@oldhead: Hey, I was going to wait to post this. I ordered this book for $9 bucks, used, & it’s going to take to the end of this month to get here. I have a lot to say. But I can say some of it now, so…I composed this in WORD & it’s a tome. I made it as fun to read as I can. Researching this stuff makes me sick to my stomach. I’ve had to move through bouts of extreme fear & anger to get ‘er done. So here goes (the Kenda’s Law article made me change my mind about posting now). This took a long time, but it’s, well, timely: Part One: (written on February 10, 2021) I got a used copy of this author’s book & while I was waiting for it, I bookmarked this article & prepared a metanarrative to something I have been tracking & felt is worth mentioning. You said: “I’ll get just a bit contrarian to say that I’m a little confused by the general level of criticism being directed at this particular author, as in terms of basic assumptions I don’t see anything here significantly more objectionable than in any pro-psychiatry MIA piece.” I think the response to this article is more about the larger implications of forced psychiatry as opposed to only pro-psychiatry. If someone gets a referral to Intensive Home Treatment (IHT), forced inpatient hospital treatment MAY or may NOT be the result of “non-compliance.” The “MAY be a result of ‘non-compliance,’ is the part that’s of interest to survivors. Of course. And that’s been pointed out. As you said, it is also about “the illusory conceptions of what psychiatry is in the first place,” and by treating “mental illness” in THE HOME, it brings up problems that are beyond the definition of “mental illness” (or lack thereof), and aids to covering up child & domestic abuse. By its very definition. Or lack thereof. But David Heath can circumvent that argument, for a while at least, by saying he does not include this to mean covering up for child abuse as he treats these “patients” out of a home setting. But he didn’t answer Kindred Spirit’s, or Steve’s question. Which Steve asked TWICE now. (also, at the time of this writing there is an article about refuting False Memory Syndrome—a lot of people, including me, have buried trauma memories, & therefore, treatment in the home wouldn’t catch this—but that goes back to the observation KS pointed out: the “diagnosis” itself is the error) You said, “It could be that the consensus is shifting about what is considered “progressive” and Dr. Heath didn’t get the memo; however I also think some of this is based on illusory conceptions of what psychiatry is in the first pace.” Yes, he either 1) didn’t get the memo, or 2) he DID get it. And doesn’t agree with it. This is in the sample pages of the book if you want to read further online without getting the book: Home Treatment for Acute Mental Disorders: An Alternative to Hospitalization From the foreword, by Anita S. Everett of Johns Hopkins University: “While 20 years ago there was a considerable debate regarding the cause of many mental disorders, we now know that many of the most seriously disabling illnesses have a clear biologic and genetic basis. We have new medications that offer significant advances in terms of long-term tolerability and physical safety compared with medications that were available 25 years ago. We have an array of services that are supported by science and are designed to provide support and to promote independence and self-reliance in community settings.” In regards to pro-psychiatry pieces on MIA, this one seems particularly retrograde. The book & the excerpted paragraphs are from 2004, to be fair. And here is the opening paragraph of the foreword. “There’s no place like home…” Dorothy chants as she clicks together the red ruby slippers and hopes for magic transportation back to her home. In this 1939 movie classic based on Frank L. Baum’s novel, The Wizard of Oz, Dorothy desperately seeks the peace, comfort and safety of the Midwestern farm home from which she came. The story begins as the young Dorothy character becomes frustrated with the conventions of the farm and seeks adventure through running away. Not unlike the course of an UNSTABLE MENTAL ILLNESS as it unravels, she encounters many unconventional thrills, risks, and perils along the way. In Oz she makes new friends, many are actually existing companions from Kansas, but existing in distorted ways.” (emphasis added) X O.K., you get the drift. Was it a coincidence that the character being compared to the “mentally ill” person-in-question was a child? Or that The Wizard of Oz is a children’s book? So why did I spend money on this book? I needed it to make an argument about how the government is closing loopholes in states that do NOT have mandatory outpatient commitment laws. And I’m going to use