Tag Archives: abuses

Things that need fixing in our mental health system


Things that need fixing in our mental health system:

1. Certification

The NYS Mental Health Law mandates OMH to certify all providers. Certification provides the legal covers that allows our public legal advocates to bring cases of abusive providers to courts. But, totally against the mandate, OMH has established since the 1990s, together with our State’s DOH, a policy of DECERTIFYING providers. At least half of providers and services are not licensed in NYS.

This decertification scheme has provided judges who are less friendly to the mentally ill in our State’s highest courts the ammunition to allow the continued abuse of the disabled and the mentally ill in not-for-profit agencies. The state knows it; it participates in the abuses and defends these practices in courts.

Refer to the DAI case. Ask yourself: why, in the new millennium, we are still struggling with Willowbrookesque cases; why did we need to create a Center for The Protection of People with Special Needs this year, not 20 years ago?

2. ‘Best Practice’: no monitoring of providers needed.

Without certification, monitoring is just a word among the many used to describe something that is not happening in our mental health system. In other words, ‘monitoring of providers’ is a delusion of our mental health system. NYS courts have decided many times that legal advocates can’t monitor the safety of their clients in places where complains were logged, because these places are not ‘certified’.

Quality of services is a mandate. There is no point in giving money away to ‘providers’ who will pocket the money and dish out substandard mental health treatment. But you can’t have quality of services because our DOH and OMH says that monitoring is not necessary for people who can “defend themselves” from bad providers.  This is actually in their ‘license’ rules. Since you can’t monitor or be defended in court, quality of services becomes an unenforceable fantasy.

3. No Consumer participation.

This is the ‘pet peeve’ of the Citywide Mental Health Project. Please, read our Vision and Mission.

Federal and state laws provide for our participation in the programs, to the policy level of the programs. These provisions are there for us to protect ourselves from the history of abuse, to prevent more abuses.  It’s part of a policy system that requires the feedback of those receiving the benefits of the policy.

If you can buy a ticket to the moon then we consumers can give feedback to our not-for-profit servers.

Our bureaucrats are mis-managing our mental health system. Look, we adore the corporate system, even our bureaucrats use that model.  Just as you find CEOs that destroy their own companies and still get bonuses, we have the corporate model in OMH. They mismanage the system and still get praised.

Meanwhile, down here in the communities, you are raking your minds about why we have Erika Menendez in the streets. You are asking the wrong question. Ask why  OMH so often the defendant in cases of abuse; why is our public system been privatized by a decertification scheme that leaves the troubled people without quality of services. Why are the families so often complaining that the ‘system’ has left them alone with their troubled child?

Don’t look for quick fixes. Forced hospitalization as a remedy to the problem is a delusion you are suffering.

Guns and Mental Illness and the “liberal impulses”. [revised]


Yet another interesting article in the NY Times on our favorite topics, guns and mental illness. This one was  written by  JOE NOCERA, appropriately titled ‘Guns and Mental Illness’. See https://www.nytimes.com/2012/12/29/opinion/nocera-guns-and-mental-illness.html?hp&_r=0

I mean, is the best way guns are discussed now a days, as associated to mental illness. Hey, they go together like arroz y habichuelas, rice and beans for you monolinguals out there.

No pun intended with this image. Do you get it?

No pun intended with this image. Do you get it?

I don’t know if  I’m getting over-sensitive about the topic of mental illness or that these journalists are just plain  insensitive. It could be both…nah, they are really way  too detached and insensitive. The case is that the blame-the-mentally-ill-and-lock-’em-up is getting to be nauseating.

The first thing that strikes me about Mr. Nocera’s article is the use of the label “liberal”, a word associated in good ol’ USA with everything…not conservative, let’s say. You know, if you feel that the poor must be left to die at the entrance of the emergency room because they don’t have money or health insurance, you are NOT a liberal, which is a good thing according to the not-liberals. So, Mr. Nocera uses a word that conveys this to America:

Liberals are viewed as against the USA, unpatriotic people.

Liberals are viewed as against the USA, unpatriotic people.

