On Tuesday, the Oregon House Human Services Committee held a four hour hearing about Oregon State Hospital.  Witnesses included administrators, workers, a resident, a former resident, a family member, the state's lawyer and a panel of advocates including Beckie Child from Mental Health America of Oregon, Chris Bouneff from NAMI and me.  Our panel recommended three things that the state should do:

1. Agree to a court-enforceable agreement to fix OSH.
2. Stop all efforts to build a new state hospital in Junction City.
3. Reform how people go into the hospital and get out, particularly from the criminal courts.

We pointed out that we cannot afford the money to run a new hospital (about $220 million per year) and have not been able to fix OSH on our own.  We said that Oregon must learn how to use precious state hospital beds more effectively and stop asking administrators and staff to be both a hospital and a prison (two incompatible tasks).

I testified that I wanted to be hopeful that Oregon could fix OSH without outside oversight, but experience told us otherwise.  I noted that DRO has sued OSH five times since 1992 in order to force improvements, but the problems don't go away. 

Committee Chair Carolyn Tomei asked me to send her a written summary of those cases.  I did, and now I'm sharing it with you.

Charles B. vs. Concannon:  A Class Action filed in 1992 on behalf of forensic patients and patients with developmental disabilities.  A Settlement Agreement was reached in 1994 which required that all patients have an individual treatment plan, a baseline assessment, a comprehensive assessment, appropriate referrals, education programs, psychosocial rehabilitation, sex offender treatment, and vocational services.  Staff were to receive 80 hours of core curriculum training.  Professional staffing levels were to be adequate, movement restriction and seclusion & restraint policies were to be changed, and patients with cognitive disabilities were to be assessed and placed in appropriate alternative settings.

Miranda B. vs. Kulongoski:  A Class Action filed in 2000 on behalf of civilly committed patients in Oregon’s state hospitals.  A Settlement Agreement was reached in 2004 which required DHS to develop 75 new licensed placements and/or supported housing, discharge at least 31 class members, begin discharge planning upon hospital admission, refer any patient who was not placed within 90 of being ready-to-place to an Extended Care Management Unit for assistance in placing, develop a fund to assist with exceptional barriers to placement which would start with $1,500,000, and develop a process to monitor vacancies in community facilities.

Bartow and Oregon Advocacy Center vs. DHS:  A Wrongful Death action filed in 2002 on behalf of a patient who died during a take-down and an unsafe conditions claim on behalf of all OSH patients.  The case was settled in 2004 for $200,000 in damages plus an agreement to place defibrillators on wards and update restraint training to include information on positional asphyxia and de-escalation techniques.

Oregon Advocacy Center vs. Mink:  A Class Action filed in 2002 on behalf of defendants who had been found unable to aid and assist in defense of criminal charges who languished in local jails awaiting transfer to OSH.  Following trial and appeal, OSH was ordered to admit defendants from jail who are found unable to aid and assist in their defense within seven days of such finding.

Harmon vs. Fickle:  2004 Class Action on behalf of forensic patients at OSH. A Settlement Agreement was reached in 2006 that required OSH to hire 30 new professional staff, DHS to hire 4 new community placement developers, OSH to increase the staff to patient ratio from under 1.10 to 1.82, and DHS to create 71 new community placements (at least 30 being intensive case management slots) in addition to 128 planned placements for forensic patients.

Good morning!  It’s 8:30 am and we’re back in the House Human Services Committee.

We’ve already heard consideration of bills affecting the sharing of mental health and physical health records among providers and a proposed traumatic brain injury commission.  Now, James Toews and Richard Harris from the state Department of Human Services are testifying about the financial cost of implementing HB 3618.  This bill would provide workers compensation coverage to personal support workers who serve individuals with developmental disabilities (DD) and with mental illness (MI).  Representative Freeman is leading the charge by Republicans who are concerned about the cost of enacting the bill.

 Toews testifies that this bill would add about 8,000 new workers to WC coverage who serve about 10,000 individuals.  Democratic lawmakers ask if home care is less expensive than institutional care. (Yes) They also ask why this group of workers isn’t covered by the Home Care Commission that provides WC to home care workers for seniors and people with physical disabilities.  Toews responds that the DD brokerage system was put together as a result of the Staley law suit settlement which occurred after enactment of the state ballot measure that created the Home Care Commission.   The duties of workers who are mandated by Staley have different duties than traditional home care workers.

 Rep. Olson is concerned about public access to the names of registered home care workers.  Toews says that names are controlled by existing public records law which means that most names must be released to the public.  Olson asks if the state does a criminal records check on anyone who asks for worker names.  Toews says no.  Olson asks if the state feels vulnerable as a result.  Toews says it is a matter of general concern.  Rep. Dembrow says that the question of problems with Oregon’s public records law is a matter that goes beyond this bill.  He asks Toews if he is aware of a person being victimized as a result of having his or her name released.  Toews is unaware of such an instance.

 Rep. Olson asks how this bill will interact with HB 2442 from last session.  This bill beefed up Oregon’s protective services laws and requires exclusion of workers with certain offenses on their criminal record.  Toews says more people will be excluded under the combined effects of these bills.

