NEC-West Teleconference on Outpatient Involuntary Commitment
Thursday, February 3, 2000 5:30 pm PST
Present: Dan Fisher; Laurie Ahern; Bob Lyons; Dolores Percy; Rob Chittenden; Louis Andrews; Mary Stewart; Ken Stockamp; Nancy Thomas; Sally Zinman; Sharon Yokote; David Oaks; Walter Shwe; Bill Compton; Mark Goldberg; Greg Warren; Billy Collins; Kathie Zatkin; Edwina Anderson; Carole Ford; ________;Edward Ellison; Catherine Henderson; Catherine Bonds; Elizabeth Elftman; Kevin Fitts; Pat Risser; Mary Curtoni; Carol Patterson; John Dorsey, Katsumi Kenaston, Phillip Buehler
What does Outpatient Commitment mean?
If you are in the community it means you can be rehospitalized for very minor infractions, such as not taking your medication or judged by a lay person that you might deteriorate. It means forced drugging in your home and that you can more easily be put into the hospital. Its also intimidation and loss of civil rights. Outpatient Commitment is AKA Assisted Community Treatment. Outpatient commitment and PACT (Program for Assertive Community Treatment) are often linked. PACT was developed in Wisconsin, as was NAMI. In PACT, patients are coerced through financial and housing incentives to take their medication. PACT is very much based on a coercive, medical model.
Many States have made it a Primary Issue. A strong coalition in New York against outpatient commitment. NEC put together a packet on Outpatient Commitment because of the New York campaign. Please send in additions to update the packet. People can write or call in to get info to use in their States. In New York a coalition called "Coalition to stop out patient commitment" - They had a strong coalition even though they were unsuccessful in stopping it. - it's important consumer survivor groups and mental health groups get together if they are similarly opposed. IAPSRS, The International Group, and the National Mental Health and The Bazelon Center have come out against outpatient commitment. These are national groups that can be contacted to get info on out patient commitment.
Forced treatment:
blocks recovery
destroys trust (Jean Campbell and Ron Schraiber's study)
creates fear and dependency
violates human and civil rights
is costly and diverts money from recovery-oriented services
1) The Bellevue study found there was no difference in outcomes between control group receiving voluntary services and involuntary outpatient group. Only difference was outreach provided on a community basis was beneficial.
2) Why Involuntary Commitment Won't Work in Nevada is a document produced by the Nevada P &A. It argues effectively against IOC but recommends PACT(!) Carol has a copy of it, if you would like a copy, call her at 1-888-746-4463 PIN 9378 (its 1/2 inch thick including attachments.)
3) NEC packet on how to fight PACT - call them at 1-800-power2u to receive a copy. If you have information to update their packet, send it to them at NEC, 599 Canal St., Lawrence, MA 01840.
4) Alternatives and PACE (Personal Assistance in Community Existence) developed by NEC
Five states including New York have said they want to develop pilot PACE programs as alternative to PACT.
We need to form coalitions and become informed and ready to respond to the media.
In Oregon, c/s/x found out about a conference on PACT and they packed the conference planning with c/s/x and changed the focus of the conference and invited Dan to speak. While PACT has been stopped in Oregon, it is being considered administratively -- the Oregon legislature is not in session this year, so can't be introduced as a bill at this time. They are trying to expand the Outpatient Commitment net. When the publicity hit in New York, we took offensive aggressive action --pictures of the Attorney General, see pictures of forced drugging and info about the results of study showing that neuroleptic drugs cause irreversible changes to the brain structures. TAC (Treatment Advocacy Center) and APA admit his.
Need also to get out that the drug industry funds NAMI. TAC is funded by the Stanley Foundation which got its money from the Stanley family mail order business. Stanley Foundation's door says "NAMI Research Foundation" on it, so it is definitely linked to NAMI. All the people on their board are medical-model oriented, including some consumers. Their goal is PACT in every state. They are collecting violent incidents and recommending to NAMI affiliates that they publicize them, write letters to the Editor.
We need to link with the prison justice movement.
Why did the coalition fail in New York?
Bad press and bad timing because of the publicized death of Kendra and the Attorney General of New York City made it a cause. NAMI and D.J. Jaffe, in the PR industry in the medical field, pushed it very hard. The one incident was pushed into a crime/public safety issue.
