How Many Dogs and Cats Die or Suffer Each Year Because Virginia’s TDO Screening Does Not Ask About Pets in the Home?

When people are involuntarily detained in an ER in Virginia an unlicensed Community Services Board employee comes in and goes through a screening form which besides not asking about domestic violence, leading to a preventable murder trial in Fairfax in the last few years, also does not ask about pets in the home.  Picture a pet owner strapped to a gurney with a non-licensed clinician going through an inadequate form, trying to answer questions usually after being shot up with Haldol and barely able to speak and ask yourself if the question if not asked, how many barely conscious adults will remember to tell this person with the power of freedom or hell over them that they have a dog or cat at home that needs feeding and walking and tending?  Not too many is my guess.  Do hospitals ask about pets in the home? No, they do not.  So unless the person being locked up against their will for being different or annoying or unable to care for themselves supposedly or suicidal sometimes has friends or family who still act like they care and who have keys to their homes and will take on the care of a dog or a cat, a dog or cat or more than one dog or cat may starve to death or suffer with no water or end up dead for the person locked up “for their own good” to find on their return from the hell that are all our psychiatric hospitals in this great state.  Good job Virginia!

In Western State Hospital in Virginia, There is a Men’s Only Forensic Ward but No Women’s Only Civil Ward–???

Um, let me try and understand this fact.  Forensic, i.e. Not Guilty by Reason of Insanity or people deemed incapable of assisting in their own defense in a criminal trial and committed to Western for restoration of capacity to stand trial, male, patients have a single gender unit/ward at the hospital.  I do not know if female forensic patients also have a single gender unit.  I do know that patients  civilly (i.e. committed  for lack of ability to care for self, danger to self, very occasionally (the lowest percentage of all commitments) for danger to others do not have any option for a single gender unit or ward, female or male.  How in the world does this make sense?  The state of Virginia uses its power to lock up women and men for being ill or diagnosed as ill by a marriage and family therapist come July 1 or a nurse specialist as of July 1 of last year or other licensed mental health professional for their own protection and than fails to protect them from the risk, a known risk, of sexual assault, of re-traumatization, of being harassed, of being intimidated, of having their religious beliefs violated if they belong to certain religions, of having their very sense of themselves as safe and of the mental health system as safe destroyed or damaged? 

If someone can explain why NO ONE in DMHMRSAS, soon to be DBHDS or anyone else in this state will address this issue at the time a New Western State Hospital is being built, I would appreciate it.  But I don’t think there is an explanation beyond “we just do not get it and we just do not care enough to spend any money to keep women and men safe from trauma at Western State Hospital.”  Why do I think this? Well for one because Virginia’s so called plan to implement trauma informed care on SAMSHA’s website lists someone who is retired as the head of their program to implement trauma-informed care and because outside of one center of excellence there is no plan to implement trauma informed care and no working groups on the issue in Virginia’s public mental health system. 

But don’t let this keep you up at night or worry you or anything, these patients are “other”, they wouldn’t be there if they were not “head cases” or losers or poor or traumatized………oops.

Virginia Senate Passes Name Change to Behavioral Health and Developmental Services with 5 Nays

After a push poll with 3 out of 4 suggestions including the name “Behavioral Health” on the former Department of Mental Health etc.’s website, after one Senator spoke very eloquently about how wrong and inappropriate it was to call mental health and mental retardation “behaviors”, after one woman senator said that the former DMHMRSAS said they only had 28 votes in opposition to Behavioral Health, a disappointing behavior on the part of the Department, Virginia’s Senate changed the name of the Department of Mental Health, Mental Retardation and Substance Abuse to a  name no one in any of those groups served wanted and a name that makes Virginia look backwards (Developmental) and corporate and sheep-like (Behavioral Health) and offended every citizen and their families who are forced to use the Department’s services due to lack of money or insurance or lack of alternatives where they live.

After last year I thought maybe the General Assembly was finished with insulting and degrading and ignoring the voice of people with disabilities, but I was far too optimistic to think that.    I do wish to thank the gentleman who spoke so eloquently againsgt the name change despite knowing he would lose and will try to find his name and update this post to reflect that.

Cesar Chumil Put Back on the Human Rights System Merry Go Round

http://www.inrich.com/cva/ric/news.apx.-content-articles-RTD-2008-11-12-0213.html

