MIKE BACHHUBER: So we wanted to just have a bit more opportunity here for discussion.
We focused on big issues today.
Or we tried to focus on big issues today about the mental health system, about some of the barriers people face, and what we want to do is lead in tomorrow on how to actually do things at centers to serve people with psychiatric disabilities better.
And so to end up the discussion for today, we wanted to kind of get back to IL philosophy and what centers can do and why centers might want to do more with respect to serving people with psychiatric disabilities.
We prepared this chart and put it in your materials, it's similar to the chart that Dan talked about earlier.
It also includes a column about rehabilitation, so it, it tries to, for folks who have seen some of the IL philosophy materials, there was a chart that came from, an article that is a lifetime ago, from 1979 on the independent living paradigm, and so this chart is like the earlier chart but tries to put in a little bit more information to compare that.
And to some degree, we need to go back to why you came.
You know, what philosophical reasons drives being involved coming to a training to learn about serving people with psychiatric disabilities? 
So with that in mind, do any of you have anything you wanted to kind of add to the introduction before we see what kind of questions people might have?
One thing I know, tomorrow you'll be talking a little bit in conjunction with services at centers, about identifying cultural issues at your centers, and I think to some degree, that will include some of the same kind of issues that we talked about today.
The, I think having this slide about philosophy, we wanted to make sure to do it because if services aren't true to our philosophy, then we're not any different from mental health services in more traditional systems.
Our IL philosophy is our strength and if we keep things to our philosophy, we're going to do a much better job of serving people, so keeping the locus of the problem in the environment, making sure that we recognize the expertise that folks with disabilities bring, and sometimes that expertise makes us difficult to deal with.
I know that when I'm upset about something, I can be a very difficult person to deal with, and I may not have had people at my IL center, I may or may not have people at my IL center when I was there upset at me because of the way that I might have talked about something, but I know that over the years, that gets to be an issue.
So if, if we have folks coming in who are hard to deal with, we need to get back to how can, how can we make them feel heard? 
Okay.
So, I saw you picking up the microphone.
SARAH LAUNDERVILLE: I forgot my, so, so I think sometimes what I hear when we're talking about folks who have psychiatric disabilities, sometimes I hear us going back to that language of really blaming diagnosis or blaming the disability as opposed to the barriers that folks are experiencing, right, that we don't say necessarily at our centers that, oh, it's the cerebral palsy.
Nope, but we say, it is that bipolar.
I think really starting to think about how we use language and how we identify, that we might not know about all of those symptoms that people are experiencing.
We might not understand what it was like for somebody to be traumatized in a hospital and when people use those words it's intentional.
It's not that they're just, you know, trying to be grandiose or whatever, that they're real systems issues in institutions across the board that folks are dealing with.
I think that's what came to my mind around individual.
MIKE BACHHUBER: Thank you.
SARAH LAUNDERVILLE: I'm sorry.
MIKE BACHHUBER: So I know, it's been a long day.
But folks who are sitting here, you all must have had some things come up in your mind.
We've had a few yellow notes and I want to remind people about the notes.
You have on your table green notes to make comments if you like the way something is going and just want to comment on it.
And I am hoping I'm getting this right Tim.
You're going to scream to me if I'm not.
Yellow notes if there's something that you just wanted to express a word of caution about.
And red notes if it's something, if something is not working for you at all, put it on a red note, and Tim will be around to collect those.
We've gotten, oh, about a dozen notes so far.
We did review them over the break, and I think in the wrap-up session you're going to maybe want to talk a little bit about what came up in the notes.
SARAH LAUNDERVILLE: No, I'm not.
I think that's some of the things that came across that will be discussed tomorrow, so I just wanted to say that.
MIKE BACHHUBER: Thank you for that clarification.
DANIEL FISHER: I have a brief follow-up.
There was a question about the accessibility of the peer run respite.
In Nebraska, I just contacted the director of it, and he said it is accessible to people in wheelchairs.
