Sunday, October 2, 2022

Comments by Amy Smith

Showing 12 of 12 comments.

  • There are eating issues attached to self perception and culture and there are other things. For me, I was near death several times because I was on 13 massive doses of pdrugs and I would FORGET to eat; then the iatrogenic effects of all those drugs coursing through my frail little 80 pound body would cause my mind to start looking askance at the entire process; thinking, perhaps, like a flower might think, these skinbags we have that require nearly constant processing of nutrients in quite an unsightly manner; watching people chewing, chewing, chewing with vast, arrogant amusement. Back in the day, I would become so weak & ill I would show up at ERs begging for treatment – after shoring me up with IV fluids, physical facilities kicked me to the curb for thinking incorrectly and psych facilities would not take on the liability. Its just one more example of how our rules, regulations & laws are all in place for the good of industry and not us; diagnosis primarily serves the reimbursement process and NOT US. But yeah, iatrogenic thinking, not on the list here. OH and hey admin: when you set this article up for printing, Jo’s name disappears ENTIRELY. Since you are a (fabulous, important, I love you) science-driven site I would imagine you might want to have software that shows multiple authors, yes?

  • I don’t think Insel’s comments are a bit different from when drugs came in favor over lobotomies; the industry simply now has something that will serve them more effectively. He certainly is not promoting Open Dialogue. He likes implants, shock & psychosurgery. He did indeed completely restructure NIMH’s granting infrastructure to focus on biological brain research emphasising those three areas of study- and NIMH is THE funder of higher education & the nation’s research scientists so I can see where this is going and it does not look so rosy to me.

  • Thank you for supporting the citizens of Colorado, Dr. Tenney! Here is my letter to my state’s elected officials:

    Amy Smith
    PO Box 6
    103 South Main Street B Up
    Eckley, Colorado 80727
    April 23, 2014
    Via email

    An Open Letter to the Colorado House Health, Insurance and Environment Committee
    RE: HB1386

    I am writing to protest the expansion of civil commitment criteria in Colorado, and HB136 in particular, which I view as a direct and clear threat to my personal civil liberties as a Colorado citizen. I know that the data do not exist that show that incarcerating people with behavioral healthcare labels increases public safety, nor that it is therapeutically beneficial. These are policies on the wrong side of history. This year, the Special Rapporteur on Torture of the United Nations declared forced psychiatry to be torture. Even on a strictly pragmatic level, Colorado does not have the infrastructure to treat the people clamoring for mental health care and substance abuse interventions now. Why are we expanding criteria in the face of a looming workforce crisis as we expand Medicaid and outreach to at-risk populations? Even as just a consumer of mental health services in Colorado, I can see that this entire process has been controlled and has been made to happen, after years of back room deals and a solid wall of defiance to Colorado’s traditional culture of transparency, honesty and fairness.

    In 2008, I was the director of the statewide mental health consumer organization in Colorado, and I & a staff member spent a day at CMHIP interviewing patients with no staff present. Not only were all the patients hungry, including the tiny little old ladies, there was a general lack of medical care available to patients to the point of criminal neglect. Patients were not allowed access to the outdoors for weeks at a time and there were very few activities including therapeutic rehabilitation, group therapy or recreation. Everyone felt over-medicated, but that is common to nearly all locked facilities in the USA. In addition to writing up my findings, we supplied the organization with audio tapes of the all the meetings. I left that position for a different job soon after, and the new director suppressed my findings and wrote “the consumers of Colorado are happy with their care”. Since that time, a number of patients have died preventable deaths, including from constipation, unobserved prone restraint, and most recently, an infected leg wound. I returned in 2012 to interview patients again under a different authority and found much the same.(more food was available, but it was inedible to me- disgusting) In addition, we found patients with traffic tickets housed in maximum security, barbaric sex offender treatment modalities, (whether that was why they were incarcerated or not) and a general inability to progress as is a person’s civil right. The morale was so bad at that time, the institution had to hire 1.7 FTE for every 1.0 FTE expected on the floor at any given moment. What a gross waste of state and federal dollars, even if you could imagine that such interventions as this can possibly be considered therapeutic.

