Florida’s Assisted Living Facilities Investigated

Sunday’s St Petersburg Times carried an article about the atrocious conditions existing in some Assisted Living Facilities in the state of Florida. Apparently there are way too few protections for people residing in such facilities now. This article bore the striking headline Oversight lacking for Florida assisted living facilities.

Created more than a quarter-century ago, ALFs were established in landmark legislation to provide shelter and sweeping protections to some of the state’s most vulnerable citizens: the elderly and mentally ill.

Many tragic examples are mentioned in this article as having resulted from this lack of oversight. Among those incidents mentioned a women “with mental illness” drowned in a pond, an Alzheimer’s patient was torn apart by an alligator, a woman died after 6 hours in restraints, and a man, also described as having a “mental illness”, died as a result of being left in scalding bathwater.

A Miami Herald investigation into shoddy conditions existing at these AFLs has laid the blame for much of this neglect squarely at the feet of the Agency for Health Care Administration.

The Miami Herald found that the Agency for Health Care Administration, which oversees the state’s 2,850 assisted-living facilities, has failed to monitor shoddy operators, investigate dangerous practices and shut down the worst offenders.

Many of the ways in which the state has failed to protect residents of ALF’s were mentioned in this article. Once a month, residents are reported to have died from abuse and neglect while would be care takers forged documents and concealed evidence. Homes routinely use restraints and drugs, and are seldom punished. Regulators shut down 70 houses in the last 2 years for serious violations, but only 7 houses were closed for good in that period of time. While 550 ALFs opened up in 5 years, the state dropped critical inspections by 33 % allowing the worst violators to slip past them. In a few words, the AHCA simply isn’t doing its job.

Despite the legislation designed to protect people in assisted living, these protections just aren’t being enforced the way they should be enforced.

Instead of inspecting ALFs once a year like most large states — including Arizona, Texas, Pennsylvania, North Carolina and Illinois — Florida cut inspections to just once every two years.

The Miami Herald deserves much credit and praise for this investigation that it has been conducting. Obviously something must be done. Let’s hope concerned citizens and Florida legislators are beginning to get the message.

2 different approaches to civil rights and mental health

Prejudice and discrimination are directed against people who have done time in psychiatric institutions

Institutionalization disrupts lives. Neighborhoods often take a “not in my backyard” approach to people who have been hospitalized. Businesses screen potential employees for mental health issues. A person who has had his or her human rights violated by the mental health/illness system then finds he or she cannot gain meaningful employment. These are further human and civil rights violations that take place on top of the initial assault and imprisonment of institutionalization. Discriminatory practices take place in the housing, the employment, and the education fields. When a person has no decent employment opportunities, what remains for that person to do during the day but waste his or her time with the absurdity and hopelessness of an inane day treatment facility in what amounts to essientially little more than custodial “care”? The media slams people who have had experience in the mental health/illness system unjustly as potential mass murderers. This type of discrimination, based upon prejudice, prevents people from fully integrating into their communities, and participating in the life of those communities. Recovery is about more than the recovery of mental health; recovery is about the recovery of purpose, the recovery of relationships, the recovery of dignity, and the recovery of a life.

There is a “stigma” attached to people who have “mentally illnesses”

This goes to the heart of what the recovery movement is all about. If people can recover from what are referred to as “serious mental illnesses” so much for the notion of “stigma”. A mentally well person would not have such a “stigma” attached to him or her. There is no “stigma” attached to mental wellness. If “stigma”, on the other hand, is a matter of a failure of people to recover from mental health issues, therefore, the best you can expect is to put a good face on a bad situation, I think people are being way too severe on themselves. I think they’ve been swindled. I think they’ve bought a pack of lies. According to this approach, this person afflicted with a biologically determined genetic “predisposition” (to complicate matters further I guess) is incapable of performing at the level of the majority of people in the world, and so the best that can be expected of him or her is a change of perspective on the part of people who encounter him or her. THAT’s what countering “stigma” is all about. I’m not against “stigma” at all. I’m for recovery.

