieted down a bit. But, as summer moved on and the next school year approached, the thought of coming back to school, where significant trauma had been inflicted two short months before, weighed heavy on students, faculty and community providers alike.

Rafferty and his team from YMO had an idea. What if students had an opportunity to reconnect with the school building? In an interview with the Oregonian, Rafferty explained that “the Schools often bring in a therapist or point students to local mental health services after a shooting, and almost always host a candlelight vigil.” Rafferty went on to say that what was needed was an opportunity for the students of Reynolds High School to be able to reestablish positive feelings about the school building with a fun event and provide easy access to peer support specialists.

The shooting happened at the end of the school year, leaving students without time to reestablish normalcy or a sense of community in the building. “While they’re sitting at home, the high school is becoming this demonized, big subject in their minds,” Rafferty said. “We want to create an environment where youth can have a positive experience. “It’s not about the shooting. It’s about: ‘This is your home. This is where you belong in the community. This is a safe place to be, and there are a lot of positive things possible here.’ We want to remind them of that.”

And thus, the “Virtual Reality and Ropes Course” was born. The course was designed as a fun and interactive welcome back to the school; students were invited to experience cutting-edge technology like Google Cardboard and other interactive 3-D gaming devices. As students engaged with technology they likely had never seen before but only read about, peer-support specialists were at the ready to talk.

The response by students and administrators alike was overwhelmingly positive. Rafferty thinks this approach could become part of a national model for post-traumatic student care. Rafferty believes the country needs a model to help young people process school shootings and move forward in a healthy way. 

Fast forward to October 1st, 2016. Umpqua Community College (UCC) unfortunately experienced a mass shooting resulting in nine deaths and nine wounded. Youth M.O.V.E. Oregon’s crisis response team, made up of young adult peers, was on site providing support to students and community members from day one. This was a national breakthrough for crisis response teams who historically only include dispatch first-responders and clinicians. YMO immediately implemented an emergency youth drop-in center and has been providing on-site services ever since. 

Rafferty and his team at Youth M.O.V.E. continue to refine their innovative technology-driven approach to post-traumatic student care, and are expanding the use of this technology to other arenas as well.

Martin Rafferty’s Next Generation Advocacy leadership extends beyond the innovations in school-trauma response. With Rafferty’s laser-focus on the critical importance of pairing innovative technology and mental health, Youth M.O.V.E. Oregon has figured how to inspire and engage emerging adults.

Over the last six years, the organization has trained over 26,000 people in 24 states. Their Facebook reach exceeds 625,000 active readers, and YMO peer support specialists provide more than 7,500 hours of peer support to transition-aged young adults each year. Early this year, YMO announced their national technical assistance (TA) program: Youth Program Builder. A program created to provide assistance, training, and support to agencies across the country. The program has had much success, having already consulted organizations to open three youth centers successfully thus far, with more in the works. In addition, YMO has implemented a national leadership program for youth called the Empowerment Recovery Academy.

Accolades and awards continue to come in for Martin and his team at YMO. Readers are encouraged to visit the YMO website to learn more about their amazing work.

  • Next Generation Advocacy leaders like Martin Rafferty don’t wait for language that reflects their work to be inserted into legislation, they just create it, find a way to fund it, and implement it. 
  • Next Generation Advocacy leaders like Martin Rafferty don’t base their work on what federal grants dictate as best practice or suggested approach. Next Generation Advocacy leaders are artists and innovators at heart. They articulate an innovative vision, find a way to fund that vision, and implement it.

Thank you Martin Rafferty for being a Next Generation Advocacy leader. 

The way we think of advocacy in mental health, which at its core is about pushing innovation, is changing. You may not know it or see it just yet, but trust me, it’s coming. And sooner than you think, the innovations these Next Generation Advocacy leaders are implementing will be cropping up in federal legislation bringing true reform to the mental health service delivery system in America.

Can you feel the tremors?

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Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

An Open Letter to Advocates About the Murphy/Johnson Bill

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Morning Zen Guest Blog Post ~ Debbie Plotnick, Mental Health America 

Dear Fellow Advocates:

It’s time to step back and take some credit. Acknowledge that your efforts have made a significant difference, even though no one has gotten everything they’ve wanted. But your efforts have had very positive results. Then gather your strength to not only beat back more of what you don’t want, and what you find hurtful, but also to fight for more of what you know is true and right, and for what you do want.