 Doug Riggs from Oregon Alliance of Children’s Programs testifies.  His providers will suffer a cost impact from this bill and they are already suffering financially.  He says the legislature must increase reimbursement for his programs (present funding only covers 60% of cost) if they are to survive.  OACP does not oppose the bill’s intent but does not want to absorb additional unfunded requirements.  Rep. Tomei says this is a matter for the Ways and Means Committee.  Rep. Freeman says that while the Human Services Committee is a policy committee and not a fiscal committee, it should still be concerned about costs.

 Next up is a representative from SAIF, the workers compensation provider who is asked about costs of providing coverage to the new population.  Representative Maurer takes the lead in questioning about how costs can be controlled.  Maurer notes that the state budget is $182 million in the hole according to an upcoming state revenue report.  He is concerned about “creating a monster” that will cost the state more than anticipated.  Maurer notes the difficulty of assessing claims that occur in family homes when family members are providing services.  How, he asks, does SAIF determine when an injury happens on the job or off the job?

 Questions continue about who bears the additional costs.  Toews notes that provider agencies will not bear the fiscal risk of worker comp claims.  Rep. Freeman asks if a disabled child could end up with less services if costs are taken out of money available for those services.  The answer is yes.

 The committee adjourns for ten minutes to review the bill’s fiscal impact statement.  I go plug my meter.  When I come back, the committee approves the bill on a party-line vote.  The bill will now go to the Ways and Means Committee which will determine if the state can afford to pay for it.

I'm sitting in the House Human Services Committee where the committee just heard testimony on a bill that I can't easily explain but have worked on for the last month.  If House Bill 3618 is passed, people who are hired by folks with developmental disabilities or mental illness to provide assistance in the home or community would be registered with the Home Care Commission, receive workers compensation coverage and be allowed to vote to unionize.

My job in the hearing was to explain the latest set of amendments to the bill.  I tried to make is as simple as possible but legislative eyes were glazing over.  The upshot seemed to be that the Democrats like it and the Republicans don't.  It looks like the biggest issue will be the cost of providing workers compensation coverage to the workers.

The committee is now hearing a bill that would set up the Traumatic Brain Injury Strategic Partnership Advisory Council.  Senator Morrisette and Sherry Stock from the Brain Injury Association of Oregon are leading the testimony.  Additional testimony from General Mike Caldwell of the Oregon Military Department centers on the epidemic of brain injury that has been experienced by service members coming back from Iraq and Afghanistan.  General Caldwell notes that early identification and treatment is essential.  He adds that the military has ignored the problem of TBI until recently.  Things are now changing but the number of affected veterans has overwhelmed VA services.

HB 3692 creates information and referral services and an advisory committee that reaches across all departments of state government.  Sherry notes that 80% of homeless individuals have TBI, particularly homeless veterans.  Inmates in Oregon prisons are also affected in large numbers.  About half of those with TBI acquire their injury through auto accidents.  This is why the Advisory Council would be funded from fees charged on traffic violations.

In April, 2001, a Portland police officer shot and killed José Santos Victor MejÍa Poot.  Mr. Mejia Poot was a patient on a psychiatric ward at the time of the shooting.  Disability Rights Oregon investigated and found that the private psychiatric facility where Mr. Mejia Poot was held did not have adequate structural or staffing safeguards and that Multnomah County had continued to use the facility even though it was aware of these deficiencies.  Interestingly enough, it turned out that the patient did not have a mental illness.  He was experiencing seizures.

I bring this up because the Mejia Poot family hired a lawyer to sue various parties to this tragedy.  One suit involved the police.  That case was settled and, as part of the settlement, the Portland police agreed to buy a new device for its officers: taser guns.  The police said that they would limit use of the tasers to situations in which deadly force was the only alternative.

So it is ironic that the taser, which was introduced to Portland as a way to avoid the gunning down of mentally ill people, has now become the option of choice for police who merely want to take a mentally ill person into custody.  For Portland police, the taser is no longer a substitute for deadly force, but a preemptive maneuver to disable a person whom they see as irrational.

Let's check the stats: In the July 2009 follow up report on the use of force by Portland police, issued by the Force Task Force to Chief Rosie Sizer, data show that when officers use non-lethal force, tasers are the favored intervention for people with mental illness.  When choosing among physical control, blunt impact, pepper spray or taser, police used the taser 52% of the time for citizens with mental illness.  For all groups (those with weapons, who are assaultive, intoxicated or mentally ill), tasers were used in 225 situations in which no resistance was indicated or the person failed to comply with an order.  When people were physically resistant or aggressive, tasers were used 1,116 times. 

As the quotation goes, there are lies, damn lies and statistics.  So the question remains, do police use tasers unnecessarily when dealing with people with mental disabilities?  Yesterday, the Ninth Circuit Court of Appeals decided that a police officer in California used excessive force when tasering a man who was nonthreatening and not trying to flee.  Among other things, the officer argued that the taser was justified because the man "may have been mentally ill and thus subject to detention."