Hawaii -- at a meeting 2 of c/s talked about what it's like to go on these drugs to educate others
California - we have formed the CARES (Coalition Advocating for Rights, Empowerment and Services) is made up of CASRA (the Psychosocial Rehabilitation agency here) Protection and Advocacy, Inc (PAI), CAMHPRA (California Association of Mental Health Patients Rights Advocates) and the California Network of MH Clients. AB1800 has been introduced and its no different at all from AB1028, which Helen Thompson withdrew.
Cal Network is organizing a protest for Monday, February 28 10am - 3 pm in Sacramento. Perhaps folks can visit their legislators in the morning. Mark suggests people demonstrate in front of local legislators offices at the same time if they can't get to Sacramento. LA will be renting a bus to bring 45 people up to Sacramento. Planning for this will be done on a closed e-list. The date was chosen because the bill has been introduced but won't have been heard in committee.
CARES has proposed a positive bill that would be an alternative to AB 1800. It proposes voluntary community services and discharge planning.
There were 40 LPS Forums held by the "Big Five" (The CA Planning Council, the Mental Health Boards, MH Director's Assn, CA Institute of MH, the MH Dept.) throughout the state to discuss changing LPS (AB 1800) with 2000 participants (consumers, families, providers). There was no clear groundswell for increasing involuntary commitment, instead the themes were: 1) change the system not the law and 2) implement the law as it is now. We can take this information to legislators.
The CA Network got a grant from Disability Rights Advocates to work on AB 1800 and the expansion of forced treatment.
We need to worry about the people who don't speak up at the forums - law enforcement, the Attorney General who will work against us in the end. In Oregon, we waged a campaign to embarrass the Attorney General in front of the progressive community. We're currently harassing the Governor and the Commissioner.
People in CA need to be calling their legislators. Need to talk to legislative neighbors. Need to go to their community.
We want to demonstrate in Davis, CA Helen Thomson's home district, in front of her home. This bill is about going into people's homes. We need a non-violent, disciplined protest on Saturday or Sunday in front of Thomson's home. We could carry a casket to represent the deaths from forced drugging.
Isn't there something procedural where a bill can't be resubmitted in the same session, with out some substantive changes? This is a rule that's internally regulated -- another legislator would have to raise the issue. If they did it, she would have to get a 2/3rd vote in the Assembly, to change the rule, which she could easily do.
Has anybody successfully mounted a legal challenge against forced out patient commitment?
Kathie has some legal arguments and papers she developed before the bill was introduced, with legal arguments and legal cites. Kathie mentioned the issue of liability for adverse drug reactions, and the bill is so vague it deprives people liberty based on status rather than on behavior. Status crimes are against the constitution. Federal law uses a functional definition of physical restraint, so medication is included as a form of restraint. So IOC is not an alternative to confinement it is a form of confinement. She will make the draft available to the Network and send them to Carol.
There is also the paper by Nevada P &A but it also recommended PACT as a solution instead of IOC.
I think it is in Kansas they have a program, something called forced medication compliance. Some one knocks on the door and gives them their daily dose, have them sign a paper that they took the meds then they come back in the afternoon and do it again.
Is there an economical study of PACE vs PACT? The bill includes $350,000,000 but if it passes, according to the MHA analyst, all the money will be spent on more inpatient hospital stays. None will be left for community service or programs. Its unlikely though, that the bill would be fully funded, Governor Davis would be against the funding that much.
NEC is in the early stages of trying to get a PACE Pilot program going in New York with Darby Penny. No economic study as of yet but it really should be cheaper than forced treatment.
John Burton is against AB 1800, he's President Pro Tem in the Senate and he's on our side. He introduced SCR59 which creates a Joint Committee on MH Reform. This committee would report back after AB 1800 would have get through the Assembly. The language in this bill is much better than in AB 1800.
There was an article in the San Diego Union Tribune, that the first two months of the implication of AB34 which is voluntary services and voluntary outreach to homeless, only got $10,000,000, was quite successful. This year Davis has $20,000,000 in for AB 34.
I think there is an advantage in California, as opposed to New York. In California the money for voluntary services came first.
In Hawaii, we have a seriously disabled bill that has passed and on the books. Some smart attorney has tweaked it so that the language for grave disability is not like the California language. As a result, no family court judge in Hawaii will proceed with using this because they don't want to be overturned on appeal. So feed the wrong language in the middle of the night, when they're writing the bill!