Look closely at where things are presently, not only where you wish they were, and just how far they have yet to go. Stop and really assess, don’t get stuck on where things were. Look at pending legislation in terms of existing law and regulation, and then think about what has the potential for good, as well as for bad. But most importantly, and hardest of all, is look beyond personalities and propaganda. Follow your own good counsel to present. Be in the here and now as you fight for what you passionately believe should come to pass (no pun intended).

What follows is detailed and nuanced. I respectfully ask you to please read it and then critically weigh what you think, and consider how you’d like to proceed. Maybe something will change, maybe everything will change, and maybe nothing will change. But it is my sincere hope that by reading this you’ll have a better understanding of where things are now, how they got there, and the important role advocacy has played, and can still accomplish.

On June 15, 2016 HR 2646, entitled Helping Families in Mental Health Crisis Act was voted 53-0 out of the House Energy and Commerce Committee. This unanimous vote showed a degree of bipartisanship that a year ago seemed almost unimaginable. This means that the bill in its current form may now come directly to the full House of Representatives for a vote. House leadership has indicated that they will move the bill after the July 4th holiday—this means in the coming weeks, before the August recess.

For much of its history, this bill was commonly referred to as the Murphy/Johnson bill, or just the Murphy bill. It began by loudly making the number one correlation that the public draws –no matter how often evidence is presented that this association is the exception and not the rule—gun violence and mental illness. Many of the original provisions seemed intended to increase old school reliance on hospital beds and involuntary commitment. However, much of the legislation that is now being sent on to the House strongly reflects the language and provisions of the Democratic alternative bill (HR 44435), which (owing to its primary sponsor) is known as the Green bill. The Green bill was the successor to what in the last Congress was known as the Barber bill. These bill have been widely supported by much of the advocacy community.

Because this is a political process, what is in currently in HR 2646 is the result of resolute advocacy but from opposing viewpoints. On one side were strong critics of the underfunded and disjointed current state of mental health , who were joined by caring but desperate families whose loved one’s were being failed but who had little knowledge about recovery and community supports. And on the other side were advocates fighting diligently to remove passages construed to be potentially very harmful to civil rights protections and decades of struggle to put recovery and peer supports into practice.

Although not 100% what the advocacy community might want, given that the bill’s initiators and original proponents have and continue to voice strong opposing views, advocacy has succeeded in removing many of the threatening provisions and greatly diminishing the impact of what remains. Some other issues that concerned the advocacy community are “done deals.” But not to be overlooked, also due to determined advocacy, the House bill and its Senate companion both contain quite a few beneficial provisions, which sets the stage for further positive change.

Here is a brief review of what advocates need to know regarding the provisions that have troubled them the most, how they’ve changed, where things now stand, and where they have the potential to go.

AOT, which refers to a specialized form of involuntary commitment called assisted outpatient treatment, presented one of the most concerning provisions for those in the advocacy community as it was originally put forth. But over time, and due to advocacy efforts and legislation that came from other arenas, much has changed.

In the first iteration of the Murphy bill (HR 3717) States that did not have, or did not adopt, an AOT law would forfeit 2% of their Federal Mental Health Block Grant. In the second version that became the Murphy-Johnson bill (HR 2646) this was changed to a 2% increase in Federal Mental Health Block Grant dollars to states with an AOT law on its books. Neither of these scenarios is currently under consideration.

As HR 2646 exists today, the AOT provisions build upon what is already in current law. It seeks to extend the length of time and funding for an AOT pilot program which already exists. Like it or not, this is a pilot that has been put into law, it will be evaluated, its outcomes reported, and it is slated to end. This program was approved in the Protecting Access to Medicare Act of 2014, (also known as the “Medicare Doc Fix”). Funding for this was appropriated in 2015 for the years 2015-2018. What is being proposed currently in HR 2646 (as passed out of committee) is that the funding would be extended through 2022 and would increase slightly from its current level.

