Updates Behind the Scenes: Mad In America Launches My Blog About SAMHSA

Updates Behind the Scenes: Mad In America Launches My Blog About SAMHSA

Mad In America, major webzine for “rethinking psychiatry,” just published, today, June 29, 2021, my new blog: “Will US Agency New Head End Stonewalling About Money for Involuntary Outpatient Mental Health?” The US Senate confirmed President Biden’s nomination for the new leader of Substance Abuse & Mental Health Services Administration (SAMHSA), Miriam Delphin-Rittmon, PhD, an African-American psychologist.

SAMHSA has been supporting involuntary outpatient mental health, which can mean court-ordering US citizens to take powerful, controversial psych drugs in our own homes in the community. However, SAMHSA has so far refused to provide any information or evaluation about their more than $25 million in grants.

My original Mad In America blog is here, please share & comment:

www.madinamerica.com/2021/06/end-stonewalling-involuntary-outpatient/

An audible version of the Mad In America blog is here:

News Updates: Will SAMHSA Start to Repair Damage?

29 June 2021

A few hours before Mad In America published my blog, 29 June 2021, Lindsay Baran, a staff person for the National Council on Independent Living (NCIL), supporting the Mental Health Subcommittee, said:

SAMHSA’s refusal to provide us with the requested information is unacceptable. People are being harmed – their rights are being violated – by these grants, and SAMHSA’s lack of transparency is incredibly alarming.

A few hours AFTER Mad In America published my blog, and I contacted President Biden & SAMHSA, a staff person with SAMHSA’s FOIA office called me at home. She was very nice. She said that there had been quite a turnover in that department. She is the third staff person I am dealing with. She said she had been hired in the Spring, and would get me some materials by this week, or at the latest next week.

This staff person said SAMHSA’s FOIA office had so much material they would need to get it to me as a “rolling” download of about three big files a week. We will let you know about the results.

We will also post other updates here, as we get them. The latest will be on top.

Additional Resources About the SAMHSA Blog

As listed in the blog, July is MAD Pride Month, and you can find out more about it here:

aciu.info/2021/06/22/mad-pride-month-july-2021/ 

Mad In America has all of my blogs from the past few years on my author’s page:

www.madinamerica.com/author/doaks/ 

Shortly before my blog was published by Mad In America, I created a personal blog about my experience, including the record heat here in Eugene, Oregon:

Waiting For My Blog, Breaking Heat Records Here In Eugene: davidwoaks.com/today-eugene-heat-record

Below, please find personal blogs over the past few months that relate to this topic:

No New Normal: MLK, President Joe & Green Disability: davidwoaks.com/no-new-normal-mlk 

Oaks Vlog #1: Mental Health, Disability & Revolution: davidwoaks.com/oaks-vlog-1-mental-health-disability-revolution

Inside Story of My Keynote at Peerpocalypse 2020: davidwoaks.com/my-keynote-at-peerpocalypse-2020

Your Feedback is Very Welcome

Whenever I blog on Mad In America, there are often comments at the bottom, and I try to reply to as many as possible. You are encouraged to comment on that blog, and the URL again is: www.madinamerica.com/2021/06/end-stonewalling-involuntary-outpatient/

You may also comment here and/or you can email me at revolution@aciu.info.

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Oregon Action Alert, June 2021:

Prevent Wasting Money on Misinformed, Coercive Mental Health Overreach!

The below alert is especially for Oregonians who support human rights and alternatives in mental health. However, even if you live outside of Oregon, your voice will help show legislators they need to urgently stop this flawed bill.

Oregon State Senator Floyd Prozanski has had a Work Group on mental health issues. Within this Work Group, the Subcommittee of Oregonians with Lived Experience of the Mental Health System OPPOSES a harmful bill sponsored by Sen. Prozanski: 

SB187 redefines “dangerous” as a legal concept instead of a clinical concept, and increases the number of Oregonians likely to be subject to civil commitment restrictions of their civil rights.

Even though Sen. Prozanski’s Work Group never addressed or voted on SB187; Even though the Subcommittee of Oregonians with Lived Experience opposed SB187; And even though most public testimony was against SB187… Unfortunately, Sen. Prozanski pushed his bill. 

