A Political Breakthrough for Mental Healthcare Reform!

In one breathtaking stroke, Kamala Harris has just widened the contours of presidential campaign history and thrown light into the darkest corridors of shameful human suffering.

On Monday, Harris affirmed that America is in the throes of a mental healthcare crisis. And she backed up her ringing assertion by adopting all the major goals of advocates for enlightened mental healthcare and fairness in our nation’s policies and practices. While several of her rivals for the Democratic presidential nomination have put forth their own reform proposals, none matches the sweep of the Harris plan, and none has triggered such rejoicing in the ranks of reform advocates. 

In the words of the premier advocate-warrior DJ Jaffe: “Wow! Wow!” Jaffe added that the Harris plan embraced “everything we’ve been looking for to help [the] seriously mentally ill.”

With these gestures, Harris has frontally attacked a century’s worth of neglect, denial, obfuscation, and wasted spending that define the country’s medieval approach to its most helpless citizens.

Among her plan’s many, desperately needed virtues:

The Harris plan reinvigorates the concept of “justice” in dealing with the mentally ill; yet it implies a range of practical economic benefits as well. Her agenda attacks the widening cone of unnecessary social cost and structural blight that proceeds from the stricken individual through the community, the city, the rural landscape, and our vast failed archipelago.

In calling for a doubling of the nation’s psychiatric beds, for example, Harris opens a path to significant reduction of taxpayer money spent on the glut of afflicted people behind bars: Each year more than 2 million people with serious mental illness are thrown in jail, often because care centers have no room. Incarcerating an inmate with mental illness costs $31,000 annually, while community mental health services cost about $10,000. 

Harris’s recommendations are protean. They contemplate the needs of psychically damaged veterans; telemedicine as a resource in under-served rural communities; the elimination of foolish laws that prevent family members from learning the state of a relative in hospital care; an increase in crisis-intervention teams; criminal-justice diversion for people in psychoses arrested for a crime; education for a judiciary too often clueless as to the nature of mental illness, and “Medicare-for-all” coverage for the mentally ill.

And it calls for the abolishment of the evil known as solitary confinement. Other Democrats have attacked this scourge as well, though that is hardly a discredit. Solitary confinement cannot be excoriated too many times.

The Harris plan is not exactly sailing in calm political waters, of course. The cynicism and bad faith that now besmirch our civic discourse might well capsize this vessel of reforms. Some pundits will almost surely write it off as a desperation gesture from a candidate struggling to gain traction in the polls–or as a cosmetic ploy to soften Harris’s residual image as a remorseless prosecutor.

Such dismissal would be as shameful–as borderline-decadent–as is the present state of mental healthcare itself. Kamala Harris’s proposed reforms are what they are, without reference to the candidate. They cry out to be lifted up from the ruck of conventional campaign promises and examined (and re-examined, and debated, and circulated“, and published) on their own merits. 

And they are something beyond themselves, as well: they are a blazing collective affirmation of the power of witness: persistent, retail, on-the-ground political advocacy. To the politics of personal persuasion and response, if you like.

Leslie Carpenter and Kamala Harris Photo Courtesy Leslie Carpenter

Virtually every Democratic candidate who has spoken up about mental health-care reform has been educated on the soil of Iowa, face-to-face, by the phenomenal team of Leslie and Scott Carpenter. They and their fellow advocates–my friends and models of informed passion and persistence–are living testaments to the ideal of Making a Difference. Most of these people have struggled for years, in small groups, in letters and emails to the powerful, and against fatigue and hopelessness. Nearly every one of them is closely related to a victim of serious mental illness. 

Now, just maybe, is their moment.

My Terry Gross Interview, Redux

In the spring of 2017, shortly after my book No One Cares About Crazy People was published, I was invited to appear on Terry Gross’s “Fresh Air.”

ron powers author

This was one of the first interviews, if not the first, that I did for the book. From my perspective, it was an ordeal: not because of any deficiencies on Ms. Gross’s part, but because I found myself almost disablingly tongue-tied. At least that was how I sounded to myself as I sat in a studio at Vermont Public Radio and spoke to her at her studio in Philadelphia.

It took two hours for Ms. Gross to extract from me the material that she and her editors stitched together for the 35-minute version that aired on March 20 of that year; it is linked below. I was so bummed by what I thought I must have sounded like that I avoided listening to it–until today, as I write.

I listened today because my good friend CJ Hanson placed this rebroadcast on her Facebook thread and alerted me. CJ, as followers of this blog know, is a sister of the brain-damaged, blind, schizophrenic and homeless Mark Rippee of Vacaville, California. 

Because CJ found the time and the largeness of spirit to repost the interview, I figured that it was time for me to listen. Judge the result for yourself. And thank you, C.J.

https://www.npr.org/sections/health-shots/2017/03/20/520809904/father-of-2-sons-with-schizophrenia-talks-of-his-struggle-to-save-them

Rights vs. Rights, Once Again: Should the Seriously Mentally Ill Be Allowed to Reject Treatment?

A ruling by the Vermont Supreme Court, in my home state, has decided in favor of a patient suffering from schizophrenia who does not want medication or treatment. It’s a supremely vexing question, but I think the court erred.

The rock has rolled downhill again. The Sisyphean slog toward rational mental healthcare once more has been flattened under the weight of judicial folly.

Sisyphus pushing his stone up the mountain.
Sisyphus pushing his stone up the mountain. 

On Friday, November 15, the Vermont Supreme Court ruled in favor of a plaintiff suffering from years of diagnosed schizophrenia—a person [mark this word] with a history of episodic violence and aggression, and periods of catatonia—who had asked not to be medicated against his will.

The ruling means that this plaintiff has likely ingested his last medical stabilizer against psychotic episodes—the final internal barrier to hallucination, delusional thinking, disordered speech and movement; and, in rare cases, violence to themselves and/or others. (It’s also likely that he wrote his request while stabilized, an irony that I will examine later.)

According to the court decision itself, as reported in the Rutland (VT) Herald, this person’s propensity to violent and aggressive acts while in the grip of psychosis is not merely theoretical. He has committed such acts before.

The court’s wording: “Patient has a history of unpredictable violence and unprovoked aggression toward hospital and treatment facility staff, police and others.”

Given the annals of psychiatric case history, there is little reason to doubt that, when seized by psychosis in the future, he will do so again.

My own family’s experiences testify to this likelihood. Our younger son Kevin was diagnosed as schizophrenic in 2003. He rejected his antipsychotic medications in 2005, and in July of that year, a week before his 21 st birthday, Kevin hanged himself in the basement of our Middlebury home.

It’s essential to pause here and parse the meaning of “person.”