Dealing With An Infestation of Disability Workers

The APA’s task force revising the DSM is not the only group of people debating the definition of “mental illness”. The Bemidji Pioneer, a Minnesota newspaper, has an article by the director of a local mental health day care facility expressing her own views on the subject. The article in question bears the headline, Here’s to you–What is good mental health? In it she poses the following question:

Can someone who has a mental illness have good mental health?

Can a contradiction in terms be anything other than a contradiction in terms!?

If, as some people conjecture, “mental illness” is only a matter of degree, perhaps mental health must be only a matter of degree, too. This is to say that maybe one person is 95 % mentally healthy while another person is 95 % nuts, and if the one who is 95 % nuts was able to get matters under control, he or she would be a good deal of a percentage less nuts. The person who is 95 % “stable” could, of course, always lose 90 % of it, and therefore things have a way of equalling themselves out.

This, unfortunately, is not the direction our director is going in.

Can someone with mental illness have good mental health? Absolutely! Many of the healthiest people I know have a diagnosed mental illness. They have learned how to manage mental illness so that it doesn’t dominate their lives, just as diabetes can be managed. These individuals know and recognize stress triggers. They take care of themselves on a daily basis with good nutrition, sleep, exercise, structure/activity, medications if needed, and relaxation/peaceful times/spiritual support. They have also developed a strong support system – pets, family, friends, neighbors, business associates, spiritual leaders, professionals – who can help when they feel overwhelmed. As a result, people who have learned to manage mental illness can live like anyone else with good mental health.

Question: what does a person with a “serious mental illness” label have that the rest of the population doesn’t have?

Answer: A diagnostic label
A psychiatrist
Bottles of pills
A pact team
A case worker
A staffed day care facility
SSI disability payments
Subsidized housing
Voc Rehab education opportunities
Discrimination and prejudice

The paternalistic nature of social rehabilitation, that is, current mental health treatment practices, is debilitating in and of itself. Imagine being more or less “fucked” by all these people who are making a decent living off your theoretical “infirmity”? It’s hard to lose a “disability” that puts bread and butter on the plates of so many “worthies“. How are they to survive? Do something real about the matter, and disappointment of disappointments, a lot of people would be forced to make career changes.

Why I’m Not Coo Coo For KKKapitalism

When our countries economy is recessed, I imagine bankers, business leaders, and corporate executives on vacation. I work with the homeless, and of them you might say they are experiencing an economic depression right now. If you’re old enough to remember hobo jungles, you must be almost old enough to kick the bucket. Now, in our new improved economy, we’ve got tent cities of the homeless. That’s a big improvement, huh? The flaws in the mechanisms of the economy that brought about the great depression have been corrected, and so now we have got the not-so-great recessions. Recessions are essentially depressions by another name. Just think of it as the wealthy on holiday.

The work-a-day world has become a non-work-a-day world for a lot of folk. America is quickly losing its work ethic. When you’ve got 5 people for every 1 decent job, that’s the way the cookie crumbles. The republicans want tax breaks for the rich while the democrats are talking tax breaks for the middle classes. These taxes pay for the poor, who have no money, and politicians, who supposedly represent the rich, the middle class, and the poor. Oops, excuse me, the majority of the voters. These politicians represent the majority, theoretically anyway. When you’ve got 3 or more candidates running, there are going to be a lot of compromises, and that means, it gets complicated. Complicated is when this politician or that will say anything and everything to get the job. This job usually means a good supplementary income, and therefore, if it’s a recession, vacation.

Politicians bail out bankers and automobile manufacturers. Why? They’re salaries are too big too qualify them for the poorhouse, and so they must be a better breed of people. Only small business owners should qualify for bankruptcy. There is a point, after all, to gambling on the market, and the market is a gamble. You understand how a casino works, don’t you? The mass of the money coming in goes to the house. The casino then has to be taking in more than it let’s out. It’s the price of the game. We arrange the market so people with money win, and people without money lose. That’s simple enough, isn’t it? The trick is receiving the training to qualify you as a person who has money rather than as a person who is unqualified to have money. The deceit is to think this has anything to do with education, it doesn’t. It’s about money. If the educated classes are to be the moneyed classes, it’s because they have the poorer classes to take that money from. If you divide a pie six ways, and give it to six people, great. If you have a pie, and a hundred people, somebody is not going to eat pie.

