American Public Health Association
San Francisco, November, 2003

Sylvia Caras, PhD

Implementing the goals of the NFCMH Report: transforming mental health care through gainful employment for consumers

Russell Pierce walked down to my hotel and we went together to Fort Mason. Russell will be coordinating next year’s APHA consumer event in DC.

Around 40 are gathered at Fort Mason in San Francisco for this day-long event which is being taped for later distribution. Lots of outreach to People Who who are here in god numbers.

Mayberg: overview of the Report, noting there were 50 thousand comments on the Report web page, mostly from consumers and family members commenting on services, and a million hits. There are 42 federal funding streams for mental health, the largest funder is SSI/SSDI, hence losing benefits is a disincentive to wellness, there is a need to generate evidence for promising practices, that we know supported employment gets better results than day treatment but we persist in giving day treatment. From a Domestic Policy Council meeting: after the State of the Union address, there may be administration emphasis on parity, leading to federal realignment (we should be watching this), state flexibility, California might use block grant money to develop consumer leadership, and CMHS’ Power is interested in trauma and women’s issues.

CA disability benefits, , CA Working while on Medical program, can earn almost $46,000 without losing health benefits

7 panelists - employment/education programs, implementation ideas. Day has been videotaped. Edited version will be available.

APHA Opening Session:

Public health mission is health people in health communities.

Bonta: Public health at its finest is social justice.

"The greatest threat to public health today is George Bush." Akmat, South Africa,

Mental health section - question was raised about possible political motives behind NFCMH emphasis on recovery, lessening federal involvement and shifting all responsibility to local, faith-based, ... ???

Around 55 people are breakfasting and listening to Mike Hogan talk about the NFCMH Report. George Bush had a friend with depression and as Bush watched the friend fail and recover he realized this was indeed a medical problem. The White House directed the Commission to not discuss force - evidence not in, controversial, would capture whole focus of input, report. There was little interference from the administration with the work of the Commission. The goal of the Report was to be acceptable to *this* administration even though the Report might not stand the test of time. Its success depends on the pick-up. Today’s system; "take your medicine, stay out of trouble, and we’ll watch over you." Medicare can indeed fund more, CMS will issue Guidances. In the US, there are 60% more deaths from suicide than homicide. Federal block grants are virtually irrelevant ( 1 - 2 % of a state’s budget). Better strategy is to change CMS coverage patterns.

Torture and Human Rights

9 in audience, speaker, two discussants, chair

Gray: must do this work without shame and without guilt. This small audience reflects the difficulty of the work. What is modern torture about? Some US thinkers are pro-torture, some to legalize (Dershowitz), some to continue to permit it but illegally. Torture is designed by psychologists, the lasting effects are deliberately induced/produced. The aim is political control. After escape, first comes elation, subsequently bad feelings, depression, suicide, alcohol, ... (I’m thinking that therefore, after psychiatric incarceration, satisfaction and outcome studies should not be done at time of release but perhaps 12 - 18 months later. S.)

If the uncle has molested a child, it does no good to put the child in therapy if the family hasn’t done anything about the uncle.

Not one case prosecuted by the US government under the ‘94 Convention Against Torture, though there have been successful civil actions.

We have all become bystanders (and thus complicit). This is political torture. The solutions must be political.

I asked about forced psychiatric treatment as torture. The medical responder answered by describing ptsd symptoms. She wasn’t sure what I meant by forced medical treatment but did note in response that medical personnel participate in about 20% of worldwide torture activates.

Weinstein: dangerous to overuse term torture, stick to medical definition

Advocacy and Media:

Media are story-tellers; APHA members are healers.

Radio story around 45 seconds - lead, 10 seconds; story, 30 seconds; sound byte, 10 seconds; Feature - six minutes; Series, several stories or features; TV speak - short sound bytes - think of talking to a 4th grader in Turlock. If it bleeds, it leads - bad news first. Know your audience, target your pitch to reporter, news service. Be transparent; who is paying. Story in the subject line! All I need, all I want is subject line, body paragraph with contact for more info. Think *small,* specific position. Macro is overwhelming, doesn’t make a story. Appropriate lead time - study date, hearing, ... one week in advance. Get in the Rolodex. Provide list of experts.