Thus, he pretends to write an ‘impartial’ article  about the topic of mental illness while at the same time using an  emotionally loaded political word, “liberals”, to invalidate the political stands of the advocates for the protection of people with mental illness.

From the outset, the tone of the article is that those who advocate for the mentally ill are wrong because they are liberals. Not only that they are “liberals”, but they suffer from “liberal impulses”:

Ultimately, the article I wrote was about how the “deinstitutionalization movement” of the 1960s and early 1970s — a movement prompted by the same liberal impulses that gave us civil rights and women’s rights — had become a national disgrace.

Is he trying to equate the struggles against oppression to some kind of mental illness?

When he mentioned “a national disgrace”, Mr. Nocera was not referring to “The last disgrace”, the title of Geraldo Rivera’s documentay in 1972 about Willowbrook and the atrocities committed in these institutions. That’s the background for the “deinstitutionalization movement” to which  Mr. Nocera refers, but conveniently he skips that background.

experimentation

He talked about “over medication” in hospitals  as the problem. Sure, sure. “Over-medication” was what those children got when subjected to medical experimentation in the ‘institutions’ for the mentally ill and the ‘retarded’, as they were then called. That topic of torture in States’ psych hospitals is tabu for these journalists. But, that’s the mental health policy they are selling to you, to go back to the houses of horrors.

THE LIBERAL IMPULSES vs THE OTHER IMPULSES

What would he call the racist society of the 60s and 70s? He didn’t talk about the ‘racists impulses’ that caused the Blacks to organize the civil rights movement as a self-defense movement. Nor did he talk about the ‘sexist impulses’ that motivated women to unite against them. I wonder if  Mr. Nocera would consider today’s women’s movement in India against rape-as-tradition   a ‘liberal impulse’, not as a movement for self-defense.

What I want the reader to notice is the consistent and persistent  omission by these ‘impartial’ journalists of the details about  the atrocities committed in those ‘institutions of healing’. No mention that people were involuntarily committed just for being ‘different’ or politically ‘liberal’. Nooo.

Mr. Nocera talks about how throwing the mentally ill out of the ‘institutions’ into the communities was worse than what they were suffering in the hospitals. He neglects to tell you that these ‘liberals’ wanted the services in the community and that it was the States that refused to provide them.

"Liberal impulses" in action. Mr. Nocera says liberals demands  are a disgrace.

“Liberal impulses” in action. Mr. Nocera says liberals demands are a disgrace.

If today you have housing for the mentally ill, less homeless mentally ill, it is thanks to those ‘liberals’. Of course, the ‘liberals’ are losing the battle today against corporate greed and, as a consequence, you  will see the same problems you see when our political leaders suck your money out of the communities and into permanent wars and for Wall Street profit.

‘Bad liberals’ demanding no budget cuts
on mental health services. Go figure.

The pro-institutionalization stance in these articles is so subtle that you find yourself at the end wanting it as a remedy to today’s problems.

With the mentally ill rarely institutionalized for any length of time — on the theory that their lives will be better if they are not confined in a hospital — other institutions have sprung up to take their place.

He is alluding to that article the other day http://www.nytimes.com/2012/12/27/nyregion/new-yorks-mental-health-system-thrashed-by-services-lost-to-storm.html?smid=pl-share about how the situation for the mentally ill have worsen since storm Sandy. Funny that he refers to that article because  it shows that the problems with institutionalization are alive and well:

“I cried when I saw her,” Ms. Rosa said. “I found her in horrible conditions. She was lying in her own feces, she had a fractured leg and the provider could not explain how her leg was fractured.”

Today, as yesterdays, we have reports of abuses in state-run home care institutions, or in those private ones contracted by the state. There’s no way you can claim that locking people up is good practice. Historically, State-run institutions are places for experimentation and abuse. We have a Center for the Protection of People with Special Needs because you can’t protect them not even in the new millennium. The Center was created THIS YEAR as a result of continued abuses for the last 12 years.

Look, whatever you do, DON’T GO BACK TO WILLOWBROOK, DON’T GO BACK TO FORCE INSTITUTIONALIZATION.

