Sunday, June 17, 2007

Report Multi-Faceted Grass-Roots Efforts To Bring About Meaningful Change to Alaska's Mental Health Program

http://akmhcweb.org/News/AKEfforts.pdf



REPORT
MULTI-FACETED GRASS-ROOTS EFFORTS TO
BRING ABOUT MEANINGFUL CHANGE TO
ALASKA'S MENTAL HEALTH PROGRAM
by
Jim Gottstein
August 2, 2005
i
I. TABLE OF CONTENTS
I. Table of Contents..................................................................................................................... i
II. Introduction............................................................................................................................ 1
III. Background........................................................................................................................ 2
IV. Alaska Attributes ................................................................................................................ 3
A. Small Population................................................................................................................. 3
B. Alaska Mental Health Trust Authority ............................................................................... 4
C. Alaska Mental Health Board............................................................................................... 4
D. Consumers Consortium....................................................................................................... 4
E. Ionia ................................................................................................................................... 5
V. Genesis of Effort ..................................................................................................................... 5
VI. Specific Efforts: Status & Prospects ................................................................................... 7
A. Acute Care: Soteria-Alaska................................................................................................ 7
B. Community Based Services: CHOICES, Inc................................................................... 10
C. Housing: Peer Properties.................................................................................................. 12
D. Legal: Law Project for Psychiatric Rights (PsychRights) ............................................... 13
VII. Final Thoughts, Acknowledgments, and Personal Notes ................................................. 21
VIII. Glossary ............................................................................................................................ 23
1
II. INTRODUCTION
A number of people both in and out of Alaska have heard of various efforts in Alaska
which attempt to create alternatives to the current virtually exclusive reliance on medication for
people diagnosed with serious mental illness and have asked for a description of these efforts. I
have also been thinking for quite a while that I should put down in writing how the various
pieces of things I, along with others, are working on in Alaska. This will not be entirely new to
everyone because last year Jeff Jessee, the Executive Director of the Alaska Mental Health
Authority (Trust Authority) called me into a meeting where he basically asked what the heck the
idea was for four recently formed non-profits: CHOICES, Inc., Soteria-Alaska, Peer Properties
and the Law Project for Psychiatric Rights (PsychRights®).1 Thus, the basic vision was conveyed
to the group of people at that meeting. Also, I have described it at Consumers Consortium
meetings, where it has been met uniformly with great enthusiasm. I hope it will be helpful to
have it laid out in writing.2
The four non-profits serve complementary roles in the effort to create alternatives to our
mental health system's3 virtually exclusive focus on the administration of psychiatric drugs for
"treatment" of people diagnosed with serious mental illness. The drugs are of dubious, at best,
over all effectiveness, are extremely harmful, and are at least halving the number of people who
recover from a diagnosis of serious mental illness. Another way to put it is our system is
creating large numbers of people4 who become seriously and persistently mentally ill,5 most of
whom become permanent burdens on government financial resources. More importantly from
my perspective, they lead much less satisfying, shorter, and less fulfilling lives than they
otherwise could.
There is a huge debate over this assertion and it is not my purpose to engage in that
debate here6 because the efforts described here are to allow choice. I know many people who
find the drugs helpful and some who feel they saved their lives. I think people who want the
drugs should have access to them.7 By the same token, those who do not want the drugs should
be given the choice to decline them. And they should have support for this choice. Each of the
four non-profits is designed to play a role in this, although one of them, Soteria-Alaska, could be
rolled into CHOICES, Inc., depending on timing and funding.
1 Due to sustainability problems, multiplicity of administrative departments, and human resources
constraints, both the Trust and the Rasmuson Foundation, which is the largest private foundation in
Alaska, are discouraging the proliferation of non-profits.
2 This Report suffers from speaking to different audiences. For example, the section on Alaska isn't
necessary for people in Alaska and the names are of no relevance to people outside of Alaska. Hopefully,
it will be sufficient unto the day for all readers.
3 Because of the way what we call the "mental health system" channels people into chronic mental illness,
I think it is more fairly described as a mental illness, rather than a mental health system.
4 At least doubling.
5 Also known as "chronically mentally ill."
6 However, there are references and links which demonstrate these are the facts.
7 I do think the truth about them should be disclosed, though.
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The purpose of this Report then is to describe the strategy, history, progress to date and
current prospects for this effort in Alaska8 to improve the outcomes of people diagnosed with
serious mental illness by making available alternatives to the coercive, substantially illegal,
essentially exclusive, over-medication regime now in effect.9
It can not be over emphasized this effort is about honoring people's right to make choices
about whether or not to take the risks associated with these drugs in the hope of achieving their
perceived benefits, or to try something else.