TAKE ACTION:

SB187 is now in the Oregon Joint Committee On Ways and Means. As a joint committee, it has legislators from both the House and the Senate. Please refer to this list of legislators in the Joint Committee On Ways and Means, and if you see any of them that represent you, please write to them and express your opposition to SB187!

Even if your Oregon Senator or Representative are NOT on the Joint Committee, email them and ask them to oppose the bill before the Joint Committee

You can also email to the six leaders of the Joint Committee, the co-chairs and co-vice chairs. You will find their email addresses in the sample letter below. 

For a sample model letter opposing SB187, click here.

To prepare your emails, you can read our one-page Brief Talking Points to Stop SB187

For a longer five-page analysis of the problems with SB187, click here.

To follow developments of this & other related bills, be sure to sign-up for email alerts from our partners at MindFreedom Oregon. Email: mf-oregon@aciu.info. (Version 20210526)

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Oaks Vlog #1: Mental Health, Disability & Revolution

David W. Oaks Vlog text:

Mental Health, Disability & Revolution

7 December 2020

Joe Biden’s Federal Mental Health Agencies

I love you. I am David W. Oaks. And I love you if you’re quadriplegic/tetraplegic like me. If you are a psychiatric survivor like me. Or if you’re not any of those.

My friend, the late Justin Dart, Jr. was a leader in disability. He connected mental health and physical disability. He said over and over and over:

“No forced treatment ever!”

And now I think he would say:

“Black Lives Matter!”

I love you whether you’re a relative who’s a Democrat. And I love my relatives who are Republicans. Justin worked with both.

And as Joe Biden becomes President, I encourage his administration to look at federal mental health agencies. Look at the National Institute of Mental Health (NIMH). Why don’t they look more at alternatives? Like Peer Support?

And I especially would encourage Joe Biden’s administration, and everyone in the US and the world,to look at the SAMHSA. That stands for the “Substance Abuse & Mental Health Services Administration.”

I’ve done this work for 44 years, and for decades SAMHSA was an ally. They supported empowerment, recovery, alternatives.

But under the wonderful Obama, who I support, they began funding cities for involuntary outpatient commitment. This is court-ordered outpatient mental health.

Now this has been going on quietly all over the US, for decades for thousands of Americans. Your home becomes an institution. You’re court-ordered to usually take drugs, powerful drugs.

Sadly, SAMHSA began funding several dozen sites, with millions of dollars. I’ve tried to get information from them.

They refuse.

Please help. Because SAMHSA is refusing to disclose. One year ago, I filed a Freedom of Information Act request, and they still have not told me anything about these programs, in terms of evaluating. One fact is that black people tend to be in these programs more than white people.

Right now, I chair a subcommittee, for a work group in the Oregon legislature, for the Voice & Inclusion of Oregonians with Lived Experience of the Mental Health System. We are concerned about the way alternatives to police violence, like CAHOOTS here in Eugene, Oregon, need to include the peer perspective, or else they can be a gateway to outpatient commitment.

Last week, we met with a representative of CAHOOTS, and they are interested in the peer perspective. Cities all over the US and Canada are looking at CAHOOTS as a model. Our local Affiliate of MindFreedom, MindFreedom Oregon, is looking at these issues.

Wherever you are in the world, you can create an Affiliate of MindFreedom, like MindFreedom Ghana or MindFreedom Ireland, who are doing great work. Or you can use your group’s name and simply be a Sponsor of MindFreedom by endorsing the principles.

I congratulate the National Council on Independent Living. Their Mental Health Subcommittee has adopted MindFreedom’s Shield campaign. And NCIL plans to reach hundreds of Independent Living Centers about this Shield program.

Today, the climate crisis threatens vulnerable people. COVID is related to climate crisis and the way we treat our environment. For us to live seven generations in the future, we absolutely need a revolution, the sooner the better.

But we will have one.

Please look at SAMHSA.

And Lead On!

Thank you.

I love you all.


David W. Oaks is a Revolutionary Consultant with Aciu! Institute (aciu.info). 