As an example of advocacy there was an anti-obesity campaign presentation, health food for youth. And there were a lot of exhibit displays about nutrition. (But the presenation seemed excessive to me, the presenter is vegan, a web with information is . I thought about other food obsessions and eating disorders and this energy and emphasis struck me as the other side of eating disorders, extreme in the health direction. S)

Peace Caucus: Patriot II Act proposes a DNA database of identification material from terrorists and suspects. Steady sinister erosion of the Bill of Rights and of opportunities for dissent.

Is there any weight to city council resolutions to not conform with Patriot Act I? Or is disagreement irrelevant in these times?

I walked from my hotel to a social hour a mile away. A person sitting on the sidewalk against a building wall asked me politely if I had an rolling paper. I was charmed that he didn’t automatically exclude me from those who he thought might have what he wanted!

"The American Public Health Association ..., Concluding that greater harm is caused by the legal consequences of its prohibition than possible risks of medicinal use, there 1. Encourages research of the therapeutic properties of various cannabinoids and combinations of cannabinoids, and 2. Encourages research on alternative methods of administration to decrease the harmful effects related to smoking; and 3. Urges the Administration and Congress to move expeditiously to make cannabis available as a legal medicine where shown to be safe and effective and to immediately allow access to therapeutic cannabis through the Investigational New Drug Program."

Sartorius: 80% of world’s population will be in cities by 2025. How is a disease affected by a city’s structure? Town are better than villages for the poor; village life is deprived; town grow faster in the third world. Those living in the slums of developing countries are able, intelligent, strong, resourceful - we must provide opportunities. Those living in the slums of developed countries are unable to take advantage of the opportunities available - we must provide care. Explosion in Africa of orphaned children, because of deaths of families from AIDS.

There’s a need for youth peer support and young adult peer support. Some peer email lists? I am regularly asked about what’s available and I don’t know. (I was talking with the mother of a hospitalized 14 year old girl already diagnosed schizo-affective, bipolar, borderline, and a couple of others - what will her life be like?! S.)

NIMH Meriakngas: major depression leading source of disability adjusted life years, in the top ten causes of disability in the world, epidemiological studies to establish validity of diagnostic nomenclature, WHO global survey of 200,000 but less data from Central and South America, survey those who suffer, suffer, are suffering, mild disorders predict subsequent severe disorders hence early, earlier intervention justified, encouraged.

(I get very out of sorts when I hear the word "suffer." "Suffer" is not a synonym for "have." Some suffer and speak of their situations in that way, some manage, manage well. When benefactors characterize the experience of others, they co-opt that personal experience. Portraying others as suffering, as helpless, as victims portrays people as needy and dependant which facilitates the agenda of the benefactor to intervene. When a benefactor speaks of the suffering of others, the very language creates a power imbalance, a power-over context that facilitates in the psychiatric disability arena, the agenda of the mentally well. S.)

Nakamura: In the US, twice as many deaths are due to suicide as to HIV/AIDS. Resilience appears to be related to the long form of the 5HTT gene. The circuitry of mental illness. Prevention. Cure. (Eugenics? S.) NIMH goals re Report: improve the potential for recovery through new evidence-based interventions, strengthen science to services; work to prevent or cure mental illness. Brain can be directly influences by our behavior and environment. The physical structure changes. (Hence scans are only at one moment of time. What then do PET images show? S.) New brain cells grow. ECT increase number of new neurons (No statement about concurrent neuron death. Nakamura is know to advocates as a stong support of shock and for his unwillingness to note the damages. S.) Psychotropics are tested a lot on kids but NIMH research can’t keep up with the demand from parents and physicians to use them earlier and earlier

Ethics, health and human rights: Human rights principles of non-discrimination, equality, participation. Constant focus on transparency and accountability. Health science as a global way to create collaborations between countries and to bring peace. Regroupings of specialities and geographies strengthens our ability to go forward. Human rights represent the fundamental values of public health.

CDC: global connectivity, collaboration, speed

White, APHA Disability Forum Chair: there are more than 50 federal definitions of disability. 247.000 living in nursing homes who would prefer to live in the community, over 70% of adults with disabilities are unemployed, less than 1% of issued TWWIIA tickets have been used (as of 11/03, 562633: 3168), health is not an end in itself but a means to a personal goal, CDC/FEMA - Nobody Left Behind - are reviewing effective planning and emergency evacuation