The Slippery Slope of Mental Health Courts…

Although the goals of these problem-solving courts are laudable, they have flourished because of systemic failures in public mental health and the criminal justice system. – T. Seltzer of the Bazelon Center for Mental Health Law

Slippery Slope

First step: Arrest.

1. Adults with mental illnesses are arrested for the same criminal behavior twice as often as people who do not have a mental illness. Studies have found that many polices officers believe they are doing a favor by providing a place to sleep and 3 meals a day, especially to our homeless.

2. By arresting quickly, there is also the erroneous belief that they are saving themselves general time and money, so that they will not have to respond to the same person down the road. The process of arrest is also far quicker than linking the person to necessary mental health services, as it often will result in long hours spent in emergency rooms waiting for service responses.

3. Studies have shown the erroneous belief that many officers believe the arrest will increase access to treatment for those who would otherwise not seek it outside of the criminal justice system.

Slipper Slop 2

Second Step: Criminal Procedure.

Although many of the procedural flaws are correctable, many can not be remedied since they require a delicate balance of a defendants’ constitutional right to trail and legal counsel versus the protection of public safety and health.

1. Transfer to the mental health court is often non voluntary or creates a sense of forced treatment. All possible consequences should be thoroughly explained to the defendant in order to make an informed decision; however, these decisions are typically made under considerable stress or with a promise of a faster release home. This also means that a defendant should be allowed at any time to withdrawal from the MHC and have their case heard in the criminal court without prejudice, which is not typical – or at least not without some restriction or sanction.

2. A defendant who accepts transfer into a mental health court is effectively waiving the right to a trail. For this reason, counsel and a court advocate should be assigned as soon as possible to the case to ensure full comprehension and appreciation of the legal process.

3. Most mental health courts require a guilty or no-contest plea for transfer. Few allow for dismissal of the charges after successful completion of treatment, and even then the defendant had to take on the cumbersome and difficult process of request the expungement. The idea behind a plea is that it is an effective form of coercion for increasing treatment compliance; however, that assumes that the defendant can put full faith into the same treatment system that failed them from the beginning.

4. Half of all arrests of the seriously mentally ill are unnecessary and discriminatory. The vast majority of mental health courts only allow misdemeanor charges; however, more are beginning to accept felonies. Mental health courts should focus on individuals who are not eligible for other types of diversion either prebooking or at arraignment, to avoid becoming the entry point for those people abandoned by the mental health system and focus primarily on those charges which would result in a jail/prison sentence.

5. The scope and duration of mental health court supervision vary from court to court, and even within the same jurisdiction. Most lack written procedures and do no explicitly limit the length of supervision to the maximum sentence that could be received in traditional court. There are many defendants who end up spending far more time under the intense scrutiny of a mental health court than if they had made a plea in criminal court. More so, the duration of supervision should be based more on the individual’s treatment plan versus initial charges.

6. Many service plans do not include detailed information on the sanctions given to defendants for noncompliance with treatment. It also must be recognized that decompensation, setbacks, and relapses can be common occurrences when treating the mentally ill. Most mental health courts utilize jail time as the primary sanction, which is a perversion of the whole notion of diverting people from incarceration. Also, about one third will drop the defendant from the program if non-compliant, which typically results in a secondary round of trail and/or punishment (i.e., what they already served in treatment plus new punishment in criminal court).

Medication Forced

Third Step: Mental Health Treatment

1. Very often there is a failure of mental health programs to meet the specific needs of the defendants. Many of the consumers are not even accepted to treatment programs because they have problems outside the scope of the programs contracted with the court system (such as co-occurring substance abuse) or because they already have a criminal record. Service providers should have active participation in the mental health court plan and in the processing of individual cases throughout the court process.

2. Most mental health courts have no authority to hold mental health providers accountable, and even fewer critically evaluate their own community’s services for evidenced-based practices and effectiveness.

Fatal Flaw

FATAL FLAWS

1. Mental health courts are reactive to a failing mental health system. Many researchers believe that until the system itself is changes, most of the larger issues will remain. There is no rational purpose served by the current system, as public safety is not protected when people with mental illness are needlessly arrested instead of treated.

2. The mentally ill will continue to be arrested on the misconception that they will received services once put into the criminal justice system (i.e., law enforcement will increase arrest rates of the mentally ill with the expectation that this will lead to the provision of services).