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8 Ways I Am Celebrating July 2019 as Mad Pride Month. How will you celebrate next July 2020?

Leonard Roy Frank
Leonard Roy Frank, one of the main heroes of the psychiatric survivor movement! Mad Pride! Leonard especially fought electroschock.

Today is 15 July 2019, and we honor the birthday of the late great Leonard Roy Frank, one of the main psychiatric survivor leaders of our modern era, and a good friend (his photo is on the left). I have blogged about Leonard before, and Mad Pride Month needs to celebrate Leonard: http://davidwoaks.com/my-friend-leonard-roy-frank

Leonard supported grassroots activism wherever you are. Our local group, MindFreedom Oregon, is a state affiliate of the human rights coalition MindFreedom International. We support calling this whole month of July, Mad Pride Month!

You probably did not hear about this call for July becoming Mad Pride Month since we have only told a few folks. It’s not too late for the rest of the month! How have you celebrated this month, perhaps accidentally? Especially, what ideas do you have for next year, July 2020, to celebrate Mad Pride? Do you support making July Mad Pride Month? If so, please contact us, there are many ways to assist this, see Mad Pride Social Media Volunteers below.

Yesterday was Bastille Day, 14 July 2019. One of the reasons July should be Mad Pride Month is that for decades, leaders in the psychiatric survivor movement have used Bastille Day to celebrate the human spirit and oppose psychiatric oppression and tyranny. One of the main activities each year is a three-day camping vigil in front of the New York State mental health agency in Albany. This vigil wrapped up yesterday. For more info about their event, their Facebook link for this vigil is here.

Here are eight ways I am celebrating Mad Pride this July:

  1. Way to go, my good friend Rev. Phil Schulman! He was one of the keynote speakers at the annual Alternatives Conference, which has just been held in DC. Incredibly, people are searching for a video or audio recording of Phil’s speech! Accidents may happen, but I call Phil “The Movement Minister” and getting out his message is a high priority. Hopefully, someone will find a recording of Phil’s keynote. After years of leading congregations, mainly Unitarian Universalist, Phil experienced a serious head injury about a year and a half ago. His resilience, love, and leadership are so very important to our movement.
  2. Opal Network: Here in Oregon, one of the main literary heroes was psychiatric survivor Opal Whiteley. About a decade ago, we created an informal coalition called the Opal Network which has spoken out for the empowerment of local mental health consumers and psychiatric survivors. We meet every time a month has five Tuesdays, about four times a year, so that means our next public gathering will be Tuesday, 30 July 2019. Our theme will be how the arts can support mental and emotional well-being, and psychiatric survivor liberation. Psychiatric survivor Chrissy Peirsol and I plan to host a round table at the downtown Eugene Trauma Healing Project, 11th and Charnelton, at 3:30 pm. We will have a web video Zoom call, so you can participate for free wherever you live. Interested? Please email us at: opalnetwork@protonmail.com
  3. World’s Biggest Sneeze! A few days ago, several of us in MindFreedom Oregon gave a presentation at a stage in Community Village, as part of the celebration of the 50th Annual Oregon Country Fair (if you’re new to OCF, watch some videos of this wild hippie gathering in the woods here). During our event, we held the World’s Biggest Sneeze! Ah-ah-ah-ah-ah-ah-ah-ah-ah… CHOO! We are allergic to what is called “normality” which actually does not exist! Our household plays a simple game you can join: Whenever we hear the word “normal” on the radio, TV, or conversation, we sneeze! The first to sneeze wins. Try it!
  4. When society is crazy & paralyzed, who are you gonna call? The Mad Pride Movement! Because of the climate crisis, 100% of humanity is clearly part of the Mad Pride Movement. We are all traumatized by the disaster. We all confront the mystery of understanding the universe. Do not wait to understand it all, act now. Those of you in the Eugene, Oregon area, please join me at an Extinction Rebellion potluck and talk on Wednesday, 31 July 2019, 6:30 pm, at our Unitarian Universalist Church. If you are outside the Eugene area, you probably live on Earth and so can take part in this nonviolent Extinction Revolution wherever you are. The Mad Pride Movement celebrates your creative way of thinking & acting. We are the new PC: Positively Crazy!
  5. Mad Pride Social Media Volunteers: To connect with those of you who are curious or supportive of a Mad Pride Month, we at MindFreedom Oregon are creating several social media places. If you would like to assist, and perhaps co-moderate, contact mf-oregon@aciu.info. Social media include: Reddit, Twitter, Linkedin, Instagram, Facebook.
  6. Remember Creative Maladjustment Week! For more than a decade, Rev. Martin Luther King, Jr. commented about creative maladjustment over and over. He even said the world was in dire need of an “International Association for the Advancement of Creative Maladjustment.” MindFreedom International produced a guide to celebrate being maladjusted every July 7-14, Creative Maladjustment Week! And of course, this is near the middle of July, now Mad Pride Month.
  7. A State Senator in Oregon Wants to Hear from Psychiatric Survivors, Mental Health Consumers, and Our Allies. My friend, State Senator Floyd Prozanski, pushed for two mental health bills this past session in the Salem, Oregon legislature. We Oregon psychiatric survivors/mental health consumers heard about these proposals and we expressed our deep concern. Thankfully, both bills failed this past session which just ended in Mad Pride Month, July! Yay! Now, I promised Sen. Prozanski that we would provided him with civil input about human rights & choice in mental health. Please email him at: Sen.FloydProzanski@oregonlegislature.gov. Please copy your comments to: mf-oregon@aciu.info
  8. Something for Everyone! I know Mad Pride may not be everyone’s cup of tea. I figured out that if a couple conceives today, their baby might be born on 15 April, tax day. This would seem to be a great Normal Shame Day, so that if anyone rejects Mad Pride Day they can always be part of that. If your baby is born on Normal Shame Day, do not worry, this is definitely not normal and your child will be a hero of the Mad Pride Movement!