Booms and busts (recessions i.e. depressions by another name) are built into our economic system. Cyclical some people like to call them, as in a bipolar economy. This is because the economy is built upon gambling. You have rich people gambling with the money of people who are not so rich. Remember the casino? “The mass of the money coming in goes to the house.” The house, in this instance, is people who are richer than the people who are less rich. The rich couldn’t keep getting richer if this wasn’t the case, and the rich, feeling so entitled as they do, must keep getting richer. This doesn’t mean that a person can’t lose riches, this just means that the system has it worked out so that the more money you have, the easier it is for you to make more money, and the harder it is for you to lose it, within limits. You could give all your money away, but for obvious reasons this is a development that seldom occurs. Life in a homeless shelter is not the most comfortable in the world.

There has been a lot of talk about putting people before profits, but it’s usually just a matter of talk. If you really want to put people before profits then you’re going to have to change the kind of economic system we have, and some people are so heavily invested in that system, particularly rich people, as to make the possibility look remote. Of course, there are scales of riches, and the less rich people have less to lose but, all in all, shit shovelers who don’t quit must love their jobs by default. I happen to think we need to change the sort of economic system we have. When you are talking about the road to ruin, it would be nice to see that road to ruin carry fewer people on it rather than more. The result of trickle down economics has been the ruin of many, and this ruin is expanding. We can continually readjust the system, and chiefly to please somebody who’s making wads of bucks every time he or she moves a pinky, as we might be forced to do, periodically, of course, or we can change that system entirely. I’m for changing the system.

A Few Words About “Positive” Psychology

I’ve got the answer to Dr. David Van Nuy’s Psychology Today blog post Did Coke Hijack Positive Psychology? Unequivocally, no. If Coke did ‘hijack’ positive psychology, it’s because with a title like positive psychology, you’ve automatically set yourself up for such exploitation. Positivity likes to edit out such errors in human character as gluttonous and greedy intent. They aren’t seen as positive, at least, not among allies.

Positive psychology is positive because of the other side of the equation, the pathologizing of negativity.

Positive Psychology was officially “born” at the annual American Psychological Association conference in 1998 during Dr. Martin Seligman’s inaugural address as association president. Dr. Seligman, already well-known for his pioneering work on the subject of learned helplessness, and later, on optimism, declared that psychology had too long focused on pathology, and that the time had come for an empirical study of human strengths and human happiness.

Blurring the focus on failure, weakness, and unhappiness doesn’t make them disappear. Seeing failure, weakness, and unhappiness as pathological states is to call diseased what, frankly, isn’t diseased. It’s also a way of denying the reality of negative experience. On top of this objection, you’ve got hunger, homelessness, and poverty. I think there is more apt to be a relationship between unhappiness and poverty than I do a relationship between unhappiness and disease, pain and discomfort notwithstanding. I also think that these conditions might have something to do with the wealth and education of other peoples such as, for instance, professional psychologists.

Interestingly, Seligman made no mention of these important forerunners. Presumably, he wanted to distance Positive Psychology from the human potential movement, which had been criticized for its excesses and tarred with the brush of narcissism. More importantly, Seligman wanted to establish Positive Psychology on a firm scientific foundation. In this regard, he has certainly succeeded.

Dr. Nuy here is confusing science with popularity, the same problem that exists in the psychiatric field. The popularity of a theory doesn’t make it true to life. The fact that the psychologist goes pop doesn’t have a great deal to do with rigorous scientific investigation. We’ve seen too many lost monkey evolution trials to believe otherwise.

In just 12 years, the Positive Psychology movement has generated 64,000 research studies, 2 academic journals, and an international professional association. Additional resonance comes from the current zeitgeist in which we’ve seen an explosion of popular interest in activities such as yoga and meditation, as well as a proliferation of books about happiness.

Scientific research is neutral in itself; it serves whoever can make the best use of it, why should psychology be different? Perhaps because we’re dealing with theologians here instead of with scientists. I think it no irony that he mentions among the above an interest in yoga and meditation.