3. Inherently coercive aspects of the model of mental health courts that often do little more than provide psychotropic medication, and only occasional therapy – which is very similar to the controversial intervention of outpatient commitment.

4. The criminal justice system is not the appropriate front door to access mental health care. Instead, communities should address the substantial gaps in services prior to the mentally ill needing to emergency response for criminalized behavior.

Virginia is NOT for Lovers of Mental Health Courts…

Virginia is for lovers

Virginia’s history of the implementation and maintenance of mental health courts (MHC), is as dismal as most other states. This isn’t to say that we should take comfort in our universal ineptness, but it should serve as a warning sign as to the abundance of hurdles, lack of oversight, and gap in funding for having truly effective mental health dockets.

Virginia currently has 32 general district courts which typically act as the primary entry point any person has with the judicial system due to it generally covering all traffic cases and other misdemeanor and civil cases involving amounts of under $25,000. Out of those 32 courts, only 2 have mental health dockets –  the cities of Richmond and Petersburg. As for circuit courts, Virginia currently has 120 courts that handle civil cases over $25,000, felony charges, and serve as an appellate jurisdiction for any cases originated in the General District Courts. Virginia has only one, Norfolk, which utilizes a mental health docket.

Court Flow Chart

Now let’s take a closer look at the history of Norfolk’s MHC. After over 2 years of trying to implement this specialized docket, it was officially established in 2008. Since that time, approximately 30 participants have been involved with the diversional program at any given time, and typically remain active for at least a year (obviously this number doesn’t even come close to addressing the disproportionate number of incarcerated individuals with serious mental illness, but its a start). With the Virginia Commission on Mental Health Law Reform  increasing focus on MHCs, Norfolk’s program became the prototype for all others in the sate to follow. This also put it under a high level of scrutiny from legislators and people within the judicial system. Old Dominion University was commissioned to completed a comprehensive study and issued a report on the MHC’s measurable outcomes. Due to this and other studies being conducted across the nation, the Commission was forced to acknowledge the substantially higher rate of access to services, less time spent incarcerated, better collaboration of services, improved mental health and engagement in treatment, and lower recidivism rates that came with the effective use of MHCs. Most important to legislators was the significant savings in jail costs, with $1.63 million being saved during the ODU study period of 18 months in Norfolk’s jurisdiction! One could assume that for this reason alone, more courts would quickly be following in step with Norfolk’s MHC.

money-grow

In 2005, both Richmond City and Petersburg City began to work towards the creation of a MHC through grants and subsidies from the federal government, yet it wasn’t until April/May 2011 that the dockets became active. Even after that long stretch of time to iron out the wrinkles, Richmond City’s docket was met with dissension from within its own judicial ranks. By November 2011, the Virginia Supreme Court issued a memo that stated the creation of any “problem-solving courts” was legislatively unauthorized. The memo sent by Chief Justice Cynthia D. Kinser to over 400 statewide judges, specifically warned that the creation of any specialized docket would need General Assembly approval before being implemented. This one memo created a level of fear in many judges across the state (even those who serve on other specialized dockets like “Drug-Courts”) to temporary suspend services until substantial research and collaboration with the General Assembly could be worked out (and we all know the speed at which the GA works!). Concurrently, Petersburg City was facing additional issues of their own. For example, they recognized that they were missing a critical factor: a position of a coordinator that could work with all of the necessary agencies since there was no precedent for inter-agency collaboration prior to the MHC creation. <Insert eyeroll> Luckily the Cameron Foundation provided funds for the position… for approximately 1 1/2 months! (Le sigh). It was after this rocky start that from a media standpoint, information on Richmond’s and Petersburg’s MHC dissolved into oblivion.

GA

With no general information available on the  interwebs, I was left cold-calling each General District Court for information. Both courts stated that their MH dockets are “active;” however, trying to get more specific information on its use, effectiveness, and evaluation proved almost impossible. After leaving numerous voice mail messages, I finally received a call back from Petersburg’s General District Court clerk’s office. Again, most of my specific questions were met with “Oh geez, I really don’t know,” but I was able to get some generic information. For instance, the process of a defendant’s inclusion on a mental health docket is a little different than in other jurisdictions. Petersburg police officers responding to a call can “fill out a form and report” to submit along with the other charge documents “if it appears that the defendant has a history of mental illness” (Leave it up to untrained and overworked police to fill out a form!?) From there, the paperwork is “routed” to the current Mental Health Docket Coordinator for review (The coordinator has evidently been in flux, because it took 4 attempts to find this person’s name and transfer me to their voice mail). A “through” case review is conducted and eligibility is determined based off of “prior police reports and additional information.” From there, District 19 conducts a mental health exam if one already hasn’t been completed to screen for Axis I diagnoses. (I’ll save my complete and utter disdain for District 19 and their unethical/ineffective services for a later post.)