Your ideas, feedback, jeers, cheers, suggestions, support, strangeness are all welcome in the comment area below, or on my Facebook page. Thanks!

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More Forced Electroshock? Let’s Stop Bill in State of Washington, Now!

ECT

Electroshock (also known as electroconvulsive therapy or ECT) runs electricity through the brain.

UPDATE 2/27/19: Looks like we won! The latest word from a staffperson at the State of Washington legislature, is that the proposed bill for easier involuntary electroshock is dead this session, and that no other bills have been amended to include this idea.

Some activists were concerned that the concept would simply be added as an amendment to another bill. However, loosening restrictions on forced shock are dead this session. This is the “understanding” of Kevin Black, staff coordinator/counsel for Senate Behavioral Health Subcommittee to Health & Long-Term Care Committee, Senate Human Services. The next session will start in January 2020.

UPDATE 2/17/19: The  public hearing was canceled 2/15, apparently because of opposition. Please continue speaking out against this bill! According to a committee staffperson, Carly, if there is no hearing by 2/22, the bill is dead.

Original alert:

Incredibly, there is a proposed bill in the State of Washington right now that would make it easier to give involuntary electroshock (also known as electroconvulsive therapy or ECT), over and against the expressed wishes of the subject.

I just phoned the committee that is looking at this bill, and you can email your opposition at any time. There is no time limit, though the sooner, the better.

Today, 15 February 2019, there was supposed to be a public hearing about this Senate bill 5842, but this hearing was cancelled.

You can email to stop this bill at any time, and since this bill may pass it is urgent that you speak out.

Below is an alert that I have created about this bill. (Thanks to Laura Van Tosh for this information.)

At the bottom is my brief initial email in opposition:

 

CALL FOR EMAIL TO STOP FORCED SHOCK

IN STATE OF WASHINGTON

SB 5842 Involuntary Electroconvulsive Therapy

Calls for involuntary electroconvulsive therapy (ECT) to be added to the Washington State RCW (Revised Code of Washington), 71.05.153.

Emergency detention of persons with mental disorders or substance use disorders. This is the involuntary treatment procedure used for commitment procedures. Today psychiatric medication is used.

This proposed bill adds ECT as an option to be utilized against the will of a person during initial commitment procedures under above RCW.