There's a ramp in the back, I guess, and also they made the bathrooms and the bedroom on the first floor wide enough in entrance for a wheelchair also.
So, but thanks for the question.
MIKE BACHHUBER: And I think it kind of fits into the broader discussion that we tried to raise about discrimination.
One of the, one of the issues we're having in Wisconsin, the biggest issue we're having in Wisconsin related to those peer respite centers that were funded finally, after several years of working, is in two of the three cities where they tried to locate homes, the neighbors, when they found out that there were going to be people with mental illness in that house complained to the city and the city said it's not zoned for that.
And so there were three centers funded, only one has opened so far, because of the zoning issues.
And it's a very difficult issue to try to resolve.
One of the three organizations that is trying to get centers opened up has engaged legal counsel, and is trying, is considering whether filing a lawsuit is their only solution on the one hand or whether they can find another house that will have the proper zoning permission.
But that's something that we oftentimes run into when a disability service provider, especially a mental health service provider is trying to open a new facility, especially a residential type facility in a residential area.
So question over on the side.
AUDIENCE MEMBER: I don't know if your state has the Dober limit or if you could apply that, where if you say that there's some educational component to the program, sometimes you can get around zoning that way.
MIKE BACHHUBER: Zoning is another thing that's a really, the laws differ pretty significantly from state to state and there is a provision in Wisconsin law that deals with community living arrangements, but these don't fall under the narrow definition, and you know, it's, there are legal issues that they're going to have to deal with, and they've come up all the time in group homes and other kinds of places like this that want to be in a residential area because they're essentially a residential service and you want people to feel homey.
You know, that's part of what the peer respite center is all about.
It's a temporary home for someone to go in and have some respite from the stresses in their ordinary life.
SARAH LAUNDERVILLE: And I think that part of, that's part of our job, right, as advocates, that the advocacy work that comes along with these things are the same issues we're dealing with across the board in identifying and working in partnership with those groups that are starting these centers.
Oftentimes you find the people that are up against it or like helpers that they only want you to do what they believe the good help is, you know, and so they might fight against these things, or it might be because it's going to affect their bottom line, so these other mental health centers that if they see this respite home or another group home going up, that's peer run, you better watch where potential allies aren't your allies anymore because they're looking for how it's going to affect their bottom line.
But using your advocacy tools that we use for everything else, making sure we're reaching out to the media, making sure we have community meetings and I think, we'll talk about this a little bit tomorrow.
Being really open, if you're comfortable sharing your own personal stories or if you have folks and peers who are really open about that, that's going miles and miles and miles, because the more people that identify being part of our community is really going to help us in the long run.
AUDIENCE MEMBER: Would you say that, did you say how people pay for this, is it covered under their insurance, Mass health or Medicaid? 
DANIEL FISHER: No, well it is not completely no.
It's, there is one center that I know that recently opened in Bethlehem, Pennsylvania, that is funded under Medicaid.
Only one.
And others have been reluctant to get Medicaid funding because the restrictions involve Medicaid funding.
In terms of the criteria for admission and reimbursement.
The one in Bethlehem, Pennsylvania, has run into a problem, and that is if their census goes down they're not reimbursed, so they then have to, they have to borrow staff because the staff that they're paying are only paid when they're working there.
So they have to have staff come that are on salary at another center.
So it's not ideal to have it on a fee for service basis at all.
It's, the others, almost all the others are funded either through block grant money or general funds, general state funds.
The one in Vermont, do you know how it's funded? And there's some private pay.
Not much private pay.
Probably general funds in Vermont.
Vermont had that extra money, though, for the state hospital not being opened 
AUDIENCE MEMBER: Does the consumer pay anything? 
DANIEL FISHER: Generally not.
I mean, you said some pay a little bit.
SARAH LAUNDERVILLE: We have one facility in Vermont, sometimes it's private pay but very infrequent that it happens.
People can't afford private pay.
In Rochester.
