Give 'em Medicaid

Amid all the outpouring of sentiment for and against the bailout of the automakers, was an excellent recommendation regarding the form of said bailout: “Give ‘em Medicaid.” Here's why:

• It would be relatively easy to implement. The basic eligibility standard for Medicaid is that you have to be desperately poor, but in 1999, Minnesota was one of a handful of states who extended Medicaid (called M.A. in MN) to the working poor, if they were disabled. This has worked great (so far) and was easy to do. The rules could easily be changed to allow states to offer Medicaid to anyone employed (a certain # of hrs/wk) by a distressed automaker.

• It wouldn’t cost anymore than other bailout strategies, and probably no more than the cost of not bailing out – people are likely to become poor soon enough if they lose their job.

• It would be a huge help to the automakers. Currently, the automakers spend more on healthcare than they do on steel. This is a major disadvantage in competing with foreign manufacturers, whose workers get free, government-paid health care.

• It would improve Medicaid. In many respects, Medicaid provides second-class health care – the UAW wouldn’t put up with this for long, and as tens of thousands of workers get added to the roles, health care providers who currently disdain Medicaid would want the business.

• Best of all, it would be a huge step toward universal care. Everyone knows that universal, single-payer, health care is the only solution to our health care crisis that makes any sense. But no one, perhaps not even Mr. Obama, seems to know how to get there from the mess we’re in. This would blaze a path, one industry at a time.

Piece of the Pie...getting smaller and smaller

English Professor and author Christopher Lane recently wrote an editorial for the Star Tribune about the process (flawed in his opinion) for revising the “Diagnostic and Statistical Manual of Mental Disorders.” This probably gathered less attention than recent laments about our collapsing economy, but the two topics are more closely related than one might think.

As Lane explains, the DSM sets the rules by which insurance companies deny or approve payment for the treatment of emerging “conditions” such as compulsive shopping and parental alienation. Lane disputes the idea that such behaviors should be treated as real mental illnesses, and I tend to agree with him. They may be real conditions but it is a mistake to lump them in with diseases like schizophrenia.

My fear is that with these emerging “conditions” being defined as mental illnesses, funding for serious and persistent mental illnesses like schizophrenia will be shifted away. Maybe that seems selfish or even paranoid, but I’ve seen it happen over and over.

My dream is to see people with serious mental illnesses, such as schizophrenia, get the care they need to recover. Because I’ve also seen people recover, become contributors rather than consumers, and live meaningful, productive lives..

Do Miracles Really Happen?

“I got my son back,” a mother said to me recently, choking back tears. “Tasks and Clozaril are miracles. Don’t let (mental illness) take him away again.” In all my years in mental health, Clozaril (generic name: clozapine) is, far and away, the most powerful, most effective anti-psychotic medication on the market. Clozaril, however, has several nasty side-effects.

The most serious side-effect is how it decreases white-blood-cell counts. For the most part, this is a modest phenomenon which causes no real health risk. However, in early trials, some patients white-blood-cell count was so low that they became incredibly vulnerable to infections, and two patients even died. This resulted in rules that force doctors to take patients of Clozaril when their white-blood-cell counts drop below a certain level, often forfeiting all the progress the patient has achieved.


Remember the movie, “The Awakening,”? Patients with a condition causing them to seem retarded and even comatose miraculously came to life as the result of an obscure treatment. But the treatment could not be sustained and ultimately, the patients drifted back to their previous condition. Can you imagine getting your loved one back and then having to see them taken away again? An almost identical thing happens to some people taking Clorazil. It is the most tragic and heart-wrenching thing I have ever seen.

A less dramatic but more common side effect is that Clozaril is a powerful appetite stimulant. Without rigorous diet-management, Clozaril can cause extraordinary weight gain, leading to diabetes, hypertension, etc. Not surprisingly, major weight gain is a powerful deterrent to taking Clozaril.

It’s NOT good enough to just put people on a miracle drug when they will eventually be taken back by their psychosis. What’s needed?- Monthly blood testing which is extremely expensive- Rigorous diet-management which is extremely expensive- Drug monitoring which is extremely expensive.

