MIKE BACHHUBER: So let's try to tie up the, the unit on prejudice, fears and discrimination, and I think we've talked about a lot of the issues.
But I think this, I really wanted to underline the, the issue of coercion and trauma, because you know, there's a lot of discussion about what causes mental illness and any time I use the term mental illness, I'm going to be cautioning you, using air quotes or some other, because I think there's a real question of philosophy, whether mental illness exists or whether it's just trying to apply the medical model to problems that some folks have identified.
And I think for some folks who feel like they've been hurt by the mental health system, the term mental illness can be very hurtful.
So that's, I wanted to underline those language issues, because those language issues really underlie a lot of the kinds of things we're talking about, so where there's trust issues, a lot of that is because people have been hurt.
People have told other folks that they were in a hospital and have a diagnosis of such and such, and it's used against them.
You know, that kind of information can be a token of power when we live in a society where there's a lot of discrimination against people because of a mental health label, so sometimes we need to think, rethink, do we need to, is disclosure really going to help us get from point A to point B, or is there another way maybe we can get from point A to point B?
And to some degree, we have to trust them to be the best judge of whether they need to disclose.
I mean, to me, that's kind of fundamental IL 101.
Consumers are their own experts, are the experts on their disability.
I also wanted to talk about, you know, again when we talk about discrimination, how that exhibits for folks.
And we have a couple people in the room whose job is getting people out of nursing facilities and other institutions, which is really good because I think it kind of highlights and thinking about this, I think that there's really two kinds of involuntary treatment.
There's folks who have lack of choices, oftentimes poverty is what forces someone into a nursing facility or other some kind of institution.
It could be a mental institution.
But for people with psychiatric disabilities, there actually are, there's a whole separate area of law.
I don't think it's quite as stark as Dan talked about this morning, but courts will order you, and they will say that you have to be in this facility at least this long, and you can only get out when the doctor says you can get out, and your rights do get taken away, in a way that doesn't happen to people with other disabilities and as a result, when we work on civil rights work, we do need to take that into account.
And I think guardianship, I didn't specifically address that, but it is, it's like, it's certainly a related phenomenon.
Guardianship is another way that courts take away the rights of people.
I'm not going to go into that whole thing.
The, the statutory scheme differs from state to state for involuntary treatment.
There are a lot of similarities, and basically, because starting in the '70s, the whole body of constitutional case law started developing that held that even when states think it's best for the person to force them into an institution, or to force them to take some kind of drugs, or some kind of other treatment, that they can't unless certain constitutional standards are met, and that all goes to that involuntary treatment regimen.
So how can CILs serve people?
RUTHIE POOLE: I'm sorry, but if I may, the law usually in most states, I think, is a danger to self or others or some form of that.
But it can be based on your history.
I had an experience two summers ago where I was brought in the worst way to an Emergency Room tied down, et cetera, et cetera, and the social worker came in and said, wow, we're exactly alike, we, I take tresadone and wellbutrin just like you do.
You know a couple years ago I was, or some years back I was in the same situation, and I didn't get locked up.
You know, my friends supported me, and so I thought he was really getting it.
That, like, what I had been expressing was really deep, deep distress and deep emotional pain.
And then he turns around, in our state it has to be a psychiatrist who actually signs the paper, that puts you in the hospital.
So he comes back, no psychiatrist had signed the paper.
It was presigned.
And he said, but I'm committing you anyways.
I said, you just told me you experienced what I experienced just a few years back, and you weren't committed.
He goes, well, I think it would be best if you were in the hospital.
And so what I'm saying is, I was not a danger to myself or others.
It was his judgment, and that they have the power to take that not what it says up there.
And in the state of Massachusetts and I'm guessing in probably most the other 49 states, they can take that, not quite follow the law.
I wanted to make sure people knew that.
MIKE BACHHUBER: That's a key point.
There constitutionally is required a legal process, but usually it's after the fact.
After you're locked up.
DANIEL FISHER: In the statistic realm, guardianship for medication, which is the way that the state of Massachusetts gets around the right to refuse treatment, first there was Rogers court case in the '70s which established by the state of Massachusetts you had the right to refuse medication, it was a emergency condition and quickly after that, the department of health passed a special guardianship called a Rogers guardianship which says you can force medication if you've been determined by the state that there is a likelihood that if you didn't take medication you would become a danger to yourself or others.