MIKE BACHHUBER: In Wisconsin, it's not a, there's not a fee to stay there.
It's a state grant to operate the houses, and 
DANIEL FISHER: Where does the money come from? 
MIKE BACHHUBER: The state general purpose revenue, general fund, yeah.
But if you think about it, that's kind of how hospitals are funded.
You know, governmental hospitals, you know, they pay a set amount to keep them open, and so this is a hospital alternative.
It does make a certain amount of sense to fund them in a similar way to the hospitals.
So 
SARAH LAUNDERVILLE: Any other questions from folks? 
MIKE BACHHUBER: I want to follow up on one of the points you made.
Sarah talked about putting yourself out there and being authentic, and we went through the prejudice and discrimination part really quickly today.
That's something that there actually has been research on as how do you change people's attitudes? 
And the research says something that I think is very intuitive to people who have been activists a long time, which is, you know, look at the other civil rights structure, struggles, and how do attitudes get changed? 
And a lot of the time it's because people put themselves out there so that the public no longer sees them as a stereotype but as people, and that's actually what the research on prejudice and discrimination based on mental health shows.
If people can go out there and share their stories, share their struggle with raising their children, share their, the loss that they felt when their rights were taken away at a hospital, or any of the myriad experience that we have, that it changed, that's what changes the way people think about mental health more than anything else is going to change it.
So that is kind of what we do in IL, and I think as, as leaders in IL, we kind of put ourselves out there about our disability and what brought us to IL a lot, and that is what we need to do.
That's one of the reasons why we need to get people with psychiatric disabilities in leadership in IL and encourage folks at whatever level they're at to talk about their personal experience and how that, how that relates to what everyone experiences.
AUDIENCE MEMBER: So I've been in and out today because of other NCIL work, so please, I apologize, if I'm being repetitive.
But, I don't really know how to phrase this, but I, so a lot of the movement around like, around, I guess a lot of the discussion around people with psychiatric disabilities and recovery and that self-determination is often surrounding surviving hospitals, right, or surviving some type of incarceration, whether that be in hospitals or what have you.
But a lot of people in my life and I'm not sure if this is more rare but a lot of people in my life who have psychiatric disabilities do not put themselves in situations where they can be hospitalized, even though they feel like maybe they should, because not just because of their psychiatric disability but because of their race, gender, and sexual orientation, and they're so afraid to even enter a system that could possibly be support them, so, because of fear of being violated and in a number of other ways, so I'm curious about individuals who feel trapped in, I mean, they do have psychiatric disabilities.
They have survived so much trauma, but have not survived that trauma in hospitals but in other places, and what would you, I guess, recommend to allies like myself, or them, about ways that they can receive support that is culturally competent and, yeah.
MIKE BACHHUBER: I think a significant part of the struggle over the years has been trying to address precisely that question.
I, first hospitalization is not an evidence-based practice.
Hospitalization helps some people, and some people it terrorizes.
In many public mental health institutions I'm going to call them, rather than hospitals, violence is indemic, rapes are common, other assaults are common, and the fact that you don't have a choice about being there or staying there is just an incredibly traumatic experience, and that's why a lot of the discussion has been about that whole hospitalization dynamic.
And I think this is where, where the discussion Dan was leading earlier about the history of the consumer survivor ex-patient movement is important, because a lot of the movement for people who get out of the hospital and were traumatized by that process has been about how can we give aid to our brothers and sisters in a different way? 
And peer support, I think, has been the, the single biggest commonality, variations of peer support, but I don't know.
I shouldn't be the only one trying to address that question, because it's something that we all deal with.
JUSTIN BROWN: One way of understanding your question, we're talking about intersectional justice, so we're talking about when I may be a black male and also have a psychiatric label, a great example is you know people poured out to support Michael Brown after he was killed by the police.
And yet, within a week, Kagemay Powell was killed within miles of that.
The difference was, Kagemay looked like us, he looked like he had a mental illness.