Competing drugs, currently available, are not as effective, in reducing psychosis, as Clozaril. We are desperate for an alternative. Yes, management is expensive but is it worth it? You decide… Someone with mental illness is no less valuable than you are but that’s just my opinion.

Witch Hunting

The Minneapolis Star Tribune reported on 9/7/08 that the cost of health care for people in jail (the article focused on Henn.Co, but included references to other Minnesota jails experiencing similar problems) is way up, driven by the demand for mental health care. The head nurse says the "mental health system is breaking down."

"IS breaking down"? Doesn't that imply that the health care system has been working and is only recently beginning to not work? The health care system has been broken down.

• Hospital capacity has been shrinking by 10% every year since 1980
• Shelters have been turned into psych wards
• According to Minneapolis Police Chief Olson, 40% of their calls were related to some sort of mental illness but hospitals are full so the only place for them to go is to jail.

Does that sound like a broken down system? It has not worked.

Most cops, though well-intentioned, have had only a few hours of sensitivity training, but they aren't mental health professionals and can't dispense meds - the only tool they have is to haul the preson to jail. This doesn't solve anyone's problems, least of all the person suffering from mental illness.

I would like to think that our society has progressed since the days of witch hunts but from the looks of it, we really haven't.

Foreclosures - Advocates just as useless

It never ceases to amaze me just how screwed up our society is. Accepting responsibility seems to be a concept that is foreign even to those who are supposedly committed to helping others, especially the vulnerable.

The Mpls. Star-Tribune has been running a series of articles under the banner “From Wall Street to Main Street,” in which they attempt to put local faces on the developing economic crisis. On 9/28, they ran another installment featuring a Hopkins couple, both vulnerable adults, who lost their townhome to foreclosure.

The article includes an impressive level of finger-pointing:
• Legal Aid blames the mortgage company.
• The mortgage company blames the “closer” and third-party investors.
• The closer blames the lender.
• The adopted family blames the birth family and an absence of “safeguards.”
• The social service agency blames the County.
• And last but not least, the social worker blames the couple (credited in the article with I.Q.s of 56) for not asking for help.

I think we have come to expect irresponsibility from realtors and mortgage companies, but I expect more from government agencies and non-profits serving this population. A photo which accompanies the article shows seven (unidentified, but presumably) service providers meeting with the couple (now that it’s too late to actually help) to bemoan the situation. One of the service providers helped arrange the original purchase, and no doubt congratulated themselves for doing so, but adamantly denies any responsibility for the foreclosure.

This couple didn’t need seven useless service providers, they needed one competent one.

Myth: Consumer Input

Obviously, consumers have opinions and legitimate perspectives; it’s the term “input” that I call a myth, because it implies that someone is listening.

In my job, I bump up against numerous efforts to solicit “consumer input.” One thing I’ve noticed is that mental health professionals are really bad at it. Professionals come to these events with our own personal bias about what the “problem” is and what should be done about it. We “listen” only for corroboration and validation of our existing opinions, and we close our ears to any opinions which conflict.

A hearing I attended last week was typical. A small group of well-intentioned professionals recruited a large group of “consumers” to an “Open Forum” regarding mental health policy. After the standard introduction about how interested professionals are in knowing what consumers think, they “opened” the floor.

Consumer after consumer rose to express their frustration with how the mental health system had failed/was continuing to fail to meet their needs. And as always happens, the professionals cut them off, explaining that “we really don’t have time today to discuss all these individual issues and misunderstandings; we’re here to talk about the big picture.”

I am sympathetic with the people who run these meetings to a degree; they didn’t personally cause the problem and they sure can’t fix it. But they entirely miss the point when they refuse to listen. The big picture is that the system doesn't work...for EVERYONE.

If they would have listened, they would understand that people's needs are not being met by the mental health system. Fact is, most people with serious mental illness are served poorly or not at all. Aren't they being paid to help people get the services they need? We need to start listening! Otherwise, what's the point of Consumer Input anyway?

Health Care Form - getting worse

Remember Al? Remember how I was optimistic about him getting dis-enrolled out of "GreenCare"? I was wrong to be that optimistic. Al, a Tasks client, is now caught in the dysfunctional managed care plan which will not provide him the medical care he desperately needs...