Here is how the court responded:

To the contrary: if Officer McPherson believed Bryan was mentally disturbed he should have made greater effort to take control of the situation through less intrusive means. As we have held, “[t]he problems posed by, and thus the tactics to be employed against, an unarmed, emotionally distraught individual who is creating a disturbance or resisting arrest are ordinarily different from those involved in law enforcement efforts to subdue an armed and dangerous criminal who has recently committed a serious offense.”  [W]e have found that even “when an emotionally disturbed individual is
‘acting out’ and inviting officers to use deadly force to subdue him, the governmental interest in using such force is diminished by the fact that the officers are confronted . . . with a mentally ill individual.”  The same reasoning applies to intermediate levels of force. A mentally ill individual is in need of a doctor, not a jail cell, and in the usual case —where such an individual is neither a threat to himself nor to anyone else—the government’s interest in deploying force to detain him is not as substantial as its interest in deploying that force to apprehend a dangerous criminal. Moreover, the purpose of detaining a mentally ill individual is not to punish him, but to help him. The government has an important interest in providing assistance to a person in need of psychiatric care; thus, the use of force that may be justified by that interest necessarily differs both in degree and in kind from the use of force that would be justified against a person who has committed a crime or who poses a threat to the community. Thus, whether Officer McPherson believed that Bryan had committed a variety of nonviolent misdemeanors or that Bryan was mentally ill, this ... does not support the deployment of an intermediate level of force. (Click here to read the entire opinion.)

The bottom line for police in Portland and elsewhere? It's time to rethink how you're using tasers.  Shock treatment is so yesterday.

Last week, hundreds of Portland police officers protested against their Chief Rosie Sizer, Portland Commissioner Dan Saltzman (our elected official who oversees the police) and The Oregonian (our major newspaper).  The protesting officers sought sympathy and support.by positioning themselves as victims of authority. 

I had something to say then, but waited to comment.

At the police protest, some officers wore t-shirts stating: “I am Chris Humphreys.”  If you weren’t closely following the action, you might assume that Chris was an officer killed or injured in the line of duty, having bravely placed himself in danger to protect a helpless citizen.  Or you might suppose he had drawn the spotlight through hours of volunteer service, promoting understanding with skeptical minority communities or educating himself about citizens with mental and physical disabilities. 

But no. Portland police identify with Chris Humphreys  because  -- three years after helping to beat James Chasse, a frail mentally ill man, to death -- he was disciplined for poor judgment after using a bean bag shot gun at point-blank range to control a flailing 12-year-old girl. 

I had something to say then, but waited to comment.

I heard that the Portland City Attorney now claims that James Chasse was having an episode of “excited delirium” when he was beaten to death.  This “disorder"has been aggressively promoted by the Taser industry to explain why some people die after being tasered or held in prone restraint.  I guess the City Attorney thinks that after the small man with schizophrenia was chased, leapt upon and had the majority of his ribs cracked on the cement sidewalk, his continued struggle was not brought on not by fear for his life, but by a mysterious medical syndrome that justified his being kicked, punched and repeatedly Tazered by a man who is now lionized on police t-shirts.

I had something to say then, but waited to comment.

When the police amassed in front of City Hall I could not help but think of all the times in history when a country’s army or police converged under government buildings to seek the removal of elected governments.  Although this overtly political action seemed designed to portray police as victims of politics and misunderstanding, the visual image struck me as intimidating.  The paramilitary to which we give special authority to carry weapons (and, of course, to use them when necessary) were making a show of force beneath the gate of our implicitly wimpy elected officials.

As you can tell by now, I find the way that this city processes the question of how our police should act to be maddening.  Letting my fury fly would just make me a player in the very process that could produce “excited delirium” in any observer.

I waited to comment because I needed to cool down. 

Portland wants a skilled and professional police force to both protect and respect us.  As a public service paid for with tax dollars, citizens are entitled to transparency and accountability in its provision.  The process that we seem to have now of dueling accusations and scare tactics, mutually assured covering of behinds, scapegoating and the seemingly inevitable publicly-funded “stress claim” parachutes and law suit settlements resolve nothing.  If an officer has joined the police force because he or she likes the feeling of power that comes from being feared, switching to an auditor position with the IRS might be a better choice.  If a police officer is in the struggle because he or she likes the feeling of power that comes from throwing stones at authority, the blogosphere offers many opportunities.

My settled down view goes like this:

Portland needs a truth and reconciliation process for its police system.  It needs an independently appointed review body with teeth for citizen complaints.  It needs the renewed commitment of police personnel to a mission of safety, professionalism, transparency and accountability.  It also needs community attention and support for the successes, not just the controversies.

Each year, Major League Baseball names two pitchers (one from the American League, one from the National) as the best in the game.  This year’s American League Cy Young Award went to Zack Greinke of the Kansas City Royals.  The voting for the award wasn’t close.  Greinke’s 16-8 season, combined with a major league-low 2.16 earned run average garnered him 25 of 28 first-place votes by the Baseball Writers' Association of America.

And, oh yes, Zack Greinke happens to be a consumer of mental health services.

Greinke came to professional baseball directly after high school in Orlando, Florida.  He was selected at age 19 by Kansas City in the 2002 player draft.  Working his way up quickly from the minor leagues, he made his major league debut in 2004.  He did well that year but had a rough season in 2005, losing 17 games.  He left spring training the following year and stayed away from baseball for 7 months.

