Lunatic at Work

Just a quick blog to give me a break from more intense work and bring attention to a Web clip I saw yesterday at MSNBC.com. The topic: “Dealing with Crazy Co-Workers?” Pretty provocative, especially if you’re “crazy,” as I am, and work at an organization where 80 percent of your co-workers have mental health issues, which I do. I actually like my co-workers very much, and pretty much like myself as well, so I couldn’t help but wonder what the Web clip was really about. Here’s the gist:

Tucker Carlson (the quasi-news-commentator who wears bowties), sets up an interview with Julie Jansen, author of the new tome, “You Want Me to Work with Who?” The interview is subtitled: “How to survive an abusive boss and incompetent co-workers,” which equates “crazy” with abusive and incompetent. Gee. Cool. That sounds about right.

The clip begins with Tucker’s eloquent intro.
“Ever look around your office and wonder why you’re working with a bunch of raving lunatics?” he asks. Hmmm. Ok. “Does your boss treat you like a child?” Hmmm. What?

He then reassures us that we are not alone and turns to Jansen for guidance as to how we might co-exist peacefully with our “unpleasant” co-workers. A sampling of Tucker C.’s questions:

What do you do about co-workers who are disrespectful?

What about people who don’t do their work so you have to do it and then they steal all the credit?

How do you deal with the boss who hasn’t given you a raise?

And, finally...

What if your co-worker is just “demented?”

Hmmm. Demented in what way, I wondered. Tucker elaborated. What if your co-worker has a drug problem? Sounds like a reasonable gripe, though I’m not sure ‘dementia’ is a likely diagnosis. Then he elaborated again. Suppose your co-worker is “one step away from pulling flies out of the air?”

Hmmm again. What? Pulling flies out of the air? Who pulls flies out of the air? Honestly, I don’t even get it.

Anyway, Jansen recommends informing the boss that said co-worker is “demented,” asking, “Do you expect me to work with this?,” and presenting an ultimatum: Either frog-tongue goes or you do.

Unless, Carlson adds, the demented person has become the “office mascot.” Then you “preserve him no matter what,” he says.

“Then you knit sweaters,” adds Jansen.

Wow. I think I’ll buy a copy of that book on my lunch hour. Right after I finish pulling fly legs out of my teeth.

Anyway, just to assure you that I DID NOT MAKE THIS UP, I’m posting the following link to the Web clip:

http://www.video.msn.com/v/us/v.htm?g=fb75bc3f-67b0-4929-9c1b-38e3ef4d4514&t=c29&f=06/64&p=Source_CNBC

Or read the transcript of the show:

http://www.msnbc.msn.com/id/11477033/


And to assure you that someone cares about this type of thing, I’m posting this link to the National Mental Health Association’s Stigma Watch page, where you can report stigmatizing incidents in the media:

www.nmha.org/newsroom/stigma/index.cfm

Posted by Daniele Sadres

Involuntary Outpatient Commitment Defeated in New Mexico

National Mental Health Advocates Praise Legislators, Offer Assistance

February 16, 2006 – The New Mexico legislature adjourned at mid-day today without passing House Bill 174, the local version of the so-called “Kendra’s Law” that would have imposed forced outpatient treatment on people with psychiatric disabilities.

According to the Bazelon Center for Mental Health Law, a national advocacy organization, implications of the bill’s demise go well beyond New Mexico. Michael Allen, a senior staff attorney at the Center who traveled to New Mexico to assist in efforts to defeat HB 174, said: “New Mexicans have turned the tide on forced treatment, and rejected the simplistic approach represented by Kendra’s Law. This victory for a sane mental health policy will resound across the country, refocusing public attention where it should be—on adequate funding for the services and supports needed by people with mental illnesses.”

Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services and a member of the Bazelon Center’s board of trustees, also went to New Mexico in early February to urge the legislature to “reject the false solution of forced treatment.” Reprising his promise to New Mexico legislators, Rosenthal today said: “I look forward to working with New Mexicans on real solutions and real reforms of the public mental health system. That begins with adequate funding for evidence-based practices like supportive housing, peer support and voluntary mental health services.”