It’s all about money. You take the money away and you have to use repression as your ‘best practice’.

And Liberals, beware. They want to label you ‘crazy’ and lobotomize you.

It’s all coming back at gun point, pun intended.

What to do? I will give my suggestion soon.

Here we go again: NYC mentally ill person kills citizen.


Bloomberg, asked earlier Friday about the episode at a station on Queens Boulevard in the Sunnyside neighborhood, pointed to legal and policy changes that led to the release of many mentally ill people from psychiatric institutions from the 1960s through 1990s.

“The courts or the law have changed and said, no, you can’t do that unless they’re a danger to society; our laws protect you. That’s fair enough,” Bloomberg said on “The John Gambling Show with Mayor Mike” on WOR-AM.

Bloomberg leaves it for you to fill in the blanks there: the court has changed the rules since the 1960s, he says, and you can’t involuntarily commit these people who need to be thrown away; and you, dutifully, arrive to the conclusion he is leading you towards: ‘stupid laws’. He wants you to conclude that the laws that ‘protect’ the mentally ill are illogical, that the laws blankly  protect the deranged. Something must be done about that, QUICKLY, like for example, HEY, let’s change the laws!!! Let’s go back to the Willowbrook times and involuntarily commit people into houses of torture.

WHAT BLOOMBERG DOESN’T TELL YOU

He doesn’t tell you that in the 1970s and 80s, the reason why the states were mandated by the courts to discharge the mentally ill and people with ‘special needs’  from the psych ‘hospitals’  was that the ABUSES in Willowbrook showed the treatment these people were receiving in those houses of ‘healing’: they were being used for medical experimentation, torture, both children and adults. Please, go back and watch Geraldo Rivera’s documentary about Willowbrook.

Willowbrook: A house of horrors.

Bloomberg doesn’t tell you either that the states ‘complied’ with the court orders at that time by INTENTIONALLY throwing these people to the streets WITHOUT HOUSING OR SERVICES in the community. He doesn’t tell you that the 1980s saw the hard-fought war of communities with the states to house and service these people. All of the major problems we saw with the mentally ill in those years (1980s) were due to the lack of mental health services and housing in the communities because the states refused to put the money there.

Once housing and services started to be put in place, the problems with them subsided significantly. Bloomberg knows this, but he won’t remind you of this because he just wants the easy ‘fix’: lock ’em all up. Hey, it’s good business for the profit seekers, the prison builders. Prisons are now our psych hospitals. Just like in the 1980s.

Look, if you divert TRILLIONS of dollars and use them for ‘permanent wars’, for surveillance equipment in each of our streets corners to ‘protect’ you from who knows what or whom (the only paranoid here seems to be the  State and the feds), there is going to be no money for humanity here. It’s not like I’m saying something new or revolutionary. You know this. You just ‘forget’ for some reason.

Of course you are going to see more of these cases! Bloomberg makes cuts to social and mental health services and then expect that the problems HE causes with those cuts can be fixed with a mental health policy of REPRESSION.

He and the governor closed psych hospitals these past two years not because the hospitals alleviated the problems and were unnecessary but despite the problems of mental illness. It’s a mindless policy that functions based on a need for profit. This policy shows that the so-called ‘BEST PRACTICES’ is fiction. You can’t have best practices when the best practice tells you to keep programs open but the state wants to save money by closing them.

I doubt that anyone is against hospitalization IF the policy is to serve the person, not to torture he or she.

It’s a very complex problem. It’s not only what you see, but what you refuse to see in terms of our investment in wars.

CUTS IN FUNDS, FISCAL CLIFF AND PERMANENT WARS = SOCIAL INSTABILITY.

That’s all you need to know.

Make the necessary adjustments: SAY NO TO WARS AND CORPORATE AND BANKSTERS’ GREED.

My condolences to the family of the victim of this horrific incident. No one wins when we save money by withholding treatment.

The situation out there


Chasing the money

It seems that our community has been forced into a tug of war by our government -state, federal and city- to protect our services from being decimated under the excuse of ‘economic crisis’. More money has been lost yearly in financial corruption than what is needed to keep small programs running: the recent CityTimes’ scandal in our city is an example.