During this period, he was diagnosed as having social anxiety disorder and depression for which he began treatment.  He returned to the majors in 2007 on a one-year contract.  He did well enough to return in 2008 and had a good year for the hapless Royals, going 13-10.  In 2009 he was the best in the majors, pitching 24 consecutive innings without giving up a run.

In an interview in the Kansas City Star after he returned to baseball, Greinke talked about his experience.  When his problems started, he did not attribute them to an emotional disorder.  He was just unhappy playing baseball.   "It was always, once I got away from baseball, I was fine.  I just thought that, at the baseball field, I was unhappy."

"I'd talk to my agent all the time and ask him: 'How can I tell the Royals that I don't want to pitch? That I want to try hitting?’  I thought that was why I hated baseball. I thought it was because I wanted to hit. It would be at least once a month that I'd be crying to myself while I'm going to bed with a bat in my hand, just swinging it. It's stupid. That doesn't happen anymore."

When interviewed, he still didn’t know what to make of his diagnosis.  "Depression kind of runs in my family.  But I don't know if that's what I was actually going through.  The medicine I take is an antidepressant. So [depression] must have something to do with it. That and social anxiety. But I don't think it was a serious case. I mean, I never thought about killing myself.”

Since that time, Greinke has not spoken publically about his depression or social anxiety diagnoses.  Some sportscasters have speculated whether Greinke has Asperger’s at the root of his social issues.  Zach has let his pitching speak for him.

Whatever the label, the Kansas City Royals admire Greinke’s performance on and off the field.  Dayton Moore, the Royals General Manager, stated it this way: “I can’t speak to this because I’ve never experienced it, but I can only imagine how difficult it must have been for him to recognize his condition and evaluate it honestly and do something about it,” Moore said. “He’s been able to take all of those experiences and combine them and that’s why he is where he is today.”

John Allen Muhammad – the “Beltway Sniper" – was put to death by lethal injection on November 9.  Muhammad had been sentenced to death for killing Dean Myers, 53, one of the10 people he gunned down in the Washington, DC region in 2002.

We are deeply saddened to hear of the death of Senator Edward M. Kennedy.

The importance of Senator Kennedy to the disability rights movement cannot be overstated.  He has been our champion for decades.  It will take volumes of scholarship to fully document his importance to our community and the nation as a whole, but let me give you a highly abbreviated taste of what he accomplished for us over the past 40 years.

1975:  Cosponsored the Education for All Handicapped Children Act of 1975, which later became the Individuals with Disabilities Education Act (IDEA). The law served to amend the Education of the Handicapped Act and to guarantee a free and appropriate public education to children with disabilities.

1975:  Cosponsored legislation to create a “bill of rights” for people with developmental disabilities, providing funding for services for people with this type of disability, supplementing funding for affiliated university facilities and creating state-based systems of protection and advocacy groups in all 50 states.

1978:  Cosponsored the Civil Rights Commission Act Amendments of 1978, which expanded the jurisdiction of the Civil Rights Commission to protect people from discrimination on the basis of disability.

1978:  Strongly supported the Rehabilitation, Comprehensive Services and Developmental Disabilities Amendments of 1978 establishing a functional definition of developmental disability, creating the National Council on the Handicapped and the National Institute of Handicapped Research, setting a funding minimum for protection and advocacy services and authorizing a grant for independent living services.

1980:  Cosponsored the Civil Rights for Institutionalized Persons Act, which enforced the rights of people in government institutions such as the elderly, the disabled, the mental ill, and the incarcerated under the Constitution.

1982:  Cosponsored the Job Training Partnership Act, designed to break down barriers facing “economically disadvantaged” individuals including people with disabilities and assuring that people could not be excluded from the training program based on a disability.

1982:  Cosponsored legislation allowing states to cover home health care services for particular children with disabilities under their Medicaid plans. This was intended to allow parents “respite” or rest periods with a trained professional helping to care for their child’s needs.

1984:  Cosponsored legislation requiring polling stations to provide physical accessibility and registration and voting aids for people with disabilities.

1986:  Cosponsored the Air Carrier Access Act requiring facilities and services to be accessible to people with disabilities traveling by air.

1986: Cosponsored the Employment Opportunities for Disabled Americans Act, which made work incentives for disabled individuals a permanent fixture of the Social Security Act.

1986: Cosponsored the Handicapped Children's Protection Act of 1986, which overturned a Supreme Court decision and allowed courts to award sensible attorneys fees to parents of children with disabilities winning in due process proceedings and other court actions under part B of the Education Act.

1986:  Cosponsored amendments to the Education of the Handicapped Act, establishing a new grant program aimed at developing an early intervention system benefiting infants and toddlers with disabilities and their families and promoting preschool programs for children ages 3 to 5 with disabilities.

1988:  Introduced the Fair Housing Act Amendments to extend the Fair Housing Act of 1968 to include people with disabilities and families with children.

1990: Cosponsored a bill that changed the name of the Education of the Handicapped Act to IDEA, changed the term from handicapped to disability, and added two categories to the amendment: autism and traumatic brain injury. It also reauthorized the programs under the previous act to provide improved support to students with disabilities particularly in the terms of computer access and assistive technology.

1990:  Introduced (with Senator Harkin) the Americans with Disabilities Act prohibiting discrimination against individuals with disabilities.