Allen said he and Rosenthal plan to return to New Mexico later this year to provide technical assistance to policymakers and advocates who are working on the state’s mental health transformation agenda. “Now that the cloud of forced treatment has lifted,” he added, “we can all get down to the real business of consensus building, and constructing a system that will meet New Mexico’s needs.”

The Bazelon Center for Mental Health Law is a national legal advocate for the civil rights and human dignity of people with mental disabilities. For more information, please see www.bazelon.org

More on "Part D"

Susan Saler of the Mental Health Association of Southeastern Pennsylvania addresses the crowd in front of the CMS regional offices. In the background is Jose de Marco of ACT UP, a leader of the event.

Activists Demand Changes in Medicare Part D


I’ve just come back from a march and rally where about a hundred of us — including AIDS, mental health and older adult activists — raised a ruckus about the horrendous problems people have been having with Medicare Part D. In case you have been living on the moon, this is the new prescription drug benefit plan of the Centers for Medicare and Medicaid Services (CMS), and it’s a mess! Its rollout has been disastrous for many of the nation’s most vulnerable people, including people living in poverty, older adults, people with HIV/AIDS, and those with mental illnesses. Many have experienced horrendous difficulties in obtaining life-sustaining medications.

The event was organized by ACT UP (AIDS Coalition to Unleash Power) Philadelphia, the Mental Health Association of Southeastern Pennsylvania (MHASP) and the Action Alliance for Senior Citizens. We gathered on Fifth Street in Philadelphia within a block of Independence Hall (how appropriate!) and marched to the CMS regional headquarters (on the other side of Independence Hall), where we rallied. (As a native New Yorker used to having to navigate the city by bus and subway, I love the fact that Philadelphia’s “good parts” are all concentrated in a very small area, so it is usually possible, like today, to walk everywhere you need to go. For example, MHASP’s headquarters are a stone’s throw from City Hall, and a 10-minute walk from Independence Hall. So we could walk there easily, holding our picket signs, mounted on wooden sticks, under our arms.)

Among our demands were immediate reimbursement of out-of-pocket expenses, extension of emergency measures past 90 days, continued improvement and maintenance of customer support, and eliminating co-pays for people who are eligible for both Medicare and Medicaid who are now covered under Part D. But these fixes amount to bandaids; what we really need is to repeal Medicare Part D and have national health insurance that covers everyone. I wonder if that will happen in my lifetime.

The police were really helpful: They said we could march in the middle of the street (although we didn’t have a permit) and, to clear the way, they drove a police car in front of us (and maybe behind us, although I didn’t turn around to see – I think I had some kind of Lot’s-wife thing going on).

ACT UP is very big on street theater and supplied a coffin, with flowers to go on top of it, and picket signs shaped like headstones, memorializing Medicaid (which was, of course, serving people infinitely better than Medicare Part D is doing). I helped carry the coffin – and, let me tell you, even a coffin filled with nothing but signs is pretty heavy!

The temperature was hovering around freezing but at least the promised snow won’t be arriving until tomorrow, so it wasn’t too uncomfortable to lie down on the sidewalk on cue in front of the CMS Building to represent the people who may die as a result of being unable to get the medications they need.

Susan Saler, who heads MHASP’s Mental Health and Aging Advocacy Project, stood on top of the coffin to address the crowd. She spoke passionately about the problems people have been having. “Medicare Part D demands that our country’s most vulnerable citizens work as their own case managers, accountants, lawyers and advocates,” she had said earlier. “The system was badly designed and badly implemented. But, even when all the ‘glitches’ are addressed, will it be sustainable and responsive and consumer-focused?”

Susan also talked about how people have been unable to access their medications because of the excessive complexities of the new plan. “In addition, people have been signed up for the wrong plan, dropped from plans and enrolled in plans that don’t cover the medications they need,” she said.

Representatives of the Action Alliance and ACT UP also spoke, as did a woman living with AIDS, whose drugstore had demanded a co-pay of nearly $300, money she did not have, as a result of the confusion with the new plan.

We got some press — radio, at least, and possibly some print media, although I’m not sure — and a relatively good turnout. Whether CMS heard our chanting and singing remains to be seen.