AB 1800 seems to fly in the face of managed care, which is trying to reduce treatment costs. Involuntary treatment is the most expensive form of treatment.
Involuntary treatment means forced drugging, as if that's the only form of treatment.
In a Massachusetts in 1976, The Ruby Rogers case created the right to informed consent and to refuse treatment for mental patients.
In Arizona, in 1980, the Arnold case gave people have the right to be treated in the community, but not sure if there is Outpatient Commitment.
Wisdom from Kevin's wall:
Saul Alinsky
1) Power is not only what you have, but what the enemy thinks you have.
2) Never go outside the experience of your people.
3) Whenever possible go outside the experience of the enemy. (Make them look uninformed and lacking in knowledge.)
4) Make the enemy live up to their own book of rules.
5) Ridicule is man's most potent weapon.
8) Keep the pressure on.
12) The price of a successful attack is a constructive alternative.
Motto: Agitate, aggravate, educate and organize
We need to address the violence issue, because the media throws it out and people react emotionally to it. That's how we got Kendra's law in New York, even though we're not violent. This issue is not unlike the issue of getting welfare mothers off welfare-- there's not a lot of sympathy.
ACLU came out against AB1800 in California. People called and kind of pestered them to take a position. The California Foundation of Independent Living Centers took a position against it.
The National Council of Disability, a Federal agency, in November l998 interviewed people with Psychiatric Disability on the barriers to Mental Health treatment. One barrier was that people were abused and mistreated in treatment. They came up with 10 points, or recommendations, the first one being any laws that create involuntary treatment are suspect because involuntary treatment undermines our self-determination. The report was just released, Jan 20th.
This issue also relates to Mental Illness Courts -- segregating us from the Justice System-- they are up and active in parts of CA.
Kevin has an article: Outpatient Commitment: Treatment or Control? Its on the damages of outpatient commitment, but it costs $1.50/page and is 25 pages longs.
Psychiatrists like Coni Kalinowsky, Loren Mosher, Doug Smith might be able to help us with position papers and arguments and expert testimony.
We have tentatively scheduled a Teleconference for Thursday, April 6th. We will do the call in April 4th. Tentatively thinking of doing it on recovery. Maybe we need some training on Media to counter act the smear campaign that goes on.
How to counter: I lived with a person with a mental illness and when they took their meds, they were so much better. Kevin will send Kathie an chapter from "Blaming the Brain" which describes how the pharmaceutical companies promotes chemical theories of mental illness. Email him at kevin@q7.com to get a copy of the chapter.
You can't make public policy based on single examples.
Neuroleptics are used to subdue and tranquilize, they don't really treat the issue- do they really help? Someone appears to better, but the meds may actually be having some negative effects on the person.
Suggestion for future teleconferences: Partnerships and True Client-Run Self Help - What does it mean? It seems that when the MH system hires consumers to work in the system, it becomes harder to maintain the client-run alternatives.
In Hawaii, partnerships can be used to give you access to more people and technical assistance.
Maybe we would find allies in the group, Physicians for Social Responsibility.
Notes submitted by John Dorsey and Carol Patterson
Involuntary Outpatient Commitment Packet Contents- This packet was distributed via snail mail.
1. 2-3-00 Teleconference Notes (above)
2. MadNation article on Involuntary Outpatient Commitment
3. Ten Things Drug Companies Won't Tell You from SmartMoney, November 1999
4. The Trouble with PACT: Questioning the Increasing Use of Assertive Community Treatment Teams in Community Mental Health, by Patricia Spindel and Jo Anne Nugent
5. The Voices of Homeless People with Mental Illnesses: Locked Out - A Report by the Coalition on Homelessness, San Francisco, June 10, 1999
6. The Scientific Argument Against Forced Treatment by Michael McCubbin and David Cohen
7. Prozac.org article from Mother Jones, November-December 1999
8. ACLU statement opposing AB 1800
9. San Diego Tribune article: Reform Bill to Detain Mentally Ill Stirs Concern
10. National Council on Disability to Release Report on People Labeled with Psychiatric Disabilities
11. CARES: We Need Your Help to Fight the Expansion of Forced Mental Health Treatment in California
12.Program of Assertive Community Treatment (PACT): A critical review by Tomi Gomory, Ph.D. (Adobe Reader required to read)