And around and around we go again.  Even though the State Human Rights Committee which is over all Local Human Rights Committees in Virginia issued recommendations for Cesar Chumil’s release from seclusion by next month, the Director of Western State Hospital, Dr. Jack Barber and the Commissioner of the Department of Mental Health, Mental Retardation and Substance Abuse, Dr. James Reinhard, have managed to use and abuse the system set up to protect patients rights to circumvent the basic human rights of Cesar Chumi.  They went back to the Local Human Rights Committee which issued recommendations in complete disregard and disagreement with the recommendations of the State Human Rights Committee.  The Local Human Rights Committee approved 6 more months of seclusion after all these years in seclusion and did nothing to improve the situation, dignity and decency of Mr. Chumil’s situation at his prison that is Western State Hospital. Of course Mr. Chumil would actually have more rights in any Virginia prison, even on death row.  He would have more time out of his suite/cell in any Virginia prison or death row but hey, let’s not let that bother us, eh?  The lame excuse of DMHMRSAS for this?  They need more time.  More time????????  Are they just waiting for Mr. Chumil to die so they don’t have to do anything????  They say moving too fast could set him up for failure.  Um, what exactly are they doing that could even lead to failure?  They have changed exactly nothing in his situation.  This is a farce and a scandal and shows that we need new legislation changing the way our human rights regulations are implemented in Virginia’s facilities so that the Commissioner, whoever he may be (and it has always been a he in Virginia by the way, unlike most states), can not override the State Human Rights Committee and the human rights system can not be used and abused to keep patients from having access to state and federal courts for years as they try if they are lucky enough to have legal representation to exhaust all less extreme remedies as required by the courts.  And this is a patient who has a pro bono lawyer and other lawyers working on his case.  99 per cent or more of Virginia’s patients have no access at all to a lawyer to represent them.  Our Protection and Advocacy represents so few people with mental illness each year it is laughable if it were not enough to make one cry.  And even when they do represent people in our institutions they never release the results of their work so nobody knows how many problems we have in our state institutions and legislators and the public can continue in the illusion that we have a beneficent state mental health system and no one is aroused to action. 

How can any decent and moral person even consider working at or with Western State Hospital given what they are continuing to do to Cesar Chumil?  It is time for all psychiatric survivors to boycott all interactions with Western State Hospital officials and staff unless and until Cesar Chumil is moved out of seclusion.

Outpatient Commitment Is About Money, Not Public Safety or “Caring Coercion”

Proponents of outpatient commitment (forced drugging and so called “treatment” in their own homes of folks labelled with psychiatric diagnoses) usually use one of two arguments or both to persuade others that it is a good idea.  The argument most often used by E. Fuller Torrey and his Treatment Advocacy Center is that people with mental illness are dangerous ticking time bombs if not force medicated in their own homes who will kill you or your child or your sister on the street if you don’t pass laws to force drugs down their throats NOW!  The argument others use and that the Treatment Advocacy Center also uses sometimes is that not forcing psychiatric drugging and “treatment” on people in their own homes is tantamount to neglect and shows a lack of caring or concern for people with mental illness.  And if the drugs didn’t shorten lives by 25 years and actually worked as they claim rather than by causing brain damage and if we as a society had decided that we were going to force drug everyone with an illness in their own home if they didn’t take medicine voluntarily, well I”d move to another country but they might have more of an argument than they do now. 

But the fact is the push for outpatient commitment in Virginia and elsewhere is not about public safety nor about “caring coercion”.  It is all about money.  Money that taxpayers and legislators and Governors do not want to spend on mental health services in the community but will have to spend if legislation is passed that makes it even easier to force a citizen of Virginia into forced outpatient “treatment”.  Once there is a court order mandating treatment, there is no way out for the legislators and the Governor.  The money will have to be found to “treat” (force drug and monitor) each and every person ordered into outpatient commitment in Virginia.  If the psychiatrists to prescribe aren’t there they will have to be hired and if there is no money in the state pharmacy to pay for the drugs it will have to be found because otherwise state employees and their bosses will find themselves in contempt of court.  Of course the money for outpatient forced treatment will only be forced out of the legislature and the Governor after every last bit of money for voluntary mental health services in the community has been squeezed out of Community Service Board budgets and there is no more voluntary care left in the state for those dependent on the public system of mental health if we can even call it a system.  But no matter right?  It’s not as if self-determination, empowerment, choice, recovery or resilience are part of the Department of Mental Health and Mental Retardation and Substance Abuse’s Mission statement and Vision and Comprehensive Plan and Transformation plan and Olmstead Plan or anything….oh wait, they are.

Talk the talk.  Walk the walk.  You can do it.  We can do it.  Yes we can.

Lack of Screening for Domestic Violence May Have Led to Death of Man

The Treatment Advocacy Center is unlikely to publish the end of the story of the woman who was taken to a Fairfax crisis stabilization center by a police officer, left to wait for 45 minutes and then left and ended up killing her live in boyfriend when she got home because it does not fit with their agenda of psychiatric patients as irrational perpetrators of violence.  I do hope that the Office of the Inspector General however will re-open its investigation into this critical incident now that new information and a verdict of not guilty have occurred.  The woman in question was, according to news reports of trial testimony, in an abusive relationship and that is what got her so upset and taken to the crisis stabilization center.  However she was not seen quickly and if she had been there is no space on Virginia’s pre-screening nor any requirement in performance contracts that women or men who seek crisis psychiatric services be screened for domestic violence, unlike most medical contacts for women even with their obstetrician or in a medical hospital.  This despite the known fact that women with mental illness are far more likely to enter into abusive relationships than women without mental illness diagnoses.