Posted by Susan Rogers

IOC

I am very disheartened to read in today’s New York Times that it looks as if the New Mexico Legislature may soon pass an involuntary outpatient commitment (IOC) bill similar to New York State’s Kendra’s Law (“Killings Loom Over Debate on Treating Mentally Ill,” 2/8/06). It’s not over until it’s over, but the bill seems to have a lot of support, including that of the New Mexico Governor.

I’m probably preaching to the choir here, but IOC – which would allow the state to force treatment (usually involving medication) on people living in the community, under threat of hospitalization if they don’t comply -- is a very bad idea.

First, force and coercion have been proven to drive people away from treatment, and are expensive and ineffective. In addition, IOC is impossible to enforce and impossible to implement in a manner consistent with due process and human rights. Minimum protections would include intensive case management, automatic referral to an attorney, a court hearing prior to rehospitalization, outlawing forced or coerced medication, and mandatory participation of community mental health centers in treatment planning.

We said all this and more in a letter we wrote to Representative Gail Chasey, who chairs the Consumer and Public Affairs Committee of the New Mexico House of Representatives. We wrote the letter at the request of Shela Silverman of the Mental Health Association of New Mexico, who solicited letters from advocates around the country in support of their attempt to defeat the bill. (Peter Cubra, another New Mexico advocate, was also reaching out for help.)

We recently sent a similar letter to Senator Joseph Vitale, who chairs the New Jersey Senate’s Health, Human Services and Senior Citizens Committee, in response to a request from Marie Verna of the Mental Health Association in New Jersey, who was working to defeat the New Jersey version of Kendra’s Law. It seems that no such bill has yet passed in New Jersey, making it one of only eight states that don’t have such bills. (The others are Connecticut, Maine, Massachusetts, Maryland, Tennessee and Nevada, according to the Times. And, of course, New Mexico, so far.)

It was great that Harvey Rosenthal, who heads the New York Association of Psychiatric Rehabilitation Services, was able to fly to New Mexico to attempt to defeat the bill. Harvey (with Peter Ashenden, who directs the Mental Health Empowerment Project in Albany, New York) presented a great workshop at Alternatives 2005, offering strategies to defeat IOC legislation.

In the Spring 2000 edition of The Key, the Clearinghouse newsletter which has since been replaced by The Key Update and The Key Assistance Report (http://www.mhselfhelp.org/pubs.php), I wrote an article called “IOC Battles Rage Across U.S.” (http://www.mhselfhelp.org/publications/key/sp00/ioc.html), in which I quoted Tammy Seltzer of the Bazelon Center for Mental Health Law about the dangers of IOC legislation, as follows:

“ ‘This [IOC legislation] may sound innocuous to some people, but it's not,’ said Seltzer. ‘In Michigan, for example, a gentleman who refused on three occasions to make himself available to the ACT [Assertive Community Treatment] team was subjected to police breaking into his apartment, spraying him with pepper spray, handcuffing him, and transporting him to the hospital, where he was forcibly injected with Haldol. The man was released within days because he did not meet the criteria for inpatient commitment; but the experience was traumatic.’

“The criteria used to determine whether someone can be committed on an outpatient basis are often much less stringent, and far less objective, than the inpatient commitment criteria (which usually involve deciding whether someone is an imminent danger to self or others). Therefore, far more people can be subjected to IOC.”

As we wrote to both Rep. Chasey and Sen. Vitale, it would make much more sense to create and fund programs that would make it attractive for people to come in and receive care. Many such models exist, including programs of the Mental Health Association of Southeastern Pennsylvania (http://www.mhasp.org/services/index.html).

Posted by Susan Rogers

To Disgruntled Consumer's Surprise, Speedy Med-Checkers Yearn To Do More

Maybe all those community mental health doctors I’ve been trashing for years aren’t so bad after all. I had the opportunity to sit in last month on a “Symposium on Recovery for Psychiatrists in Pennsylvania,” and it served, if nothing else, to change my attitudes toward the doctors I had demonized as uncaring slugs. (Sorry!) The event was sponsored jointly by the Department of Psychiatry at Thomas Jefferson Medical College and the Institute for Recovery & Community Integration at the Mental Health Association of Southeastern Pennsylvania (MHASP). The organizers needed people to take notes during work sessions, and looked to the Clearinghouse, whose mother organization is MHASP, for volunteers.