So you didn't even have to reach the level of criteria of committability and still could be forcibly given medication.
There is a hearing that occurs periodically.
You have to actually call for it.
It's not one that you know that you have a right to.
97% of the cases in those hearings, they go against the person who is, has been deemed under guardianship, so there's, it may seem stark what I said this morning but when you look at the statistics, the actual rights, the practice of rights, is almost nonexistence.
I'll give you one other reason for this.
In order to get, to win a case, if you're up for guardianship or you're up for committability, and you're the person, you know, deemed mentally ill, in order for you to win it, you have to have an independent psychiatric assessment, and until recently, and I stopped doing them, there were only two psychiatrists that I knew of in the Boston area that would actually give independent testimony, myself and another psychiatrist.
He's retired, and I just can't keep doing them.
We need to have a mechanism for independent psychiatric assessment because it doesn't matter whether you have a lawyer.
It's what they do, they defer to the psychiatric expert, and if there's only one in the room who happens to be hired by the state or the state hospital, that's the one they listen to.
So I'm not sure it's, I'm pretty sure it's pretty stark at this point.
Your rights are almost nonexistence once you're deemed you know, mentally ill.
Maybe other states have more adequate provision for independent psychiatric assessment.
Do you know if somebody is up for committability or up for guardianship in other states besides Massachusetts, is there a provision for an independent psychiatrist to come in and give judgment? 
MIKE BACHHUBER: I know in Wisconsin there are, I think the same issue you're talking about 
DANIEL FISHER: How do you find them? 
MIKE BACHHUBER: Finding a good one.
DANIEL FISHER: How are they paid too? 
State would be one year late in paying not even very much money for an independent assessment.
There's rights in the books and there's actual exercise of rights, and I think this does perpetuate the discrimination.
MIKE BACHHUBER: It really goes to the, to the trust issue that I think keeps coming up, is that folks who have had that kind of naked take away of their rights don't want to have anything to do with the mental health system.
And frankly, I understand that completely.
So did I see a hand up in the back of the room before? 
AUDIENCE MEMBER: Virginia has a similar law but plays out pretty much the same way.
Only a certain number of people, pardon the pun, committed to doing it.
It does not pay very much, they have to go to the hearing, et cetera.
It's there, at least on the books but in practice, doesn't really play out that way.
MIKE BACHHUBER: Yeah. So 
AUDIENCE MEMBER: Okay.
Sorry, but I'm, just wanted to clarify, so if we are just diagnosed with mental illness, we have lost our, to a great deal constitutional rights? 
DANIEL FISHER: That's right.
One of the, in some states, for instance, you can lose custody of your children just by having been labeled mentally ill.
Because, the problem is once you're labeled mentally ill, you don't have standing in court, your testimony is no longer considered valid testimony.
AUDIENCE MEMBER: And one, and so independent living would eliminate that then, or 
MIKE BACHHUBER: I think the point we're trying to make is that providing peer support, providing people connections to a community outside of the mental health system is something that can really help folks find their own way forward.
Once they've kind of taken that realization that the mental health systems, mean my rights can be taken away, it's important to have something different that folks can look to.
DANIEL FISHER: And someone different.
If you're in the Emergency Room, and there's question about whether or not you're going to be committed, the doctor will be influenced by just a phone call from another person who said, I know this person, and you know, I'll visit them, or you know, they can spend some time with me tomorrow, or I'll make sure they come to their, you know, therapy appointment.
Somebody who, somebody can vouch their person.
Can make a big difference, and I see you have advanced directive here.
That's another area that only can take effect, you're familiar with advanced directives? 
Yeah.
They only work basically if you have a friend.
You have to have a person who is familiar with, you know, I don't want to be in the hospital, but if, you know, I could stay with so and so, instead of going to the hospital, then that, that would make all the difference, and just that friend who can be contacted can then allow the advanced directive to take effect, but if you don't have a friend, you don't have a phone call, you don't have another person, the Emergency Room is going to override any advanced directive, which they can override by just saying, well, you know, you're competent.
That's the irony, if you're deemed competent, then the advance directive does not take effect.