PAMI: When changes to the Protection and Advocacy (for people with) Mental Illness first appeared in HR 3717 the effects if signed into law would have been devastating to the program and a blow to civil rights protections. Funding was to be slashed by 85%, leaving few resources. From the beginning there were also strongly worded provisions prohibiting state (and national) PAMI organizations from using federal funds for purposes of lobbying.

In the next iteration of the House bill, PAMI funding was no longer threatened, but most concerning to advocates were restrictions that would prevent PAMI advocates and lawyers from protecting people with mental illnesses in their right to refuse a prescribed medical directive. This would have meant that PAMI’s couldn’t defend people’s rights to refuse treatments they didn’t want, or from unfortunate but common exploitation by bad actors, such as those that bill Medicaid for unnecessary medical procedures. Provisions prohibiting state (and national) PAMI organizations from using federal funds to for purposes of lobbying were again reiterated.

In what has passed out of committee the restrictions prohibiting PAMI’s from defending people from exploitation are gone. What is presently in the proposed legislation are some changes and additions to existing reporting requirements, and a directive to establish new grievance procedures. It also strongly states that PAMI’s are to be “exclusively focused on safeguarding the rights of individuals with mental illness to be free from abuse and neglect.” The lobbying prohibition is also clearly stated. There is a clause in the present version that would prohibit PAMI’s from counseling “a person that lacks insight, from refusing medical treatment or going against the wishes of their caregivers.”

Here’s what advocates need to know as they consider the PAMI provisions, which were rewritten with input from PAMI advocates. The prohibition against using Federal funds for lobbying, and the directive to safeguarding the rights of individuals with mental illness to be free from abuse and neglect are in existing PAMI authorizing legislation. And while the counseling provision is new, what PAMI’s presently do, and can continue to do, is defend and protect, not counsel.

IMD Exclusion: Just the term makes advocates shutter—Institutions of Mental Disease (IMD). This fifty- year-old prohibition was put into place for reasons that are two-fold. One was to prohibit the Federal Government from paying the costs for what was considered to be the states’ responsibility—State Hospitals. And secondly, the IMD was intended to facilitate the closure of what had become state-run warehouses where millions of Americans languished sometimes for decades. Over time, among the unintended consequences of closing the these dying behemoths, is that in some locales there is nowhere to get care at all, as the number of community hospitals that were intended to afford acute care dwindled, and envisioned community-based services never fully came to fruition. Also substance use treatment facilities (which were not yet widely in existence) came to subject to this law.

There were concerns that provisions in earlier versions of the bill would allow the IMD to be repealed, and that there would be a return to institutionalization. What the current bill language seeks to do is to codify (put into law) what has already recently been finalized in regulation. Presently under a CMS final rule set out earlier this year, Medicaid dollars may be used for up to 15 days per month when a state Medicaid plan utilizes managed care for people to receive care in hospitals that meet the definition of an IMD (a mental health facility with more than 16 beds).

HIPAA: Advocates were greatly concerned that information would be shared against the wishes of the person receiving treatment. The bill as passed out of committee asks for clarification on under what circumstance this may be permissible and states that whatever is clarified must mesh with regulations that were issued by the Department of 6 Health and Human Services on February 20, 2014. It states that anything related to HIPAA will be done in conjunction with the Federal Office of Civil Rights within the Department of Human Services (HHS).

It is the discussion in a section entitled “Sense of Congress” there is language that will not make any legislative changes, but may be disconcerting to advocates. It is the use of the term “anosognosia.” This usage singles out people with mental illnesses who purportedly do not have awareness about their condition. However, such a phenomenon is common across many health areas. Use of this term in this context may be rhetorically offensive. But rhetoric is exactly what it is.

SAMHSA: This is an area about which there are differing interpretations. In early version of the bill the intent was to put an assistant secretary over the SAMHSA administrator. Presently the bill calls for an Assistant Secretary in place of an administrator and gives this person more power to coordinate across federal agencies. There will also be a Deputy Assistant Secretary who will assume a more administrative role. Bill language states that “a preference be given,” but not a requirement that the Secretary (but not the deputy) be an MD or PhD. This section as passed out of committee (uses language put forth in alternative bills, and has been signed off on by SAMHSA). Language in this bill should be more agreeable to advocates than what is presently in the Senate bill, which goes back to earlier versions of the House bill.