1990: Introduced the Ryan White CARE Act which provided emergency relief to thirteen cities hardest hit by the AIDS epidemic, and also provided substantial assistance to all states to develop effective and cost-efficient AIDS care programs, aimed particularly at early diagnosis and home care.

1991:  Sponsored legislation to reorganize the Alcohol, Drug Abuse, and Mental Health Administration.

1997:  Cosponsored amendments to IDEA directing inclusion of special education in state and district-wide assessments, promoting mediation as an option to disputes between teachers and parents of children with disabilities, providing that special education students be disciplined in the same way as other students, continuing services to adult inmates with disabilities who were eligible for IDEA prior to their incarceration, and requiring charter schools to meet the needs of children with disabilities and to receive IDEA funds from district schools.

1998: Cosponsored the Crime Victims and Disabilities Awareness Act of 1998 directing the Attorney General to conduct a study of crimes against people with disabilities.

1999:  Cosponsored the Ticket to Work and Work Incentives Improvement Act. The law and its “ticket to work and self-sufficiency” program expanded employment opportunities for people with disabilities through providing disabled Social Security beneficiaries greater support and more options. It also allowed for working people with disabilities to receive benefits from Medicaid and/or Medicare.

2004:  Cosponsored the Assistive Technology Act which supports states in to sustain and strengthen the capacity to meet the assistive technology needs of individuals.

2004: Sponsored the reauthorization of the IDEA, with a new focus on promoting better alignment of special education with general education and having school districts be accountable for the educational outcome of all students, including students with all ranges of disabilities.

2006:  Won a 5-year-long battle to pass the Family Opportunity Act. The law provides states the option of allowing families of disabled children to purchase health coverage through Medicaid. The bill passed as an amendment to the budget reconciliation bill.

2008:  Championed mental health parity legislation assuring individuals living with mental health and substance abuse issues that their mental health benefit would be treated equally with the medical-surgical benefit regarding treatment limitations and financial requirements.

2009: Succeeded in having the CLASS Act included in the text of the Affordable Health Choices Act that was passed out of the HELP Committee. This bill aims to provide elderly and disabled individuals with a daily cash benefit to purchase services and supports they need to remain in and be a productive member of the community.

 These accomplishments amount to a virtual history of the disability rights movement.  For this and so much more, we salute and thank Senator Kennedy.

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.

In an initial interview, Humphreys stated that he first saw James Chasse standing some distance away, rocking back and forth in an exaggerated motion.  Humphreys stated that he considered this a sign of intoxication, and that he did not consider that Chasse might be suffering from a mental illness. Humphreys ruled that possibility out from the get-go, concluding that Mr. Chasse had committed a crime, was committing a crime right now, or was about to do so....

When Chasse walked away, out of sight, Humphreys and his partner went looking for him, found him, did not witness Chasse commit any crime, misdemeanor or infraction, and apparently didn't need to. That's when they made the transition from police officers to thugs with a badge.

The video record shows Humphreys et al strutting around like they had just arrested Osama bin Laden, while James Chasse, who had committed no crime, misdemeanor or infraction, was in the act of dying from his injuries and from medical neglect following this horrific beating.  A quick check of the alleged "crime" scene might have turned up a wet spot, and might have turned up nothing...ah, but the thrill of the chase...the refreshing crack of ribs breaking, a "lesson" soundly delivered...should end that rocking back and forth in public once and for all...a dozen extra knee drops just to drive home the point...this boy's gonna remember this for the rest of his life....

This is a case that will never be forgotten; a case about a person who was loved by many and feared by no one; a person who for years suffered a severe illness in plain sight and threatened no one.

Then one day comes a thrill-seeking thug with a badge....

- Sean Cruz

Many, many years ago.  Back when Vera Katz was Speaker of the House and the legislature decided to take a crack at setting new limits on gun ownership, a bill emerged that would prohibit people who had been civilly committed from buying, owning or possessing a firearm.  The country was still reeling from the acts of John Hinkley and politicians wanted to make folk feel safer, however illusory that safety might be.  I argued at the time that civil commitment was a a poor standard to use to judge ability: many people were committed who were not dangerous and the whole purpose of commitment was recovery.  To my amazement, legislators were willing to compromise the point.  A provision was added to the mental health commitment law that allowed a judge to bar gun ownership but such a prohibition would not be automatic.  A process was also put into place to allow those who had been barred to show, at a future point, that they were no longer a risk.

Four years later, I was not so persuasive (or lucky).  The legislature established a permanent ban on gun ownership in Oregon for those who are committed because of mental illness.  What most people in Oregon didn't know was that the federal government had outlawed gun possession by committed people long before any of these laws were enacted in our state.  Oregonians were not unique in this knowledge gap.  The feds had never done much to let people know.

But then came the Virginia Tech shootings and Congress decided to take stronger action.  It created a nation-wide, FBI registry for conviction and commitment information.  Law enforcement and firearm merchants will be able to use the registry to determine if a person is prohibited from having a gun.  But this won't work unless the information gets to the FBI.  And that's where House Bill 2853 and my deja vu moment come into play.