 

ACTION: Please email your opposition to SB 5842 now, give some good reasons against involuntary electroshock!

carly.johnson@leg.wa.gov

Carly is a staff person at the Senate Committee on Behavioral Health Subcommittee to Health & Long Term Care, J.A. Cherberg Building, Olympia, WA.

 

BILL INFO.:

https://app.leg.wa.gov/billsummary?BillNumber=5842&Initiative=false&Year=2019

Sponsors: Reuven.Carlyle@leg.wa.gov annette.cleveland@leg.wa.gov manka.dhingra@leg.wa.gov

Senate Committee on Behavioral Health Subcommittee to Health & Long Term Care is where the bill is being heard.

 

Below is my initial brief email, which you can use as a model, but please write this in your own words:

14 February 2019

To: Senate Committee on Behavioral Health Subcommittee to Health & Long Term Care, J.A. Cherberg Building, Olympia, WA

From: David W. Oaks, Aciu Institute, Eugene, OR

Please halt the bill SB 5842, which would make it easier to give involuntary electroshock (also called ECT) to citizens of the State of Washington.

I have worked for human rights in mental health for more than 40 years.

  1. The World Health Organization in Geneva is the main world body on health issues. The WHO has opposed all forced shock, and has had this official position for years. Please inquire with WHO about this bill immediately.
  2. A few years ago, when I directed MindFreedom International, we had a major campaign to stop the forced shock of a Minnesota citizen. Please google this phrase: Ray Sandford electroshock
  3. Shock has never been formally approved by the FDA for safety and efficacy. So forced shock would be a violation by compulsory experiment.

David W. Oaks

Please consider copying your opposition to my comment area below, to inspire others to speak out.

Spread the word!

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Speak Out to Break the Silence: President Trump Appoints Mental Health Leader Who Campaigned for Involuntary Outpatient Drugging

By David W. Oaks

Dr. Ellie McCance-Katz, appointed by President Trump to a important mental health position.

I am a survivor of human rights violations in the mental health system. And even though this was a long time ago, back when I was a college student in the 1970’s, the issues are more relevant than ever. My friend, Patch Adams, MD, has connected the dots for me: Our society needs to be very agile right now, but has to overcome centuries of mental health oppression. But with compassion, we can have a global nonviolent revolution! 

Recent events show that mental health human rights violations are important for everyone. MindFreedom International was my employer for 25 years before my accident in 2012. They are an independent, activist group, and we need that energy as never before. 

The White House announced this past Friday, 21 April 2017, in the evening, that President Donald Trump has, for a pivotal mental health position, appointed a psychiatrist who openly speaks out for involuntary psychiatric drugging of people living outside of institutions, even in their own homes. This appointee criticizes our social change movement, especially our dedication to empowering peer support and our concerns about psychiatric drugs and labeling. It is important for everyone who supports human rights, especially in the social change movements for disability rights and those critical of mass incarceration, to speak up and oppose this approach.

Please phone your U.S. Senators to block this confirmation. This is a chance to raise these issues, now!

This “Assisted Outpatient Treatment” (as supporters call it) or “Involuntary Outpatient Commitment” (as it is known by many) has been quietly growing on the State level for decades, but is now being funded on the federal level, such as through the enormous 21st Century Cures Act that was passed by Congress at the end of last year. Whatever it is called — AOT or IOC — under these laws judges may order folks to have mental health care, which could be a range of approaches. In my experience, staffing a human rights phone and getting hundreds of contacts for decades, “mental healthcare” for the “seriously mentally ill” almost always includes psychiatric drugging, often with neuroleptics, or “antipsychotic medications” as prescribers often call this family of pharmaceuticals.

Neuroleptic drugs began in the 1950’s with such brands as Thorazine, Stelazine, Haldol, Mellaril, etc., all of which I have had. I personally experienced involuntary neuroleptic injections more than 40 years ago as a college student at Harvard. About five times I was placed in a psychiatric institution for emotional difficulties, and twice I experienced the sharp end of a needle, when in solitary confinement I was held down on the bare mattress and got forced drugging in my butt. I graduated anyway, in 1977, and our class is celebrating its 40th anniversary this year.