We don't know why he did what he did, but you see him on that tape and he's clearly as much a victim of injustice as Michael Brown is, but when we try to do intersectional justice, it's hard because it's easy to look away.
It's easy to see issues as racial or disability, but to really bring those two together is hard work, and I think part of the answer to your question is we need to be doing that hard work.
We need to be creating affinity groups where people have intersectional injustice in their lives can get together with others who share those same intersections, and we don't necessarily need to be in bigger groups until we've experienced that brotherhood, sisterhood collaboration, then we can join others in this larger struggle for justice.
DANIEL FISHER: I see this struggle really sort of within the context of institutions overall.
The, we need sort of ombudsmen structure.
For any, I mean, it's a consumer, consumer advocacy.
Or human rights advocacy for any of these institutions that people get put in.
There's no, there's really no excuse for the kind of oppression and injustice that occurs in psychiatric hospitals.
They, people ask me, what's a good psychiatric hospital? 
And there just aren't very many because the control that they have once somebody is hospitalized is almost absolute.
You can be an outpatient psychiatrist and I've had, I've had, you know, clients of mine, one was recently hospitalized and didn't want ECT themself.
Their family didn't want them to have ECT but their doctor, in a private psychiatric hospital wanted to have ECT.
And I knew the doctor.
I knew the psychiatrist, and if I hadn't known him, I'm not sure he would have listened.
I finally though had to threaten and say, you know, look at all the people, outpatient psychiatrists, me as opposed, is opposed to it, the person themself is opposed to it, their family is opposed to it.
This sounds like a potential legal case if you give ECT.
Oh, I hadn't thought about that, he said.
You shouldn't have to threaten a legal case.
There should be proactive, proactively ways so that if somebody is hospitalized they would be protected.
And that there would be review of what goes on in the hospital.
Maybe you need more videos.
Why was this person put in seclusion restraint? 
We don't know.
I worked as an inpatient psychiatrist for three years in a state hospital.
I'd come in, in the morning, there would be somebody in seclusion.
I'd say, what happened? 
Well it was the night staff, we don't know.
There had been initiatives to reduce seclusion restraint in hospitals but their is still the oversight problem, there needs to be reporting, there needs to be regulations.
Same thing with nursing homes, the abuses that goes on there.
Needs to be oversight.
I think gets back to what Justin was saying, in terms of how people are viewed in society.
We need to show that we're of equal worth, and unfortunately we're not viewed as of equal worth.
And until we are, there won't be these protections set in place because there won't be a protest if something happens to us.
You got your hand on the mic.
SARAH LAUNDERVILLE: One of the thoughts that came when you were talking about folks who just don't, are not going to even want to go to that place, they are going to stay away from all services is what I was kind of getting, right? 
And that, and I wish I had a great answer for you.
What some of the things I think of when you were talking about that is, we've had people ask, you know, are you mandated reporters, for instance? 
Because I want to tell you things that I don't want you to tell somebody else and so finding out the laws in your state, you know, for instance, in Vermont we're not mandated reporters, except for our Meals on Wheels program, specifically and we really worked on figuring all those little strategies out because as peer-to-peer support I want to be able to have somebody tell me something that is not going to be taken the wrong way or any of those things, and I think it's really important to find that out.
I also think just suggesting to friends or you know, interviewing, it's sometimes a luxury for folks, so it might not happen for everybody, but being able to interview different psychiatrist or mental health workers going to different peer groups, finding out which is the right fit for them and maybe having questions in their pocket like, I'm here for a friend, and if this was to come out, what would you do, or those type of things so people can feel comfortable around that.
I think on the flipside is, we're designing programs and procedures, making sure we're not as its been, it's been said couple of times, doing something medical model, which is often done.
I think when we're talking about mental health issues we kind of add on doctors and psychiatrists where we don't when it's other types of programming that we do.