Al has a bright and experienced Tasks Unlimited Case Manager, Peg (not real name), who is now advocating for him full time. Since her involvement, I thought that she could help spring him from the clutches of "GreenCare" on Aug. 1, 2008. But I was wrong; I underestimated how difficult it would be. Turns out that it is easier for a court-committed patient to escape from Anoka State Hospital than to dis-enroll from managed care.

• In early July 2008, Al's Case Manager, Peg, had him send his GreenCare Coordinator the dis-enrollment form. But Peg was informed that it was the wrong form.
• Peg requested that the correct form be mailed to her, but the Coordinator didn't have the correct form and referred her to someone else
• The other person didn't have the correct form either.
• This went back and form several times, until it was determined that the correct forms didn't exist. A letter would be sufficient, but it had to be sent to someone else at GreenCare.
• Peg sent the letter as directed, but that didn't work either. The recipient suggested sending the letter to "someone at the State," but she wasn't sure who.
  

Meanwhile, July has ended and August has begun. As I write, Al is still enrolled in GreenCare and is still without the medical services he needs, and still ineligible for M.A. because the funds the government would otherwise use to pay for his health care are still going to GreenCare. Peg will continue to advocate on Al's behalf; maybe Al can get his health care restored in September but I'm now cautiously optimistic.

My theory? There are no procedures for dis-enrollment. During the planning stages of privatization, I (and others) asked about dis-enrollment and were repeatedly told that anyone could dis-enroll at any time, and they continue to insist that this is true. No one at GreenCare, or at any other insurance companies, bothered to come up with a dis-enrollment process. They don't even have the forms!

To the insurance companies I ask you this: If you can't take care of one person, how do you propose you will take care of everyone on M.A.? I want them to explain to Al why he can't get his post-operation check-ups and why all the promises they made don't apply to him.

Healthcare Reform - better?

In 2007, legislation, promoted by Governor Pawlenty, was passed pointing towards privatization of our previously public mental health system. The proponents of this legislation say it will be "better". I guess that could be possible, but what scares me is that, no one has ever articulated a single, clear, compelling reason why we ought to privatize. I've heard lots of different reasons, but they are vague and ever changing. It kind of reminds me of when we invaded Iraq.



Privatization began this past spring when various private health care plans launched something called Special Needs Basic Care Plan, or SNIBS (don't ask). SNIBS are voluntary; consumers don't have to sign up for a SNIB. Preferred Integrated Networks (PINS) are scheduled to roll out January 2009 which will be less voluntary and eventually involuntary. SNIBS have begun soliciting (some more aggressively than others) people with serious mental illness to sign up. So far, the skeptics that we are, Tasks has been urging our clients to be cautious about giving up their Medicaid (M.A.) for private insurance.


But Tasks clients tend to be free thinkers, so one, Al (not real name), signed up with a SNIB, GreenCare (not real name), on 6/1/08. Al's troubles with getting medical care began immediately:

• Al is currently on medical leave due to a recent heart surgery but his surgeon is out of the SNIB network. Now, he has to find a new surgeon.
  
• Al receives case management from Tasks Unlimited (he is currently on medical leave recovering from heart surgery) and Tasks has a contract with GreenCare to provide Care Coordination for clients who enroll. We submitted the list of clients to GreenCare but did they check the list for Al's name? Nope.
  
• All routinely receives occupational therapy through M.A. The GreenCare rep told Al it would be covered. What he neglected to say was that Al's diagnosis excludes him from this coverage. Will he have to go without therapy?
  
• GreenCare promises free transportation to doctor appointments, and their Care Coordinator insists that this is true. But Al has been unable to navigate the automatic reservation system and the Care Coordinator suggests that "something is wrong with Al that he can't do it." A Tasks staff member has tried to navigate the automated system and even she found it difficult.
  
• SNIB rules allow dis-enrollment at any time. When we heard about Al's difficulties, we encouraged him to dis-enroll. He called his GreenCare coordinator on June 26 and submitted a request the paperwork. Oh, by the way, dis-enrollment is more difficult than enrollment so we assisted Al in completing the paperwork and mailed it back on July 3. But it turns out that Al can't dis-enroll until the end of the month, so he won't get his M.A back until Aug. 1. Meanwhile, Al goes without the medical care he needs. Tasks will provide Al a ride to see his psychiatrist, who, thankfully is in-network.
  