I don’t think it takes a PhD in research to see the numerous shenanigans of Virginia’s Mental Health Courts. After a rocky start, contempt from naysayers, and general funding and logistical concerns, one can easily see where program access, effectiveness, and outcomes can be called into questions. Even with the totality of these chronic issues, it does not signify a need to scrape the whole idea of mental health courts – as research shows them to be overwhelmingly beneficial to consumers, the judicial system, communities, and tax payers. Instead I believe it shines a spotlight on the necessity to establish funding streams and subsidiaries to encourage the creation of specialized dockets, provide technical assistance  to negotiate inter-agency collaboration and fast-track MHC creation,  and have a regulatory body provide oversight and adherence to evidence-based practices that serve the consumer above all else.

The Band-Aid of a Failed System?

Mental Health Court

“Mental health courts exist because the system has failed.
If these people were being treated,
they wouldn’t end up with misdemeanor charges or
felony charges against them in the first place.
The very existence of mental health courts is really an
indication of the system’s failure.”
– E. Fuller Torrey (psychiatrist/activist)

Mental Illness and the Law: Thursday February 28, 1-2 pm
(Midday on the Law’s Podcast with Judge Gale E. Rasin discussing Baltimore’s “Mental Health Case Management Docket”)

The Bureau of Justice Assistance’s definition of a mental health court:

A mental health court is a specialized court docket for certain defendants with mental illnesses that substitutes a problem-solving model for traditional criminal court processing. Participants are identified through mental health screening and assessments and voluntarily participate in a judicially supervised treatment plan developed jointly by a team of court staff and mental health professionals. Incentives reward adherence to the treatment plan or other court conditions, nonadherence may be sanctioned, and success or graduation is defined according to predetermined criteria.

I believe it is within the very vagueness of this definition that the trouble lies. Each jurisdiction is allowed to establish their own criteria for establishing a mental health court system. For example, some dockets seem largely dedicated to ensuring that criminals are competent enough to stand trial or stay on probation, rather than actually finding necessary treatment for mental disease; whereas, others have expanded that mission, by focusing on assessment, treatment, and reintegration into society. Similarly some dockets across the US have a rather frightening  “forced treatment” feeling, with outlandish sanctions for noncompliance that create dangerous loopholes where defendants have ended up in worse shape then if they never entered the mental health court to begin with.

As you can see, the current status of mental health courts is far from perfect; however, I believe the problems lie more in the lack of appropriate policy, as well as general ignorance of mental illness within our judicial system. A central governing body (state, federal, organizational, anything!) needs to be able provide sound best-practices and oversight in creating, evaluating, and regulating mental health courts to ensure that each one adheres to true evidenced based practices which serve the benefit of the consumer only. Second, we have to also make sure that there is sufficient funding for these specialized dockets (you don’t want me to start ranting on some jurisdictions that only offer dockets if a judge is willing to “donate” their time). Lastly, I believe that our criminal justice system needs to ensure better methods to “funnel” necessary defendants to these specialized dockets to make sure they are being utilized correctly and with the most beneficial acceptance criteria (again, please don’t make me rant about some jurisdictions with eliminating factors like: no violent crimes – no exceptions,  required guilty pleas, no repeat offenders, etc.)

MHC Judge Hug

The organization Mental Health America has made substantial efforts to address these very topics by specifically identifying key aspects that SHOULD be present in all mental health courts (let me stress that ‘should’ word again!)