I believe in giving people, social animals, more control over their lives, plural. I think that that is the answer to failure, weakness, and unhappiness. I think the answers to these matters can come from political science, I don’t think they can come from psychology. The problem is with this tunnel vision of focus on humanity as the atomistic entity it isn’t. Man isn’t a man, woman isn’t a woman, and human isn’t a human. Where success for the individual is achieved at the price of an absolute apocalypse for the rest of the species, doesn’t that speak volumes as to the root of the problem we see here? Positive psychology in this context becomes just another magical thinking method for ignoring the overriding concerns of the vast majority of our species, people who aren’t wealthy.

Repairs Needed For A Broken Mental Health System

Psychiatric hospitalization disrupts lives. After hospitalization occurs, we are not only talking about the need for recovery of rationality and emotional stability, we are also talking about the need for recovery of economic status, and the recovery of, and possibly even reinvention of, family, friends and lifestyle.

The creation of an unbridgeable gulf between before hospitalization and after hospitalization is a professional cop out.

I think an over reliance on psychiatric drugs has a great deal to do with why this is so, but I don’t think that this over reliance on psychiatric drugs is the only culprit when it comes to low recovery rates. I think a lot of it is built into the mental health system, a system that encourages people not to work and, in fact, rewards them for not doing so.

Among these other culprits are:

1. Cynicism, cowardice, and pessimism among mental health professionals.

2. Paternalism and the devaluation of people into “adult children” (i.e. people with “chronic” uncontainable “mental illnesses”) deemed unworthy or incapable of making their own decisions and managing their own affairs.

3. The results of this paternalism: a poverty that forces people to live on federal benefits within the mental health ghetto. The lack of any upward mobility, for people who have had “issues”, outside of the mental health field.

4. The business advancement end of mental health treatment: facilities would prefer expansion over closure. More patients foster greater job security and more status for employees, a more pressing need that also encourages more bucks to be spent in the field. Fewer patients are bad for business. (Doctors and mental health facility staff, in other words, get rewarded for their failures rather than for their successes.)

5. Mental health consumerism: there is no mechanism for cessation of consumerism except personal decision, a decision that need not ever be arrived at. Mental health recovery (i.e. the cessation of consumerism) is a tag word. Recovery is not a consumed “service”, or a consumer “product”. Treatment junkies just aren’t recognized for being what they are–addicts. The dependency habit can be a very difficult habit for some people to overcome and break.

6. People are prejudiced. Employers won’t hire people labeled “mentally ill” on account of their sketchy work histories. NIMBYism [Not-In-My-Back-Yard-ism] prevents them from getting decent housing, and from building workable alternatives to what the public mental health system provides. Legislation enacted to deal with these matters is often, if not inadequate, unevenly enforced or unenforced.

7. The mental health system has not yet seen its role in promoting community integration, recovering people from mental health consumerism, and remedying a situation it has created (i.e. the disruption of lives caused by hospitalization.) Until it does so, it is only managing the convalescence of the artificial invalids it has created. It is also avoiding responsibility for its own part in these matters.

We’ve got a system that is going from bad to worse. Warehousing people labeled “mentally ill” in a community setting is little better than warehousing people in state mental hospitals. Until the overall treatment paradigm changes dramatically as practiced by community mental health facilities across the country, this situation is bound to grow even worse.

Let’s return to the 7 criticisms offered above, and let’s take a look at the improvements that are implicit within them.

1. Experimentation and guarded optimism from professionals. Exceptions should be permitted to the professional standard of care. Different results are bound to result from doing things differently, and these are matters that take a long time to register in meta-analysis.

2. Empowerment of mental patients and mental health consumers is bound to result in improved performance. Responsibility breeds responsibility. Give them something to do with their hands, and pay them for it! Having them pay you to pretend to work…Hey, it’s not really rehabilitation either, is it?

3. I never had much faith in the “self-esteem” theory of mental health. It is, in fact, one of those myths exposed in research that we haven’t yet disposed of entirely. I think other esteem has a lot more to do with it. Finding ways to advance human interests outside of those in the mental health system I feel can help improve our other esteem. Relationships matter much more in these matters than do smoke and mirrors.