The man in question—the core person—is not inherently a criminal, just as life-affirming Kevin was not inherently suicidal. The authentic person is described as intelligent, a reader, a researcher of information. It is the incurable disease itself, which invaded the person’s brain and has rendered his life hellish since the age of 12, that bears responsibility for his aberrant impulses.

The basis for the court’s ruling seems to be an “advance directive” created and signed by the patient in 2017, in which he stated that he wanted no neuroleptics or antipsychotics, no psychiatric drugs, “no medications I do not desire at the time.” Advance directives are documents that state the signatory’s medical-care wishes in the event the writer has lost the capacity to make such decisions on his own.

I believe that the Vermont Supreme Court’s ruling in this case was misguided. I believe it poses risks to people who come in contact with the plaintiff (or more accurately, with his psychosis); risks to the plaintiff himself; and risks as a dangerous precedent, for the same general reasons.

I don’t write these words lightly. Severe mental illness is a uniquely accursed affliction that defeats good intentions and pits legitimate purposes against legitimate purposes, as in this case. No one wants to live in a society that withholds a person’s right to control her medical destiny.

But there is that stubborn word again: “person.” It’s revealing that the plaintiff wrote and signed his advance directive in 2017, a period in which he was in the care of the Brattleboro Retreat for a sixth time and was being administered the antipsychotic medication compound trifluoromethyl phenothiazine. Presumably he was in relative control of his thoughts and actions. If so, he was in (relative) control exactly because of the medication. This is the irony I promised earlier.

I write “relative” control because a frequent traveling companion of schizophrenia is anosognosia—a medical term for “lack of insight.” Anosognosia shows up in about half of all schizophrenia cases. Its effect is to convince the sufferer that everything is fine. There is no disease. And so, no need for medications and their often harsh side effects.

Ultimately, the Vermont Supreme Court decision was grounded in “rights”: the “right” of a citizen to be free from involuntary medical treatment if he so decides. But what if the decider is not the citizen but the disease itself? In my clearly non-judicial opinion, the “right” in such a case must default to the core person: the entity who will be among those harmed, perhaps fatally, by the disease’s “harm to self or others.”

Vermont, and the nation, need to drastically reconsider the balance of legitimate purposes in granting medical immunity to people who are incapable of judging that right in a rational way. The entire question of “rights” in this context is an artifact of overzealous liberal activism in the 1960’s. Vermont is a fairly liberal state, and I personally hold to liberal views. But this is not really a question of ideology. It is a question of common sense.

https://www.rutlandherald.com/news/high-court-overturns-involuntary-medication-order/article_bba91529-cb0a-5b7f-838a-9b0d29089135.html

Susannah Cahalan’s latest book tour!

The author of the best-selling BRAIN ON FIRE is back with a riveting investigation into the life and works of David Rosenhan, the late Stanford psychologist known for his influential views that challenge the validity of psychiatric diagnoses. Her tour schedule of The Great Pretender is below. If you live in or near a city where she will be speaking, I urge you to attend.

I’m taking the liberty of reprinting the book-tour schedule sent to me and others this morning by my friend Susannah Cahalan. You may recall Susannah’s stunning 2012 memoir Brain on Fire: My Month of Madness, in which she chronicled her own descent into what appeared to be severe mental illness until she was rescued by a brilliant doctor who recognized it as a rare autoimmune disease of the brain. The 2016 film adaptation starred Chloe Grace Moretz as Cahalan.

Susannah’s new book, The Great Pretender: The Undercover Mission that Changed Our Understanding of Madness, builds upon the skills and awareness that she developed compiling her first book; yet its range of inquiry and analysis is of a different magnitude.

Susannah Cahalan – Author of The Great Pretender

In the 1970s, David Rosenhan sent seven volunteers into various psychiatric asylums around the country to test the validity of the doctors’ diagnoses and conclusions. The results shattered existing opinions of psychiatry and led to the closing of several hospitals. In this masterpiece of dogged, almost incomprehensibly persistent intellectual detective-work and sustained reasoning, Cahalan has exposed the flaws, the deceptions and the distorted understandings that found their way into society on the ballast of Rosenthal’s influence. The book is destined to become a standard of its genre and a daunting model for immersive journalism.

Here is Susan Cahalan’s tour schedule:

NOVEMBER 5 – MANHATTAN

Barnes & Noble —  Upper East Side in conversation with the marvelous  Melissa Dahl, science editor and author of  Cringeworthy, a book I LOVE.

NOVEMBER 6 – BROOKLYN

Books are Magic with the loves of my life, fellow  Sob Sisters  Ada Calhoun and  Karen Abbott, brilliant authors of many amazing books, which you all should read.

NOVEMBER 7 – BALTIMORE (area)

Carroll Lutheran Village—  sponsored by A Likely Story Bookstore

NOVEMBER 8 – BOSTON

Brookline Booksmith –  sign up here

NOVEMBER 12- ST. LOUIS

ZACK — sponsored by  Left Bank Books

in conversation with the legendary St. Louis Post Dispatch columnist  Bill McClellan.

NOVEMBER 13 – MINNEAPOLIS

Magers & Quinn —  sign up here The Great Pretender‘s own “footnote” will be making a special appearance….(earlier in the day I will be doing a talk at the University of Minneapolis, email me for details).

NOVEMBER 15: TIVOLI, NY

Upstairs at Murray’s Literary Series –  Oblong Books.

NOVEMBER 18 – SEATTLE

Town Hall Seattle Science Series – sign up on Facebook here.

NOVEMBER 19 – PORTLAND

Powell’s City of Books –  sign up on Facebook here.

NOVEMBER 20 – MENLO PARK, CA

Kepler’s Books —  sign up here in conversation with  Dr. Shaili Jain, psychiatrist and author of the beautiful book about trauma and PTSD  The Unspeakable Mind.

NOVEMBER 21 – SAN FRANCISCO

Commonwealth Club –  more details in conversation with the inimitable Judge LaDoris Cordell, pioneer, advocate, musician, artist, writer, and friend.

NOVEMBER 23 – MIAMI

Miami Book Festival In conversation with bestselling author/therapist/dynamo  Lori Gottlieb, author of  Maybe You Should Talk to Someone.

DECEMBER 3

Mark Twain House 

Moderated by psychiatrist Dr. Harold Schwartz

JANUARY 27 – MANHATTAN

New York Public Library — details to come!

In conversation with journalist/author Luke Dittrich, author of one of my favorite non-fiction titles ever Patient HM.

A Senate Candidate from Colorado Speaks Brilliantly for “the Movement”

Andrew Romanoff could be our long-awaited congressional beacon of mental healthcare reform–if the lifers among the Democratic power-brokers will give him the chance to shine.