  1. Comprehensive mental health outreach – Access to community-based mental health treatment services for all people needs to be improved, and should not depend on the existence of mental health courts. Equally effective services should be assured for the treatment needs of persons not accused of crimes. This requires an investment in outreach services to promote voluntary treatment as an essential complement to any mental health court program.
  2. Maximum diversion – Pre-booking diversion should be assured for all persons accused of crimes for whom a voluntary mental health treatment plan is a reasonable alternative to the use of criminal sanctions. Timely and accurate mental health screening and evaluation is the single most critical element in a successful diversion program. Mental health courts may be helpful in assuring such diversion, but should never be the only way, or even the primary way, that it can occur.
  3. Meaningful diversion – Meaningful diversion would require that when appropriate, no charges would be filed, and the individual is diverted directly to treatment without entering the criminal justice system. In the alternative, when charges must be filed, criminal proceedings should be deferred for a set period, usually not exceeding a year. Dismissal of criminal charges would then be guaranteed after a set period of successful treatment participation.
  4. No requirement for a guilty plea – A guilty plea should not be required to enter a mental health court program. This requirement precludes diversion from the criminal justice system at the earliest possible point in time and further criminalizes a person because of his or her mental illnesses. As indicated above, the preferred method is to hold charges in abeyance until the successful completion of the treatment program.
  5. Voluntary/Non-coercive – While the threat of criminal charges influences any decision, participation in any mental health diversion program should involve the same level of voluntary choice required of a criminal plea. No one should have to decide whether or not to accept diversion until the terms and the nature of the proposed treatment plan have been fully discussed and documented.
  6. Least restrictive alternative – All persons participating in diversion programs should be treated in the least restrictive alternative manner available, and all unnecessary institutionalization should be avoided. Jails are generally an inappropriate place for persons waiting for diversion as jail experiences tend to exacerbate underlying symptoms of mental illnesses. Long jail stays should be avoided in all diversion cases.
  7. Right to refuse treatment – The qualified right of a person with mental illness accused of a crime to refuse a particular treatment, including a particular medication, should be protected in a manner at least as protective of the consumer as the civil commitment process. A process should be established to review treatment refusals of persons diverted from the criminal justice system so that any decision to reinstate charges is made in an informed manner after all reasonable alternatives have been exhausted.
  8. Advocate/Counselor – In addition to competent legal counsel in any criminal case, an experienced counselor, who may be a peer or other non-lawyer counselor, independent of any treatment facility, should be available to help the accused person to reach an informed decision. This person should also serve as an advocate to ensure that necessary services that have been mandated as part of a treatment plan are provided in a timely and appropriate manner. MHA affiliates and other consumer advocacy groups may take on this important role.
  9. Confidentiality – Networking to find an appropriate treatment setting, without safeguards, could compromise client confidentiality. Systems must be put in place to ensure confidentiality from the time that a person enters a mental health program.
  10. Cultural and linguistic competence – Cultural and linguistic competence is essential to treatment success. MHA believes that services must be tailored to the specific needs of communities and individuals in order to effectively address public health problems.
  11. Community coalitions – The development of community coalitions, including partnerships between criminal justice, mental health and substance abuse treatment agencies, is essential to successful diversion programs. Such coalitions also should be involved in the creation and oversight of mental health courts. Consumers of mental health services and family members affected by mental illness need to be included in all such coalitions to assure that they address the real barriers to effective mental health treatment in that community.
  12. Comprehensive outreach and training – Community coalitions need to reach out to all criminal justice system personnel and ensure that training is provided at all levels to deal with issues of mental illness, wherever and whenever they occur.
  13. Co-occurring disorders – In addition, persons with co-occurring disorders, and especially substance abuse, must be treated in an integrated way, so that substance abuse is not an impediment to diversion.
  14. Convening role – The focus of mental health courts should be on convening prosecution, probation, treatment and social services agencies to promote interagency collaboration in the interest of the individual. The focus should not be on the use of criminal sanctions to compel treatment.
  15. Consolidation and coordination of cases – Cases should be consolidated to assure that the individual is the focus rather than the case. Centralized, coordinated case management and a single treatment plan are needed to avoid fragmentation, with or without a mental health court.
  16. Handling relapses in the court setting – Relapses are inevitable during the recovery process. As such, an individual’s time under jurisdiction of the mental health court should not be extended as a result of these relapses.
  17. Evaluation – Timely monitoring of court processes, waiting lists, and consumer outcomes are essential to ensure that mental health courts are responding appropriately to persons with mental illness, that waiting lists are kept to a minimum, and that treatment providers are held accountable for consumer outcomes.

Welcome Back to The Dark Ages…

This past week, the nation was shocked to learn of the story of Stephen Slevin.