Governor Kulongoski learned that only two Oregon records were in the FBI registry and that the Oregon State Police would lose a bunch of federal grant money unless we got with the program.  This prompted a rush of work to put together a bill (sponsored by Rep. Galizio) that would require the collection and transmittal of the required data.  And when various stakeholders were brought together to discuss the bill, I was there saying the same things I had said back in the late 1980s.  Again, to my amazement, there was flexibility in the state's position and after many hurried compromises, amendments and hearings, a bill got out of the House Rules Committee.

I don't know how you feel about firearms.  They are not at the top of DRO's agenda.  But the US Supreme Court has found gun possession to be a a fundamental right and a bunch of folks in Congress have earmarked "persons adjudicated as a mental defective or those committed to mental institutions" as being unworthy of exercising this right.  The original Oregon bill would have gone further to include people who were in the state hospital for only evaluation and those found incapable of facing criminal charges due to their young age.  It did not provide a way for a person to demonstrate that he should no longer be barred, did not provide a way to expunge a commitment and did not require notice to those who might be affected.  When it came to people with mental illness or developmental disabilities, life-long incapacity and dangerousness was assumed and need not be proven. 

More will need to be done to balance public safety and individual rights in a manner that is not discriminatory. As is often the case, disability discrimination arose in Congress and in HB 2853 from unfounded assumptions about people's abilities.  Rep. Sara Gelser, a Rules Committee member, said it best: People who have never committed a crime or hurt anyone should not lose a constitutional right because they have a disability.

It's not my job to advocate on every bill affecting people with disabilities, that would be impossible.  Every bill affects folks in the disability community in some way because we are all citizens.  DRO only weighs in on legislation that directly affects people who are most likely to be our clients.  Yesterday, as most committees prepare to shut down, there was a lot to weigh in on.

At 8:00 am in Senate Judiciary, we had HB 2441 that would allow those who sexually abuse folks with developmental disabilities to be more easily prosecuted.  This bill is getting strong push-back from criminal defense and civil liberty groups.  Also on the docket was HB 2335, a bill that we don't care about except that it is being used as a possible vehicle for a variety of amendments that could be used to save the state some money.  The "-11 amendments" would eliminate client-requested hearings before the Psychiatric Security Review Board and extend a time limit for another type of hearing.  Both of these bill did not get a hearing because of time and were set over to today.

At 1:00 pm, the Ways and Means, Human Services Sub-committee heard SB 25 that would create an advisory board for Oregon State Hospital and HB 2442 that would create a Quality Care Fund to support training and technical assistance for group homes to achieve high standards of care.  Both bills were amended to remove fiscal problems and moved to the full Ways and Means Committee.

Then, at 3:00 pm, three separate committees were hearing bills that DRO has worked on.  In House Health, SB 16 was passed after last minute negotiations with the committee chair.  The original bill allowed advance health care directives to be used to authorize in-patient psychiatric care for people with dementia.  The committee chair wanted the bill to also allow any person to receive such care, not just folks with dementia (presently, the advance directive can't be used for this purpose - you have to use a "declaration for mental health treatment").  A compromise was struck to make the change only for people with dementia but to form a work group to explore other changes.

While that was going on, the House Rules Committee was hearing HB 2853, a bill that would require information about criminal convictions and civil and criminal commitments to be sent to the FBI for a national registry to prevent those convicted and committed from buying firearms anywhere in the country.  Many changes have been made to the original bill to address concerns of gun advocates and disability advocates (an interesting alliance).  Additional amendments will be needed before the committee will act on the bill.

Not to be outdone, the House Consumer Protection Committee heard SB 731.  It would assure that people who receive public benefits that are exempt from garnishment do not have to go to court to reclaim their exempt funds.  This bill would protect many of our vulnerable clients from losing access to money that they rely upon for food, housing and other essentials.  The committee adopted the bill's "-11 amendments" and passed the bill out.  [Careful readers will note the second occurrence of -11 amendments today.  Coincidence?]  This is one of those bills that will help many of our clients in a very direct way. Many thanks to Sybil Hebb from the Oregon Law Center for her skilled shepherding.

So that's enough, right?  Well, no.  Midway through the afternoon, we learned that our #1 priority, SB 874, had run into a technical problem.  This bill would conform state law to changes made by Congress to the ADA.  It has already passed the Senate and the House Judiciary Committee.  But the Legislative Council decided that the bill has to amended.  Another bill was recently signed by the Governor that changes a section of law that our bill affects.  If our bill is not amended, it will wipe out the other bill's changes.  So SB 874 is coming back to the Judiciary Committee today to be amended.  It will then go to the House floor for a vote and then go back to the Senate for concurrence (knock on wood).  Since the bill had a close vote in the Senate, we are not thrilled by this development.  But that's how things go here at the legislature.

Here I am again at the legislature.  This time its the House Health Committee.  Senate Bill 16 concerns the question of whether an advance health care directive can be used to involuntarily hospitalize a person with dementia for the purpose of providing psychiatric treatment. 