What’s in the bill for advocates and the people they care about—potentially a lot, including a $10 million grant for peer workforce development and training. There are also provisions that will further screening and early intervention. There are resources for Assertive Community Treatment (ACT), which often includes peers and is intended to support people in their home settings. It has provisions that can further parity, such as a Government Accountability Office (GAO) study. It reauthorizes or reinforces the use of important programs, including those that focus on trauma, integration of health services, suicide prevention, children’s health insurance and the uses of mental health screening and treatment for children in Medicaid.

So fellow advocates, please think carefully about what it is that you are and are not willing to live with to get more of what you want, especially since much has come to pass already. Remember, there will be changes and amendments, and most likely a need for House and Senate versions to be reconciled—more opportunities for advocacy. No matter what the reason, there is more interest in making a substantive change in national mental health policy, changes that will result in documenting what works (stuff we like) what may, or may not, be working (treatment as usual), and it is likely that legislation will be enacted. Please continue to fight to it legislation reflects your views and that builds upon what you know will make a positive difference. So speak up now—time is short.

plotnickDebbie F. Plotnick, MSS, MLSP 
Vice President
Mental Health and Systems Advocacy
Mental Health America

The post MHA Advocate Explains Why Those Opposed To Bill Should Be Proud Of Revisions Making It More Palatable appeared first on Pete Earley.

HR 2646 Meddles in Executive Branch Management and Offers an Empty Promise to Families and Providers

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Morning Zen ~ Scott Bryant-Comstock ~

By now, you most likely have heard the news that the House Energy and Commerce Committee unanimously approved the Helping Families in Mental Health Crisis Act of 2015 (HR 2646). Amid the cheers among national mental health advocacy groups and members of Congress, I find myself bewildered at the apparent willingness to overlook the many critical flaws in this bill. Have we come to the place where we choose to settle for a bill that is so vacuous and watered down as to be relatively meaningless? My hope is that as this bill and the accompanying bill in the Senate move forward, advocates and members of Congress will grow a spine and call out the more egregious aspects of both bills so that we can hopefully end up with a final bill that means something.

HR 2646 Attempts to Address a Management Issue Through Legislation
Almost a year ago to the day, I wrote:

For the past two years, there has been a constant drumbeat from members of Representative Murphy’s committee that the Administrator of SAMHSA had been a major obstacle to getting committee questions answered about how SAMHSA approaches its responsibilities...

Frustrated as they might be, Congress can’t “fire” Administrator Hyde, as the separation of powers between the executive branch and the legislative branch dictates that while Congress has the authority to investigate and allocate funds, the power to replace senior leadership is the purview of the Executive Branch. However, there is nothing to stop Congress from abolishing the position of the SAMHSA Administrator. No position, no Hyde.

Fast forward to today and former Administrator Hyde is gone and the recommendation to replace the SAMHSA Administrator with an Assistant Secretary for Mental Health and Substance Abuse remains. The question we need to ask ourselves as advocates, and then ask our elected officials, Is this the most prudent way to deal with a management issue? Do we need an “extreme makeover” because we are frustrated with the SAMHSA Administrator? Is this the way Congress should address frustration with Executive Branch management issues in the future? This is a dangerous precedent to set. I encourage you to read a post I wrote last year that provides some historical context for the dangerous folly behind this proposed action:

Empty Promise to Providers 
Adding to the significant lack of awareness in this bill of what is needed to achieve meaningful mental health reform is the stripping of the few key elements of earlier versions of the bill that could potentially make a difference at the local level, most notably the provisions based on the Excellence in Mental Health Act and the Mental Health First Aid Act. Also, once again, parity took a back seat as Rep. Joe Kennedy's (D-MA) amendment based on his parity enforcement legislation, the Behavioral Health Coverage Transparency Act (H.R. 4276), was withdrawn, as was Rep. Ben Ray Lujan (D-NM) amendment based on the Mental Health in Schools Act (S. 1588/H.R. 1211).