I’m glad I obliged because not only was the food really good, (thanks to our director, Chris Simiriglia, who apparently has a knack for throwing symposiums), but I got to see first-hand that the community psychiatrists who provide care for the poorest and most severely afflicted among consumers of mental health services are as human, complex and somewhat perplexed as the people they—to my shame—sincerely want to serve.

First off, I had to give credit to the forty-some doctors who attended for, well, attending. For those of you who don’t already know the drill, patients rarely get more than fifteen minutes and a prescription out of these people, notoriously at six-week intervals. That more than forty of these doctors took the day to come discuss how to change this practice was impressive enough; then I heard them speak. They didn’t want to just do med checks, they said; they wanted to be involved in a “recovery model.” In place of the brusque, inept, and yet too-somehow-still-too-important-for-your-hopeless-case drone, I saw an earnest group of frighteningly out-of-the-loop men and women who knew they were providing shabby service to very sick people and wanted to do better.

They wanted to establish a standard of care, they said. (Note: This apparently means that, as of last month, there was none!) They wanted to spend more time with their patients, to advocate for community support, to show people that psychiatrists don’t just keep watch over people who are a burden on society, that psychiatrists are doctors in the business of helping people get better. They want society to know that people with mental illnesses can recover and help build their communities rather than weighing them down.

Some even said they wanted to play a part in revitalizing the distressed communities in which their patients often live. This way, they reasoned, key ingredients for recovery: jobs, housing, social supports, quality medical care, etc., would be accessible for consumers.

Pretty impressive for a bunch of—what did I used to call them? Oh, never mind…

I guess the one thing that still bugs me about all this is that no community psychiatrist I ever saw took advantage of our fifteen minutes together to explain that my prognosis was grim because he or she could not provide the care that I needed. As must be true for many consumers, these doctors represented mental health care to me; I knew nothing else. I assumed this was how mental illnesses were treated and I didn’t know that my life, or at least years of it, might be saved by more appropriate care. I eventually learned that for myself, and that knowledge made all the difference. I took out my credit cards, held my breath, and paid a private doctor out-of-pocket in a last-ditch effort to end my pain. Years later, I’m much better, and I have a suggestion for my new-found friends, the community psychiatrists with whom I dined at the Hilton:

IF YOU DON’T HAVE THE RESOURCES TO HELP A PATIENT, TELL THAT PATIENT THAT HE/SHE NEEDS BETTER CARE.

Sorry for the yelling, but it’s an important point. An oncologist wouldn’t see a very ill cancer patient once every six weeks for fifteen minutes without mentioning that better treatment was available, no matter how poor the patient was. A person has a right to seek better treatment, to be informed, to at least try to scrape together enough money to stop the world from disintegrating. Self-advocacy is an important component of any “recovery model,” and we can’t advocate while hobbling around in the dark. We should be able to trust Dr. Stifled-by-the-System to tell us when his hands are tied, because our lives are in his hands.

I think that makes a pretty good interim ‘Standard of Care.’

Posted by Daniele Sadres

A Plea for Louisiana

Denver Nobles of Meaningful Minds in Louisiana writes that his organization is in great need, and that "the need is totally both money and bodies." He writes: "Either organizations have a human interest at hand and want to do what they possibly can from the person-to-person perspective or they have funding that will allow them to direct dollars that are used for the philosophy of that organization."

"The one thing we have realized in Louisiana is that all of our allies—national organizations with offices in Louisiana, any national grassroots organizations with mental health ties to Louisiana, national legal organizations that can address basic human and civil rights, national funding sources—have a network that should help us capitalize on what limited resources we have. The ground zero level is an opportunity to bring successful programs to duplicate, and any visions that have not been reached could be reached in Louisiana.

"I am asking for help. I will answer questions, research answers, whatever it takes to get us the help we deserve. Especially when the federal government is saying for the first time that a state has to repay the financial assistance received after a disaster.
"The national level needs to be informed from the grassroots level."

Denver Nobles can be reached at lafayetteredneck@yahoo.com, revnedselbon@hotmail.com, meaningfulminds@yahoogroups.com, MentalHealthVoicesofLa@groups.msn.com.

Posted by Susan Rogers