I had, optimistically, anticipated that some Tasks clients would have good luck with privatization, and others would experience various problems. I never imagined that our first, volunteer guinea pig would encounter every possible problem.


It may be early on but so far, privatization doesn't seem "better" to me. You know what scares me? Al will have to go without medical care. How many people will we lose to this health care reform?


Email me for more information or for ways you can help actually make the healthcare reform...well, better.

Giving Back

This is unusual for me to post 2 blogs in a day but today, I'm so proud.

A few weeks ago, a client who usually cleans our offices, Steve Erickson, asked "Why don't we help Iowa?"  I have to admit that I was a little apathetic about it but I asked if any staff would be willing to help put a trip together.  

On Wednesday, a crew of 6, 3 clients and 3 staff, left to go to Iowa City to help the United Way of Johnson County with flood clean-up.

This morning, I woke up to 2 articles written about our crew who were cleaning up rancid garbage and moving sandbags.  And of course, there was Steve, in his humble way saying that he was just moved by the disaster areas he saw on TV.  He just wanted to help.

This isn't the first time Tasks clients have given back using their own vacation time to volunteer and help others.  There were crews that went to Grand Forks, ND and Appalachia.  But this time, people noticed that those who are so often mistaken to be burdens of society are not, they can be regular people.  No, they're not regular people, they're extraordinary people.

More Will Die

I can honestly say that I was sick to my stomach and yet, not surprised that this has happened.  In fact, it is the norm and the exception.  The only difference is that this was caught on tape and leaked to the media.  Outrage?  I feel like I've been outraging for the last 30 years. 

People are shocked that this woman had waited over 24 hours in the waiting room.  Really?

Locally, a 2006 Pioneer Press documented a 16 hour wait for emergency psych care at Regions Hospital, and reports waits of up to 52 hours.  During 2006, it was widely known that the average wait time at Hennepin County Medical Center was 8 hours.  Reportedly, the situations at both Regions and HCMC have since improved.

Closer to home are waiting lists at Tasks Unlimited.  Tasks operates multiple programs serving multiple counties which results in multiple waiting lists.  The average wait time on many of these lists is shorter than the month it takes to access hospital records and obtain the required signatures.  But some of our waiting lists are long - up to 10 months.

Yes, I know, a 10 month wait for psychiatric rehabilitation is as dysfunctional as a 10 hour wait for emergency care.  It has actually happened that people have died (usually from suicide)while waiting for admission to Tasks.  I don't know all that might be wrong in Brooklyn, but the main problem here at Tasks is under-funding.  The number of people we can afford to serve has increased while demand increases.

We don't have enough funding to keep up, and more will die.  I don't know what to do.

It's a Hoax. Part III

The more I think about Minnesota's Sex Offender Program, the more absurd it seems to me.  Continuing my rant on the MSOP... 

QUESTION #2:  Who Works At MSOP?

For starters, there are guards or correctional officers or psych assistants, whatever they call them, presumably locals. I understand that the farm land around Moose Lake is poor, and that anyone trying to ram needs a part time job to support his farming addiction. I got no beef with them...no pun intended.

But the state's pretense of psychiatric treatment surely requires the presense of a few doctors, nurses, or social workers - people with the credential to call themselves "Mental Health Professionals."

• Dr. Michael Famsworth, who apprently designed MSOP in 1993 ("offering sex offenders the opprtunity to participate in high quality treatment to enhance re-entry to society") resigned in protest in 2003, finally figuring out that the state would never allow anyone to leave the program alive. One might questions why it took Farnsworth 9 years to do the right thing.
  

• I know that questions have been raised about ethics of psychologists involved in the torture of detainees at Guantanamo (psychiatrists have been refusing Guantanamo duty).  I have similar questions about ethics of "mental health professional, from any discipline, working in such an obviously fraudulent "treatment" program.
  

FINALLY, QUESTION #3:  Does MSOP create a safer society?

In the short-run, maybe.  The guy who murdered a 12 year old seems scary.

But I don't think the people who wrote and passed the Bill of Rights (of course, it would never pass today) would have approved of a system patterned after the Soviet Gulag, as Solzhenitsyn can attest.