And the last thought I have is around advanced directives, that if folks aren't as familiar with that, we have, we do a lot of work around advanced directives, that if my symptoms get to a place, you know, I have my husband as my contact person and I have the different places, like, versus, here are the places I would choose to go if given a choice and sometimes I haven't been given a choice, but, but if you have those opportunities, all those different things I want to make sure I have access to, and really thinking about advanced directives for folks who have mental health issues is part of that conversation if you're not already in your programs.
And I think that's all that I could think of, but 
MIKE BACHHUBER: Looks like we have a couple more questions.
AUDIENCE MEMBER: I'm just really concerned about the ECTs that the studies have shown, that they don't necessarily have good results, and that they did a panel and they voted against it and yet they're still happening, when they came out in the 1930s and 1940s.
Is there anything we can do to proceed with minimizing or not having so much access to ECTs across the board? 
DANIEL FISHER: Yeah, I was actually at the hearing, is this speaking? 
I was at the hearing that Mike is talking about, which was, a horrible snowstorm and they should have postponed it and that snowstorm actually prevented a lot of the advocates from making it to Washington.
It was 2011, January, 2011 and it was a hearing before the Medical Advisory Board, the FDA.
And the reason for the hearing was that the, the people advocating for ECT and there are about four psychiatrists that run the whole show for the whole country, they, they had petitioned the FDA to lower the category from category three to category two, medical instrument.
If that had occurred, category two is a wheelchair or a syringe, basically and category three, though you have to establish efficacy and safety, so we did all this testifying over two days, a close vote, but the panel did vote to keep it as a category three, which it has been for 28 years at a category three, without any testing having to be done of the machine or of the device or anything else, so that was 2011.
Basically they upheld that it should be tested.
Not that it should be banned but it should be tested.
However, in theory, it shouldn't be used until the testing has occurred, so in a sense, that would, under any other circumstances mean that it would not be used.
Four years have gone by, and there's been no action by the FDA whatsoever to force the practitioners of ECT and they by their own admission say that, number one, it almost always causes memory damage and number two, it almost always needs to be repeated after you know, two to three months, because it's not effective.
Should never be used, I feel.
MIKE BACHHUBER: So there are organizations that have been engaged in a campaign to stop ECT or at least to stop involuntary ECT, and I think the, the NCIL mental health civil rights task force has also been working to try to get some federal pressure on that issue, but again, a lot of mental health stuff is regulated at the state level, so as long as the FDA doesn't ban this, states can continue to authorize their use and state courts can continue to order it involuntarily.
AUDIENCE MEMBER: I'd be happy to speak up against it, because I've experienced it, and I suffered profound memory loss for a very long time.
And another thing I wanted to say too, I don't know if you're familiar with documentary called anonymous people, which is to give a political voice to recovery of addictions, people with alcoholism and other addictions without breaking their, without breaking the traditions, if they're in a 12-step program because people do tend to think alcoholic, drunk.
Addict, user.
And without knowing like I myself have over 36 and a half, I have 36 and a half years recovery.
So recovery is real and it does, it goes on.
I have lived, experienced mental illness, a very long time ago.
That's why I'm concerned to think that I may not have any constitutional rights as a result of that diagnosis when I was 20 years old and had 20 shock treatments.
You know, and many other, many other hospitalizations after that.
And even into recovery, but recovery is real, and you know, like, like other movements such as HIV movement and the gay rights movement, it's because they got political and they became public and they went very public about it, and things changed.
And right now, there's, like very little treatment for addiction and kids are dying all over the place of IV drug use.
It's rampant and the treatment centers are dwindling because of the, I guess stigma isn't the proper word anymore, because of the misunderstanding and fear about that.
And because insurance companies seem to have the say about treatments.
So it seems to me.
I don't know.