Now neuroleptics have dozens of more brands, but many of the hazards and risks are the same. For instance, in the long run there is the danger that many people can experience involuntary twitching that can apparently often be permanent. There is also the long term risk of brain damage and even death. Some folks choose these medications, but others do not. I choose to not take them, and I have not for these past four decades.

Takes One to Know One

President Trump has appointed Dr. Ellie McCance-Katz for a high-level position created by the 21st Century Cures Act. Dr. McCance-Katz would become the first Assistant Secretary for Mental Health and Substance Abuse (SAMHSA) inside the federal Department of Health and Human Services.

In an essay published last year by the Psychiatric Times, Dr. McCance-Katz was highly critical of SAMHSA, especially its sub-agency Center for Mental Health Services (CMHS), headed by Paolo Delvecchio, who has long-identified himself as an individual who has used psychiatric treatment. Many mental health consumers and psychiatric survivors know Paolo because of his work in this field for decades.

In her essay in Psychiatric Times, Dr. McCance-Katz:

  • Endorses federal funding of AOT (or IOC).
  • Criticizes SAMHSA for allegedly being critical of psychiatric drugs.
  • Challenges the support for “recovery” in mental health, a term used by many consumer/survivors as a rallying point for hope and empowerment.
  •  Calls for mental health care, which appears to be led by psychiatric drugs, for more than three million Americans.

Are You One of the Many Targeted? 

Dr. McCance-Katz wrote in the essay: “It is estimated that 10 million Americans (4.2%) are living with serious mental illness. However, only 68.5% of the most severely mentally ill will receive any type of mental health services.”

I wonder how many of these three million Americans would refuse psychiatric drugs? Of those who would refuse, I wonder how many this psychiatrist would like to see drugged against their will?

This professor challenges the great interest in using peer support as a humane, empowering alternative priority. She writes, “Workforce issues focus in large part on the development of a ‘peer workforce.’ This ideology purports that one can become a mental health professional by virtue of having a mental illness. Peer support can be an important resource for some, but it is not the answer to the treatment needs of the seriously mentally ill.”

There are only a few, small groups that focus on involuntary psychiatric drugging, such as the Treatment Advocacy Center. The topic actually divides a lot of folks, since the average American in my experience does not like the idea of the government forcing citizens to have involuntary psychiatric drugs, once the value of empowering alternatives are explained. IOC can even for a small group include involuntary outpatient court-ordered electroshock, or electro-convulsive therapy (ECT). For example, search the web for the names Ray Sandford and Elizabeth Ellis, with the word electroshock. These two Minnesotans who received such horrible involuntary procedures, but MindFreedom put out human rights alerts that stopped the series of electroshocks.

In my decades of work in the field of human rights and mental health, I have been impressed with the way concern about this issue crosses political lines. Yes, support for this field has often been among those who would be seen as on the left. However, some of the most effective organizing about psychiatric over-drugging of children has been done by activists that would be seen as on the right.

I have seen both the Libertarian Party and the Green Party both pass planks in their platform, years ago, expressing support for some of our goals. Today we are often seeing critics question the sanity of the President of the United States because of his support of untrue beliefs, such as his denial of climate crisis and his many years of championing the odd belief that President Obama was born in Africa.

Well, it takes one to know one, and I am also a White Aging Crazy Citizen (WACC). Actually, what I have found in my work is that 100% of all people struggle about their mental wellness, it is a universal challenge. The distinction is between negative, bigoted craziness and positive, constructive, creative craziness. In fact, I would argue that the new PC is Positively Crazy.

Perhaps at this time, we need a Positively Crazy dedication to the First Amendment, which not only includes free speech, but according to the US Supreme Court, the right to think unusual thoughts, even irrationally. There are more compassionate, effective, sustainable ways to help troubled people. Let us all break the silence about human rights violations in mental healthcare, including IOC. Centuries of abuse in this industry have helped silence the population on many outrages, including the threat of climate chaos.