No one has ever been discharged so how do we know that anyone has been effectively treated?  Or are we all disillusioned to think that this program will CURE sex offenders?  The better question is whether we, as a society feel better now that these "dangerous" people are hidden away...seemingly forever?

Can't we just agree to treat crimes as crimes and mental illness as the medical problem it really is?

It's a Hoax. Part II

A few weeks ago, I responded to a Minneapolis Star Tribune series regarding Minnesota's Sex Offender Program (MSOP) which is located in Moose Lake.  The Strib says that the facts raise the question, "Is MSOP really mental health treatment, or just permanent incarceration?" This is a good question but I can think of some much better questions:

QUESTION 1 - Who gets "committed" to MSOP, and why?

• Eerily similar to Guantanamo, the Strib could only identify two-thirds of detainees.
  
• A couple, identified by the Strib, seem like pretty bad dudes:
  
• Dennis Linehan, famous enough that the Strib had a stock photo of him, bears, with missing teeth, a strikin resemblance to Hannibal Lechter.
  
• Lorenzo Sanchez raped and murdered a 12 year-old.  Why doesn't that deserve an old fashioned "life without parole" sentence to prison?

But others identified seem odd choices for a life sentence:

• 10 percent were juveniles when they committed their crime.
  
• Ben Alverson was in his early 20's when he had "consensual" sex with two girls ages 13 & 14. Where's the pathology here?  When I was 20, I was attracted to teenage girls who looked older than they really were.  Yes I understand there is no such thing as consensual sex between a 22 year old and a 13 year old (in this state) we have defined such acts as crimes (which is why I backed away when I found out how old the girls were).  But Alverson, now 32 years old, already served his prison sentence for said crime.
  
• Dwane Peterson was convicted of kidnapping an elderly man (the Strib didn't mention a motive, but it did not involve sex) and served his prison sentence for said crime.  Then, despite never having committed a sex crime, he was committed to MSOP because of fantasies he admitted to during therapy.
• Isaiah Swedeen was committed to MSOP after disclosing, during treatment, a vaguely homosexual incident from his past, unrelated to any crime he had been charged with.  And treatment officials admit that Swedeen doesn't respond to psycho-tropic meds - presumably because he doesn't have mental illness.

The legislature has the right, under the constitution to make kidnapping or sex with under age girls a capital offense.  But lets keep this debate in the criminal justice arena where it belongs.  Do we really want to live in a society where people can be confined indefinitely because of impure thoughts.  The Strib appropriately quoted Tom Paine on the subject, they could have just as easily quoted Solzhenitsyn.  

QUESTION 2 - Who Works at MSOP?

Stay tuned... 

Sex Offender Treatment? It's a Hoax

A month ago, I commented on criminalization of mental illness. Related to it, this week's topic is the pathologyzation of criminal behavior. The Minneapolis Star Tribune just began a 3 part series about Minnesota's Sex Offender Program (MSOP) located in Moose Lake. Here are the facts as reported by the Strib:

• MSP was created 14 years ago.


• 544 men and 1 woman are confined under MSOP
  - Technically, MSOP officials report holding 544 + 1; we don't really know what that means because the names of those detained in their "gulag" is a state secret.


• No one has ever been discharged. That bears repeating...NO ONE HAS EVER BEEN DISCHARGED!!!! Commitment to MSOP is a life sentence but it differs signifantly from a life-time prison sentence:
  - subjects have no right to a jury trial
  - the standard is "clear and convincing" evidence (well below "beyond reasonable doubt")
  - subjects are required to testify against themselves
  - subjects are "committed" to MSOP after they serve the prison term commensurate with their crime
  - and, of course, gang-bangers convincted of murder and sentenced to life are eventually paroled


• As implied by the Strib, the "treatment" is sort of a hoax. Matter of fact, a 2005 report commissioned by the Vermont Legislature concluded that Minnesota just warehouses sex offenders.

The Strib says these facts raise the question, "Is MSOP really mental health treatment, or just permanent incarceration?" REALLY?!?! That's the question? When the 35W bridge collapsed, did we ask if it was a good thing?