I traveled to the Denver suburb of Lakewood, Colorado, over the weekend, to flap my gums about reforming mental healthcare in America. And found myself listening to the most stirring talk I have ever heard about reforming mental healthcare in America.

Hint: it wasn’t mine. It covered much of the same ground, but with the riveting pace, passion and purpose that educates and inspires.

The talk was delivered without notes by a guy who came so late to the event that people were starting to walk toward the exits. When they spotted him coming through the door, they rushed back to their tables and shouted in unison: “You’re LAAAAAAATE!”

The shout was not hostile. It had been rehearsed: an affectionate scolding to one who was known and loved by the people there, who understood that he is deluged with speaking obligations. 

The speaker did not disappoint. His remarks galvanized the audience, which erupted in a standing ovation at the conclusion. He had completely upstaged a certain gum-flapping speaker from earlier in the evening. The gum-flapping speaker hardly minded. He recognized that if the political will of Colorado voters were to move in the right direction, this late-arriving figure could well be the charismatic figurehead of the mental-health reform movement from the floor of the United States Senate.

If that should happen–well, better late than never.

The occasion was a gala honoring Heart-Mind-Connect, a new entrant in the expanding archipelago of grass-roots advocates for fixing our broken systems for reclaiming the mentally ill. H-M-C was recently organized by a small collective headed by the singer-songwriter Maree McRae, whose son Stephen was stricken with a rare disease known as common variable immune deficiency. CVID, a genetic disease, attacks antibodies that fight infections, and can produce schizophrenia-like behavior in its victims.

The galvanizing, late-arriving speaker was Andrew Romanoff, 53, a Democratic candidate for the U.S. Senate in 2020. Romanoff is campaigning to get past a crowded primary field that includes the former Colorado governor, John Hickenlooper, so that he can take on the incumbent Senator, the Donald Trump-supporting Cory Gardner.

Andrew Romanoff

Romanoff’s resume bristles with achievement. He won four elections to the Colorado House of Representatives, serving from 2001 through 2009, serving as Speaker from 2005 until term limits ended that run. His causes included expanding the Medicare health program; supporting the “Green New Deal” to promote renewable Energy; championing immigration reform to ease the path to citizenship for undocumented immigrants; and opposing special-interest funding of political candidates. He has rejected Political Action Committee donations for his Senate campaign.

Romanoff holds degrees from Yale and the University of Denver Sturm College of Law, and a master’s degree in public policy from the John F. Kennedy School of Government at Harvard. He has researched the Ku Klux Klan for the Southern Poverty Law Center. He has taught English in Nicaragua and Costa Rica.

He served as president and CEO of Mental Health Colorado from 2015 until 2019.

So naturally (according to Romanoff’s own accounts) the intrepid and visionary Democratic Senatorial Campaign Committee has done its best to make him disappear. Apparently the DSCC prefers the easy listenin’ strains of the incumbent to the reformist drums and trumpets of candidates such as Romanoff.

As Channel 4, the CBS affiliate in Denver, reported in August:

“The DSCC is a powerful political machine that spends hundreds of millions of dollars each election and Romanoff says it is threatening polling, media and other political consultants that if they work with him, it will cut them off.”

“The DSCC has endorsed John Hickenlooper. Romanoff says helping Hickenlooper is one thing, sabotaging his campaign is another.”

Via CBS Andrew Romanoff Accuses Democratic Senatorial Campaign Committee Of Trying To Push Him Out https://denver.cbslocal.com/2019/08/29/andrew-romanoff-democratic-senatorial-campaign-2020-cory-gardner/

What a waste of hope and vision that would be.

Romanoff’s focus on mental healthcare springs from personal experience–as it does for so many advocates and policymakers. 

During his tardy appearance at the H-M-C gala, Andrew Romanoff spoke for about twenty electrifying and lucid minutes, sans suitcoat (the polar opposite of being an empty suit, it occurred to me), tie loosened, fingertips in his trousers pocket, crisply ticking off the goals and the challenges of the mental healthcare reform movement. I did not take notes–no one at the event had prepared me for the eloquence and accuracy and force of Romanoff’s words. I can guarantee one and all, however, that the standard-bearer we have all longed for within the halls of political power may be working his way there.

The emotional peak of his remarks came as Romanoff recounted the horrific story of a family member who put a pistol to her head in 2014 and pulled the trigger.

The victim was Romanoff’s first cousin. “I thought of as her my kid sister,” he said. The calamity occurred without warning, without advance hints that the young woman was disturbed. “Her mom and dad and I–the four of us–were celebrating New Year’s 2015 when she walked into the backyard and killed herself.”

Romanoff’s casual, wry demeanor changed as he briefly told this story. His eyes filled and he paused several times.

A cynical politician–perhaps a lifer on the Democratic Senatorial Campaign Committee–might have seen this moment as calculated; a carefully rehearsed, twice-told tale manufactured to elicit sympathy.

I choose not to think so. As Huck Finn said, I been there before. I doubt that many readers of this blog, burdened in private by their own bereavements, would think so either.

Andrew Romanoff
Andrew Romanoff, Photo Credit: Jeffrey Beall via Flickr http://bit.ly/2Mg8jqI https://creativecommons.org/licenses/by-sa/2.0/

I choose to believe that Andrew Romanoff is the goods: as a potential voice in the Senate for enlightened reform of our country’s shameful mental healthcare systems; but also as a voice for enlightened governance generally. 

I wish him well.

Beyond Denunciation

“There is a crime here that goes beyond denunciation. There is a sorrow here that weeping cannot symbolize. There is a failure here that topples all our success.”

John Steinbeck

Vacaville, California, has a history of popular uprisings to confront the powerful as they violate the humanity of the dispossessed.

In 1932, organizers came to Vacaville to organize the Cannery and Agricultural Workers’ Industrial Union, which fought the starvation-wage exploitation of farm and orchard laborers by the state’s powerful growers. The CAWIU went on strike that December–one of 140 strikes, some of them violent, that occurred between 1930 and 1939. These actions caught the attention of John Steinbeck, and triggered his impulse to write The Grapes of Wrath, which won the Pulitzer Prize in 1940 and contributed to his Nobel Prize for Literature in 1962.

Now Vacaville finds itself at the tipping-point of another defining moral struggle pitting society’s outcasts against entrenched power. The outcasts in the current showdown, the homeless mentally ill, are represented by James Mark Rippee, the blind, gravely brain-damaged street dweller of whom I’ve written extensively on this blog. The power centers that control his fate are the extravagantly named Kaiser Permanente Vacaville Medical Center, and the Solano County Board of Supervisors.

James Mark Rippee – Photo Courtesy Linda Privette

On Tuesday, October 8 (tomorrow, as I write this) one or both these institutions will render decisions that will either end Mark’s twelve years of unimaginable suffering on the small city’s streets, or cast him back into the chaos and brutality of those streets as if he were a leper from the slums of New Dehli.  