We need a nonviolent revolution throughout our society, in mental healthcare, in energy, in so many ways. There is no guarantee of results, but at least we can speak up about freedom!

My friend Patch Adams, MD has spoken out many time about the need for fun, creativity and  peaceful rebellion. You may read a recent blog I wrote after chatting with him recently, which you may read here

End

Below, for the very interested, you will find an essay I have just submitted to be published in the Harvard Alumni Association publication that comes out every five years. In my essay, I appreciate that a Harvard volunteer group first placed me as an intern working for human rights in mental health. Unfortunately, the nonviolent revolution we have long called for in mental health has not quite happened yet. However, perhaps now this topic may get more attention. 

My Essay to Harvard Alumni Association for My 40th Reunion

Mental health. Activism. Community organizing. Human rights. Disability. Nonviolent revolution! Thank you, Phillips Brooks House Association, for placing me as an intern in my senior year as a community organizer of people in the mental health system, because the above passions became my career. The incredible riches I have gained from working with some of the most powerless in our society are invaluable. After 25 years as Executive Director of the human rights nonprofit MindFreedom International, I had an extreme accident and broke my neck, and I now use a power chair. While it would be impossible to be totally prepared for this, my work in the disability movement managed to teach me a few principles. For example, I apply lessons from Martin Luther King, Jr.: What is my creative maladjustment?

Reflecting back on Harvard, the most memorable and influential class for me was about comparative religion. It would be fun to be in touch with any of you reading this. You can find me easily by directing your search engine to this phrase: david w oaks blog. When I summarized my passions above, I included “nonviolent revolution.” Yes, for decades I have raised this as a real choice. Now, with the climate chaos looming, I feel nonviolent revolution is an option we might want to choose. Scientists have estimated that the lag for carbon-induced impact is about 40 years. In other words, the pollution during our years at Harvard is only now changing the climate. I am very concerned that during the next lag, many more feedback effects can be triggered. For the current moment and for seven generations in the future, we truly need a nonviolent revolution. I estimate seven generations would extend to about the year 2192. May there be a healthy graduating class that year! The Butterfly Effect gives us a good chance, uncertain, but a good chance. Perhaps it is up to you?

It is important to create a dialogue to address the values we need today for excellent care. Therefore, I am copying the commentary that I very much disagree with. You may read the essay by the Trump appointee from Psychiatric Times below:

The Federal Government Ignores the Treatment Needs of Americans With Serious Mental Illness

By Dr. Ellie McCance-Katz

There she was again—a middle-aged woman, disheveled, crouching in the doorway of a closed store, grasping a notebook and pencil and scribbling. Intermittently, her eyes darted around and she would mumble, then go back to her notebook. Her eyes never met mine, but I wondered why she was not getting help with what was clearly a severe mental illness. I would see her in that same doorway several times a week for a couple of years before I left Berkeley, California, to become the first Chief Medical Officer of the Substance Abuse and Mental Health Services Administration (SAMHSA). In doing so, I hoped to help people living in the grips of cruel disorders that affect one’s thinking, one’s reasoning, one’s ability to relate, and one’s ability to even understand that one suffers from a disorder that can be treated.

It is estimated that 10 million Americans (4.2%) are living with serious mental illness. However, only 68.5% of the most severely mentally ill will receive any type of mental health services. Whether those services are necessary and appropriate is not known. People with schizophrenia, bipolar disorder, depression, and other severe mental illnesses often complicated by substance misuse need effective, safe, evidence-based treatments as well as community resources where their clinical service needs can be met. The federal Department of Health and Human Services (HHS) is composed of numerous agencies that address the health care needs of Americans, but only one agency within HHS is charged with addressing the needs of those with serious mental illness and that is SAMHSA.

SAMHSA is a small federal agency with a budget of roughly $3.7 billion per year; much of that is in the form of block grants to states that are the arbiters of how the funds will be spent in support of the treatment of substance use and mental disorders. SAMHSA does, however, have the ability to focus on areas and issues that would improve the lot of individuals affected by severe mental illness. Unfortunately, SAMHSA does not address the treatment needs of the most vulnerable in our society. Rather, the unit within SAMHSA charged with addressing these disorders, the Center for Mental Health Services, chooses to focus on its own definition of “recovery,” which generally ignores the treatment of mental disorders, and, as a major initiative under “recovery” services, focuses on the development of a “peer workforce.”