The Price of a Life

The Pioneer Press published a three-part series May 18-20, 2008 regarding the death of a person with mental illness which raised allegations of unethical practices by a U of MN (U) psychiatrist in connection with drug company-sponsored research . It brings me to wonder how we value the life of a person with schizophrenia. Is their life worth the same as anyone else’s?

THE FACTS (as reported by the PP, I have not verified them):
- Dr. Stephen Olson, the U psychiatrist in question, has attracted and conducted several studies sponsored by AstraZeneca, manufacturer of the anti-psychotic drug Seroquel.
- One of the studies focused on people newly diagnosed with/treated for schizophrenia, comparing the effectiveness of Seroquel to two competing drugs.
- Dan Markingson was a participant in this study. Markingson’s mother felt his treatment wasn’t working and asked Olson to drop her son from the study, but to no avail.
- Markingson eventually committed suicide in the bathroom of a St. Paul group home.
- An autopsy revealed no sign of Seroquel or any other anti-psychotic drug in Markinsin’s body.
- Mom sued Olson ,the U and AstraZeneca for causing her son’s death, but the University and AstraZeneca were found to have no responsibility. Mom won a judgment of $75,000 against Olson, reportedly just enough to cover her legal expenses.
- In the end, the study found little difference between the three drugs.
- One in four Minnesota psychiatrists receives “research” money from drug manufacturers.
- According to 2007 figures, 167 Minnesota doctors accepted at least $100,000 from drug companies since 2002.

THE ALLEGATIONS (implied in the PP articles) and TREPP’S TAKES:
But first, a few disclosures:
- As far as I know, I never met Markingson; he has never been served by Tasks Unlimited.
- I have met both Olson and Schulz. Dr Schulz, Director of Psychiatry at the U of MN, is a donor of Tasks Unlimited.
- I am a former Gopher.
- In 2002, my wife received an experimental bone-marrow transplant at the U of MN hospital, which saved her life.
- I wrote the first draft of this blog using a drug company’s ball-point pen.
- Tasks clients have participated in research conducted by Drs. Olson and/or Schulz – but actually very few, because their studies of schizophrenia presume that patients will be motivated to participate by token compensation ($10- 20/visit). Unfortunately, they’re right, because, except at Tasks, schizophrenia renders its victims destitute. [I am intrigued, by the way, that the PP article never refers to the compensation paid directly to Markingson for his participation in the study.]

Allegation: AstraZeneca uses selective information to promote Seroquel.
TT: Duh! That’s what advertising is – every advertisement for a product, service or political candidate that ever appeared in the Pioneer Press uses selective information to promote.

Allegation: Drug companies shouldn’t be allowed to sponsor research on their own products, and it was unethical for the U or Olson to accept money from drug companies, in part because then Olson became financially dependent on AstraZeneca.
TT: Drug manufacturers are the only source of funding for research on the treatment of schizophrenia. The government doesn’t sponsor any Bill Gates doesn’t, that I know of. Is drug company-sponsored research a bargain with the devil? Maybe. But without it, there would be no research at all! And, of course Olson’s salary comes from research money; that’s what sponsorship means. Do you think Pawlenty wants to pay for it? Should they take it out of tuition?

Allegation: Olson (and maybe Dr. Charles Schulz) were recruited by the U for his/their ability to attract research dollars.
TT: No kidding? Next the Pioneer Press is going to reveal that Tubby Smith was recruited to win basketball games.

Allegation: The U’s Institutional Review Board (IRB) is suppose to protect people like Markingson from unscrupulous researchers, and its guidelines specifically prohibit “power-based” coercion, but it doesn’t actually work. Markingson was not competent to consent to participate in the study.
TT: IRB’s are probably a joke, in general, but when it comes to research involving people with schizophrenia, they are a cruel joke, adding time and expense to every research project, but no actual value. IRBs focus on informed consent and full disclosure; neither of which is remotely possible when working with people experiencing psychosis. Of course Markingson wasn’t competent to understand what he was consenting to – the target population for the study was actively psychotic patients. If we really want to insist on informed consent of the subject, there would be no research involving psychosis.

In fact, Olson once told me that the IRB wouldn’t allow him to pay Tasks’ clients more than $20 per visit because adequately compensating them for their time would be coercive. Kind of a Catch 22, don’t you think? You can only participate in this research if you fully understand that it might cause you to commit suicide, and only if you consider $20 adequate compensation for that risk.

