Thursday, May 22, 2014

Maryland work group on legislation regarding involuntary care needs PATIENT input!

On May 20th, I attended the Maryland Department of Health and Mental Hygiene (DHMH)'s first Outpatient Services Programs Workgroup, designated by Senate Bill 882/ House Bill 1267.  These were bills proposing legislation to bring outpatient commitment ("assisted" outpatient treatment - AOT) to Maryland and to look at the use of ACT (assertive community treatment) and other outpatient services in Maryland.  The meeting was the first of 8, and they are open to the public.

Since involuntary outpatient treatment is a controversial topic, it's no surprise that the room was full and all the stakeholders were represented.  I'm going to guess there were 120 people there, and I saw people from NAMI, TAC, the public defender's office, the psychiatric society and our diligent lobbyist.  One thing that surprised me was when one man announced that he was one of only three consumers there.  Really?  This is about legislation that might impact people with psychiatric disorders, shouldn't they come to have a say?  I spoke with this gentleman after and was told there was no transportation available to bring people them from their day programs.  But really, aren't there people out there who have been committed to hospitals, who might be concerned about this legislation, who have cars? I guess they'd need to get time off work, as I did.  I also think it's possible they didn't know about the meetings, so I'm posting this here.  I knew about it because I'm on the psychiatric society's legislative committee, and obviously another hundred or so other people knew about it, but if you know someone who might like to attend, please spread the word.  Please be aware that the meetings may be moved to a larger space. 

I hate the idea that stakeholders make these decisions for people -- some of whom are quite outspoken and organized -- without their input.  Those who've benefited from forced care need a voice. And those who've been harmed by forced care also need a voice.  If you have something to say, or you just want to listen to the process, these meetings are open to the public. 

Per Facebook:
DHMH to Convene Behavioral Health Integration Stakeholder Workgroup: Members of the public invited to participate

The workgroup will make recommendations on issues related to behavioral health, including statutory and regulatory changes to... See More


Joel Hassman, MD said...

I'll be posting about this and something else tomorrow that Fox has reported today, but, I think readers need to read this link and digest once and for all why you DO NOT turn to politicians for psychiatric matters:

Imagine what they will do when it involves other trivial matters, like money and special interests, or just frank control over peoples' lives?!

You people really don't get it, the narcissism and antisocial tendencies of politicians are so dangerous to the very people who are most vulnerable to such predators!!!

And, once again another portion of psychiatric programs intended for primary psychiatric patients gets tainted for forensic agendas. I worked for an ACT program last year, and the growing forensic intrusions are just ruining it for the staff! Face it, for every patient who is innocently excessively punished for trivial misdemeanor or minor felony acts, easily the next 1-2 coming into psychiatric care are just antisocial people.

Yeah, you are really going to dismiss my experiences between working at a State inpatient program and the ACT work in the past 3 plus years, eh?

Anonymous said...

Mary Allen Copeland, PhD

Position paper on the elimination of seclusion, restraints, force and coercion:

Force and coercion are not the answer.


Anonymous said...

The Center on Adherence and Self-Determination

From Treatment Compliance to Personal Choice:


Anonymous said...


This is not even a hard question to answer. Being the victim of a coercive psychiatric intervention remains a highly stigmatizing experience that people are not willing to share in forum like that unless they feel they have nothing to lose in life.

Unlike what happens with victims of rape, those of us who have been involuntarily committed are doubly victimized: by the psychiatrist(s) who committed us and then by society at large.

Victims of rape at least enjoy sympathy from society. In other words, society accepts that involuntary "sex" is wrong, even though some people claim to have benefited from having been raped. Victims of psychiatric abuse -my position is that all forms of involuntary psychiatry constitute abuse- have then to endure the humiliation of having people like you defending in public forums that involuntary so called "treatments" are necessary in "some cases".

The incident mentioned by Joel is an example of the stigma surrounding these issues. In fact, it begs the question for Dan Patrick WHAT WAS HE THINKING? It is obvious that something like that bars anybody from seeking positions in which there will be public scrutiny.

Anonymous said...

...there are rape victims who claim to have benefited from being raped?

Anonymous said...


Sure! The most obvious example are the many women who have suffered marital rape (or rape/sexual assault within in a relationship) who go as far as retracting their testimony to the police to spare their husbands/boyfriends of a criminal conviction. Even many years after the rape happened they blindly defend their men claiming that it was all a "misunderstanding".

In other forms of relationships where coercion plays a role, the phenomenon known as "Stockholm Syndrome" is also well documented.

In short, for every coercive intervention that our society deplores officially -rape, battery, kidnapping-, I can find you people who claim to to have benefited from what any objective observer would see as abuse.

When it comes to coercive psychiatry, our society has a clear double standard. It accepts for the so called "mentally ill" the type of abusive treatment that it rejects not only for the above situations, but others in which the case for coercive so called "treatment" is more scientifically warranted than in the case of "mental health". I am talking of course, of coercive Truvada for gay males, IV drug users and prostitutes. Such measure would get rid of at least half of the 15000 deaths caused by AIDS each year in the United States.

I don't see Dinah, Torrey or DJ Jaffe having the same concern for people who will die of a preventable HIV transmission -by preventable I mean that the transmission would not happen if they were forced on Truvada- as what they "allegedly" have for the so called "mentally ill".

Our society makes it acceptable to exercise bigotry against the so called "mentally ill". Defending "forced medication" for them obviously contributes to their stigmatization and continued abuse.

Every single person who defends coercive psychiatry for the so called "mentally ill" contributes to the stigma that exists around those whom the APA dislikes via their invented DSM labels.

Unknown said...

This policy dilemma also touches upon another challenge: how is the quality of the program legislated? While in Florida I endeavored to try a day treatment program. Many individuals were required to attend because of alcohol or substance abuse related crimes. I was not prepared to handle some of the stories I heard and cannot handle discussions about violent crimes committed. The integrity of the therapeutic environment could not be preserved for me and for the individual needing help with his violence. I also believe I needed a bit of intensive therapy, but as 1/2 of the individuals were parolees required to attend and 2/3 were alcoholics or addicts and I was neither I left the treatment program as it was not a safe and therapeutic environment for me.

The program was government supplemented and paid for by taxpayers. We sat in a group of around 25 people and read handouts printed from the Mayo Clinic website for 2/3 of the groups. Individuals who needed community could receive help because it was a group, but individuals seeking active treatment could not. When I looked into the legislation of programs paid by Medicare and Medicaid the question was whether it was medically necessary for the individual to receive services not whether the program offered adequate and quality treatment. A week cost around a thousand dollars.

In ACT programs the issue is often the education of the staff. While working in an agency in Maine I encountered many individuals with limited mental health experience, on the job training, who "patrolled" and enforced DBT in ACT programs. For many it was a power trip and those with PTSD may have been traumatized more. (I was a therapeutic art teacher and intervened several times as a client rights advocate.)IN my experience many programs are not equipped to handle individuals with high IQ's as well.

Until the staffing is adequately educated an individual is more at risk in these programs. Until learning styles have been incorporated to psychological treatment models and the " one size fits all" idea is denounced individuals can become increasingly marginalized and be seen as resisting treatment. Therapeutic interventions are an ideal, but on a practical level will likely not help. Peer support, mindfulness based stress reduction are avenues that have led to increased success in some states.