SARAH LAUNDERVILLE: I think about also that as independent living centers for peer to peer workers, we talk about choice, right, and I remember when I joined the movement that people were talking about these different treatments as choice, and when I was, one of my hospitalizations, the doctors told my parents that ECT treatments would be really good for me because I would forget all of my bad memories, but don't worry, I would still have good memories, and you know, we didn't have Google back then, so my parents couldn't, like, Google that, and I, you know, I was lucky enough my mom really questioned that strongly, but I think it led for me to have conversations with people when I joined the movement around you know, when we're talking about different choices that it's really around informed choice and we really need to have dialogues within our communities around, if you're coming to the table today and ECT is the first time you're hearing about this, that might be true for somebody around the room, that's true for lots of different medical models we have medications, whatever, and we can have lots of dialogues about all those things but really finding out and informing yourself and good thing we have Google now to really make more information available.
AUDIENCE MEMBER: I actually wanted to spin off of, add to something Sarah was saying earlier about mandated reporting.
Not only is it important to know whether or not you're a mandated reporter but also what you're mandated to report.
There's this kind of pervasive misconception in Massachusetts that you're required working in ILC to report suicidality and you're not.
You're required to report very, very narrowly caregiver abuse of a person with a disability, and caregiver is only defined as someone who gives hands on help with ADLs.
One might say that's too narrow a category of things that you have to report, but it does give you a lot of freedom to exercise good judgment around other things that people may be telling you.
The other thing I wanted to say is when I talk to people about the recovery movement, one of the things I hear from folks who I would consider to be in our community, is, that's not for me, because you know, I take medications and I'm happy about it.
Or you know, I, I had a tough but helpful experience with the mental health system.
And there's this sense from a lot of people that the movement is in favor of choice so long as it's the choice that people are in favor of and if, you know, if you're making an informed choice about a certain treatment, it must be because you're not informed enough.
And if you really understood and stopped being a dupe of the system, you wouldn't choose medication, so I feel like that's alienating to a lot of people I talk to, but I'm not quite sure what to tell them because frankly I heard it too.
SARAH LAUNDERVILLE: One thing I was sharing with someone earlier, in Vermont we've started folks who are peer workers who might not have gone through some of the similar experiences that I've shared, saying that they've actually not shared about their experiences because they don't think they're peery enough.
They're not enough part of that movement and I think we can't alienate people.
I think about the old NARFA conferences, people used to go to, if you went to some of these conferences, they started going away from that practice of saying, trying to get people to stop their medications at the conference, that's the extreme stuff that we were doing at one point and I think we need to be inclusive of everything and have those conversations, and the reality is that I hope that people don't go through the experiences that I went through, right? I hope that as time goes on and we have all these different options that we're talking about, we're going to have less and less people doing that, but we need to remember that history, talk about it.
We need to figure out ways to have conversations about it, so it's not forgotten and we don't revert back to that too as time goes on.
MIKE BACHHUBER: As long as you're piggybacking on that privacy issue, the Rehabilitation Act does require centers to keep information about consumers confidential, and there are specific rules about that, that go above and beyond any confidentiality requirements under state law or HIPAA or any other laws that might apply.
And so specifically with mandatory reporters, each center probably ought to be consulting with an attorney to see whether, in fact, their consumer's right to privacy trumps the state mandatory reporting law.
DANIEL FISHER: I want to say a word about what to say to people who feel that they've been helped by medication or helped by the system.
I don't see that as contrary to recovery.
First of all, I don't think taking or not taking medication is always a indication of whether you've recovered or not recovered.
There are so many people in our society that take medication but haven't been labeled seriously mentally ill.
Haven't been put in that position in society.
What I see as much more, a bigger factor is, are you seen and actually there is a global assessment of functioning, you get a passing grade of 70, which is no longer reimbursable under insurance, a passible grade of 70 under, everyone familiar with the global assessment of functioning? 
I mean, it's something if you are providing for services they may ask at some point.
A 70 says, you could not be distinguished, a layperson, untrained person could not distinguish you from someone who was sick.
So basically, you pass.
And that really is one of the biggest indicators of recovery, is how you're viewed by the people around you.
Neighbors, employers.
You know, unfortunately, this is one of the reasons why people don't disclose, is that the position in society is really the marginalization in society is what you're really overall recovering from.