    I have a somewhat clearer understanding of how behavioral healthcare policy-making in Colorado is crafted than most. As the ‘director’ of Colorado’s then-consumer network, WE CAN! Of Colorado, I was a member of the Mighty Mental Health Coalition. Other members included the Executive Directors of MHAC, NAMI, Federation of Families, CBHC, CPS & CPA. I knew how the back room deals go down, how the answers are decided before the questions are posed and how and who decided who got the funding. Colorado consumers were taught for decades not to listen to the national voice of the Consumer/ Survivor/ Ex-patient (CSX) movement, and that “advocacy” meant to beg for more beds & more meds. I appeared at every event, microphone in hand, reading the bullet points provided to me by the state and the industry. I was Patrick Kennedy’s poster child for parity & testified at a House of Representatives Committee on Education and Labor Subcommittee on Health, Employment, Labor and Pensions with him and Rosalind Cater in 2007. As long as I kept my hand clenched around that microphone and read the bullet points provided to me by the industry, I was treated like a queen. Long story short, when I began to question some of the obviously immoral practices I was observing around me, I was removed from my many positions of power on various councils, boards and advisory groups and although I have been literally begging to be allowed to participate again for over seven years, to the most powerful people I could access, I have not only not been given a seat at the table but have been denied at every turn, save Colorado’s Protection and Advocacy system. No matter that I am considered a subject matter expert on peer services, public policy and behavioral healthcare trends under the ACA internationally, I am not welcome at most policy tables in Colorado today. I asked many times to participate on the civil commitment task force and was denied, clear up to last week when Rep. McCann denied me once again. Coloradans civil rights would have been more carefully looked after on my watch.

    The eyes of the world are on Colorado as we mimic the punitive and groundless fear-based policies of New York State with no vibrant, informed and engaged peer community as they have. Our policy-makers and elected officials are mocked as they buy into the fictional junk science of the Treatment Advocacy Center. Informed Coloradans gasp as our rights are written out of our law books and we weep with frustration and fear as one after another advocacy organization that are charged to protect us sign off with their organizational logos on the task force letterhead.

    I have looked the other way over the years as I have identified state budget “errors”, contractual fraud, kickbacks, billing fraud, employee abuse, EEOC issues and much, much more. When Colorado turned back the contracts for Recovery Innovations I knew nothing would ever change, and frankly, that was the last straw in my book. We use the most archaic, expensive, disabling treatment modalities available on Earth. The expense to the state pales next to the human suffering and waste. Colorado legislators must awaken to the dirty sinkhole the Colorado behavioral healthcare system has become, and question these people in a more informed manner, rather than trusting them to inform lawmakers to the best course of action to protect the health, safety and welfare of our citizens.

    Please feel free to contact me with any questions or for further comments or citations.
    Amy Smith

    [email protected]

  • Thank you, Tina, and yes, I am very interested in reporting opportunities. I felt it was duplicitous to suggest P&As hold any responsibility for overseeing all sketchy aspects of the behavioral health systems in states; if that WERE the expectation, they would be funded for such. I should have emphasized that in my state, PAIMI and the Colorado Cross-Disability Coalition are the only legitimate MH advocacy operations in town; all the rest are internal and are managed & paid by the entities they report on, which is certainly no recipe for transparency or fairness. There IS nothing else. We used to have an independent ombuds organization that was effective and downright beloved by peers statewide, but it was shut down by the same cartel that squashed all unruly peer leaders like insects, myself included.

  • Thank you, Tina, Aubrey & Patricia for your work on this!

    I find Dr. Jones’ answers do not directly address the questions posed, or even the tenor of the dialogue, as indicated by her language change from ‘nonconsensual psych medication, electroshock and other coercive practices’ to ‘nonconsensual medical treatment’. There are no states within the USA that have given a single jot of consideration to imposing bans recommended by the UN Special Rapporteur on Torture; I would fall over in a dead faint if any state BH policy makers in this entire country are even aware that such bans have been defined. To suggest that the nation’s sequester-slammed PAIMI programs oversee consensual treatment issues demonstrates a lack of understanding of PAIMI funding guidelines, outcome targets or typical case studies. Colorado has an especially stellar protection & advocacy program, successfully resolving cases that range from prisoner lawsuits within the notorious ADX facility in Florence, Colorado, to helping a woman keep her companion animal in her apartment as guaranteed by ADA law. I am vice-chair of the Colorado PAIMI, in addition to holding several roles reviewing managed care grievances & complaints spanning the last decade statewide, and have never seen one single case of a person grieving a medication compliance judgment.

    Of course, my personal experience is in Colorado, where the CSX movement is so co-opted that few individuals question any form of treatment; we were so thoroughly trained to ignore national & international communities and that ‘advocacy’ means to beg for more beds. So, compliance is not exactly on the table here, which brings up a very large over arching issue of informed consent. People do not question their treatment modalities if they do not know the risks and are not told that even obvious iatrogenic problems were drug-related. I also have a difficult time reconciling Dr. Tom Insel’s announcement that the same week these talks are taking place in Geneva, the National Institute of Mental Health launched its experimental medicine approach in which interventions serve not only as potential treatments, but as probes to generate information about the mechanisms underlying a disorder. NIMH continues to chase the elusive biomarker, a complete guess that fails in the face of common sense, now at the expense of just about everything else unless it features a knife, a laser or a conductor. I can’t consider this a moral approach, and wonder how can this be legal, even here?