Dr. Maureen Nash is the person who brought this issue to the legislature.  She says that there is a tsunami of people with dementia coming to Oregon as we age.  There will be a 90% increase in occurence of dementia in the first 25 years of this century.  Many may need psychiatric care.  She says that sometimes family members present health care proxies so that they can admit a loved one with dementia to Dr. Nash's hospital for psychiatric treatment.  But the lawyers for Dr. Nash's hospital (Tuality) say that the law does not allow a health care representative to place a person with dementia in the hospital for treatment.  The person with dementia is often unaware of the need for treatment.  This means a person must go through civil commitment or a guardianship proceeding.

Rep. Greenlick wants to know why the bill doesn't just eliminate the provision of the law that does not permit an advance directive to be used to commit a person to a psych hospital.  Dr. Nash says dementia is different from severe and persistent mental illness.

A citizen testifies that his wife appointed him to be her health care representative.  His wife had an early onset of dementia and he was unable to admit her to Tuality Hospital because of the exclusion of mental health treatment.  He finally obtained a guardianship so that he could make this type of decision.

Dr. Tina Kitchin from DHS testifies that she worked on the advance directive laws that were passed in 1993.  She notes that it is complicated and many different perspectives were involved.  She says that dementia was very much in mind to those who crafted the law.  The law was designed to be empowering for those who wanted some control over their lives.  She was surprised when she heard that some hospitals believe that they don't have the authority to admit someone with dementia for psychiatric care.  Recently raised concerns are being addressed by amendments.

 Oops!  I'm being called up to testify.

Well, I put in my two cents along with David Nebel who was representing the Elder Law Section of the Oregon State Bar.  Rep. Greenlick wants to get rid of the prohibition of using the health care directive to put a person in a psych hospital.  I said that this will be threatening to many people with mental illness but that if he tries to do it, he should make sure that the directive contains clear information that it may be used for that purpose.   More to come soon on this.

I'm sitting in the Oregon House Human Services Committee.  The committee is conducting an informational hearing about oversight of children's mental health programs.  Representatives Kennimer and Kotek have asked for the hearing. 

The programs are here to complain about redundant, burdensome and inefficient oversight.  Kim Thomas from Trillium is testifying right now.  He mentioned DRO as one of the ten or so agencies that oversee Trillium's activities.  He is now speaking directly to seclusion and restraint oversight.  Again, DRO is mentioned as one of the 4 agencies that Trillium must report to.

Janet Arenz from the Oregon Alliance of Children's Programs notes that Morrison Center has, in the past 6 months, spent 333 staff hours on audits and reviews.  Those reviews took 20.5 days.

Donna Keddy, Mike Morris and Janette Williams  from DHS are now speaking to the issue.  237 agencies are licensed by CAF.  After getting private health care agency license, AMH can certify psychiatric programs.  Oversight presently comes from CAF for health and safety, AMH for MH clinical services, SPD for seclusion and restraint, DD Services for health and safety and individual services plans, and OIT for protective services.

Psychiatric residential programs may have numerous contracts that have separate regulatory requirements.  Bruce Goldberg has asked for an efficiency review to eliminate duplication and redundancy.  An action plan is to be completed by July 31, 2009.  OYA and DHS consult with one another but it doesn't sound like duplication in oversight is addressed.  Rep. Kotek seems to be concerned about this.

Janette Williams notes that the state must fulfill requirements of multiple funding streams and multiple program requirements, e.g. DD does not allow restraint and OYA does not allow "hands on."  Mike Morris is testifying that he worked in hospitals for 20 years before coming to DHS.  He did not like the review processes when he was in that role.  Now, as a reviewer, he always seeks efficiencies.  He notes that very serious problems have come to AMH attention and they have had to close programs who had been certified by national accredidation organizations. 

Rep. Kotek asks if a waiver can be obtained from CMS to cut back on oversight requirements.  MIke Morris notes that some CHS requirements are not tied directly to funding.  He is not sure if CHS would allow streamlining of those requirments.  Rep. Kotek notes multiple reviews by state, county and MHO at Morrison Center.  She suggests that Medicaid funding structure should be reformed to cut down on duplication of required oversight.

Rep. Van Orman notes problem of staff turnover in these programs that can cause rule violations.  All agree.  Janet Arenz is now testifying again to push back a bit.  She says that her organizations' choice of business models is not as responsible for how oversight works as DHS might suggest.  Programs have just responded to what the state has sought to contract for.  Kim Thomas again testifies to the desire to have "a more consolidated approach" to review. 

My observation: Janet and Mike were the only ones to note the problems that have occurred in these programs despite the present oversight.  It would have been nice to discuss not only greater efficiency but also greater effectiveness.  I will make sure that this message is sent.

Recent news reports about the official sanction of, and guidelines for, torture (or, if you prefer, "enhanced interrogation techniques"), brought me back a couple of years to some work I did for the government.  I was on a monitoring team, checking out a Protection and Advocacy organization in the Midwest.  A member of the team had recently returned from Guantanamo where he had worked as a mental health therapist for prisoners.

Unable to resist, I asked him what it was like.  I had heard that many prisoners were attempting suicide or other self-harm.  He told me that all the prisoners received excellent care and that their psychiatric records were sent to Washington every day for review at the Pentagon.  He said that the prisoners were very scary, noting that having someone stare at you who you know would like to kill you was a chilling experience.

