Advocates dialogue on Assisted Outpatient Treatment – Next steps

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Front row, left to right: Bethany Lilly, Bazelon Center for Mental Health Law; Shibli Nomani, Asra Nomani, Treatment Before Tragedy; Maria Silva, Allegheny Family Network; Lisa Lambert, Parent Professional Advocacy League; Debbie Plotnick, Mental Health America. Back row, left to right: Dennis Embry, Paxis Institute; Scott Bryant-Comstock, Children's Mental Health Network; Brian Stettin, Treatment Advocacy Center; Ron Honberg, National Alliance on Mental Illness; Mary Jacksteit, Creating Community Solutions.

Back in August, when we first conceptualized the idea of the dialogue series, it was in large part based on the encouragement from a Politico article in June that stated that a bipartisan group of House lawmakers were looking for compromise mental health legislation between the two bills in the House (HR 3717 & HR 4574). In the Politico article, Rep. Tim Murphy (R-Pa.) expressed hope that common ground could be found on his Helping Families in Mental Health Crisis Act, which he introduced late last year. And Rep. Ron Barber (D-Ariz.) expressed similar optimism for his bill, which was introduced six months after Murphy’s. According to news reports, the negotiations would begin during the July recess. 

Of significant concern to the Children's Mental Health Network was the fact there was very little discussion of the impact of these two bills on the children's mental health community (including emerging adults up to the age of 26). This vacuum in the conversation about children's mental health reform encouraged us to begin a dialogue with advocates, families and providers, figuring that if members of Congress were going to do it, we should as well. 

The dialogue series we have been conducting over the past several months has pointed out in stark relief that a) the issue of Assisted Outpatient Treatment is more complex and far-reaching than many of the most vocal proponents and opponents would have you believe; and b) successful strategies using the AOT process utilize treatment approaches supported by those on both sides of the debate – especially (our personal vested interest) as it relates to emerging adults up to the age of 26!

The format for this dialogue will be similar to the previous dialogues. We will begin with a "fishbowl" group that will share experiences with AOT for young adults over the age of eighteen and the process of directing treatment for youth under the age of eighteen. Per usual, House congressional staff are invited to observe the dialogue. We are also inviting advocates and interested citizens to attend the event and observe the dialogue.

Upon completion of the dialogue, we will open up a discussion highlighting our findings over the past several months and encouraging all in attendance to share ideas for how to further develop a comprehensive understanding of the AOT process and the impact this controversial component of HR 3717 is having on the overall discussion of meaningful mental health reform.

The Advocates Dialogue on Assisted Outpatient Treatment (AOT) is being conducted to achieve two primary objectives: 

  • For advocates, families and providers 
    Bring together advocates on both sides of the AOT discussion to listen to differing perspectives and share ideas for how to move the national conversation about AOT forward. Key to this effort is a focus on strategies that facilitate collaboration, civility, and improvement of services and supports for individuals with mental health challenges, their families and the communities in which they live. 
  • For congressional representatives and staff 
    Provide an opportunity for congressional representatives and staff to observe the dialogue and gain deeper insight into the perspectives and the different advocacy positions. Since legislative staff are critical to the writing of language in any proposed bill that addresses this topic, it will be beneficial for them to have a broader understanding of perspective and utilize that broadened perspective in working on compromise language. 

    We will capture key points and suggestions for moving the dialogue forward in the discussion and will prepare a written report for dissemination to members of the House Committee on Energy and Commerce for their consideration as they work toward compromise language to pass meaningful mental health legislation.

Note: For background context on the creation of the Advocates Dialogue on Assisted Outpatient Treatment, please click here

Overall purpose of the dialogue 
The goal for this meeting is not to pit "for" and "against" head to head. Quite the opposite. The purpose of the discussion is to provide an opportunity for the sharing of personal experience around the challenge of addressing this issue, the emotion it brings, and how we can move forward – precisely why this discussion will not focus on research, data or other props to support a position one way or the other. Everyone in the discussion is quite astute and could argue a position either for or against with plenty of supported data to back them up. 

How is the dialogue be structured? 