If this woman had been screened for domestic violence it is unlikely she would have been sent home.  Instead she would we hope have been referred to a domestic violence shelter for women.  If that had happened, she would not have faced a murder trial even though she was found not guilty in the end, and her abusive boyfriend would probably still be alive. 

It is past time to take the issue of domestic violence perpetrated ON people with mental illness labels seriously and to screen for it at every juncture that a person with a psychiatric label interfaces with the mental health system.  It could save lives.

Aging in Place Does Not Mean Aging in a Nursing Home or ALF

Aging in Place–The ability to continue to live in one’s home safely, independently, and comfortably, regardless of age, income, or ability level. It means living in a familiar environment, and being able to participate in family and other community activities. http://www.naipc.org/Default.aspx?tabid=103

Discharging someone from a state hospital to a nursing home is not helping someone to age in place, it is trans-institutionalization, see definition:

transinstitutionalization

A Dictionary of Sociology | Date: 1998

transinstitutionalization A process whereby individuals, supposedly deinstitutionalized as a result of community care policies, in practice end up in different institutions, rather than their own homes. For example, the mentally ill who are discharged from, or no longer admitted to, mental hospitals are frequently found in boarding-houses, nursing-homes, and homes for the elderly.

Community services mean services in the community, not services in a medical facility.  

Anti-psychotics decrease the life span of older people.  That is why CMS has regulations on their use in nursing homes for behavioral purposes. Dying in a nursing home instead of a state hospital is not what most folks would call an appropriate benchmark for success in a program to discharge elderly folks from state hospitals to the community where they lived their lives.  Some trade offs, such as death, can not ethically be made for others by policy makers, program designers, state agency employees, psychiatrists nor social workers nor anyone who is not the person himself or his designated surrogate decision maker.  In fact, to call earlier death a trade off is disturbing in and of itself in anyone responsible for designing programs for elderly folks who are under the care of the Department of Mental Health, Mental Retardation and Substance Abuse. 

One can’t just take existing terms that have a meaning and change that meaning to be whatever you want it to be anymore than one can call increasing beds community care or lobbying for decreased regulation of anti-psychotic use in nursing homes person-centered, empowering nor recovery oriented.  Words and phrases have meanings as do regulations, just not so much in Virginia apparently. 

 

Why Doesn’t Virginia Have an Office of Consumer Affairs in the Department of Mental Health, Intellectual Disabilities and Substance Abuse?

DMHMRSAS/DMHIDSAS used to have an Office of Consumer Affairs.  I was not in on the reason for its closing but as I think about our state mental health system and our most unrepresented and isolated public mental health system clients and patients I think we really need such an office.  An Office of Consumer Affairs with a toll free number to take and even more importantly log and sort by type complaints and concerns of all consumers/clients/patients across the state who use our mental health system would give us information we just do not have access to now on what are the most pressing concerns of the majority of people who use our mental health system in Virginia.  It would also give a place to be heard to folks who are not able or ready or interested in becoming advocates nor peer specialists nor even going to a WRAP group, folks who simply want someone to hear what they are dealing with in the mental health system and what would make it better for them.  Folks in state hospitals are the most isolated from mainstream consumer/survivor/peer groups and the most vulnerable to abuse and neglect, a toll free number would give them an outlet and not one where they have to fit into a set priority and number of cases such as Virginia Office of Protection and Advocacy uses to even be heard.  The office could be staffed by mental health professionals and trained peer specialists both to give folks a choice of who they want to talk to since I hope we are still all about choice even when it comes to using peer specialists or not.  Not every one is comfortable with the peer specialist model at every stage of their recovery, some never are and that has to be respected in my opinion. 

It is time to bring back an Office of Consumer Affairs and to use it to take the pulse of EVERY consumer of Virginia’s mental health system, not just that of the few who have access and privilege.

Resignation of Medical Director and A Psychiatrist Do Not Affect Patient Care?

The Department of Mental Health, Retardation and Substance Abuse’s spokesman is quoted as saying that patient care is and was not affected at Southwestern Mental Health Institute (also known as Marion).  So the resignation of the hospital’s medical director and at least one other psychiatrist will have no affect on patient care?  Really?  It’s that easy to replace doctors, especially psychiatrists, in Southwestern Virginia?  No medical director and increased patient to psychiatrist ratios won’t affect patient care?  Really?  Hmm.  I guess I see things differently than the Department. 

Update, September 24th, 2008–turns out I was completely wrong in my assumptions.  Patient care quality measures have actually improved since the resignation of the medical director and another psychiatrist.  Admissions to medical hospitals are down, behavioral emergencies/codes have been cut in half, seclusion and restraint are down and all patients have adequate medical coverage through the use of local physicians to cover. 

It is really nice to be wrong about something like this .