    Finally, as far as I can see, Mental Health Courts and Addiction Courts continue to flourish with strong community support. I wonder myself at the very blurry line between law and health in these rooms and question if participants really receive legitimate due process when confronted with the choice of prison or treatment. With adequate informed consent…. yeah, maybe, but I am not seeing any professionals telling folks they are about to enroll in a sweeping reform-driven national experiment.

  • I AM talking about the public system,David, which is primarily Medicaid & Medicare, if you can find a provider. Waivers are a Medicaid function. I don’t know much about private insurance, although I know some CMHCs use it. I CERTAINLY am not talking about municipal or foundation funding; you are correct that that is a completely different thing. I also will say again I don’t think Jack is correct when he states the ACA does not allow third party funding without a diagnostic code & the examples I mentioned address why- those are all in place NOW & the ACA allows for much more state-based protocol creation and innovative models to address some of the new mandates, such as integration of MH & SUD for example. I asked Jack to point me to where in the ACA it states that but haven’t heard back from him yet.

  • David, actually there are a number of mechanisms now to avoid diagnostic coding, such as blended or braided funding structures, waivers for non-medical use of federal dollars, and domain-based services. I called Colorado’s Health Care, Financing & Policy (HCPF, our Medicaid payers), yesterday to drill into the details of the “service-based state plan” details and they told me it is a secret, LOL! (They are currently writing the RFP for the next behavioral health managed care contracts) I have calls into quite a few other subject matter experts who I am sure will be more forthcoming & will post here when I know more. Jack wrote me in an email, “First, Amy, we’re stuck with coding for the foreseeable future — Obamacare requires it for all 3rd part reimbursement –Medicare , Medicaid & private insurance. Indicative of what we’re up against. We don’t
    endorse ICD — as I wrote, anything but the DSM. For now. As I wrote to someone else, first steps first,
    tomorrow the revolution. Our next step, assuming we get 10-20 K signatures, will be to launch a no-diagnosis pledge campaign. First things first. The struggle will be a long one. FYI, to date, much of our support is coming from peer/survivors, who are happy that someone is taking a kick at the monster. Please re-read what I wrote. ” I do not think that is correct; I study the ACA and it appears to me it is MUCH more flexible in terms of service delivery options and I know the feds are EXPECTING states to formulate their own rules & regs, including coding protocols. Its a real conundrum to figure out the integration into a behavioral health system (instead of “mental health” and “substance use”. Many SUD providers do not now use diagnoses to provide services and I suspect that is one issue Colorado is attempting to address, as we are one of 15 states that has integrated early. We also have severe access issues, when, for example, a kiddo is dx’d with “mental illness” & “developmental disabilities”, both systems often refuse to treat- some children have almost died at home because of this problem & it was a hot issue this last year after a great, comprehensive report called “The Harvey Report” was published & presented at a number of state policy councils. One thing that really lights a fire under folks here: Colorado just hates to be embarrassed.

  • Please see my response above. While a different billing system based on expressed or perceived needs is a big shift, it can be done at the local level, making it much more doable. This sort of philosophy is strongly preferred in the ACA; actually the quandary of integration of MH & SUD is perplexing to many payers & a follow-the-person, service-based billing system solves those issues nicely. This reform is the biggest ever in USA history and the feds are counting on states to work out the details- it is a STUNNING opportunity to effect significant change, but PC thinking, compromising & dejectedly voting for the lesser of two evils is NOT the way to accomplish that.

  • I do not agree that recommending the use of an equally unsound construct is the only solution, or even an acceptable one. In Colorado, the entity that manages the Medicaid behavioral healthcare contracts is considering using a service-based billing system rather than a diagnostic-based system as we always have, and for many other reasons besides OUR reasons of the damaging & unscientific natures of both the DSM & ICD. Not the least of which is that a service-based system falls into perfect step with many ACA mandates, but they have many other valid (primarily fiscally based) reasons as well. Calling for a boycott of the DSM (already done a year ago, by the way), and supporting the use of the ICD is like our advocates here patting themselves on the back for insisting on “people-first language” in the new unconstitutional profiling laws. This is no time for compromise. We must state our message very clearly and with conscious intent; the consequence of lukewarm, politically correct messaging is too serious.

  • This is an accurate and informative article but I find it somewhat amazing that anyone can write at length on this subject without referencing the work of Dr. Paula Caplan, who has been campaigning against psychiatric diagnosing and specifically the DSM for decades, often at great personal peril. Her recent work with the DSM9, where nine brave souls have filed formal grievances against the American Psychiatric Association for harm caused to them because of the DSM IV, is especially noteworthy and unreported. Others who have been harmed by diagnoses from the DSM can file complaints themselves with templates found at