This is the game we are forced into by the powers that be: stay focused on trying to keep programs open: low quality of services, abuses and mistreatment, our lack of meaningful participation in shaping our so-called public mental health system and programs policies, these issues are perennially moved to the back burner.

And our justice system seems unavailable for us too.

THE JUSTICE SYSTEM: hmmm.

Despite so many laws supposedly there to protect us, few cases brought to courts by legal advocates denouncing discrimination and physical and mental abuses in state and private institutions are actually won. Then many are overturned on appeal. Example, DAI v OMH (among other defendants), a case about abuse and discrimination of people with disabilities won in 2010 but over turned in April 2012 on technical legal grounds: OMH argued successfully that the non-for-profit legal group it itself hired to advocate for these people had no right to do their job! Go figure.

There is no expectation that the mentally ill will find in courts relief from abuse. The long arm of cultural stereotypes and prejudice about the mentally ill reaches our courts. The actual reason for the new 2008 ADA amendment was precisely that our nation’s court, all the way up to the SCOTUS, had been circumventing the ADA 1990 to deny relief from abuse to people with disabilities. In the “findings and purpose” of the amendment, it states, among other things: “(4) the holdings of the Supreme Court in Sutton v. United Air Lines, Inc., 527 U.S. 471 (1999) and its companion cases have narrowed the broad scope of protection intended to be afforded by the ADA [1990], thus eliminating protection for many individuals whom Congress intended to protect;”. To remedy this legal abuse, the amendment relaxed the definition of disability, among other things.

Many judges have done the ‘homework’ and have been allies of the mentally ill/disabled, but there are still a few who betray that culture of stereotypes. It shows in uncompassionate rulings.

The operating stereotype is still that the mentally ill must be mentally deficient and simple-minded,  a dependent  child-adult, not a citizen with political and human rights capable of thinking and standing for himself; otherwise, he or she must be a faker. Or, the interests of a whole group of people being physically abused (as in the case above) must be relegated to the interests of the ‘non for profit’ business or to protect legal technicalities.

We must carry our labels everywhere we go and have our social worth measured against them.

If you think that the new Justice Center for the Protection of People with Special Needs will change this, you are up for a rude awakening, again. But that’s topic for another time.

POLICY MAKING and citizenry

I have been speaking recently to some of my peers in the community about how they rate their participation in their programs.  The message I’ve been getting is pretty much generalized: they feel voiceless in their programs and treated in undignified manner. It seems to me that my peers suffer not only from chronic mental illness, but from a chronic lack of political power, they are treated as less than full-fledge citizens.

The ‘public’ mental health system in our state (and federal) is based on a carefully studied and planned mental health policy. Ingrained in all policies is, or ought to be, a mechanism for those directly affected by it to provide feedback about how efficient these policies have been in achieving their goals. Hell, even Staples asks for consumer feedback. So, our mental health policy gives us the Consumer Advisory Boards (CAB) or councils at state, city and program levels. These CAB are tools we have gain through years of struggles to participate in the system to have a voice, not ‘gifts’ from a benevolent state. But few consumers know about ‘policy’ or about CABs.

WE ARE NOT ALLOWED TO TALK ABOUT IT

The efficiency of  a legal or mental health system is measured, in part, on how good or bad YOU are being treated by  it or in it, how it feels on your skin,  not on the ‘quantity’ of laws and services tabulated. If our feedback is being heeded then it should reflect at least in superior quality of services or on how we are not been abused. Take note of these facts, though:

  • The Medicaid Redesign Team described our mental health system as “fragmented”. Imagine that, they gave it a thumb down. Evidently our “feedback” has not been heeded.  A “fragmented” system is by nature unaccountable and insensitive to the needs of those it’s supposed to serve.
  • The new Justice Center for the Protection of People     with Special Needs comes about as a result of all those articles in the NY Times since at least 2002 denouncing  Willowbrookesque houses of horror for the mentally ill in our state.  In the new millennium of technological advances, of cellphones and surveillance cameras under our noses, we are still facing the inhumane treatment behind closed doors of the mentally ill in the hands of those paid to protect them.
  • There are hardly any CABs in the programs we attend; the few out there are totally inefficient to collect our feedback and help us make the system and providers more sensitive  to our needs and humanity.