The report is extensively footnoted for those who wish to explore the topics in greater
depth, and a glossary is included to define unfamiliar terms and acronyms.
III. BACKGROUND
The underlying premise is the mental illness system's over-reliance on medication is at
least doubling the number of people who become seriously and persistently mentally ill and
causing great harm to a great number of people,10 including death,11 and that by offering various
alternatives to medication, many of which have been proven to work,12 substantially better
outcomes will result.13 That the over-reliance on psychiatric drugs is not only worsening
8 I live in Alaska and as will be described below, it has some unique potential advantages, which makes it
a good place to attempt to effect the type of meaningful change described here. The general ideas,
however, can be used by people around the country (and to a certain extent, around the world) and I am
also working with people around the country on various such efforts.
9 The strategy is mine, but I think it is fair to say that many, if not most of the people in the C/S/X (see
Glossary) community are very supportive and a substantial number of policy makers have expressed
verbal (but not meaningful fiscal) support for various elements of what is laid out here.
10 It would unacceptably increase the length of this Report to support this statement here, and readers are
directed to the Scientific Research by Topic section of the PsychRights website,
http://psychrights.org/Research/Digest/Researchbytopic.htm as well as its Suggested Reading webpage,
http://psychrights.org/Market/storefront.htm, for such support. I have no doubt about the accuracy of the
statement. If only one book is to be read on this topic, Mad in America: Bad Medicine, Bad Science and
the Enduring Mistreatment of the Mentally Ill, by Robert Whitaker is recommended. Toxic Psychiatry, by
Peter Breggin would be the next one.
11 See, e.g., Prospective analysis of premature mortality in schizophrenia in relation to health service
engagement: a 7.5-year study within an epidemiologically complete, homogeneous population in rural
Ireland, Psychiatry Research, 117 (2003) 127–135, which can be found at
http://psychrights.org/Research/Digest/NLPs/MM-PsychRes2003.pdf. This study concluded: "On longterm
prospective evaluation, risk for death in schizophrenia was doubled on a background of enduring
engagement in psychiatric care with increasing provision of community-based services and introduction
of second-generation antipsychotics." In other words the death rate doubled over the already elevated rate
with the introduction of the so-called "atypical" neuroleptics, such as Zyprexa and Risperdal.
12 See, e.g., the material at Effective Non-Drug Treatments,
http://psychrights.org/Research/Digest/Effective/effective.htm.
13 The current system essentially channels people into becoming permanently disabled and thus a
permanent financial burden on government. One of the side benefits of the change envisioned here is a
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outcomes, but creating great harm, makes involuntary medication (Forced Drugging) particularly
abhorrent. Legal proceedings in the US for involuntary commitment and medication are
essentially a sham14 and the lack of efficacy and the serious harm caused by the medications (and
other treatments, such as electroshock) eliminate the justification for the prevailing paternalistic
attitude that "we can't let these pesky rights get in the way of what we know is in the person's
best interests."
If people's rights were actually honored, my sense is at least 90% of court orders for
Forced Drugging would not occur.15 However, it is recognized (a) that society will not tolerate
just letting people go who come to the attention of authorities in a way that invokes the
involuntary treatment mechanisms, and (b) such people often really can benefit from (and want)
a safe, nurturing and helpful environment to get through their acute problems. Thus, even with
respect to legal rights to be free from illegally imposed forced "treatment," it is absolutely
essential that alternatives to the current, essentially medication only treatment regime must
become available.
The four non-profits are designed to offer the choice to pursue a non-medication
approach in four distinct functional areas: Acute Care, Community Based Services, Housing,
and Honoring the Legal Right to Choose. As mentioned previously, acute and community based
services could be performed by one agency. There would be a number of benefits to this, the
most important perhaps being that people would not lose the community based support system
they have when they need acute services and vice versa. In other words, they can continue
working with the people whom they have grown to trust.
IV. ALASKA ATTRIBUTES
There are several attributes in Alaska that are fairly important in perhaps making it a
more favorable place to accomplish the goals presented here than other places.
A. Small Population
Alaska has a very small population, which makes it easier for one person or a relatively
small group of people to impact things. Policy makers are generally much more accessible than
in most places. I have been involved in mental health policy development for a long time, know
many of the key players, and have a certain amount of credibility and respect. As will be
evident, however, while all of this may be true, the goals are still not easy to accomplish by any
means.
substantial number of people can get off, or never get on the welfare rolls, thus not only having much
better lives, but decreasing the cost to government.