Mark Rippee. Photo Courtesy CJ Hanson.

Mark Rippee is 56 now; emaciated, sickly, and delusional, as he has been since the motorcycle accident in 1987 that cost him his vision, crippled him, and left bits of his brain scattered in an alfalfa field.

Winter is coming on. Mark has routinely been beaten and robbed over the years by random thugs who have taken a succession of walking sticks his sisters have provided him, as well as blankets that have been his only insulation against the cold. 

Mark Rippee

His age and failing health augur against his surviving the cold months out-of-doors one more time. The ongoing, unfathomable indifference of the County board to his physical exposure, and the equally bewildering failure of Kaiser Permanente’s psychiatrists to find anything wrong with his psyche, augur against his rescue by those whose charge is the public health and safety. 

The “policy” decisions on October 8 at the Kaiser Permanente Vacaville Medical Center and the Solano County Board of Supervisors, then, probably amount to a life-or-death sentence for James Mark Rippee. “Policy” explains why Mark Rippee remains homeless. The pertinent “policies” ensnarled in the maimed reasoning of brain-damage victims and in the equally maimed consciences of bureaucrats. “Policies” have constricted his sisters, Linda Privatte and C.J. Hanson, as they have struggled to gain simple shelter and medical care for their brother, whose fog of reasoning blocks him from giving necessary consent. 

Mark is in the hospital because on September 14 he stumbled into traffic and was hit by a car as he wandered blindly along Monte Vista Avenue in Vacaville. The impact knocked his head against the concrete and re-opened an abcess. The pain overcame his delusional resistance to being hospitalized or treated (a common resistance, known as “anosognosia,” or lack of insight, in schizophrenia victims).

Mark Rippee’s hospital stay seems likely to end on October 8, when the Kaiser Permanente Vacaville Medical Center will release him to–well, it will release him. It is not the “policy” of the Kaiser Permanente Vacaville Medical Center to give much of a rap where patients such as Mark Rippee end up. “Policy,” you see, allows no moral dimension. It normally is accompanied, however, by a burning desire not to spend money.

And on this same day the bureaucracy known as the Solano County board of supervisors will hold yet another hearing to hear opinion on whether Mark Rippee’s sisters should, at last, be granted a conservatorship that would allow them to make decisions on his behalf. Conservancy, like hospital and psychiatric care, requires the expenditure of money. Such money is sometimes available through state and federal government. But then there is that annoying matter of consent by the patient.

One thing will be different, in Mark Rippee’s favor, on this Tuesday. Public opinion is at last beginning to coalesce in his favor. The sisters’ exhaustive efforts at rallying community support have started to pay off, in the form of rallies and an expected turnout at the supervisors’ hearing. Advocates around the country are on standby, alerted by Facebook postings. A T-shirt is available for purchase online. It bears Mark’s ravaged likeness and the declaration that he blurted out, surprising everyone, during his recuperation. It should serve as a manifesto for all his brothers and sisters on this country’s streets:

“I am NOT homeless! I have a home! My home is the United States of America!”

Mark James Rippee

On Tuesday, October 8, we will see whether the United States of America fulfills Mark Rippee’s cry of trust.

https://www.facebook.com/cj.hanson.908/videos/757849507989657/

https://www.facebook.com/kerri.whitney.52/videos/2291283497649873/

I am NOT homeless!

I have a home!

My home is the United States of America!

James Mark Rippee
James Mark Rippee after his motorcycle accident June 1987

Listen to the words above. Say them aloud. And try not to feel stirred. Angry. Transformed. Try not to feel inspired to stop what you’re doing and throw your energies into a cause that is becoming a national movement.

Maybe you can do this. Maybe you can hear those words and remain unmoved. Maybe you can hear them and shrug and turn back to the duties of your day.

I cannot. I can’t stop hearing them. I hear those words as fierce poetry. More to the point, I hear them as a manifesto, one that should take its place among the great declarations that have defined our nation and our obligations toward it, and its most maimed and outcast citizens.

I hear it delivered with the same patriotic pitch as “Give Me Liberty Or Give Me Death.” “The Better Angels of Our Nature.” “Ask Not What Your Country Can Do for You; Ask What You Can Do for Your Country.” “We Can Do Better.”

The words are the more compelling in that they were uttered–on Wednesday, October 2–by a man so grievously crushed by brain injury, schizophrenia, blindness, broken bones, and more than twelve years struggling for life on the streets that one hardly imagines him capable of speaking a coherent sentence, much less this burst of eloquence.

And this is exactly the fundamental barrier that inhibits people and political bodies from doing more to rescue the mentally ill who cling to existence in desperate circumstances–to rescue the mentally ill, period. Consciously or unconsciously, they are seen as not fully human. Monsters. Half-sentient beings who “don’t even know they’re living that way; but perhaps they like living that way,” in the considered analysis of the current president of the United States.

These are essential reasons why, as it has been said, no one cares about crazy people.

The man who spoke this manifesto is James Mark Rippee of Vacaville, California. You know Mark’s story if you have followed several entries in my blog. Nearly killed in a collision while riding his motorcycle in June 1987 that blinded him and left parts of his brain in an alfalfa field; prohibited by his distraught father (who died of a stroke a few years later) from commitment to an institution; endurer of nearly fifty operations to remove abscesses from his brain; cared for by his sisters Linda and CJ until his violent psychotic episodes made him a danger in the household; a street refugee for a dozen years and counting as the two sisters have petitioned his case to the blind eyes and deaf ears of numerous agencies and levels of government.

Mark Rippee

The sisters’ goal is simple, and reasonable to anyone with a bit more compassion than God gave a goose, or a Solano County pol: to secure conservatorship for Mark a measure that allows county public health officials to steer mentally ill and homeless people toward housing and medical treatment without their consent.

(The requirement of consent has, for more than half a century, stood as a vexed impediment to providing medical and psychiatric care for people in psychosis who refuse to admit that they need it. Designed to protect such victims from fraud and predators, “consent” in practice has blocked emergency help victims of psychosis who will not or cannot admit they are ill.)

Linda and CJ have fought across two decades for their brother’s reclamation–for some mechanism of policy that would remove him from the streets where he has been routinely ridiculed, robbed, and beaten up–and into some safe place; some room; some bed; some sanctuary where doctors could nourish him, salve his wounds, give him medications to tame the psychotic demons inside him.

No agency in the state of California is interested. California harbors half the homeless people in the United States, and so the violate humanity of Mark Rippee has not sunk in. He is just another statistic. The Solano County Board of Supervisors has long since grown tired of the sisters’ petitions and their pleading. They have stopped pretending to care. They say that Mark Rippee is not their responsibility. Linda and CJ believe otherwise. But they have lacked the money and the access to public attention to make their case.