Maryland, mostly, as an example. Here is Maryland’s Inpatient Commitment Law: *Maryland does not have an outpatient commitment law. INPATIENT COMMITMENT MD. CODE ANN., HEALTH-GEN. § 10-632(e)(2). The hearing officer shall [o]rder the release of the individual from the facility unless the record demonstrates by clear and convincing evidence that at the time of the hearing each of the following elements exist as to the individual whose involuntary admission is sought: (i) The individual has a mental disorder; (ii) The individual needs in-patient care or treatment; (iii) (iii) The individual presents a danger to the life or safety of the individual or of others; (iv) (iv) The individual is unable or unwilling to be voluntarily admitted to the facility; (v) (v) There is no available less restrictive form of intervention that is consistent with the welfare and safety of the individual; AND (vi) (vi) If the individual is 65 years old or older and is to be admitted to a State facility, the individual has been evaluated by a geriatric evaluation team and no less restrictive form of care or treatment was determined by the team to be appropriate. Alright, let me take # 4 first. “There is no less restrictive form of intervention.” Well, IHT covers this, & it’s called Mobile Crisis Home Treatment Services in the United States (as well as other acronyms). In addition to MCHT, Maryland (and other states) also have ASSERTIVE Community Treatment, which is the same thing as Assisted Outpatient Treatment (IOT), or close enough. In other words, it’s a shell game. And a shell game that the reformists cannot follow because they are not looking at the spider web of monies in service of FORCED TREATMENT. All of these overlapping programs, including hospitalization, converge to catch any & all would-be “non-compliant” victims. (survivor, as a term, must needs be past tense) Monies are coming in from everywhere, not just from the 21 century Cures Act, but later, in Crime Prevention monies, which can & will be used for “mental health” funding. This includes the development & use of pre-crime & predictive programming software. From David Heath: “The easiest way to conceptualize how MCHT fits into a mental health system is to think of it as simply an alternative to admission. It TARGETS any patient who is destined for admission. “(emphasis added). I know you understand how I feel about the word “Target.” Additionally, Maryland has a spider web application process for any group who wants to apply for ASSERTIVE Community Treatment (similar to MCHT, but entraps & infringes on the civil liberties of a slightly different type of victim), here: (also, let me add at this point, that there is a strong Consumer presence in Maryland, & those reformists who rely on their paycheck are certainly aware of the $ trail. Some of the consumer groups are cross-listed in those already awarded money. This will not surprise an abolitionist, but a reformist who is NOT getting a paycheck from these sources may or may not need to have that pointed out to them) https://health.maryland.gov/innovations/Pages/assertive-community-treatment.aspx https://health.maryland.gov/innovations/Pages/selection-process.aspx With talk of defunding the police & reallocating the monies to “mental health,” and with the *doubling* of graduate applications for social work and counseling during the pandemic, I think you can see where this is heading. All MCHT & ACT treatment programs use therapists, social workers, psychologists (in addition to psychiatrists), &, in some cases, “peer counselors.” After graduation, these people will have debt & need jobs. X While we are talking shell games, the appeal for *some* to have home treatment over hospital “treatment” obscures the real reason for the funding of these programs. This is something that a reformer would miss—distracted by the appeal for *some* in what looks like a reform or improvement in “treatment”—“there’s no place like home” to be poisoned & shocked. THE REAL REASON FOR FUNDING OF THESE PROGRAMS IS THAT THE GOVERNMENT WANTS TO SAVE MONEY. AS THE “SEVERELY MENTALLY ILL” ARE THE HIGHEST COST TO TAXPAYERS. THEY DID A REVERSE COST ANALYSIS USING INSURANCE COMPANY MODELS TO DECREASE THE USE OF EXPENSIVE INPATIENT BEDS—I SAY REVERSE, BECAUSE THESE “SEVERELY MENTALLY ILL” FIRST NEEDED TO BE TARGETED. AND THEN THEY USE A SHELL GAME, USING THE APPEAL FOR HOME TREATMENT TO DISCLOSE THEIR TRUE MOTIVIATIONS. TO GET AS MANY PEOPLE DRUGGED AS POSSIBLE BY USING THEIR OWN HOMES, RESOURCES & SOCIAL NETWORKS AGAINST THEM. These are the true intentions of the funders, more so than the “practitioners.” But the practitioners have to play along. In the online pages, you can read “A senior psychiatrist in Britain, very involved with MCHT, implied crisis