Then you say to somebody, the medication helps you to function, helps you to pass, helps you to, you know, not be drawn to the attention of police or medical authorities, that's understandable that, you know, you would continue to take that, and maybe have a therapist or case manager that helps, but the major overall goal is, unfortunately, is to pass.
I mean, you know, that's, wouldn't you say? 
I mean, you want, you don't want to be, you know, oh, look, there she is, she's not passing, and you know, it's not paranoia.
It's just plain the way you're viewed.
I mean, if on my, the block where I live, if my neighbors were all the time saying, oh, you know, gee, you know, he's probably still mentally ill.
Look at that.
But we hold dinners, we get to know each other.
You know, I can pass.
MIKE BACHHUBER: We're getting near the end of our time, I saw you had a question.
DANIEL FISHER: Very strongly holding up her hand.
MIKE BACHHUBER: I wasn't going to pass her, but I wanted to kind of let people know that I think she'll probably be the last hand.
AUDIENCE MEMBER: And on a high point.
Question, kind of going off of this, is, you know, you're talking about passing, and you're saying unfortunately, as kind of a, you know, you shouldn't have to pass.
Which I can understand some people, that's not important to them.
What about somebody, and this kind of goes back to the whole, you know, if someone says that I, what do you do if someone says, I am in recovery because of the medical establishment? 
You know, because I have access to pharmaceuticals, because I have access to therapy, I am not only passing, but I am no longer caused pain by my psychiatric disability, because while somebody may not see themselves as being caused pain or being caused suffering by a psychiatric disability, there are other people who do feel that way, and you know, are we to tell them that, no, you, it's fine that you feel pain or suffering, because of your disability.
Own it.
Would we do that to someone who had a physical disability or chronic illness? 
DANIEL FISHER: No, no.
Let me make this clear.
First of all, I personally was helped a lot by therapy.
I was helped by peer support.
I mean, I think, these are real problems.
I'm not saying they're not real problems and there is suffering.
I know I've gone through it.
I know other people have gone through it.
And it's really, should be a matter of choice.
Some people, and honestly, for instance, I notice that somebody who is very religious wants me to be very much a doctor, generally.
I mean, generalization, but I look at a person's culture.
If they're from the Far East, maybe they want me to be a doctor also.
You know, a little bit more formal.
So I'll sometimes think about how I'm dressing if I'm, before an audience that expects formality, I'll be more formal.
If I'm with somebody who is, you know, an atheist, or you know, takes any particular holistic route, I'll talk with them about holistic approaches, so I think one as a supporter or a practitioner has to be adaptive to the cultural expectations of the person that you're with.
And it's a respect.
It's a matter of respect.
AUDIENCE MEMBER: Okay.
DANIEL FISHER: Some people, they want a doctor.
You know.
And they feel, demeaned if they are given a peer.
Seriously, somebody will say why am I not getting the real doctor here? 
And we'll say, well, peers, you know, have a great deal of experience.
No, no, I want a doctor.
Okay.
We'll find you a doctor.
And some people prefer you know, medication over St. John's wort.
It's, the problem with me is that I felt that the, and honestly, we haven't talked about the pharmaceutical industry that much but they have basically over convinced people they have to have their particular drug in order to, you know, get relief.
And it's an active placebo in a way, because the tests show that they are no more effective in almost all cases than a placebo.
It's just that they've gotten the results that they wanted for antidepressants.
There are now more and more books out, not just Whitakers books, but many books that show this.
However, if you offer somebody that expects Zoloft, you offer them St. John's wort, they will say that's not what I'm looking for.
I've come to say, what is it you're looking for, and I will try to reeducate somebody, I'll show them results, that St. John's wort, have you heard of St. John's wort? 
It's, it's as effective in double blind studies as Zoloft or Prozac.
AUDIENCE MEMBER: For treating depression.
DANIEL FISHER: For treating depression.