14 See, http://psychrights.org/force_of_law.htm#Corruption.
15 This is based on the premise that people may not constitutionally be Force Drugged unless it can be
scientifically proven it is in their best interests and there is no less restrictive alternative that could be
made available. Involuntary commitments are perhaps legally justified a greater percentage of the time
under the current state of the law, but not therapeutically.
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B. Alaska Mental Health Trust Authority
A totally unique attribute of Alaska is the Trust Authority, which was created as a result
of the settlement of litigation (Trust Settlement) over the state of Alaska stealing one million
acres of land granted in trust for Alaska's mental health program (Trust).16 The Trust now has
about $300 million in cash corpus, makes some money off its land corpus, and spends about $20
million a year on what it considers innovative programs and to facilitate major initiatives, such as
constructing a new state hospital. In addition to people diagnosed with mental illness, the Trust's
beneficiaries include chronic alcoholics with psychosis, the mentally retarded and mentally
defective, and people with Alzheimer's Disease and related dementias. The influence and ability
of the Trust Authority to impact Alaska's mental health program far exceeds the relatively small
amount of money it has to spend on it and should not be underestimated.17
C. Alaska Mental Health Board
Under the Trust Settlement, four state boards, each representing one of the four groups of
Trust beneficiaries, provide recommendations to the Trust Authority regarding mental health
program funding. The Alaska Mental Health Board provides recommendations with respect to
people diagnosed with mental illness. The quality and influence of the Mental Health Board has
waxed and waned over the years depending on its personnel and the political climate. At least
one half of the members of the Alaska Mental Health Board must be people with a mental
disorder or members of their family, which potentially gives excellent representation for
Consumers' interests in policy development.18 Appointments to the board are by the Governor,
though, and are thus political to a greater or lesser extent.19
D. Consumers Consortium
In 2002, all of the Consumer run programs in the state got together and formed the
"Consumers Consortium" to provide a united voice to policy makers.20 See,
http://akmhcweb.org/Announcements/2002rfr/consortiumproposals.htm for its initial set of
proposals. It seems worth quoting its organizational statement:
16 See, http://www.touchngo.com/lglcntr/spclint/mht.htm. I was one of the four plaintiffs' attorneys in
that case. The Trust Settlement was valued at $1.1billion by the trial court and consisted of $200 million
in cash and a little under 1 million acres of land, approximately half of which was mineral estate only,
such as the oil and gas rights.
17 Having said that, the current state Administration is generally disinterested in any outside input, which
has diminished the Trust's influence since 2003.
18 See, AS 47.30.662(b), which can be accessed at
http://www.touchngo.com/lglcntr/akstats/Statutes/Title47/Chapter30/Section662.htm
19 I was on the Mental Health Board from 1998 to 2004, but was not reappointed after I sued the State
regarding the interpretation of the Trust Settlement. See,
http://psychrights.org/States/Alaska/4bdSuit/4bdSuit.htm. Being re-appointed under the current
administration was always unlikely because I was not of the right political party.
20 A Consumer membership organization, Mental Health Advocates of Alaska (MHAAK), was formed in
2004/05 with the intent of representing Consumers (as contrasted with Consumer run programs) statewide
to policy makers. It is too early to tell if it will attract enough members to legitimately claim such status.
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Consumers Consortium came together when disparate and exhausted
consumer run organizations discovered their common problems and began
looking for common solutions. The consortium has the assumption of
commonness rather than the assumption of separation. We believe that it will be
much easier for the MH system to respond effectively to us as a group, working
together. In that spirit, we have come together to build a consensus around the
mental health system in response to the Board’s call for input into the budget
building process.
From 2002 until 2005, the Consortium's members were able to reach a consensus on how
available funds for Consumer run programs should be allocated. However, for the state fiscal
year starting in July, 2005, funding was cut so much21 this was no longer possible, which
resulted in the more typical free-for-all competition process with winners and losers.
E. Ionia
In 1987, a group of what I think of as refugees from the mental illness system in
Massachusetts founded the community and non-profit, Ionia, in Kasilof, Alaska. They pooled
their resources and created a lifestyle that totally works for them.22 They now have over 40
people living there, including many children. I don't think they have had a psychiatric crisis in
well over ten years, perhaps not since the community was founded. They built their own log
houses, eat a strict macrobiotic diet, growing and gathering much of their own food, and meet
every morning for as long as it takes to work through any issues. A few years ago, they needed
some grant funding to expand their agricultural operation and build a community building they
call the "Longhouse." The grant application brought what they were doing to the attention of
policy makers, and Ionia became an example of a group of people who, after being pronounced
hopelessly and permanently mentally ill, created their own environment, and proved it is
possible to recover from a diagnosis of serious mental illness and thrive.