Wavelets of sympathy, gestures toward “doing something,” arise and fade. And Mark Rippee edges ever-closer to a sordid death on the streets of Vacaville.

Ironically–and ironies glut the world of mental illness–it has taken another vehicle accident to galvanize a fresh groundswell of support for Mark Rippee’s cause.

On the evening of September 14, as Mark wandered blindly along Monte Vista Avenue in Vacaville, he stumbled into traffic and was hit by a car. (Until then, he miraculously had eluded such a mishap during his years on the streets.) His head struck the concrete pavement, re-opening the abscess behind one of his eye sockets. The pain evidently was so intense that this time Mark agreed to be hospitalized.

At this writing, October 4, Mark remains in a Vacaville hospital. His sister Linda has been with him. (CJ’s mobility has been limited by illness.)

It was a nurse’s question about Mark’s residency, and Linda’s response to it, that prompted Mark’s burst of eloquence.

“The nurse came in [to Mark’s room] and questioned me about what equipment or help he has at home,” Linda told me by email. “I said without thinking, ‘He is homeless.’ And Mark loudly said, ‘I am NOT homeless. My home is the United States of America!'”

Linda added, “If only he knew how he was abandoned by his own country.”

Mark Rippee’s abandonment; at least, his invisibility, may be near an end. While it is true that every level of American governance has ignored him or brushed him aside so far, a grass-roots movement–tiny in numbers yet explosive in its sudden presence and growth–has sprung up in his behalf.

On September 30, a Solano Community College student named Kacie Hill created a Facebook page, “Mark of Vacaville.” . By Friday afternoon, it had attracted 1,300 members. A young Vacaville man, Jaden Ghent, began printing T-shirts in various colors, with images of Mark and the text of his manifesto. A rally on his behalf is being planned for Sacramento, the state capital.

If the Mark Rippee story is in fact arriving, it will not be a moment too soon. He is 56 now, and obviously in terrible health. If he is not rescued from the streets soon, especially with winter approaching, his life may end soon.

I have been convinced for two years–since discovering his plight upon commencing this blog–that Mark’s saga is of national significance; that this tragic, deformed man might well serve as a living symbol of so much that is deformed in our systems of mental health care. In these two years I have contacted political figures (including the Solano County Board of Supervisors), media watchdogs, and mental health advocates on his behalf. The advocates have shown interest but none has had an idea for how to break through. The rest have remained stonily silent.

But last Wednesday, with one impassioned, eloquent outburst, Mark Rippee may have done the trick himself. However improbably, he has risen up from his tortured silence to declare himself a man. Whose home is the United States of America.

And people–ordinary grass-roots people, if not (yet) those who represent the United States of America–listened.

And the silent, suffering, frequently incoherent James Mark Rippee of Vacaville, California, may yet transcend his victimhood and become the standard-bearer of reclamation that we have all been looking for.

I will revisit Mark Rippee’s story next week.

Trump to Homeless: Get Lost

The good news is that President Trump wants to do something about homeless Americans on the streets.

The bad news is that President Trump wants to do something about homeless Americans on the streets.

On Monday, newspapers and television networks broke the news that the President of the United States, whose name is Donald Trump, had at last swiveled the full attention of his very, very large brain to one of the most appalling crises confronting American cities: the crisis of homeless people on the streets.

Social scientists and others of sadly lesser intellect have noticed the crisis as well, of course, and analyzed it to the best of their limited ability: as a vast ongoing human calamity with dire implications for public health (the containment of hepatitis and opioid epidemics, for example); community and family stability, criminal justice and law enforcement, the control of dangerous drugs, productivity and the employment base.

These are vitally important but largely utilitarian considerations. They do not contemplate the profound moral/religious dimension of this malady: the obligation to reclaim disintegrating human lives.

Photo by Matt Collamer on Unsplash

Few agents of disintegration are more darkly effective than mental illness–serious mental illness (incurable brain diseases such as schizophrenia) in particular. A 2015 survey by the The U.S. Department of Housing and Urban Development, the latest available, reported that of the nearly 565,000 people who were homeless on a given night, fully one-quarter, or 140,000, suffered from a S.M.I. (Serious Mental Illness). Nearly half, or 250,000, were in the grip of some sort of mental disorder.

S.M.I. victims, their reasoning powers diminished or gone, are essentially helpless on the streets. Cut off from providers of stabilizing medication, they are prey to robbers, thugs, thieves, and sometimes rogue police officers. On rare occasions, they become predators as well: upon others, and upon themselves, via suicide.

That is the context of the societal predicament which, nearly three-fourths of the way through his term of office, has activated the engines of President Donald Trump’s very large intellect.

And here is the distillation of Donald Trump’s mighty cogitating, as explained in this July 1 interview conducted by his pal Tucker Carson on Fox News. The relevant part of the interview begins 3 minutes and 22 seconds in. https://www.foxnews.com/politics/trump-tucker-exclusive-interview-homelessness

It is clear from this interview that Donald Trump does not see homelessness as a social-justice problem or a humanitarian problem. He sees it as a cosmetic problem. One that “started two years ago [sic]”

It is further clear that the homeless are inconveniences. Disgraceful pests who make beat-walking police officers sick. “I mean actually they’re getting very sick.” They are affronts to civic pride: human (or semi-human) obstacles to decent upstanding work-loving citizens. The homeless make it very difficult for office-workers to get to work, you see, and thus are ruining our cities. “You have people that work in those cities,” Donald Trump revealed to his pal Tucker Carlson not long ago. “They work in office buildings. And to get into the building, they have to walk through a scene that nobody would have believed possible three [sic] years ago.”

–And let Donald Trump tell you something: the threats posed by the homeless reach far beyond those that menace nauseated beat-cops and nimble-toed office workers. The homeless strike at the very foundations of America’s might. Take Washington, D.C. (before Donald Trump got in): “When we have leaders of the world coming in to see the President of the United States and they’re riding down the highway . . . they can’t be looking at that [sic]. I really believe that it hurts our country.”

–Don’t get Donald Trump wrong. Nobody is more ruefully forgiving of the barbaric horde than Donald Trump. “San Francisco–I own property in San Francisco; I don’t care, except it was so beautiful.”

–Because, you see, Donald Trump is very, very educated about mental illness: In fact nobody knows more about mental illness than Donald Trump: ” . . . the people living [on the streets] are living in hell, too . . . although some of them have mental problems where they don’t even know they’re living that way; but perhaps they like living that way.” (Emphasis added)

No doubt! Just like those African slaves in the antebellum South were “happy with their situation,” as my innocently bigoted mother used to assure me.