There is a perceptible hostility toward psychiatric medicine: a resistance to addressing the treatment needs of those with serious mental illness and a questioning by some at SAMHSA as to whether mental disorders even exist—for example, is psychosis just a “different way of thinking for some experiencing stress?”

SAMHSA’s approach includes a focus on activities that don’t directly assist those who have serious mental illness. These include programs such as Mental Health First Aid, which seeks to teach people about the warning signs of mental illness in an attempt to provide support to those who are experiencing symptoms. Significant dollars are spent on hot lines for callers who may be experiencing suicidal thinking or who know someone who may be—yet suicide rates continue to climb in the US. SAMHSA supports integrated care programs that would bring some aspects of primary care to mental health services programs—worthy programs, but which do not address the treatment of serious mental illness. Programs that undertake the “re-education” of mental health practitioners who are assumed to be abusers of “consumer” rights and who dictate treatment to patients have been funded in the Recovery to Practice initiative.

Workforce issues focus in large part on the development of a “peer workforce.” This ideology purports that one can become a mental health professional by virtue of having a mental illness. Peer support can be an important resource for some, but it is not the answer to the treatment needs of the seriously mentally ill.

Lost in all of this are the real and pressing treatment needs of some of the most vulnerable in our society—those living with serious mental illness. Nowhere in SAMHSA’s stra­tegic initiatives is psychiatric treatment of mental illness a priority. The occasional vague reference to treatment is no substitute for the urgent need for programs that address these issues.

What’s needed?

What is needed is an agency soul-searching and a re-prioritization that places the treatment of serious mental disorders at the very top of the list of agency goals. SAMHSA needs leadership that acknowledges the importance of addressing serious mental illness. Initiatives that provide funding for new approaches to engaging the seriously mentally ill; for assisted outpatient treatment with enriched psychosocial services; and for additional psychiatric hospital beds, particularly for longer-term care given the severe shortage of such resources in the US, should be at the top of SAMHSA’s agenda.

Clinical education programs that address current, evidence-based treatment for serious mental illness, and new funding for the training of mental health professionals, including psychiatrists, advanced practice psychiatric nurses, and psychologists, should be a major focus. SAMHSA should develop closer ties with the National Institute of Mental Health, which is helping us to better understand the neurobiological underpinnings of mental illness every day. The real hope, change and ability to recover from these disorders, lies in their effective treatment. To ignore this is to leave a large segment of some of the most seriously ill in our society abandoned—indeed, discriminated against by the very agency charged with serving them.

What can be done to change the current course? Stakeholder groups that seek to ensure psychiatric treatment for all who need it should band together and exert pressure on SAMHSA, on political administrations, and on congressional representatives to address the needs of the seriously mentally ill. Skilled behavioral health providers with patient care experience—psychiatrists, psychologists, social workers, counselors—should consider committing a period of service to SAMHSA and to other federal agencies to inform policy decisions related to substance use and mental disorders. This is especially important because too many in the government have education in behavioral health fields but have never worked with patients, or if they have, it was many years in the past. Being inside the Beltway also imbues an artificial perspective that may be informed by lobbyists if at all. This does not serve the American people.

Time for change

I left SAMHSA after 2 years. It became increasingly uncomfortable to be associated with an agency that, for the most part, refused to support evidence-based psychiatric treatment of mental disorders. It was also quite clear that the psychiatric perspective I brought—inclusive of assessment, diagnosis of mental disorders, utilization of evidence-based treatments, including psychotropic medication and psychosocial interventions as integral components of recovery—was a poor fit for the agency. SAMHSA needs a complete review and overhaul of its current mission, leadership, and funded programs. Congress should quickly address this through legislative mandate.

For too long the treatment needs of the seriously mentally ill have been ignored by SAMHSA, and this needs to change. In doing so, perhaps people like the woman in the doorway will be able to move out of the shadows to live full and productive lives in our communities.

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