4. Facilities and professionals need to be judged more on their outcomes and recovery rates than on their acceptance of the problem as a permanent fixture. It’s a growing problem, too, and what it grows upon is this “acceptance”. Why pay people to acknowledge a failure when maybe it’s a failure they can do something about? Unworking and unworkable treatment programs don’t need to be paid for with taxpayer monies.

5. Incorporate cessation of mental health services into mental health services. Cease to use the terms “chronic” and “long term”. Don’t adopt treatment plans without beginnings, middles and, most importantly, ends. Treatment plans should have timelines and deadlines, extensions are permitted, but they should never be permanent or indefinite.

6. Enforce and extend legislation directed against discrimination in education, employment and housing practices. Enact more legislation where appropriate and possible. Direct public relations campaigns at showing that people can leave mental health treatment, perform responsibly, and advance in the community.

7. Mental health professionals and paraprofessionals need to work with employers and community members to get people engaged in their communities. Insulating people from community ultimately does more harm than it does good. The community needs to be encouraged to include people who have experienced the mental health system, too.

I’ve heard it said that nobody ever succeeded alone; the same can be said for failure, nobody ever failed alone. Failures receive a great deal of help at becoming failures. We can change the system, and by doing so, we can raise the success rates and lower the failure rates. I have always thought so called “mental illness” ultimately was about failure. Get rid of the failure, and you’ve also gotten rid of the “illness”. The human condition should be different from the wild boar condition. The ethics of the roulette wheel doesn’t need to rule our species. When more people succeed in the world, it is my belief that there will be fewer people labeled “mentally ill” among them.

Fuel For The ‘Mental Illness’ Generator

To maintain that a social institution suffers from certain ‘abuses’ is to imply that it has certain other desirable or good uses…. My thesis is quite different: Simply put, it is that there are, and can be, no abuses of Institutional Psychiatry, because Institutional Psychiatry is, itself, an abuse.
~Thomas Szasz

Excuse my lax PC, if that’s what it is, but I see no ends to the fun that can be had in playing with the notion of ‘a stigma’ attached to the likewise foolish notion of ‘having a mental illness’. Take an article from the Mayo Clinic entitled Mental health: Overcoming the stigma of mental illness, for instance. We have a confusion of terms that grows even more confusing with the subtitle: Progress is being made to remove the stigma of mental illness and mental health disorders. You can take positive steps to combat stigma. Mental health, mental illness, mental health disorders and the Pacific Ocean between, just what the bleep do the authors of this article think they are talking about!? Then the authors start going all military on us, take positive steps, no problem, to combat, problem. If this means that the drug industry has a great deal of stock in the military industrial complex of super power imperialism, no doubt, but still such a thought is conducive to paranoia. The unasked question then becomes is the notion of ‘paranoia’ stigmatizing.

After a regurgitation of some of the presumptions of the bio-medical school of psychiatry, the way these presumptions are being regurgitated in so many places these days, we get the following bulleted list on what are seen as the harmful effects of stigma.

 Trying to pretend nothing is wrong

Good one! Now try pretending something is right.

 Refusal to seek treatment

This is particularly annoying, especially when the treatment you would be seeking, as so often is the case in the mental health field, turns out to be mistreatment in reality. The right of people to refuse unwanted psychiatric treatment is something these folk haven’t gotten around to considering.

 Rejection by family and friends

This is where the idea of extended families and new friends comes up. Who, after all, needs to be stuck with such shallow relatives and acquaintances as those that would reject a person because that person has had a difficult time? The Mad Movement itself is not nearly such an exclusive club.

 Work or school problems or discrimination

I think we have a civil rights struggle on our hands here. I don’t think you can just tell people to be kind to your nutty buddy, and expect it to happen. With your slutty buddy, well, that’s a different matter.

 Difficulty finding housing

Homelessness, and let me stress this point, could be considered a step up from ‘having a mental illness’.

 Being subjected to physical violence or harassment

I couldn’t agree with this point more. Those people, who are statistically most apt to be victimized by a violent criminal, are now being suspected of being the population most apt to perpetrate a violent crime. You can’t have it both ways.