So doctor says, oh well, Mike is competent, so I don't have to listen to his advanced directive.
MIKE BACHHUBER: I don't have to do what he says because he's mentally ill.
And it's, and I guess my caution is just that the legal systems vary quite a bit from state to state and the situation does vary from state to state, even with advanced directives, so you know, but that diagnosis does put someone at risk.
And that's true in every state.
AUDIENCE MEMBER: So Dan, I have all the hometown love in the world for you but I have to push back a little bit.
Two things, first of all, it is also legal to have your child taken away from you for a purely physical disability.
There is national brief written about it, what, last year? 
So I think, again, our communities have more in common than we'd like to acknowledge sometimes.
But also, there's a huge difference, maybe not in practice, but a huge difference between a right you have and can't exercise, and a right you don't have at all.
And I think conflating those two, because there are cases that have been won on constitutional grounds civil rights with people with mental health disabilities, so saying you don't have those constitutional rights is a very different message to be giving consumers you have these rights, and it is going to be damn hard to exercise them.
But we are going to fight with you all the way.
One leads to despondency and giving up, and surrendering the rights that you could have, and the other, puts fight into you when it is most needed.
It's dangerous.
DANIEL FISHER: What worries me though is that people are fooled into thinking that those rights are actually going to be made available to them.
So I, I say this to wake people up.
I say this, I mean, in Massachusetts, for instance, we had to pass separately five rights at a state level.
Why should we have to do that? 
Because those rights were not guaranteed by the Constitution.
I mean, if you're in a hospital, you shouldn't have to be given the right to receive letters or to have a lawyer come and visit you.
But actually in Massachusetts, and I think a lot of states probably should do this, at a state level, we had to pass five fundamental rights, plus sixth one for fresh air.
And now, 11 years after those fundamental rights were passed, they still are not enforced.
You're aware of that.
So that's why I say, we're not covered, you know, constitutionally.
We wouldn't have had to pass five fundamental rights if we were covered constitutionally.
AUDIENCE MEMBER: We can 
MIKE BACHHUBER: I think you all have kind of heard this discussion, and I find it very interesting, and would be happy to make it a bar time discussion tonight.
But I think we need to move on now.
So the other thing I wanted to point out, and this is something that actually came up in our lunchtime conversation is that for someone who ends up in the Veterans Administration system, the rights that you may or may not have under state law don't apply because in Veterans Administration, if the doctor believes that you are a threat or are gravely disabled, they can keep you there regardless of what state law, in whatever state you're in says.
We all know how CILs can serve people with psychiatric disabilities.
We can help them get housing and all kinds of stuff.
Going to move on.
So staff competence.
That's one of the themes that came up over lunch, training.
I think those squiggly line diagrams we had for eCPR were, were not the finest art in the world, but I think they underlined a very important point, connecting people up with one another is perhaps the most crucial thing that we can do, and it's a skill that will help not only working with people with psychiatric disabilities but with anyone who comes in the door at our center.
So helping people learn how to engage someone emotionally, being able to listen to them, being able to talk to them, and sometimes just being able to kind of share the emotion that they're experiencing.
Folks who have mental health or substance abuse issues almost always have a trauma history.
In independent living center we are very familiar with people with trauma histories because so many of the people with any kind of disability that we see have a trauma history, and learning how to engage folks with a trauma history better is going to help our work with any consumer that we have.
You kind of, that's kind of underlining that.
I'm just trying to figure out, I think it's time that we kind of move into the next section.
Unless people have questions about that.
There's so many issues related to prejudice and fears, and some of them came out during the lunch.
I think a lot of them didn't.
I think sometimes we get very afraid of emotion, and sometimes it's because it triggers us.
And we can take that as a challenge to ourselves to get in touch with what within ourselves is making it difficult to deal with the emotion.
And I think when we do that, we engage someone.
When we can be open about that, when we can share that kind of thing.
But if we, if we're on a time clock, if we have to get through and see the next consumer or whatever, that's probably the biggest enemy to actually, helping someone through whatever, whatever the issue that they came to us for is.
And with the discrimination, I think we've talked about bits and pieces of it, but we, I'm not sure where we can go without having a much longer discussion about that.
So that kind of leads now into the overview of the mental health system, I think.