Slevin

After suffering from years of severe depression, Mr. Slevin (59) awoke one morning and decided to drive cross-country with no set route or destination in mind. On August 24, 2005, he was arrested on aggravated DWI charges and for driving a vehicle that he did not own, which landed him in the Dona Ana County (New Mexico) Detention Center. He was immediately placed naked, with only a suicide smock on, into a padded cell to await processing. Slevin was then moved for 2 weeks of observation before being placed in solitary confinement. For the first three months living in a segregation cell, Slevin was able to write letters; some to his sister and others were sent to his very own jailers politely requesting assistance for medical attention, trouble sleeping, and increasing panic attacks.  Within 3 months of solitary confinement, he became delirious and had profound symptoms of psychosis. Slevin lost the ability for most meaningful communication, was no longer able to write, and spent the entirety of his days rocking back and forth. Initially, he was able to get out of his small cell a few times a month, but he eventually would go for periods up to four months without ever walking out his cell doors. Slevin was given food and medication, but was not bathing, had fungus growing on his skin, developed bedsores, and even had to perform his own tooth extraction due to severe decay.

During May 2007, Slevin was sent to a psychiatric facility for two week where there was drastic improvement in his cognitive and mental functioning due to the proper care, socialization, and medication he was provided. Unfortunately, he was returned to his segregated cell at Dona Ana Detention Center, where he  once again rapidly decompensated. On June 22, 2007, Slevin’s case was finally brought before a judge and was eventually dismissed.

The news story that swept the nation was not the shocking fact that Stephen Slevin spent 22 months in solitary confinement under inhuman conditions; instead, it was headlines of him being awarded $15.5 million in a lawsuit that caught the media’s eye. Slevin, who was recently diagnosed with lung cancer and given 1 year to live, suffers severe post traumatic stress that this windfall of money can only offer minimal relief from.

One has to wonder how many other Stephen Slevins are currently lost in our criminal justice system, not receiving proper care, treatment, or case management? A quick search on the internet yields a startling number of local news stories, blogs, and videos on this very topic. Most of these tend to be “after the fact” stories… like those of Armando Cruz or Tony Lester… who’s suicides could have been prevented with the appropriate mental health care received prior to or during their incarceration.

I am left wondering who is to blame for the downfall of our system? The US is plagued with ineffective policy, legislation, and improper funding towards every aspect of mental health treatment and care; maintains a longstanding stigma on the incarcerated and mentally ill;  supports a broken punitive-based judicial system; and endorses the misguided privatization of our very jails and prisons.  The answer appears to be as vague as the path to fix it, as this has become everyone’s problem – from policy maker, to consumer, to tax payer.

For informational purposes, I’ve decided to include two of my favorite videos on this very matter…

FRONTLINE: The New Asylums (2005)
America’s severely mentally ill, who once would have been in state psychiatric hospitals, are now in state prisons. Why is this happening? And what is mental health care like behind bars? FRONTLINE goes deep inside Ohio’s prison system to examine a troubling and growing issue.
Direct link where additional information and continuous video play pack available HERE.

Fault Lines: Mental Illness in America’s Prisons (2009)
Al Jezeera’s correspondent Josh Rushing goes deep inside one of the largest prison systems in the United States to look at the criminalization of the mentally ill.

There is no single answer that can once again take us back out of the Dark Ages in how we mistreat and subsequently criminalize the mentally ill. But in the coming weeks I look forward to exploring one significant step that we can take as a nation to address our most vulnerable people – the movement towards the creation and regulation of Mental Health Courts throughout all of our federal, state, and local jurisdictions!

From “Old Dominion State” to “New & Improved Dominion State”

Born and raised a proud Virginian, I’ve unfortunately come to know that my state has a checkered history of making legislative decisions that are most definitely not for the “common wealth” of it’s constituents.

While doing research on the state of mental health treatment in Virginia, I have come across numerous statistics that corroborate what we as social workers see all too often.

The National Alliance on Mental Illness (NAMI) currently gives Virginia a grade of “C” (on an A – F scale), in its treatment of the mentally ill. See the breakdown below:

NAMI Score Card VIRGINIA

On a good note, Virginia was able to improve from it’s 2006 rank of “D” and is currently offering more services to the mentally ill than many states with dismal numbers like Arkansas, Kentucky, Mississippi, South Dakota, Wyoming, and our dear ol’ neighbors, West Virginia.  Virginia now is on the positive side of the national average; however, there still is a great amount of room for improvement.