had become a buzz word: ‘we have to use the word crisis, in order to get the funding.’” OH REALLY? Which brings me to bullet point # 3: “The individual presents a danger to the life or safety of the individual or of others; “ In the book, Heath delineates two levels of intervention: urgent & emergency. I’ll spare you the headache of having to read this & go straight to the point: “However many psychiatric emergencies can arise in situations where stress may play only a minor role as a precipitant or perhaps none at all. Others include STOPPING MEDICATION, SUBSTANCE ABUSE, AND DISTURBED BRAIN BIOLOGY.” (emphasis added) X So, although we all know that the 21 c. Cures Act rolled back the need to have “presents a danger to the life or safety of the individual or others,” it still was up to each state how they were going to achieve this. In Maryland, it’s with the help of the Consumer/Reform-minded community programs, in Pennsylvania it took a different turn. In House Bill 1233, the bill loosens the standards for IOC to include “noncompliance” to taking “medication.” So, strictly a legal stance. It also loosens the “individual presents a danger or safety of the individual or of others,” definition to include the person’s “state-of-mind” anytime up to 48 MONTHS PRIOR to that determination. So THAT’S NEW. In the article below from Public Source: “Why aren’t counties using it? Just because no counties are implementing the new law doesn’t mean they won’t in the future. Counties choose whether to opt out or implement the policy on an annual basis, with the next deadline in January. “It’s not off the table,” Eisenhauer said. “According to Eisenhauer, the Pennsylvania Office of Mental Health and Substance Abuse Services was charged with providing the forms and instructions on how to implement the new law. “Eisenhauer also expressed concerns over the law’s four-year look back period, which he called “exceedingly long.” “Whatever was going on in your mental health history four years ago should not necessarily be relevant to your mental health today,” Eisenhauer said.” https://www.publicsource.org/pas-recently-changed-its-standard-for-involuntary-outpati The bill passed in 2018. https://namimontcopa.org/pa-hb-1233-becomes-law-assisted-outpatient-treatment-bill-becomes-law/ NAMI was one of the most outspoken critics AGAINST the bill, since it provided no funding. And some of the counties within Pennsylvania are not enforcing the law for that reason. So, states with the largest reform/consumer presences can actually be more restrictive to survivors!!! As Consumer groups have watchdog groups to thwart forced treatment. Unless it comes to their own paycheck. Or, in other words, follow the money. X And one last observation about the state of Wyoming, Title 25, for IOT. I think the language is interesting here, because it outright restricts travel & nanny-state’s your social circle. It’s built right into the law, as opposed to being an obnoxious part of home treatment. “ Conditional outpatient treatment may require periodic reporting, continuation of medication and submission to testing and restriction of travel, consumption of alcoholic beverages or drugs, associations with other persons or other reasonable conditions …. the rest is here: https://law.justia.com/codes/wyoming/2011/title25/chapter10/section25-10-110/ For such a libertarian state, I guess the freedoms do not extend to the “mentally ill.” And there’s another odd observation about their commitment laws. It has a different definition of “resident,” than what I’ve come across. Or maybe it is in other laws, and I haven’t checked. To be committed, you only have to be living in the state for 90 days & you can be locked up (!). I assume that’s to “deal with” 1) transients or 2) people who want to have their residences in other states with less restrictive IOT laws if a family member lives or works in Wyoming (although, there aren’t any bordering states with more lax laws). The only saving grace about this state is that it rarely uses its laws. Although it built a big, new shiny hospital, so maybe that’s going to change! They need some warm bodies to put in it after all, because, you know, people need JOBS! “(xv) “Resident” means a United States citizen who has been a resident of and domiciled in Wyoming for not less than ninety (90) days and who has not claimed residency elsewhere for the purpose of obtaining medical or psychiatric services during that ninety (90) day period immediately preceding the date when services under this act were sought or imposed. . . you can read the rest, here: https://law.justia.com/codes/wyoming/2011/title25/chapter10/section25-10-101/ I’m going to wrap it up now. Sorry for the tome. But this will lead nicely into what I have to say next.