It is interesting to note that The National Council for Behavioral Health has been a primary force in encouraging members of Congress to include provisions in the Excellence in Mental Health Act and the Mental Health First Aid Act. The Council's membership is comprised of organizations who provide the services that will ultimately make a difference with whatever mental health legislation is passed. Maybe the Council ought to be listened to just a bit more when it comes to understanding the realities of implementation.

Empty Promise to Families
I continue to be haunted by the speeches that politicians make, preying on the horror and tragedies faced by so many families in the wake of the continued onslaught of public massacres in America. Every time I read a news account of a politician telling families who have suffered unimaginable loss that HR 2646 will prevent a Columbine, a Sandy Hook, or an Orlando, my stomach turns. And so should yours.

Statement by Congressman Tim Murphy during the markup of HR 2646 
“For those children and families, we made a promise: we’re going to fix the broken mental health system. For those innocent people in a movie theatre in Aurora, the grocery store in Tucson, wherever the perpetrator was someone with severe mental illness, for victims and their families we made a promise to deliver treatment before tragedy.” 
~ Representative Tim Murphy, PA ~ 

Over the past few years, the Children's Mental Health Network has featured posts by family members who are in staunch support of HR 2646. Wonderful advocates like Liza Long (The Anarchist Soccer Mom) and Dottie Pacharis, speak from the perspective of parents who have experienced tragedies that none of us would want, or I could even begin to imagine. We owe it to the Dotties and Liza's across America to not passively sit by and support a bill just because it is "better than nothing." Speak your mind, Network faithful. Now is not a time for celebration. Now is a time for doubling down and holding politicians feet to the fire. Empty promises help no one.

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Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

Samantha Bee Addresses the Political Hypocrisy Regarding Guns and Mass Murder in the Wake of the Orlando Massacre - Advocates Should Do the Same

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Morning Zen ~ Scott Bryant-Comstock ~ 

For those of you who are celebrating the movement of the Helping Families in Mental Health Crisis Act of 2015 (HR 2646) through the House, you might want to watch this commentary by Samantha Bee. And as you do, ask yourself a simple question. How many of the Congressional "Champions" of HR 2646 are speaking out against Assault Weapons? Or even more basic, publicly supporting the change in the federal law that would allow the CDC to conduct research on gun violence?

Remember, the architects of HR 2646 spread their sails on the winds of mass shootings, pairing the need for mental health reform with promises to end public massacres like those that took place at Sandy Hook, Columbine, Orlando and more.

Statement by Congressman Tim Murphy during the markup of HR 2646 
“For those children and families, we made a promise: we’re going to fix the broken mental health system. For those innocent people in a movie theatre in Aurora, the grocery store in Tucson, wherever the perpetrator was someone with severe mental illness, for victims and their families we made a promise to deliver treatment before tragedy.”
~ Representative Tim Murphy, PA ~

Warning: This video contains some expletives and profanity in the expression of strong views and opinions that viewers may find controversial.

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Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

Hey Congress, Get Your Head Out of The Sand - Approve CDC Research on Gun Violence

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Morning Zen ~ Scott Bryant-Comstock ~

Another horrific mass murder takes place, this time in Orlando, Florida, and still, we have a Congress that continues to shuffle its feet on the topic of gun violence. For those in Congress who speak of "doing something now" to stem the tide of mass shootings, I have an idea for you – Reverse the nearly 20-year-old ban on funding for the Centers for Disease Control and Prevention (CDC) to conduct research on gun violence. 

We as a nation of voters need to hold our representatives' feet to the fire on this issue. Over the past two years, we have seen a dramatic uptick in the political debate about mental health reform. The debate has at times blatantly, and other times, more subtly, made the connection between mental illness and violence. This connection continues to be made, in spite of the research showing that people with mental illness are far more likely to be victims than perpetrators of violent crime. Using the fear tactics inherent in connecting mental illness and violence while simultaneously blocking funding for research to understand better gun violence is not only disingenuous, it is unforgivable.