Overall, there is a pretty wide cloud of consumer dissatisfaction with our mental health system, its quality of services and the lack of true participation in the system. We are just not allowed to talk about it.

Let’s face reality:

·   The system is in dire need of repair

·   Our consumers’ movement has been  mainstreamed, forced to focus on the financial aspects of the system.

·   The system has given us the first salvo signaling the end of the ‘benevolent’ mental health system: the unprecedented arrest of ADAPT activists in DC this year (April) where they were denied legal access to their lawyers. Read in ADAPT’s website the information and updates.

·   Incidents of police killing people with mental  illness in distress are rising.

It’s time for us to start speaking up about these things which are taboo now-a-days. I would suggest opening the discussion via some consumers’ conference in the city. I invite my peers to open this discussion soon, for our nation is turning into a surveillance state in an effort to keep everybody ‘normal’ and ‘safe’ from people like you and me. After the current Colorado killings, people are commenting “we need crazy control, not gun control”.

Be ready. Be very ready.

Are NYS OMH’s license policies violating our Mental Health Act?


For an  answer to the above question you have to read OMH’s policies.

NOTE: I’m not a lawyer, nor a paralegal, or a legal counselor or legal advocate. These are my opinions, the opinions of a lay person’s interested in understanding the State’s mental health laws and the ADA. These comments are intended to open a public discussion about NYS OMH’s license policies.

I: NYS Mental Health Act, Title E,  Section 31.02 Operating certificate required.

A. But what does that mean?

That statement that “operating certificate required” looks to me like a declaratory statement:  a requirement for something has been stated. It doesn’t seem to imply in any way, shape or form that operating certificates (op cert) are required only for a few people or only in few  occasions. The statement that “operating certificate required” carries a meaning of purpose and intention: ‘Let it be no doubt about it: operating certificate required, PERIOD.’ That’s what it seems to say and imply. Don’t you agree?

So why has OMH declared that (in what seems to me to be) about half of all mental health providers do not need an operating certificate? I would understand it if FEW providers were exempted from the mandate; after all, every law has an exception on how it is applied:

(a)  Except as provided in subdivision (b) of this section…

That’s the ONLY exemption in the mandate that “operating certificate required”. And what does that exemption say?

(b)  A  provider  of services operating a community residence on April first, nineteen  hundred  seventy-six [1967!],  shall  be  issued  an  operating certificate  by the commissioner without requiring proof that there is a public need for such residence, providing application for such operating certificate to  the  department  in  accordance  with  this  article  is submitted  prior  to  September  first,  nineteen  hundred  seventy-six. Pending the determination of any such  application  the  continuance  of such  operation shall be lawful.

That’s the only exemption: that a provider running a community residence program open for business since April 1967 or before will be exempt from the requirement IF the operation is deemed “lawful” by today’ standards.  I venture to say that MOST programs we have today didn’t open for business until after at least 1985, the decade of the big changes in our public mental health system. Those programs would NOT qualify for the exemption. I hope you agree with me up to here.

What activities are mandated to have an op cert?

(a)…no provider of services shall engage in any of the following activities  [ there are 5] without  an operating  certificate…
1. operation of a residential facility  or  institution,  including  a
  community residence,…

Let’s see this one first. Only in court would you split hairs in interpreting the meaning of “residential facility”, “facility” “or community residence”. If you are in a  supported housing program (SHP), you would consider it a “residential facility”, wouldn’t you? Same if you live in congregate housing, SRO, etc, whether or NOT it was run by an institution. It seems logical: I live there, therefore it IS  a RESIDENCE.

