Opinion: What’s it going take before we take mental illness violence seriously?

The Monsey machete attack, the media is focusing on the racism of the horror. Soon, the focus will move to any mental disease history. Today, the first mental disease article hit the newsfeed.

Suspect in New York Hanukkah celebration stabbings has ‘long history of mental illness,’ family says

The public discussion will follow the bread crumbs leading to the well-trot “mental illness means violence” stigma. This stigma will lead the discussion, and in time the discussion will find another well-trot topic:

Why wasn’t he getting treatment?

Assisted Outpatient Treatment. Kendra’s Law. Preemptive Services.

It’s a no-brainer. It’s obvious. It’s a simple solution. Why hasn’t it happened yet?

The conversation on preemptive services exists. It has for years. To answer these questions, here are some thoughts on what’s holding things up.

I’m placing no dispute or endorsement for preemptive treatment. This info is based on advocacy work I’ve done in jail diversion and law enforcement crisis response. And what might sound like an absolute is only to shorten this article.

As I see it, there are three conflicting factions that stall any serious and productive resolution.

One faction is law enforcement. Their primary principle is “officer safety first.” Repeated engagements with a violent peer wears on the officers. Left to their own, violent peers would be removed from society permanently … not execution, permament incarceration. Since this isn’t possible, preemptive and mandated statutes like AOT are ideal to them.

The next faction is parents of adult children with violent mental illness. In New Mexico, well-organized members of this faction can be found in NAMI. Their primary motivation is love. They love their children and want for their children safety and happiness. Left to their own, these parents would have the legal authority to direct their adult child’s treatment, including the legal authority to place their adult child inpatient; often, violent peers need safety from themselves. Since their children are adults, rarely is guardianship granted. So, AOT is very attractive to these parents, as are programs like Community Engagement Teams.

The final faction is civil rights advocates. These individuals are often lawyers who studied constitutional rights for peers. Ensuring all programs, services, procedures, and statutes adhere to constitutional guarantees first and foremost is what motivates them. They are watchdogs and are often directly opposed to both law enforcement and parents.

The iffy collaboration of these three factions jam up any real progress on preemptive services. I’ve muscled my way onto enough committees and elbowed my way in to sit at enough tables that I have a really good handle on the segregation and dynamics of preemptive service development.

A few closing remarks:

Purposely, I left out providers because traditonally they side closely with law enforcement. Providers are witness to “revolving door treatment.” In and out of the ER, in and out of jail. Providers interact with law enforcement by circumstance.

And, I didn’t include peers. I’ve been doing this long enough I know peers are undependable. This includes me. A peer’s primary purpose is being healthy. This is a fulltime job. Many times, symptomatic behavior is intense enough all their energy goes into staying well. It’s very difficult to be fully dedicated to advocacy, legislative advisement, directed community committees, and all venues where the discussion and decisions affect peers and how pees function in society.

Peers can’t guarantee consistent availability. I was knocked out of the game for two years after being attacked by another peer at an APD meeting. Two years is what it took to learn about myself and CPTSD. Writing this comment now that I’m back is a huge triumph for me.

What I’m saying about peers is it’s difficult creating lasting advocacy groups to see a project through from start to finish. If peers can get themselves to the table, they are the only true volunteers, with families as well. Every other faction receives a salary as their part in the behavioral health community. It’s also tough to be a meaningful faction when available time is curtailed by having to make a living elsewhere.

The term “preemptive services.” It’s a semantics argument, stating “preemptive”; it portends a violent act fueled by mental disease is a foregone conclusion. “Preemptive” also suggests a lack of trust in the peer and a lack of faith in recovery and maintained wellness. I’m giving feedback on how I would view this if I was mandated to “preemptive services.” It’s not a useful term.

The final comment is there is a notion that “everyone has a right to their mental illness.” This is true However, everyone has the same social contract and part of that contract is behaving in a way that isn’t harmful to the community. Violent behavior from mental disease breaks this contract and like anyone else, a peer must be removed from the community if attacking others.

I know the original lament is this dude is only going to get help now, after he killed someone, and the humane thing to do was to get him services before he killed someone.

As I like to put it: “Catching us upstream before we hit the rapids.”

I just wanted to share my thoughts on why such an obvious solution stalls and doesn’t come to fruition.

How just another behavioral health meeting opened my eyes and my heart

During my short tenure on the NAMI Albuquerque board, the one project I worked on was Community Engagement Teams (CET). The idea behind CET was if a family member, neighbor, friend, etc. believes a peer might benefit from services, they can request a CET visit with a peer and offer help locating services, before the peer falls into crisis. As I liked to call it, “Catching us up river before we hit the rapids.” CET could be the conduit to services.

I saw a secondary purpose for CET. I remember when I first was divorced. I had no idea where to get help, and I really wanted to keep my treatment going and didn’t know how, or even where to start. The ex-wife was the person who helped me with this. In my struggles to get help, I really could have used a clearing house for info on and direction to services. CET could be the conduit to services for peers who want to catch themselves up river.

For several legislative sessions a state CET bill failed to become law. The best chance it had didn’t come through because the governor vetoed the bill, on the grounds the service should be in HSD (Human Services Department) and not DOH (Department of Health). Drats.

After the bill was vetoed, a small group of us went a different way. We decided to ask for the blessing of HSD to develop and implement a pilot project in Bernalillo County. The two people I worked with closely were Jim Ogle and Nils Rosenbaum. We all came to the table with distinct perspectives on how CET could be useful.

