As reported earlier this week, Richard Harris from the Addictions and Mental Health Division (AMH) emailed an open letter to the mental health community in answer to the question: Why Zero?  The Why Zero? Campaign wants to know why an Office of Consumer Affairs has not been funded.  Richard replied that AMH  has long supported a consumer office but its requests for money have never made it into the Governor's budget.

David Oaks from Mind Freedom now has his own response: Let's all ask the Governor, Why Zero?

For more, visit MindFreedom at:  http://mindfreedom.org/zero

Yesterday, I received an email from the state Addictions and Mental Health (AMH) Division entitled: “Why Zero? Followup”.  Attached was a letter from Richard L. Harris, Interim Assistant Director. (Click here to read the letter.)  I was not the only recipient.  The email was sent to well over a hundred people, outside and inside government.

Here are some quotes:

"AMH has supported restoration of the Office of Consumer Affairs every budget cycle since the program was cut in the last round of budget cuts in 2003.  AMH fully supports this concept and we will continue to do so.  It is unfortunate that the proposal has not made it through the next steps of the process.  But the decision not to fund this program has not been made by AMH.  Others in the process have not made this a priority."

"AMH wants to work with the consumer movement to obtain the necessary support from key legislators, the Governor, stakeholders and other advocates in championing a new Office of Consumer Affairs.  Without champions in the legislature and the Governor, the possibility of getting this program restored is doubtful.  AMH cannot be the sole 'official' entity advocating for this concept."

Here is my commentary:

In a public world in which “transparency” and “accountability” are constantly touted as positive values, the state budget process is opaque and evasive.  Yes, I admit to knowing some of the basics.  The agencies (such as DHS) submit budget proposals to the Governor.  The Governor decides what to propose to the legislature.  The legislature then hears from agencies (that must support the Governor’s proposal) and citizens and makes the final decision.  Later on, agencies do things like “reshoots” and “rebalances” and money is shifted around to address bulges and gaps.  There are also things like “continuing service levels,” “essential budget levels,” “Christmas tree bills” and “roll-ups” whose workings seem to be understood only by people in capes and pointed hats.

In addition to state general funds that get the lion's share of attention, there are also federal match dollars, grant funding and, for AMH, block grant funding.  And there are probably a lot of things I have not mentioned or know about.  And that is the rub among advocates.

It can appear to a mere mortal that huge sums get allocated and spent (or not spent) mysteriously.  And there are often no fingerprints to show who made the critical decisions.  Note in the first paragraph that I quoted above, Richard is clear about who is NOT responsible (AMH) but vague about whom IS responsible.  This isn’t because Richard is hiding the ball; he’s just reporting how things work.

His advice is sound, at least for state general funds.  One must work tirelessly to move any proposal higher on the state's priority list.  Will AMH truly do that for consumers?  Will it demonstrate that effort through it's own prioritization and use of block grant funds?  Will it support consumer efforts to reach the key decision-makers?  Those who value transparency and accountability are curious to find out.

Asking questions (and expecting answers) is something that empowered people do.  Last week. David Oaks, Director of MindFreedom International, sent an email asking a simple question:

"Why is Oregon one of few states to provide zero (0) for state-wide voice of
mental health consumers and psychiatric survivors?"

Or, to put it even more simply, "Why Zero?"

His email notes that the 2009 legislature did not make the predicted deep cuts to mental health services. Yet proposals to fund a state-wide consumer/survivor voice within Oregon government were both excluded from the Governor's proposed budget and, due to - consumers were told - tight resources, denied funding by the legislature. 

David is not buying it. 

He contacted Richard Harris, the Interim Assistant Director of Oregon's Addictions and Mental Health Division, to ask: "Why Zero?"  He also requested a reply by 30 July 2009, the one-year anniversary of the passing of "the amazing, outrageous mental health consumer/psychiatric survivor advocate Dave Romprey."

David is also asking others to participate in a "Why Zero?" Campaign by asking Richard ( Richard.harris@state.or.us) the same question:"Why Zero?" 

During the 2009 legislative session, advocates like Beckie Child and Meghan Caughey from Mental Health America of Oregon worked on a bill to achieve a stronger consumer voice.  Senate Bill 378, sponsored by Senator Bill Morrisette, would have created an Office of Consumer Affairs in DHS and an Ombudsman for mental health consumers. The bill received a hearing but died due to lack of funding.  

DRO strongly supported Senate Bill 378. Here is an excerpt from our written testimony:

Nationally, the Substance Abuse and Mental Health Services Administration’s Center for Mental Health Services (CMHS) has established a Consumer Affairs Program within the office of its Director.  CMHS policy: "supports the meaningful participation of mental health consumers/survivors in all aspects of the mental health system including the planning, design, implementation, policy formulation and evaluation of mental health services.”

CMHS policy statements recognize that, for many years, decisions about mental health policies and services were made without any input from people who have mental illnesses or their families. As a result, some policies and programs failed to meet the needs of the people they were intended to serve.  Through strong advocacy, consumer and family organizations have gained a voice in mental health research, legislation, and service delivery, working to overcome stigma preventing discrimination, and promote recovery from mental illness.

It makes sense that the experience of consumers of any service, public or private, should inform its operation.  DRO has a consumer advisory council that is invaluable in setting goals and policies for our program serving individuals with mental disabilities.  DHS (and Oregon) would similarly benefit from a more established consumer voice, and consumer-directed services within all sectors of our mental health system.  SB 368 will further this improvement.

Disability Rights Oregon applauds MindFreedom International's effort, and joins them in asking, "Why Zero?"

~~~

For more information about the "Why Zero?" Campaign, visit:
http://mindfreedom.org/zero.

The opposite of love is not hate, it's indifference.
The opposite of art is not ugliness, it's indifference.
The opposite of faith is not heresy, it's indifference.
And the opposite of life is not death, it's indifference.

(Oct. 1986)

Thanks to the miracle of WIFI, I am sitting in the gallery of a state legislative hearing that is discussing whether the state mental health delivery system needs some fundamental changes.  The Oregon system has been criticized for being "fragmented" and "inefficient."  Senator Bates and Representative Kotek have raised the question of whether the state system should be "regionalized" and "integrated" with physical health services. 

For over a century, publicly-funded mental health services in Oregon have been county-based.  By state law, each of the 36 counties must have a mental health authority that provides an array of services.  In recent years, many small rural counties have combined forces to provide services regionally.  During the 1990s, the Oregon Health Plan (OHP) spurred the creation of regional managed care organizations that administer OHP money for mental health services.  Non-OHP money from the state continues to go directly to counties.

The state Department of Human Services has weighed in, suggesting that three major pilot projects be established to test whether regionally-administered and funded services would save administrative costs and deliver better services.  It also wants to test whether health outcomes for individuals needed public mental health services can be improved.

Having heard some of the testimony, it seems that folks that run community mental health services are supportive of the goals but skeptical about the approach of regionalization.  Hospitals and managed care entities seem to welcome carefully-implemented change.  Advocates seem to be eager for change.  Counties are feeling threatened.

There can be no doubt that in this time of fiscal austerity, efficiencies are welcome.  Treatment approaches that keep people in their homes and support healthier lifestyles are welcome.  But people involved with mental health services have good reason to be wary.  Years of chronic underfunding have been punctuated by periods of serious racheting back of support.  Will efficiencies merely result in loss of local control and a loss of financial support that is never returned?  Or will changes result in more uniform access to quality services across the state and elimination of the 25 year life-expectency gap for people with mental illness?  The conversation ensues.