In June of last year, the House Appropriations Committee voted 19-32 against ranking member Rep. Nita Lowey's (D-N.Y.) proposed amendment to a bill that would fund health, education and labor programs in the next fiscal year. Representative Lowey's amendment would have reversed a nearly 20-year-old ban on funding for the Centers for Disease Control and Prevention (CDC) to conduct research on gun violence. Specifically, the amendment would have struck Section 216 from the bill (Section 216 prohibits funds from being used to advocate or promote gun control) and this section of text from the accompanying report(page 47-48):

  • Gun Research.—The Committee continues the general provision to prevent any funds provided from being spent on gun research, to include collecting data for potential future research, such as was proposed in the budget request for the National Violent Death Re- porting System. The Committee notes the budget request for Gun Violence Prevention Research is not funded and would be contrary to the prohibition. The Committee reminds CDC that the long- standing general provision’s intent is to protect rights granted by the Second Amendment. The restriction is to prevent activity that would undertake activities (to include data collection) for current or future research, including under the title ‘‘gun violence prevention’’, that could be used in any manner to result in a future policy, guidelines, or recommendations to limit access to guns, ammunition, or to create a list of gun owners.

For readers who have congressional representatives that continue to invoke a mental illness - violence connection, yet pride themselves on being forward thinking about mental health reform, time for a gut check.

Put on your advocacy hat, pick up the phone and call your representative's office. Ask them what they think about the wisdom of blocking a proposal that would have reversed a nearly 20-year-old ban on funding for the Centers for Disease Control and Prevention (CDC) to conduct research on gun violence. Ask them if they think this action falls in line with their publicly-held position on the connection between guns, violence and mental illness. Ask them, regardless of their position on gun violence and mental illness, if they think it would be a good idea to get a better handle on understanding the increasing gun violence in America. Ask them if they are committed to designing mental health legislation that incorporates sound research on gun violence. Remind them that the current mental health reform proposal in the House (H.R. 2646) “requires” family members of mentally ill individuals who have committed violent acts to be involved in decision-making around government grants focused on mental illness. Then ask them again, if they think it would be important to include sound research to understand gun violence in America better.

Hold your representative's feet to the fire on this issue, Network faithful. Over the past two years, we have seen a dramatic uptick in the political debate about mental health reform. The debate has at times blatantly, and other times, more subtly, made the connection between mental illness and violence. This connection continues to be made, in spite of the research showing that people with mental illness are far more likely to be victims than perpetrators of violent crime. Using the fear tactics inherent in connecting mental illness and violence while simultaneously blocking funding for research to understand better gun violence is not only disingenuous, it is unforgivable.

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Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

Congress, hear this mother's plea: Help families with mental illness

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Morning Zen Guest Blog Post ~ Dottie Pacharis ~  

The media coverage of this year's presidential election rages on. Meanwhile, meaningful mental-health reform legislation introduced in Congress has been relegated to the back burner. What was to be at the top of the 2016 House agenda, according to House Speaker Paul Ryan, has been pushed aside while Congress focuses on the politics of the election.

We have a presidential election every four years. We have a mental-health crisis in this country 365 days a year, every year. We only hear about the mass shootings that make the national news; yet tragedies involving untreated mental illness occur daily throughout this country and will continue to do so until Congress passes meaningful mental-health reform legislation.

Just this past February, it was reported that a father in Cape Coral was murdered and dismembered by his son who suffered from mental illness. The father's torso was found wrapped in a sheet in a wooded area behind their home. Body parts were found in a suitcase floating in a canal.

The father lived in fear of his son. Because the son did not meet the commitment criteria for involuntary hospitalization, the father was unable to get the treatment his son so desperately needed to prevent this gruesome tragedy.

Yes, this year's presidential election is important. So is mental-health reform. Seriously disturbed people struggling with mental illness need help now — not after the election — not next year. They need it now.

There have been multiple legislative proposals introduced in Congress to improve this country's broken mental-health treatment system. The strongest bill is from Rep. Tim Murphy, R-Penn., the "Helping Families in Mental Health Crisis Act," (H.R. 2646), which has 191 bipartisan co-sponsors — 138 Republicans and 53 Democrats.

This proposed legislation calls for a complete overhaul of the current federal system, refocusing resources on helping those with the most serious mental illnesses by getting them treatment before, during and after a psychiatric crisis. Individuals with serious mental illness such as schizophrenia and bipolar disorder can lose touch with reality. Many don't even know they're sick.