  • Scott Bryant-Comstock will facilitate the discussion. Discussants will be seated in a circle in the center of the room. Congressional members, staff and interested citizens will be invited to observe the discussion. 
  • No charts, graphs, research studies, or speeches allowed! There have been presentations of research on both sides of the issue in many different forums. And it seems to us that neither side is listening to the other, so we are gonna leave the PowerPoints behind!
  • At the end of the dialogue, observers are welcome to interact with discussants in an informal "after the meeting" environment. 
  • The goal of the discussion is not to “solve” anything – just to broaden understanding of the unique perspective each brings to the topic. Quite bluntly, our goal in this meeting is not to convince members in Congress of what the “right decision” is, but more to encourage continued and more frequent dialogue between proponents of both bills. Knowledge is power. Ignorance is bliss, which is always short lived. 
Participants in the fishbowl dialogue include (in alphabetical order): 

scott4Scott Bryant-Comstock, President & CEO, Children's Mental Health Network – Scott has worked in the mental health field for over 30 years in a variety of roles, including therapist, trainer, mental health board chair, state level mental health official and national consultant, trainer and facilitator. Over the course of his career, Scott has incorporated learnings from policy-makers, families, providers and community leaders throughout the United States into a focused approach to improving services and supports for youth with emotional challenges and their families. Scott is the founder, President & CEO of the Children’s Mental Health Network.

enbryDennis Embry, President/Senior Scientist at PAXIS Institute – Dennis D. Embry is a prominent prevention scientist in the United States and Canada, trained as clinician and developmental and child psychologist. He is president/senior scientist at PAXIS Institute in Tucson and co-investigator at Johns Hopkins University and the Manitoba Centre for Health Policy. His work and that of colleagues is cited in 2009 the Institute of Medicine Report on The Prevention of Mental, Emotional, and Behavioral Disorders Among Young People. Clinically his work has focused on children and adults with serious mental illnesses. He was responsible for drafting of the letter signed by  23 scientists, who collectively represent scores of randomized prevention trials of mental illnesses published in leading scientific journals. In March 2014, his work and the work of several signatories was featured in a Prime-TV special on the Canadian Broadcast Corporation on the prevention of mental illnesses among children—which have become epidemic in North America. 

ronRon Honberg, J.D., National Director of Policy and Legal Affairs, NAMI, the National Alliance on Mental Illness. Mr. Honberg oversees NAMI's federal advocacy agenda and NAMI's work on legal and criminal justice issues. Mr. Honberg has drafted amicus curiae briefs inprecedent settinglitigation affecting people with mental illnesses and has provided technical assistance to attorneys and NAMI affiliates on legal and public policy issues. He serves as a frequent resource for print and broadcast media on legal and policy issues. Mr. Honberg has a Juris Doctor degree from the University of Maryland School of Law and master's degree in education from the University of Maryland. 

mary2Mary Jacksteit – Professionally, Mary Jacksteit is a seasoned practitioner who supports collaboration, joint problem-solving, dialogue and conflict resolution in a number of settings – community, organizational, and institutional. With a small DC firm, Justice and Sustainability Associates, LLC, (JSA) the context is mediation and public engagement on land use/development; with the Public Conversations Project, the context is divisive issues within groups/communities/institutions; with the Federal Service Impasses Panel the context is union-management relations (she Chairs the Panel, having been appointed by President Obama in 2009.) Over the last year she participated on the virtual team implementing Creating Community Solutions, part of the National Dialogue on Mental Health led by SAMHSA. In the past she has run two projects for Search for Common Ground, a conflict resolution organization. She has a JD and Masters in Conflict Analysis and Resolution.