Allegation: Olson’s dual/triple role as treating physician, researcher, and witness in involuntary commitment proceedings against Markingson, was improper.
TT: This is not merely common; it’s the norm. Three psychiatrists involved with one patient doesn’t provide better care; it creates chaos. Plus, there is a shortage of psychiatrists in the Twin Cities; and a critical shortage of psychiatrists willing to treat schizophrenics. Quite frankly, it’s not very rewarding, financially or otherwise (unless you work for Tasks, where patients actually recover) – and they get sued a lot.

Allegation: Now the U is suing mom for their legal expenses.
TT: Classy move; makes me proud of that big Maroon M

But ultimately, it’s the facts of this case that are more revealing than the allegations:
- It seems likely (obviously, this is just speculation based on limited data) that the real cause of Markingson’s suicide was untreated schizophrenia. It doesn’t seem to matter whether Markingson was in a research study, whether Olson and the U were profiting from the study, or what medication Olson or anyone else might have prescribed because MARKINGSON WASN’T TAKING IT ANYWAY! [I don’t exactly understand the point of a study comparing patients not taking one drug to other patients not taking something else.]

- Schizophrenia doesn’t respond to psycho-therapy. Effective treatment requires (among other things) the prescribing and taking of medication. The psychiatrist’s role is to prescribe the right medication, but that’s only half the battle. The Tasks program and staff happen to be very good at motivating our clients to take their meds as prescribed. Tragically, only a small percentage of Minnesotans with schizophrenia receive comparable support for this, and Markingson wasn’t one of them.

- The $75,000 Markingson’s mom recovered from Olson seems low. Unless you consider that our legal system routinely assesses the value of a schizophrenics life at less than $75,000. Which also doesn’t seem fair.

On the other hand, if we don’t value these individuals, while they are alive, enough to publicly fund research into their illness, if we don’t care enough to create a system that actually guarantees they will take the medication and get the other services we know will help them, why should we value them at death?

Veterans Can Lie?

Last week, the federal government announced a new policy related to security clearances for government jobs. They still ask applicants if they have consulted a health care professional in the past 7 years, but as of last week, it is no longer a federal crime to deny having sought mental health counseling IF “the condition was related to service in a combat zone.”

It’s Good News because even though over 4,064 American soldiers have been killed in Iraq, and 29,829 physically maimed, and tens of thousands psychologically damaged by an ill-conceived war, and even though the Veteran’s Administration seems horribly ill-prepared to provide appropriate mental health treatment for the returning hordes of traumatized soldiers, at least our heroic soldiers, many of whom have paid a terrible price in service to their country, won’t be prosecuted for lying on their job application.

But it’s Bad News because we all know that anyone who has ever sought counseling for any sort of emotional stress is forever after incapable productive activity, and thus this new policy will frustrate our burgeoning security-clearance industry’s efforts to ensure that no such persons are ever given an opportunity to earn a living.

The new policy is also bad in that it may provide access, for disabled people, into government-work environments which, as we know, are widely regarded as models of efficiency and productivity – what if one of these veterans landed a job at the post office, a place never previously exposed to mental instability?

But actually, it’s No News because the new policy applies to such a tiny fraction of the workforce – only those traumatized by service in Iraq, and only those applying for government jobs, and, worst of all, only those who have sought treatment. We need to realize that 20% of the population experiences some form of mental health problem during their lifetimes; we need to ensure that none of these damaged Americans ever gets a job.

Cycle of Criminalization

Our society tends toward confusion regarding the needs of people with mental illness; unnecessarily, because it isn’t really so complicated. Even those with serious mental illnesses, like schizophrenia, want, first and foremost, to be normal. They want a good job, a comfortable home, and friends – they want what you want.

Unfortunately, the good job has become almost unattainable, not only because of the very real disability, but also because of numerous barriers our society has created, including the stigma created by Hollywood and a system of financial dis-incentives which penalize a person for entering the work force. Punishing and locking up those with mental illness is not a new idea. .But the most pernicious barrier is the criminalization of mental illness.