Among many important provisions, the Helping Families in Mental Health Crisis Act would reorganize the way the federal government funds mental-health services by identifying and prioritizing programs that have a proven track record of success.

This bill would provide funding to help states use assisted outpatient treatment, a lifesaving program for people who are too sick to maintain treatment themselves. It would increase the number of inpatient psychiatric beds and make adjustments to the Health Insurance Portability and Accountability Act that prevents doctors from giving families the most basic information about their mentally ill relatives' conditions.

Our current dysfunctional mental-health system abandons at-risk people to the devastating consequences of untreated mental illness. Mass shootings are on the rise. Suicide is the 10th-leading cause of death in the U.S. Untreated mental illness not only results in suicide and homicide, but in substance abuse, crime and homelessness.

Our failure to care for the mentally ill comes at a high cost — not just in economic terms but in wasted human potential. Yet with proper diagnosis and treatment, many patients are able to overcome mental illness, contribute to society and live normal and happy lives.

Mental illness is not something people choose. It's not a character flaw. It is a disease. It does not discriminate based on age, class or ethnicity. It affects all segments of society. According to the National Institute of Mental Health, the number of people with schizophrenia and severe bipolar disorder now tops 8 million adults in the U.S. Close to half of these people are going without treatment as families struggle to care for them.

As the mother of an adult son who suffered from severe bipolar disorder and took his life, I can personally attest to the fact that families for decades have had to watch their loved ones descend into "Code Red" territory because current laws do not allow them to push the "help" button until the person reaches the crisis stage. Only when an ill person becomes a danger, as determined by a judge at a commitment hearing, can this person be involuntarily hospitalized and treated.

Helping Families in Mental Health Crisis will mark a new era for mental-health care in this country. It will move mental-health care from crisis response and tragedy to recovery. Congress should move this comprehensive mental-health legislation forward now — not after this year's election. 

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dottieDottie Pacharis is the author of "Mind on the Run — A Bipolar Chronicle." She divides her time between Fort Myers Beach, Florida, and West River, Maryland. Since her son’s battle with bipolar disorder, she has become an advocate for appropriate care for the mentally ill, especially family involvement in decisions about treatment. Dottie is the author of Mind on the Run – A Bipolar Chronicle, the story of a suicide that proper treatment would have prevented. She has been a featured speaker at various mental health organizations and has been published in the Wall Street Journal, Washington Times, Guardian UK, News-Press, Ground Report, and the Orlando Sentinel. 

This article was originally posted as an editorial in the Orlando Sentinel.

It’s Time for Mental Health Advocates to Take Back Assisted Outpatient Treatment From Misguided Politicians

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Morning Zen Blog Post ~ Scott Bryant-Comstock ~ 

The month of June 2016 holds promise for being remembered as the time when “something” was done about mental health reform. The Senate is hard at work on crafting mental health legislation, and the House Energy and Commerce Committee has announced that Tim Murphy’s Helping Families in Mental Health Crisis Act of 2015 (H.R. 2646) will rise again, apparently with a robust managers amendment to address some of the most problematic aspects of the bill.

One of the more ironic aspects of the protracted debate about what defines mental health reform is the discussion of Assisted Outpatient Treatment (AOT). Followers of congressional discussions of mental health reform will remember that since the early crafting of HR 3717, the precursor to the current HR 2646, AOT has been the tip of the spear for Tim Murphy’s campaign to get his bill passed.

Over the past few years, in stump speeches and editorials too numerous to count, the term AOT has become synonymous with mental health reform. Never mind the not insignificant fact that AOT is already on the books in 46 states or, even more telling, that I have yet to hear a politician articulate, with any sense of clarity or understanding, what is involved in the AOT process other than the civil commitment hearing component. Somehow, AOT has become the media darling for the “thing” that is going to prevent mass shootings and make us all safer from seriously mentally ill individuals determined to commit mass murder.