 Inadequate health insurance coverage of mental illnesses

As has been pointed out before, where the mental illness ends at the running out of the health insurance coverage, maybe more health insurance isn’t such a great idea.

Then there are the steps suggested to cope with stigma.

Get treatment.

One could get treatment, yes, or one could get a second, a third, or a hundredth opinion questioning the need for any such treatment in the first place. If this treatment is going to mean mistreatment, maybe you don’t want to receive it?

Don’t let stigma create self-doubt or shame.

I don’t know. I don’t think there is a mental illness pride movement in this country. Maybe you need to revise your terms and redefine the problem.

Seek support.

Confess your mental illness? Here again I wonder. Why not confess your mental health? Oh, right, because you need the support of a crutch of one kind or another. Why didn’t you just say so? We can’t just throw off a crutch because we don’t need one. No, never. Besides, if it doesn’t makes it easier to panhandle then maybe it makes it easier to defraud the government.

Don’t equate yourself with your illness.

Personally, I don’t think ‘having a mentally illness’ is such a big improvement over Mr or Mrs Bipolar Disorder, Mr. or Mrs. Schizophrenic, and Major or Majorette Depressive Disorder. On the other hand, if you could lose your mental illness, then you might be getting somewhere. I just don’t think mental illness is such a good imaginary friend to keep around the house as some people seem to think he or she is.

Use your resources.

Call the disability squad. Sure, that might work, but then you may have other resources at hand you haven’t even considered trying. Ingenuity humankind is credited with having in no short supply. You don’t, and this is a point I must make, have to be disabled to be resourceful. (I know. Some of you out there are saying, “But it helps”.)

Get help at school.

It beats getting bullied at school. Of course, sometimes help is harm, and so you have to be very careful.

Join an advocacy group.

Sure, you could advocate for your own oppression. This article, for instance, suggests joining NAMI. NAMI is an organization composed primarily of family members of psychiatric inmates and ex-inmates. Family members are often responsible for having other family members locked up, forcibly drugged, physically restrained, and electrically shocked. NAMI also receives the majority of its funding from the psychiatric drug industry.

There are other groups that don’t advocate for oppression. You might look into joining one of those groups instead.

Speak out.

Did somebody say, “Squeak out!”?

This line of questioning naturally enough could lead to a discussion of human rights as opposed to mental patient rights, or mental health consumer rights, or mouse rights.

Historic Legal Settlement Reached In Illinois

A new legal settlement in Illinois calls for removing some 4,500 people with psychiatric histories from nursing homes, and placing them back into the community.

The Chicago Tribune covered the story with an article, New hope for Illinois’ mentally ill nursing home residents.

Thousands of psychiatric patients are likely to move out of nursing homes and into community-based settings in the next five years under a landmark legal agreement designed to reshape Illinois’ troubled long-term care system.

The agreement, expected to be filed Monday in federal court in Chicago, lays out a schedule for state officials to offer approximately 4,500 mentally ill nursing home residents the choice to move out of two dozen large facilities known as “institutions for mental diseases,” or IMDs, and into smaller settings that experts say are more appropriate and less expensive.

This outcome is the result of a law suit filed by the American Civil Liberties Union (ACLU) of Illnois.

More than any other state, Illinois relies on nursing facilities to house younger adults with mental illness, including thousands with felony records. A recent Tribune investigation detailed numerous reports of sexual assault, violence and drug abuse in some facilities where psychiatric patients got little treatment or supervision. Some of the homes failed to create adequate programs or discharge plans for residents who milled about or watched TV in dreary common areas.

The ACLU used the 1999 Olmstead Act, calling for the least restrictive environment of care, in filing their suit. This suit only deals with people in IMDs. It is estimated that there are at least 10,000 people labeled mentally ill in nursing homes that are not classified IMDs, and so much work still remains to be done. It is estimated that the settlement could save the state as much as $50,000,000 over the next few years. Many advocates have voiced their support for the agreement.

This settlement comes at the heels of other recent rulings in Pennsylvania, New Jersey and New York City releasing people labeled mentally ill from hospitals and adult homes in those states. We can only hope that this trend of decisions favoring liberation for people with psychiatric labels from unfavorable housing and treatment situations continues to gain strength and grow.