Currently Virginia’s urgent needs towards mental health include:

  • Expand community services, including case management and crisis services
  • More housing options
  • Health care coverage for uninsured persons that includes mental health care

In recent years, the Treatment Advocacy Center has also identified another crucial barrier to treatment of mental illness. They specifically looked at the disproportionate number of mentally ill incarcerated within each of the 50 states. Regarding the odds of a seriously mentally ill individual being in jail or prison compared to a hospital, the odds in Virginia was 3.6 to 1 that they would be incarcerated. This means that in 2004–2005, throughout the state, there were almost four times more individuals with serious mental illnesses in jails and prisons than in hospitals. Virginia was ranked #32! Ouch.

In 2008 a Virginia state mental health commission estimated that “15 percent of all inmates in states prisons and jails are seriously mentally ill.” Roanoke County Sheriff Gerald Holt said it was 25 to 30 percent in his jail. In Virginia Beach, Sheriff Paul Lanteigne “estimated that it typically takes at least six months to find an available bed for a deranged inmate at Eastern State Hospital or a nearby psychiatric center. Scores of people are sitting in his jail today, long after they would normally have been released on minor charges, because they are too sick to be freed.”

In summary, national surveys and state reports both suggest that at least 15–20 percent of jail and prison inmates are seriously mentally ill. We have thus effectively returned to conditions that last existed in the United States in the 1840s:

Mentally Ill Incarceration Over Time
It is imperative that we as dedicated Virginians, work to stop the “frequent flyer” cycle of mentally ill being incarcerated versus receiving necessary treatment. This will come from utilizing assisted outpatient treatment, implementing mental health courts, maintain critical assessments and evaluations of state and local policies and programs, shift state and federal funding to address current service gaps, and work on reliable prevention and intervention services to address mental health before an individual is deemed dangerous.

Kudzu, Kudzu Everywhere…

Maybe kudzu can patch that broken window?

Just about every law, invention, treaty, and large-scale action has unintended consequences, which often alter society as a whole through a butterfly effect – like the ripples after a rock is thrown into a calm body of water.

The 19th Century French economist, Frederic Bastiat, warned of the dangers of unintended consequences in his classic essay That Which is Seen, and That Which is Not Seen. He taught that, “in the department of economy, an act, a habit, an institution, a law, gives birth not only to an effect, but to a series of effects. Of these effects, the first only is immediate; it manifests itself simultaneously with its cause – it is seen. The others unfold in succession – they are not seen: it is well for us, if they are foreseen.”

It wasn’t until the 20th Century that American sociologist Robert Merton popularized the concept of unintended consequences and provided several possible causes: ignorance in that not every possible outcome can be anticipated, error from incorrect analysis, immediate interest that take priority over long term goals, basic values that prohibits certain outcomes, and self-defeating prophecy where well-meaning worrywarts attempt to fix a problem before it even comes to fruition.

If we focus only on the visible effects of a proposed policy, we may not recognize the invisible effects until the harm is done. How is it our policy makers seem so oblivious to the latent effects of choices supposedly made for society’s benefit?

Just a few infamous examples:

Prohibitionnascar-pepsi-400

  • Prohibition brought us bootleggers/gangsters and NASCAR (lest we all forget that moonshine runners were the originators of stock car racing!)
  • Passing NAFTA decimated Mexico’s agriculture industry and crippled their economy, leading to the vast influx of illegal immigration to the US.
  • The failed 1990s “War on Drugs” only served to solidify and consolidate the profitability of drug cartels.
  • Rent controlled housing was meant to help secure housing for low-income tenants, but essentially created a drought of quality in housing for most major cities.
  • Creating antibiotics saved millions, but now our bodies are unable to fight of “superbugs” that are resistant to our greatly outdated antibiotics