–But not to worry. Donald Trump’s very large, very beautiful mind has not only identified the issue at the heart, as it were, of the homeless problem: bad cosmetics. He has fingered, as it were, the Masters of Evil responsible for the atrocity. “And this is the liberal establishment . . . When you look at some of these, they’re usually sanctuary cities, they’re run by very liberal people, and the states are run by very liberal people.”

–Donald Trump has clashed with these evil forces before–and sent them packing with a strategy that was stellar in its simplicity. “When I first became president, we had certain areas of Washington, D.C., where that was starting to happen. And I ended it very quickly; I said, ‘You can’t do that.'”

–And now Donald Trump is poised to expand that breathtaking solution into a national plan of action. As he told Tucker in the July 1 Fox News interview I have been drawing on here: “So, we’re looking at it very seriously. We may intercede. We may do something to get that whole thing cleaned up. It’s inappropriate [!]. Now, we have to take the people, and do something. We have to do something.”

Take what people where? And do what? one wonders with a shudder. The loyal Tucker Carlson didn’t ask, and Donald Trump didn’t say. But the national press, those damned “enemies of the people,” did not wait for the president’s second-favorite cliche, “You’ll see.” They checked some sources. Here are some of the headlines that resulted on Monday:

Trump pushing for major crackdown on homeless camps in California, with aides discussing moving residents to government-backed facilities (The Washington Post)

Trump Reportedly Wants to Destroy Homeless Camps in California. Officials Say He Doesn’t Have a Clue. (Vice)

Trump officials look to fix California homeless problem, state officials say back off (USA TODAY)

Below the headline of this particular article, a team of three reporters quoted the executive director of the Sacramento Regional Coalition to End Homelessness, as saying:

“My first reaction is that it felt like internment camps for people experiencing homelessness. The president doesn’t seem to have any grasp of the homeless crisis not only in California but around the country.”

It doesn’t take a very, very big brain to suss out Donald Trump’s entire, unabridged spectrum of thought about mental illness. (1) He does not know diddly-squat about the disease. (2) He doesn’t care diddly-squat about its victims. And (3) coming as they do from the lips of a self-styled “man of the people,” Donald Trump’s remarks are about as consummately elitist and plutocratic as you are ever likely to hear outside the Clarence Day Room of the Yale Club.

If you are homeless and mentally ill–hell, if you are homeless, period–you are to Donald Trump as a speck of acne on the Ivanka-like face of America.

You are an impediment; an inconvenience; an ugly flaw to be hidden under a cosmetic treatment. (The “cosmetic treatment” in this case seems to require “facilities.” Camps. And this much is true: Donald Trump does know a little about camps.)

But in a darkly intuitive way, Donald Trump may know what he is doing. Rounding up homeless m.i. victims and sweeping them away out of sight behind walls and locked doors would place his aims squarely on a plane with history’s first institution designed to, let us say, cosmeticize urban streets of “lunaticks,” “morons,” and “idiots”: the notorious Bedlam Asylum in London, which opened for business in the 13th century and brutalized generations of “patients” until it was closed in 1815.

Bethlem [Bedlam] Hospital, London: incurables being inspected, 1789. Credit: Wellcome Library, London CC by 4.0

Of course, that sort of barbarism is unthinkable in enlightened, humane, modern-day America. As unthinkable as separating small refugee children from their parents at our southern border and placing them in cages.

In case you thought I was making up or paraphrasing the Donald Trump quotes above, please carefully review the clip I posted above, from his July 1 interview with Tucker Carlson.

My next blog will focus on the impending public-policy threats–and promises–vis-a-vis the homeless population.

Examining Solitary Confinement

The leading Democratic candidates for president in 2020 have at long last agreed that abolishing this atrocity is an essential part of criminal-justice reform. It is up to us to hold them to their words.

When you hear or read the words “solitary confinement,” what images form in your mind?

A naughty inmate spending some time in a kind of “time out” space wearing a hang-dog expression?

A lonely prisoner in a tiny dark cell gazing at light from the slit of a window, with maybe half a bowl of dirty drinking water at his feet?

A mentally ill man who, after 112 consecutive days of solitary, has just severed his penis with a razor and flushed it down his cell’s toilet? 

One of these things is not like the others.

All three images are rooted in the dark dominion of solitary confinement. Only one of them burns through the fog of euphemism and forces a reckoning with a terrible truth—in this case, one of the most perverse, destructive, and unnecessary varieties of soul-murder yet devised by man.

The topic “solitary confinement” has been raised lately (and gingerly, and fleetingly) by several candidates for the 2020 Democratic presidential nomination: raised as an agenda item in their calls for repairing the fissures in America’s criminal-justice system. (Criminal-justice reform is tightly intertwined with reform of our negligent systems of mental healthcare in America.)

Dorothea Dix

The candidates have in turn been influenced—inspired—by the efforts of a bright new coalition of mental-health reform advocates: parents, mostly, spurred to action by the death or deep psychosis of a beloved child. Polite yet unyielding, ferociously informed, they amount to a neo-Dorothea Dix approach to getting justice for the dispossessed. 

Iowa is their perfectly chosen beachhead. Not only does the state offer an early concentration of corndog-chewing candidates for them to buttonhole. Iowa City is the home of the turbo-charged advocacy team of Scott and Leslie Carpenter. Armed with an exhaustive five-point bill of particulars for mental healthcare reform compiled by the California advocate DeDe Moon Ranahan, the Carpenters essentially have brought the grass roots onto equal footing with the political elite—on this issue, at least.

But why shine the spotlight on solitary confinement when the justice reform agendas are crowded with so many other “big-ticket” demands? Cutting the U.S. prison population in half comes to mind, as do ending the notorious “cash bail” system that keeps poor young inmates locked up only because they can’t afford otherwise; or tightening up on police oversight; or legalizing marijuana; or abolishing private prisons. 

Here is the reason: I sense that of all these important, difficult-to-achieve goals, the abolishing of solitary is among the easiest to bring up and then dismiss: the one most vulnerable to lip service.

Thomas Edward Silverstein

And that would be a colossal shame. Stuffing sentient human beings into small, dark, fetid enclosures and leaving them there is about the worst thing it is possible to do to one’s fellow man. The American record for duration in solitary was held by a triple murderer named Thomas Silverstein, who died just last May at age 67. He’d spent more than half his life in isolation. 

It borders on the impossible to find shared humanity with a monster like Silverstein. Yet traces of his humanity struggle to declare themselves like green shoots through cracked pavement. “It’s almost more humane to kill someone immediately than it is to intentionally bury a man alive,” he wrote. For one superb writer’s searching attempt, read Pete Earley’s masterful 1992 book, The Hot House: Life Inside Leavenworth Prison.