As a parent, Mary has direct experience with issues concerning mental health/treatment. As a child her son was diagnosed with OCD and treated with CBT; early adolescence brought with it serious depression and other very challenging symptoms leading to a diagnosis of bipolar disorder and anxiety and treatment with medication and psychotherapy. Acute illness led to hospitalization and then an extended period in an adolescent treatment center.  After returning home he finished high school, worked and went to community college, on a steady path of recovery. He now lives independently, and just completed an AA degree in mental health, intending to work in the field. He manages continuing issues with a treatment regimen of CBT and medication. 

lambertLisa Lambert, Executive Director, Parent/Professional Advocacy League (PPAL) and Children's Mental Health Network Advisory Council member – Lisa Lambert is the executive director of Parent/Professional Advocacy League (PPAL), a statewide, family-run, grassroots nonprofit organization based in Boston. Lisa serves on a number of committees in Massachusetts as well as the Building Bridges Initiative Youth and Family Partnership workgroup. She has been instrumental in working with local and national media to highlight the concerns of families and youth. She is dedicated to ensuring that family voice is included in every state and national conversation about the policies, practices or services that impact them. 

bethanyBethany Lilly, Policy Attorney, Bazelon Center for Mental Health Law – Bethany Lilly is a policy attorney with the Bazelon Center for Mental Health Law where she works primarily on federal policy impacting people with mental illnesses, with special focus on Medicaid, community integration, and employment services. Before joining the Bazelon Center, Bethany served as a law clerk with the U.S. Senate Committee on Health, Education, Labor and Pensions and as a legal fellow with the Center for Medicare Advocacy. Bethany received her J.D. from Duke University School of Law, where she also worked at the AIDS Policy Project advocating on behalf of people living with HIV in North Carolina and the Southeast, and her B.A. from the University of California Los Angeles. 

asraAsra Nomani, President, Founding Member, Treatment Before Tragedy – Asra Nomani is the President and one of the founding members of Treatment Before Tragedy, a non-profit organization advocating for better treatment, services, research and a cure for individuals and families impacted by serious mental illness.  Asra is a former Wall Street Journal reporter who has taught journalism at Georgetown University. A cross-cultural communications trainer and independent journalist, Asra has written about mental illness and trauma for the Washington Post, the Los Angeles Times, the Daily Beast and Washingtonian magazine. She has loved ones diagnosed with serious mental illness and has witnessed firsthand the challenges that families face in seeking treatment and services for loved ones.

debbieDebbie Plotnick, Senior Director of State Policy, Mental Health America, works with affiliates and state and local advocates on Medicaid, health reform, and state mental health programs and policies. She also coordinates the efforts of the Regional Policy Council, a ten person council of state affiliate policy leaders. Debbie also provides technical assistance to mental health advocates, participates in national mental health coalitions, and develops and disseminates policy information for affiliates, stakeholders, decision makers and the general public. She can also speak about community inclusion, evidence-based practices, and her own experiences with mental health challenges and as a family member. 

mariaMaria Silva, Senior SupervisorAllegheny Family Network. Allegheny Family Network (AFN) is a Allegheny County, Pennsylvania, “family run” organization (all staff are or have raised children with mental health or behavioral concerns). AFN provides one on one in home peer mentorship through a variety of programs to parents/caregivers, addressing their needs and helping them achieve the goals they and their family make. Maria is the mother of six children, two of which have mental health concerns. Maria is President of the Prader-Willi Syndrome Association of PA, a trainer for: Mental Health First Aide both the adult and youth version, NAMI Family to Family, Agents of Transformation (a Parent leadership training), and presents at a variety of conferences on: NSSI (non-suicidal self-injury, Peer to Peer Support, and Behavioral Health concerns from a family viewpoint.

brian

Brian Stettin, Policy Director, Treatment Advocacy Center – Brian Stettin is the Policy Director of the Treatment Advocacy Center, a national advocacy organization based in Arlington, Virginia that works to remove legal barriers to the treatment of severe mental illness. In 1999, as an Assistant New York State Attorney General, Brian was instrumental in conceiving and drafting "Kendra's Law," landmark legislation establishing Assisted Outpatient Treatment (AOT) in New York. After leaving the Attorney General's Office in 2007, Brian served as Special Counsel to the New York State Commissioner of Criminal Justice Services and Counsel to the Health Committee of the New York Assembly.  Since joining the Treatment Advocacy Center in 2009, Brian has worked with state legislators and policymakers across the U.S. to improve mental health commitment laws and establish AOT programs. Brian is a 1991 graduate of the City College of New York and a 1995 graduate of the University of Texas School of Law. 

Here are the details again: 

Questions? Please contact Scott Bryant-Comstock, 919-219-2342 / scott@cmhnetwork.org

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