After undergrad (and in a former life) I worked in government relations and public policy for a medical non-profit in the DC-area. Fresh from a small town, I was completely content traipsing around the Capital for hearings, meetings, and the typical “schmooze fest” where every move  made was well calculated and micromanaged in order to have the best odds at “winning.” Our goal was simple, pharmaceutical companies had long abandoned research and development on antibiotics (something you take for only a short period of time) for the more lucrative medical innovations like Viagra, breast implants, and medications that secure a life-time of use. Most antibiotics still used today were originally invented in the 40s and 50s, and for that reason the levels of antimicrobial resistance continues to skyrocket. The bill introduced to US Congress aimed to create a number of incentives for pharmaceutical companies, and urged them to abandon the bottom dollar in exchange for the common good. I organized lobby days, press briefings, trips to the CDC and pharmaceutical companies, and attended countless meetings with Congress and their limitless legislative assistants. Our initial support was huge – because you couldn’t deny the scientific evidence! Our thought was if you ran a facts-based campaign, how can anyone vote “nay”? As voting day arrived, I sat nervously waiting for the results. The bill was voted down. It didn’t just die… it was slaughtered, burned, tarred ‘n feathered! Over a year’s work was gone and I sat stunned, holding back tears. I started the job thinking that the opening theme of Mary Tyler Moore was my background music, yet here I sat with only a funeral dirge playing on repeat. My mentor, my boss, had been through this rodeo several times before. He merely shrugged and said, “Next time.” I stammered, “But why?” His response was simple, “Pharmaceutical companies are the top financial backers of the elections,” and re-elections were right around the corner. I was so disheartened and jaded by the process of our government; I left the job (perks and all) to find a new career path.

Let me go back for a second to Bastiat and the Broken Window Phallacy. The salient point is that destructive policies will  destroy prosperity, regardless of the amount of “spin” that someone puts on the visible consequences. This short video does a great job of summarizing a highly debated theory:

It was almost two years later that my former boss contacted me out of the blue.  A prominent congressman had lost a loved one to MRSA (the antimicrobial resistant strain of staphylococcus). He just so happened to be one of the early backers to our bill who appeared to thoroughly enjoy our lavish dinners and “legal donations,” yet ended up one of the turncoats that voted against us. He wrote my boss a cryptic letter that apologized for his “oversight.” He quoted Bastiat, and made sure to point out that he and many of his fellow senators had voted for their own immediate best interest. It wasn’t until that a “nasty little infection” affected his own life that he was able to say, “Oops, My bad.”

In some hypothetical alternate universe, our country would have an “Oops, My bad” list to save us from the bipartisan blame-game and come clean about negative unintended consequences. I’m pretty sure if the south has anything to say about this list… the US bringing Kudzu over from Japan would be near the top! This fast growing plant brought over to help with erosion has since created substantial environmental and fiscal consequences as the “Vine that ate the South.”

Kudzu3

We teach our kids that it’s okay to make mistakes because it’s just part of the “growing pains” of life and meaning-making towards lessons learned and self-preservation. I would not only trust, but respect, my own government if they would just admit their own mistake. As Winston Churchill stated, “those who fail to learn from history are doomed to repeat it.”

When Tragedy, Mental Health Policy & Practice Intersect…

(Click Picture for Article)
Slide1 Slide2

For six months I’ve had the opportunity to intern as a therapist at a children’s acute psychiatric facility. It didn’t take long to see the competing agendas of all the key stakeholders: clinicians from various fields, parents, patients, the hospital, and insurance. I’ve bared witness to numerous parents begging and pleading for the mental help that their child so desperately needs, and listened to the heartbreaking stories of the children who struggle on a daily, or even hourly basis, to pretend to exist as “normal.” I’ve seen policies affect the quality of care, most specifically how insurance dictates a patient’s treatment and length of stay. I sometimes feel as though we spin a roulette wheel and see where chance lands each child on what service we’ll be allowed to provide, regardless of symptoms they present. I’ve sat around tables finagling with billing employees on a single word choice in a health record and how that could negatively impact coverage. The hospital even conducts strong-armed meetings, where the message is quite clear – more patients equals more money and better reporting numbers. I’ve seen pressure to lower admission criteria, which robs the bed of another child in crisis. I’ve also seen countless parents adamantly protesting the release of their child (and sadly, the mental health clinicians typically agree), yet show up on discharge day putting up yet another brave front and knowing we’ll probably see each other again next week. The clinicians always sense the fear, anxiety, and apprehension in the parents, and empathize with the utter lack of options throughout the state. Until there is a day where policies and control over care are put back into the hands of the patient, family, and clinicians, I know that other tragedies loom around the corner.