A few months ago I asked our research team to conduct an analysis of the news stories in support of HR 2646 listed on Representative Murphy’s website. Not surprisingly, the articles are filled with provocative and inflammatory language, graphic descriptions of violent incidents, and emotionally charged personal anecdotes. Headlines and articles contain references to "bloodiest rampages," "horror," "heinous crimes," "blood-curdling screams," "murderous assaults" and "apocalyptic assault." Authors have referred to seriously mentally ill individuals as "deranged," "frighteningly unstable," "shooters on the dishonor roll of evil," "a clear and severe risk to the public" and "a threat to society." Some headlines send the message that mental illness causes violence: "Floyd: Dallas police department attack highlights mental health needs," "New Mental Health Bill Could Prevent Mass Shootings," and "Efforts Underway To Prevent All Too Often Tragic Results Of Untreated Severe Mental Illness."

Despite the overwhelming statistics dispelling the idea that mentally ill individuals are inherently violent, the public buys into this notion in part because of the media's depiction of mental illness as a predicting factor of violent incidents such as mass shootings (Hoffner et al. 2015; Swanson et al. 2015).

Sadly, while many of the current 189 cosponsors of HR 2646 will admit that they understand that most seriously mentally ill are not violent, they continue to let the sensationalized misleading headlines in the media pairing violence and mental illness go unchallenged. The tacit approval of the guns, violence mental illness comparison is a disgrace, but then again, this is politics. 

The AOT divide - advocate against advocate 
It is important to understand that the narrative about AOT that drove much of the discussion in Congress the past two years during hearings on the Helping Families in Mental Health Crisis Act was narrowly defined, focusing primarily on the civil commitment procedure in a courtroom. Justifying the need for AOT, architects of the various versions of the Murphy bill undertook a systematic campaign to eviscerate the peer support recovery movement and SAMHSA. Nowhere was this campaign more evident than in some of the hearings held by the House Committee on Energy and Commerce, Subcommittee on Health. Advocates supportive of the most intensive treatment end of the AOT spectrum railed against advocates supportive of the peer-to-peer support community seeking alternatives to AOT. Another sad tragedy caused by misguided politicians trying to move forward with an ill-defined bill at all costs. 

Time for advocates on both sides of the AOT debate to band together 
For several years, the Children’s Mental Health Network has called for advocates on both sides of the AOT debate to come together to find ways to meet the needs of individuals with serious mental illness. With the recent announcement by SAMHSA of the Assisted Outpatient Treatment (AOT) Grant Program, advocates on both sides of the AOT debate have an important opportunity to work together to design an AOT process that incorporates the full breadth of community involvement.

The AOT pilot program was established by the Protecting Access to Medicare Act of 2014 (PAMA), Section 224, that was enacted into law on April 1, 2014 (Commonly known as the “Doc Fix” Bill). Rep. Tim Murphy (R-Pennsylvania) and Senator Debbie Stabenow (D-Michigan) are credited for getting the pilot program into the Doc Fix bill during the height of controversy around AOT being considered as part of HR 3717.

The description of the grant announcement includes language that states that "...grants will only be awarded to applicants operating in jurisdictions that have in place an existing, sufficient array of services for individuals with SMI such as Assertive Community Treatment (ACT), mobile crisis teams, supportive housing, supported employment, peer supports, case management, outpatient psychotherapy services, medication management, and trauma-informed care." 

Mental health advocates need to seize on the language in the grant announcement that provides an opportunity for states and communities to put together applications that reflect the full breadth of what is required to make the AOT process work. I know this may seem difficult for anti-AOT advocates, but now is the time to get involved in the design and delivery of these pilot projects. Leaving it up to politicians to define what AOT is will result in more of what we are currently seeing – a gross lack of understanding of the importance of the recovery community in treating and supporting individuals with serious mental illness.

I encourage you to read our review of a community implementing AOT so that you can have a better understanding of what is required to make the process work. Also, take a look at Dr. Dennis Embry’s article on the science behind the AOT process. The recovery community must work in close collaboration with the treatment community if the precious federal dollars devoted to this effort are to have any chance of success. A winning proposal will honor both the need for high-intensity services along with the need for peer-to-peer supports that are designed for and by individuals with a history of mental illness. 

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scottScott Bryant-Comstock
President & CEO
Children's Mental Health Network

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