Are there any other exemptions if, as I said, they ALWAYS exist in any law? Yes, they are here too! Continuing on the same “(a)1” as above:

It shall not include a place where the services rendered consist solely of non-residential services for the mentally disabled which are exempt from the requirement for an operating certificate under article sixteen, thirty-one or thirty-two of this chapter, nor shall it include domestic care and comfort to a person in the home.

So here we have the characteristics  of those services exempted of the requirement to have an op cert:

a. services that are SOLELY non-residential in nature – this means that if there is at least ONE residential service in it, it is NOT exempt from the op cert requirement, it HAS to have one. To be exempt it has to be SOLELY of non-residential nature AND, in addition…

b. services SOLELY of non-residential nature which are  exempt by articles 16, 31 or 32 of this chapter. That means that even non-residential services REQUIRE an op cert  if they are not “exempt by articles 16, 31 or 32 of this chapter.” There seems to be an intent running through these exemptions: that as long as you provide SERVICES, you  MUST HAVE AN OP CERT, PERIOD. (caps are for emphasis, not shouting.). Whether residential OR NON-RESIDENTIAL, you must have an op cert.

c. domestic care and comfort at home is not required to have op cert.

This intent that all services require an op cert is shown in the second description of activities that require one:

2. operation of any part of a general hospital for the purpose of providing residential or non-residential services for the mentally disabled.

And if you are still not satisfied that the INTENT of this “op cert required” is to have ALL mental health services covered by a mandate, check the third characteristic of services which must have one:

3. operation of a facility established or maintained by a public agency, board, or commission, or by a corporation for the rendition of out-patient or non-residential services for the mentally disabled;”

Even “corporations”, not only public  “board” and “commission” and ‘agency” must have an op cert EVEN if they provide out-patient or non-residential services. Of course, there are the eternal exemptions in this case too  for these “corporations’ which provide non residential services. These are:  pastoral mental health services, providers licensed by another agency, and private practice.

The 4th and 5th activities which requires op cert:

4. operation of a residential treatment facility for children and youth.

5. operation of a residential care center for adults.

So there you have it. The INTENT of our NYS Mental Health Act seems to be that providers of services, including out-patient, residential and non-residential services, must have an op cert.

Again, why have OMH apparently decertified more than half of all providers of these services?

II: Why op cert required?

The question is Why are so many programs exempt? Does it matter? Of course it does! This is the DMH/OMH reason for having op certs:

Part 70.01 (b)2…The issuance of an operating certificate is intended to signify that a provider has met minimum standards for conditions conducive to safe and effective operation and to establish the accountability of the provider for operation in accordance with those standards.http://weblinks.westlaw.com/result/default.aspx?cnt=Document&db=NY-CRR-F-TOC%3BTOCDUMMY&docname=365892426&findtype=W&fn=_top&pbc=DA010192&rlt=CLID_FQRLT64198413922156&rp=%2FSearch%2Fdefault.wl&rs=WEBL12.04&service=Find&spa=nycrr-1000&vr=2.0

So, no license = no accountability, no safety, no quality of services. This explains why so many providers accused of abuses on consumers go without punishment: because they are unlicensed! The State has no power of oversight if these providers are unlicensed. To be unlicensed means to be OUTSIDE OUR PUBLIC mental health system.

These are two of the six reasons given by the Act for having an op cert:

“(a) No operating certificate shall be issued by the commissioner unless the commissioner finds:

1. that the premises, equipment, personnel, records, and program are adequate and appropriate to provide the services for the mentally disabled which are sought to be authorized,

2. that such services will be provided in compliance with applicable law and regulations,”  at NY Code – Section 31.05: Issuance of an operating certificate.

Look it up yourselves in the link below, don’t take my words for it: more than half of programs are unlicensed, meaning out side our public system, not required to provide MINIMUM quality of services and protection, etc, etc, etc. See them here and count for yourselves, then answer the question: Why are so many programs unlicensed?

NYS Consolidated Budget and Claiming Manual, Appendix F – OMH Programs Types, Definitions and Codes

(start at 0040 – Family Care
(Licensed Program)

http://www.omh.ny.gov/omhweb/cbr/fy09/section_30.html

Next: OMH’s licensing rules. Are they in violation of the ADA?