We like to imagine that we provide “community treatment” in lieu of hospitalization, and for a small percentage, effective community treatment is a fortunate reality. But has anyone noticed that as the hospital population shrinks, the prison population grows? Does anyone seriously think that’s a coincidence? The National Alliance on Mental Illness (NAMI) reports that, on any given day, there are four times as many people with mental illness in jails and prisons than in hospitals and one in seven inmates in U.S. prisons and jails has a mental illness.

How did they get there? Well, if you call 911 to report a friend or relative experiencing a psychiatric crisis, they don’t send a social worker, they send a cop. It has been explained to me that sending a social worker would be prohibitively expensive. Odd, considering that cops earn more per-hour than social workers. It has also been explained that it would be much too complicated to determine when to dispatch a social worker versus a cop. Odd, considering that when my power goes out, they never send a plumber.

Minneapolis’s Chief of Police brags that 15 percent of his force have had a full week of mental health training. Is that adequate since they report that 40 percent of the calls involve mental illness. And even if a cop has sufficient training to distinguish a mental health crisis from criminal intent, where will he/she take the person? (Hint: the hospitals are always full.)

About 50 years ago, we realized that asylums were a flawed (and expensive) approach, and started closing them. Today, there is less than one-tenth the number of psychiatric hospital beds per-capita than 50 years ago. Does anyone think we have less mental illness? Mental illness, in fact, is on the rise. And yet, resources have decreased. In Minnesota, people who need psychiatric hospitalization are routinely turned away for lack of space.

I know that some will argue that America doesn’t put people in prison unless they actually commit a crime. Okay let’s go with that. But imagine that you were homeless, unemployed, friendless, confused and scared, so you sought help at your local hospital, only to be turned away because your condition didn’t seem as severe as that of others in the waiting room. After a few years, do you think you might commit a crime?

If it were me, and I am thinking fairly straight, I would try for a “victimless” crime – hmmm, I don’t have $4300, so I guess Spitzer’s friend is out. Maybe I could jaywalk or something. But here is a surprising fact: most people experiencing a mental health crisis are not thinking real straight. So they steal food, or they buy drugs, or they scream and holler, or they drive their car into bridge abutments. Whatever it takes…

So now that gaining admittance into any form of health-care facility has become increasingly difficult, and acquiring a criminal record has become increasingly easy, and a criminal record of any kind prevents one from obtaining employment, the circle is complete. If you have schizophrenia, we’re never going to let you have a job. I wonder if that will help with your mental illness?

So, we find ourselves in a peculiar predicament. Mental illnesses are on the rise in our country and adequate resources are diminishing so those who have mental illness can only access varying types of help if they commit crimes. Does that make any sense? There has to be a better way to help those suffering from these very real diseases. There has to be a better way to break this cycle of criminalization and give them the treatment that works so that they can have what all of want: a good job, a comfortable home, and friends.

Introduction

It seems appropriate that I would introduce myself...this being my very first blog. I am John Trepp. I'm still not quite sure what it means to blog. I think it's where I can call bullshit, bullshit.

I have worked for Tasks Unlimited for the last 30 years. Tasks is a non-profit based in Minneapolis serving adults with mental illness. We follow the Fairweather Model which creates an environment where people with schizophrenia and bi-polar disorders can manage their illnesses and lead productive, “normal” lives. I am constantly amazed by the accomplishments of Tasks clients – people who have been told they can’t work or lead normal lives because of their illness, but do so anyway.

Along the way, I have been involved in The Barbara Schneider Foundation, the Coalition for Community Living, the Minnesota Association of Community Rehabilitation Organizations, the Minnesota Extended Employment Advisory Committee, the Hennepin County Mental Health Advisory Committee, the Task Force for Redesign of the Civilian Review Authority, and other related activities. I also wrote a collection of short stories, Lodge Magic, and a stage play (a dark comedy) by the same name, which was a big hit at the Minnesota Fringe Festival.

Through my years, I have found our public mental health care system dysfunctional – mostly because it is designed to meet the needs of staff, not the needs of the service consumer, nor the interests of the general public. My hope is to influence and empower those interested in mental health care to make real change. My passion is to see those with mental illness find what they want most in life, a good job, a nice place to live, and meaningful relationships. My dream is a system which is accountable to those served and those who pay for it.