Or return for a moment to the lost soul who severed his penis with a razor. That would be the mentally ill inmate identified by his initials, J.I., a solitary inmate at Broward County Jail in Fort Lauderdale, Florida. On the night of September 2018, jail guards, alerted by prisoners’ shouting in a lockdown unit, rushed to the scene, where they beheld J.I., his hands and forearms bloody, who told them: “I have a real medical emergency. I just cut my penis off and flushed it down the toilet. I have no need for it anymore.”

J.I., who survived, had sat in solitary for 112 consecutive days. He’d been sent there for yelling at staff members. Records showed that guards had been negligent in monitoring his therapeutic needs. 1

Solitary is patently barbaric; bereft of any use (other than convenience and a lust for inflicting psychic pain).  It is a legalized yet likely unconstitutional torture which, I have come to believe, is slightly more heinous even than the death penalty: its victims, while not dead, experience death as their own observers, existing in claustrophobic isolation and silence and darkness and decay, with no definable release awaiting them. 

And so in order to tolerate it as public policy or even as a thought, some self-anesthetizing helps. (Those charged with actually imposing it on human beings presumably develop tougher psychic scar tissue.)  “Solitary confinement” is a term useful for the necessary numbing: an abstraction, one of those “Orwellian” constructions that serve more to camouflage than to evoke their full, and usually terrifying implications. 

That very abstraction is dangerous. It can too easily lead to evaporation.  

This blog, then, is a plea to those presidential candidates who have made the abolition of solitary confinement a part of their criminal-justice reform demands: Do not let this happen. Honor the constituency that has materialized in Iowa and exists throughout the nation. Keep this issue alive. 

In subsequent blogs I will trace the peculiar origins of solitary confinement in America, and will look into some of the lesser-known forms of its use—for example, as an instrument of control for juvenile inmates and even schoolchildren.

I will close this blog with a soaring testimony of hope, resilience, faith, and self-reclamation written by a former criminal and solitary inmate named Thomas Tarrants, and published in the August 19 edition of Christianity Today. 2 It was sent to me by my friend, the literary scholar Harold K. Bush of St. Louis University. Thank you, amigo.

JUBILATION ALERT: Democratic Candidates and Grass-Roots Advocates Combine to Urge Seminal Reforms in Criminal Justice and Mental Health Care!

Two mobilizations of historic enlightened reform are abruptly converging in American politics and policy. Their aims are intertwined: to bulldoze and rebuild our blighted structures of criminal justice, and to reclaim our dispossessed mentally ill brothers and sisters from the hellscape of danger, pain, and early death that the blight of justice confers on them. And the economic drain that it exacts from all of us.

The symbiotic forces are (1) the elite tier of progressive candidates for the 2020 presidential election, and (2) the sleeves-up cadre of activists working at Ground Zero who toil because they daily confront serious mental illness up close, and witness its effects for what they are: cancers upon our societal health and sense of decency.

(The first of two parts)

At first glance, justice and mental-healthcare reform may seem but a marginal sliver of all the issues pressing in on America in the 2020 elections. (The physical salvation of the planet comes to mind, and abolishing the immigrant gulags at our southern border.)

This is a distorted, damaging perception, made more dangerous because the crisis is so easily concealed. It can sometimes seem as though insanity and incarceration are like two undersea predators, their tentacles wrapped around each other in a death-struggle of futility. The quality of courts, jails, and prisons has been weakened by years of tending people who should be under psychiatric care. The essentially helpless 11.2 million seriously mentally ill population in turn is vulnerable to suffocation in the folds of feckless court rulings and inhumane treatment behind bars, including deprivation of essential meds and the beckoning maw of solitary confinement (about which more—much more—later.) The one in five adults with less chronic afflictions—nearly 47 million—are within range of the tentacles as well.

Yet that perception, or lack of perception, prevails. It prevails because to open our eyes to the full truth of these abominations is to risk scorching the soul. “I’ll do what little I can in writing,” lamented the great James Agee in another, and again oddly similar context some 75 years ago. “Only it will be very little. I’m not capable of it; and if I were, you would not go near it at all. For if you did, you would hardly bear to live.”


Thus we banish the ghastly effects from our attention as “normal” Americans, until it is too late. The entwined crises strike quickly, and from nowhere, and spread ruin: in households and communities (black and poor ones especially), in the workplace, in public places, in our economic state, and in the less tangible spheres of our collective optimism, hope, and peace of mind.

America has needed an “intervention” for more than two centuries. Intervention seems, at last, to be on its way.

To review the Democrats’ reform plans:1

Pete Buttigieg photo credit: Gage Skidmore

The most ambitious manifestos, in my unscientific reckoning, were issued within the last ten days by Senators Bernie Sanders and Elizabeth Warren and South Bend, Indiana Mayor Peter Buttigieg. Nearly as powerful were the earlier justice reform announcements of Cory Booker, Amy Klobuchar, and Julian Castro. Joe Biden and Kamala Harris submitted strong, if not notably comprehensive, reform ideas.

This ranking hierarchy is not as fixed as the tiers might imply. The eight plans are far more significant for their overlapping reform goals they stress than for their differences.

Elizabeth Warren

Slashing into federal prison glut is high on most lists. Sanders, Warren and Buttigieg unveiled proposals that would cut into mass-incarceration, each by roughly 50 percent: by reducing long sentences, ending the “cash bail” system that pauperizes poor families of those arrested, tightening up on police oversight, legalizing marijuana, and abolishing private prisons. Sanders’s document, at 6000 words, is by far the most minutely detailed. Warren would go after policies that “criminalize” homelessness, poverty, and mental health problems (critically, she has not elaborated on this last). Booker would scale back inmate numbers via a clemency program that would free many elderly inmates under the theory that criminals “age out” of their impulses to commit violent crimes. Klobuchar also embraces clemency via a restructured reform plan and would modify the “tough-on-crime” stances she held as a prosecutor in Minnesota. 

Julián Castro

Castro’s vision is likewise far-ranging, but he places special emphasis upon overhauling violent and clueless behavior of policemen. He wants to curb the use of force, end stop-and-frisk, holding police more accountable for misconduct, and restoring trust among police and the communities they are sworn to protect.

As for Biden and Harris, their reform plans are similarly comprehensive and replicate the bold ideas of their rivals as listed above. Both candidates—and to some extent Klobuchar as well—are preoccupied with freeing themselves from the taint of the “tough-on-crime” stances that they adopted in the mid-1990s.

That is my personal survey, unfairly truncated perhaps, of the generally ground-breaking flurry of criminal-justice reform ideas released by eight of the leading progressive presidential candidates. 