AUDIENCE MEMBER: But not necessarily for, cause antidepressants can be prescribed for other 
DANIEL FISHER: I'm talking about depression, it's as effective.
It counts for 2/3 of all psychiatric problems at this point, but it's as effective.
But if the persons belief, this happened to me while I was working in a clinic.
In two different instances, I showed them results, everything.
One person didn't want to gain weight.
I said it doesn't cause weight gain, but it is quite effective, level of depression they had.
And in two instances, they contacted the administrator of the clinic and said I wasn't given the proper, you know, medicine, and in one case, the medical director of our clinic, who I'd actually hired, came in and said, why did you, you know, recommend St. John's wort, and I showed the results and everything.
He said, well, there's one study in the U.S. that showed it was no more effective than placebo and I said also Zoloft was no more effective of the placebo in same study, which is true.
So why should we prescribe Zoloft any more? 
And the answer, that's what the person wanted.
Belief is very important, and I wish that we had independent testing of medications and alternatives to medications, and independent information given.
It's not really going to help to say informed consent, if there is no independent information given as to effectiveness, so it's a whole topic in itself.
MIKE BACHHUBER: Your question was great, for an IL program, because it really comes back to what our philosophy is all about.
What is independent living, what is recovery, and ultimately, we decide what is recovery for ourselves.
We decide what is independent living for ourselves, and if, for me, if that's medication, it doesn't matter what the science says, that's what it is for me.
And maybe it won't always be that for me.
Maybe at some point I'll evolve my thinking and want something different, but consumer choice.
AUDIENCE MEMBER: We have a person very active in the state who chooses to remain in a nursing facility.
He's very active in the IL movement but that's his choice.
MIKE BACHHUBER: I know David.
SARAH LAUNDERVILLE: The other thing that came to mind with comments was around the pride and who we are as people with disabilities.
And just touching upon that, that for me as a person, who identifies as a person as a psychiatric disability.
That the pride comes around being part of this movement and having acceptance around that movement.
It's not around the fact that I lose time, like that's, I don't remember who I was for a few hours, that's a big problem for me still and it's something I have to sort of navigate my life around.
The pride comes I can share in a room like this and not feel completely judged around that and that's important to us in our movement, I think.
JUSTIN BROWN: I think, again, along this line of self-determination, a second way to think about recovery is not so much how have I changed but how has my environment, my world changed? 
And so when I can, you know, you look at the AA movement, people stand up and say, I'm an alcoholic, and they use that label on themselves as a choice that they make, and I often will stand up and say, you know, I've been diagnosed with bipolar disorder, and rather than fearing that, I believe it connects me to other people who may have had that same experience, and our goal together is to change the neighborhood so that even when we say that, people accept who we are.
And I think a big piece of access, you know, with physical disabilities is creating a world that's more accessible.
Well, I think we'll create a world that's more emotionally accessible.
It's a world where when you tell me, you know, you survived a suicide attempt, I can cry, and not be ashamed of my tears.
That's the world we all want to live in, not just because I have a diagnosis.
It's a better world for us all.
SARAH LAUNDERVILLE: So thanks, Justin.
So we're going to, want to just check in because we're going to close up the day.
And so we've learned a lot, we had a lot going on today, and I want to do a quick check in with folks.
I want folks to know that when you come to trainings like this, if this is your first experience, that sometimes stuff might come up for you in a couple of hours, you might say, oh, my God, that was really heavy or it might be coming up for you now, and I encourage you to, you know, seek out other people, to make a plan, if that's going to happen.
You know, is there someone in the room or someone around that you can check in with tonight, if those things come up for you, or have a plan of, you know, tomorrow morning kind of checking in about that, and I say this purely from experience.
I've jolted from a lot of conferences like this before on day one and I can't take off as easily today because I don't have a flight.
But you have to figure out, help figure out those things.
And I encourage you, if there is anybody that just wants to share how they're feeling or how today went for them or one take away from today, we'll take a couple of comments, that time is, any thoughts?