We had several meetings in Santa Fe with HSD to lay out our ideas for the pilot project. For one middling meeting, two representatives from the City of Roswell asked to attend. Their names I can’t remember. Their faces I do. One worked directly with their mayor, the other was a peer who was there to describe what mental services were available to them. This peer was a revolving door peer at their detention center … jail. This was the only mental health service in Roswell. Literally.

Mistakenly, these two representatives believed that CET was a fully realized program with funding. They were attending to speak of their community’s needs and secure funding. If CET funding was dedicated to Roswell, this would bring providers and services to Roswell to support CET. Sadly, this wasn’t going to be available.

I’ve been at a few hundred behavioral health meetings in the last decade. This meeting I remember because of what the mayor’s rep said.

“I’m supposed to be going home with hope. I was supposed to bring services to Roswell. What do I tell them now?”

He said this through tears.

Of all the behavioral health meetings I attended, this one meeting exemplifies the critical need for services around our state and how the programs and funding do not exist. And Roswell is not a tiny railroad town. It’s one of the largest cities in southeast New Mexico.

More and more, the issue I see that is impeding health care availability in New Mexico is funding. There are so many great, innovative solutions already planned for addressing the needs of frontier services, but without money it’s just talk.

Having an active and funded CET program to share with other needful New Mexico communities woukd have been … just grwat. I teared up big time at this meeting, and meeting that proves New Mexico social are dangerously underfunded. The coffers run in the red. And, newly identified peers with specific needd aren’t addressed because it’s a lot of money to develop brans new services.

We need money. The reality is New Mexico is one of poorest (financially poorest – we are rich in community and culture) states in the union year after year. A main primary solution is to identify services peers don’t use and don’t want and eliminate these to fund the useful needs of peers. Based on our peer focus groups, I can name five of these progeans right here in Albuquerqhe. Another solutionn is to look at novel funding otberwise untapped. I’ll be sharong more on this after beta-testing with STS funding. And where it comes to government funded social services, we need to get out of the cycle of increnentally taxing the existing pie more and morr year after year We must make our tax pie larger.

The CET meeting opened my eyes and my heart to realities outside my day to day life. And very directly, I find these realities unacceptable and, thankfully, only temporary. I have a few ideas.

Community Awareness Conversation: Deconstructing Behavioral Health Non-profit Corporations – Prologue

A peer advocacy project I’m taking on this year is more of a community awareness conversation than an actual advocacy project. What I want to share is a deconstruction of non-profit corporations (501c3) and how the idea of a non-profit is misconstrued as all donations (or most) go to charitable community projects. This just isn’t the case and it’s a misconception nurtured by several non-profits to mask a branding and income-generating machine.

Many of you know I was president of DBSA Albuquerque for seven years. We did a lot of really great things for our community – as volunteers – for which DBSA National gained respect and noteriety in New Mexico. The accolades rightly belong to our peers and our community and not an organization in Chicago that never finacially supported our local projects in any way.

Financials get people’s attention. Let me give you some quick rough numbers on the Depression and Bipolar Support Alliance that our former treasurer researched last year. There are about 700 DBSA chapters (the majority are 100% staffed by unpaid volunteers) and each chapter pays a $120 affiliation fee yearly to use the DBSA brand.

This adds up to $84,000 from annual affiliation fees.

Now, here are the numbers our treasurer found in his research:

  • The DBSA organization is worth $89 million.
  • The DBSA head-honco is paid $9 million a year.
  • This head-honcho has access to annual travel funds in the tens of thousands of dollars.

$84,000 versus $89 million.

Not once in my seven years as president did DBSA National fund any local projects. We requested an inter-organizational grant each year to simply cover the cost of support group venue rental costs.

Most people in Albuquerque, if asked what DBSA is, have the impression the ENTIRE ORGANIZATION is a volunteer peer group providing peer support groups for free.

This misconception is one main reason we brought our peer support groups to the local community, adding the groups along side our existing Stand Up To Stigma education programs. All of what we do remains free to the community. We receive funding in more transparent and honest ways. And we’re open with our plan to pay peers for giving presentations, facilitating support groups, and taking part in community advisement. Our time has value and not simply “doing good is its own reward.”

This is the proverbial “tip of the iceberg” and our research includes many more behavioral health non-profits. This is an ongoing community awareness conversation we’ll be detailing this year.

A final note for this prologue. For my entire tenure as DBSA Albuquerque president, each year I invited a representative from DBSA National to visit us, to put a face on our affiliated parent organization in Chicago. From what I gathered from peers who have been attendees at DBSA Albuquerque since as long ago as the 1990s, no one can recall meeting anyone from DBSA National.

Each year, DBSA National was thrilled receiving our invitation. I was quoted the speaker fee plus expenses.

This is an ongoing community awareness conversation.

Slander & Libel Concerns

A colleague who reviewed this article asked/warned me, “Aren’t you afraid DBSA National will sue you to get you to shut up?”

Absolutely I’m afraid. I don’t have the backing of $89 million for attorney fees. And, I’ve already been threatened by DBSA National in a way that violates the First and Thirteenth Amendments.

So, yes, I’m very concerned. If it cones to civil litigation, hopefully folks will understand it’s merely a large organization bullying a peer advvocate striving for peers to be valued and justly compensated for their value.