An obvious but important caveat: none of these audacious ideas will tap-dance its way into law or policy should its sponsor get elected. (The proto-autocrat decrees of our current incumbent might lull some into that assumption.) A new chief executive will need to inspire the House and Senate to a pitch of pro-active fervor not seen since the First Hundred Days of Franklin D. Roosevelt’s presidency when the New Deal took form in a blizzard of “relief, recovery, and reform.” For our present stumbling and divided Congress to suddenly sprout capes, masks, and flippers and get busy cleaning out the present rot may seem a stretch. Yet things can happen quickly, as the last midterms showed, and a whiff of activism does linger in the air.

With all this in mind, let us turn to the symbiotic manifesto that has arisen from those ordinary heroes at Ground Zero: “Grassroots 2020: A 5-Part Plan for Mental Illness SMI.” 

Dede Ranahan

As I’ve mentioned, this inspirational document is largely the labor of the advocate, blogger, and author Dede Moon Ranahan (“SOONER THAN TOMORROW –A SAFE PLACE TO TALK ABOUT MENTAL ILLNESS IN OUR FAMILIES” / SOONER THAN TOMORROW – A MOTHER”S DIARY ABOUT MENTAL ILLNESS, FAMILY, AND EVERYDAY LIFE 2019. Dede’s mentally ill son Patrick, a luminous man of 45, died under medically muddled circumstances in a California hospital in 2014. To paraphrase myself from an earlier blog, her compilation proceeds from “a wide-ranging national canvass of those in the ‘sub-nation’: the mothers, caretakers and advocates of people suffering from serious mental illness: schizophrenia, bipolar disorder, and related incurable afflictions.”

Grassroots: 2020 has been personally distributed to visiting Democratic candidates or mailed to their offices by Leslie and Scott Carpenter of Council Bluffs, Iowa. The Carpenters’ tireless work has helped join the reformist trajectories of these politicians and the people.

I lay it out below with minimal editing, in summary form. You will note that each part of the plan delineates action that a president can undertake, sometimes independently of Congress. And unlike the candidates’ ideas above, Grassroots: 2020 addresses justice-reform issues (incarceration-trimming, for example) only incidentally. It focuses on existing rules, many of them arcane to the non-specialist, that nonetheless have caused decades of frustration and despair for those struggling to reclaim their afflicted loved ones from a decayed system:

A FIVE-PART PLAN TO ADDRESS SERIOUS MENTAL ILLNESS (SMI) 2020 PRESIDENTIAL CANDIDATES. PLEASE ADDRESS THESE TOPICS IN YOUR CAMPAIGN APPEARANCES AND DEBATES:

1. RECLASSIFY SERIOUS MENTAL ILLNESS (SMI) FROM A BEHAVIORAL CONDITION TO WHAT IT IS – A NEUROLOGICAL MEDICAL CONDITION  

WHY RECLASSIFICATION IS IMPORTANT:  

Re-classification will unlock more research funding and help eliminate discrimination in treatment, insurance reimbursement, and the perception of SMI as a “behavioral” condition.  SMI is a human rights issue. The National Institutes of Mental Health ranks SMI among the top 15 causes of disability worldwide with an average lifespan reduction of 28 years.  

PRESIDENTIAL ACTION: 

• Create a cabinet position exclusively focused on SMI. • Push for Congressional appropriations to include schizophrenia in a CDC2 program that collects data on the prevalence and risk factors of neurological conditions in the U.S. population. 

2. REFORM THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)3  

WHY HIPAA REFORM IS IMPORTANT  

Overly strict HIPAA laws make it extremely difficult for families and caregivers to partner in the treatment of their loved ones, resulting in important life-saving medical information gaps. By eliminating this barrier, family support will be strengthened, reducing the chance of relapse, homelessness, imprisonment, and death. 

PRESIDENTIAL ACTION: 

Work with legislators to change HIPAA law to ensure mental health professionals are legally permitted to share and receive critical diagnostic criteria and treatment information with/from parents or caregivers of SMI. 

3.   REPEAL MEDICAID’S INSTITUTES FOR MENTAL DISEASE EXCLUSION (IMD). 

WHY IMD REPEAL IS IMPORTANT: 

The Medicaid IMD Exclusion prohibits Medicaid payments to states for those receiving psychiatric care in facilities with more than 16 beds for those in the 21-65 age group.  This demographic represents the majority of SMI cases. Repeal of the IMD Exclusion will increase the availability of acute care, inpatient psychiatric beds. The IMD exclusion not only discriminates against those suffering from neurological brain disorders, it’s a leading cause of our national psychiatric hospital bed shortage.    

PRESIDENTIAL ACTION: 

• Work with legislators to repeal the IMD exclusion. 

4.   PROVIDE A FULL CONTINUUM OF CARE FOR THOSE WITH SMI  

WHY A FULL CONTINUUM OF CARE IS IMPORTANT: 

A continuum of care insures that SMI patients receive early intervention at all stages of their illnesses, long-term care when needed, and follow-up treatment (medications and therapies) when they’re released.  Providing a continuum of care reduces: incarcerations, emergency rooms visits, homelessness, and death. A continuum of care provides life-time management that permits a patient to move without penalty from one level of care to another as needed.  

PRESIDENTIAL ACTION: 

• Create federal incentives to states which are addressing a full array of inpatient, outpatient, and supportive housing care. 

5.   DECRIMINALIZE SERIOUS MENTAL ILLNESS (SMI)  

WHY DECRIMINALIZATION OF SMI IS IMPORTANT: 

People suffering with other neurological conditions like Alzheimer’s and dementia can get treatment promptly without being kicked out of their homes to wander the streets until they are arrested and put in jail or prison rather than a hospital. Serious mental illness is the only disease where the doors to treatment are shut unless a crime is committed. This is pure and simple discrimination with the disastrous results we see in our country today — homelessness, incarceration, the disintegration of families, and death.  

PRESIDENTIAL ACTION: 

• Work with legislators to change “must be a danger to self or others” criteria. • Work with legislators to change involuntary commitment criteria, alleviating the subjective nature of “gravely disabled” and redefining it in objective terms based on scientific medical need for treatment. Psychosis, like a stroke, is a traumatic brain injury and needs immediate treatment for the best outcome.

Bernie Sanders

Returning to the candidates’ manifestos, I have omitted two demands that show up in most of them, yet are given no more than lip-service by none except Bernie Sanders: abolishing capital punishment and solitary confinement. Both are urgent. Deciding which is the most urgent depends, I guess, upon the morbid calculation of whether continued existence in the “hole,” with its barbaric history of destroying human personality, is worth the torture. I have felt my way to an agonizing decision. In my next blog I will urge the candidates to meditate on solitary confinement for exactly what it is, and to treat it as primary target for abolishment.