Recent documents that the government has released show that medical personnel were always present at water-boarding sessions in order to assure that the prisoner did not die in the process.  All treatment of the prisoners was under medical supervision.  This, according to defenders of the interrogation techniques, demonstrates that the interrogators were not truly engaged in "torture."

When I recently read that one of the prisoners who received a lot of "enhanced techniques" probably had a psychotic disorder, a number of thoughts came to mind.  These prisoners had been sent to a place that was out of the way where nobody could see what was happening.  They were often held in segregation even when known to be mentally ill.  While it is generally understood that segregation exacerbates mental illness, exacerbation seems to have been the purpose for all prisoners, not just those with mental illnesses.  The medical staff who were there to care for them were, at least in the case of the fellow I met, deathly afraid of them.  Those same medical personnel monitored enhanced techniques that were performed in order to protect society from harm. 

Defenders of the program seem to assume that inflicting mental and emotional pain cannot be categorized as torture.  Driving a person into psychosis and suicidal action is one of those items that does not seem to be considered as severe as causing organ failure.

Back here in Oregon, we put many hundreds of mentally ill people into jails, prisons and the state forensic hospital each year.  Many end up in segregation for behaviors associated with their mental illness.  The staff who oversee them are often scared of them.  Officials who are responsible for putting them in custody, often want them to stay behind high walls regardless of their mental condition or their risk of harm because the public is afraid of them.  All of these inmates and patients are under some form of medical care and supervision that is provided with the resources and in the environment at hand.

I am not suggesting that Oregon officials are engaging in torture.  But are we causing some of our fellow citizens unnecessary mental anguish in order to feel more secure?

The public is now turning to a debate of whether torture is justified if it can yield life-saving information.  How do we justify our treatment of Oregonians with mental illness?

I'm back home from a full day at the state Capitol.  We are three legislative days away from a big deadline.  Any bill that has not moved out of its original committee by the close of business on Tuesday is dead.  This deadline sets up a last minute scramble for folks to keep their bill breathing.  A bill can die for many reasons.  It may never have had a hearing or been heard and left its committee unmoved.  It may need amendments that cannot be agreed upon or cannot be produced by Legislative Council on time or in technical shape.  It may lack a Fiscal Impact Statement from the Legislative Fiscal Office because of time restraints or a the bill may just have a crippling cost (in this session, virtually any cost is crippling).

I arrived at 8:00 am in Hearing Room B for a Work Session on the ominously-named Senate Bill 911.  The committee chair promptly banged her gavel and said that SB 911 would not be heard because it lacked a fiscal impact statement.  I was then told that House Bill 2353, scheduled for a hearing that day at 1:00 pm, would not be heard because the amendments had just arrived and they also did not have a "fiscal."

These bills concern standards for secure residential homes serving mental health clients and the reporting of people who have been committed to a psychiatric hospital to the FBI in order to prevent them from having guns.

At noon, I made a half-hour report on pending legislation at the Mental Health Caucus, a bi-weekly meeting of legislators, lobbyists, advocates and bureaucrats convened by state Representative Ron Maurer.  Afterward, I worked with some lobbyists on a bill affecting the procedural rights of families in special education hearings and discussed ideas on how to improve the state hospital and to get kids in community mental health facilities the education services they need.

Then, some great news.  Senate Bill 731 passed out of its committee in its eighth amended form.  This bill will save people who receive public benefits from having those benefits garnished from their bank accounts.  Now, even though these funds are protected by law, banks have to turn them over to collectors and the person has to go to court to get them back.  This is money that people rely upon for subsistence.  Many are not able or brave enough to go to court to assert their rights.  Kudos to Sybil Hebb from the Oregon Law Center for great work!  (I helped a little.)

And so, amid all the frenzy and talking and mulling, something good was accomplished!  On to tomorrow.....

I recently got an email from a Community Mental Health director asking me what I thought a program should address when designing a proposal for a pilot project to demonstrate the integration of physical and mental health services.  My very short response to this big question went like this:

We seem to have a rare opportunity to step back and ask ourselves how a public mental health service would be constructed if we were starting from day one.  I would begin by trying to understand who the service recipients are and what they want.  I'm no marketing guru, but I think people want the same thing from MH services as they want from other goods and services:  convenience, reliability, choice, good customer relations.

I also think that everyone needs a measure: how do we evaluate our success?  Care of chronic disease seems to be a focus of many health care reform discussions.  If we can diagnose an individual, provide them with the information and tools to manage their disorder and then provide clear feedback on how they are doing, we can minimize acute episodes and the cost associated with them, keep the person feeling reasonably good and save bucks.  We can also use those measurements to demonstrate the overall effectiveness of the service which supports future investment in the service.

I'm at the Red Lion Hotel in Salem, attending a meeting of about 150 people who have been convened to discuss what factors should be taken into account in creating pilot projects to test the integration of mental health, chemical dependency and physical health services.  The attendees broke into five work groups to discuss System Structure, Performance-based Contracting, Financing and Payment Methodologies, Goals for Integrated Service Pilots and Essential Services for Recovery.

Through the mass of discussion, a few things became clear.  This is a complex undertaking.  There are many interests that are affected.  There is excitement about change but also anxiety.  Resources and time are very limited for the task at hand.

We've just finished up the meeting.  Hold on, there is much more to come.