V. GENESIS OF EFFORT
While I have been involved in mental health policy in Alaska for quite a long time in
various capacities23 and had a pretty good sense of the failure of the mental illness system to
truly help most people diagnosed with serious mental illness, this particular effort arose out of
my reading Mad in America in late 2002. It is an excellent, very readable and enjoyable, yet
extremely alarming book in that it revealed vast numbers of people are being greatly harmed by
the current "treatment" paradigm.24 Of course, there have actually been many books
documenting the same thing, including Dr. Peter Breggin's seminal book Toxic Psychiatry.
21 The Trust Authority doubled the amount of money it had previously allocated for what was called
Consumer run programs, but expanded eligibility to include all four of its beneficiary groups in what it
now calls its "Trust Beneficiary Group Initiative" or "TBGI."
22 See, http://akmhcweb.org/recovery/ioniaadn.html and http://ionia.org/.
23 A brief bio can be found at http://psychrights.org/about/Gottstein.htm.
24 This is one of the reasons why I often put "treatment" in quotation marks. Another is the idea that if it
isn't voluntary it isn't treatment.
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Toxic Psychiatry is also a compelling and well documented indictment of the current system, but
I found it was when people read Mad in America that they really "got" on an almost visceral
level the scientific and moral bankruptcy of the current system and the scope of the harm being
done.
I was on the Alaska Mental Health Board at the time and sent every member of it, as well
as every member of the Trust Authority, a copy of Mad in America, exhorting them to take
action to improve the outcomes for people diagnosed with serious mental illness by providing
alternatives to medication.25 PsychRights brought Bob Whitaker, the author of Mad in America,
to Anchorage in December 2002, to give a presentation to the Alaska Mental Health Board.
While he was here, Whitaker also spoke to the Alaska Psychiatric Institute and to the state-wide
organization of community mental health centers. The Mental Health Board's reaction was
mostly positive, though with state personnel and NAMI-Alaska members on the Board tending to
be negative. However, there was general agreement people ought to have the choice to pursue a
non-medication approach. No such changes to Alaska's mental health program have occurred.
In the Spring of 2003, as chair of the Mental Health Board's Finance Committee, I
convened a Budget Summit, which produced a report which can be found at
http://akmhcweb.org/Docs/AMHB/2003BudgetSummitReport.pdf. This report was formally
adopted by the whole board in August of 2003. A couple of quotes from it are:
There were discussions of . . . whether it was clear enough from the data that the current
reliance on psychiatric medications substantially increases chronicity. These and similar
items are referred to the full Board/Planning Committee for further development and
consideration. (p.1)
The Mental Health System currently relies heavily on psychiatric medications. It is
recommended that further research on how the use of these medications impact desired
results should be conducted. (p.10)
I think it is fair to say there has been little, if any, follow-up on this, although I can't say for sure
because I am no longer on the board. Much of this can be attributed to the animosity of the
current administration to the Alaska Mental Health Board and to its attempts to enfeeble the
board by reducing its funding and attempting to combine it with the Alaska Board on Alcoholism
and Drug Abuse.26
25 The transmittal to the members of the Alaska Mental Health Board can be found at
http://psychrights.org/states/alaska/2002/MadInAmericatxtoMHBltr4Web.pdf. In March of 2003, I also
transmitted a copy of Mad in America and other materials to the Commissioner of the Alaska Department
of Health and Social Services exhorting him to address the situation. This transmittal letter can be found
at http://psychrights.org/alaska/DMHDD/3-24-03jgtogilbertson.pdf.
26 When the Administration discovered it could not do this without breaching the Trust Settlement, it
accomplished much the same thing by forcing the Alaska Mental Health Board and the Alaska Board on
Alcoholism and Drug Abuse to share staff and hold joint meetings and by refusing to appoint the person
they selected as their joint Executive Director.
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To date, neither the Department nor the Trust Authority have taken any action to allow
people to choose a non-medication approach,27 and the four non-profit effort is designed to work
within existing mechanisms to achieve this critical change.
VI. SPECIFIC EFFORTS: STATUS & PROSPECTS
A. Acute Care: Soteria-Alaska
Dr. Loren Mosher's Soteria-House project and study in the 1970's proved that people who
are in acute psychiatric crisis, who would normally be hospitalized, can be at least as
successfully treated and have better long term outcomes (lives) if they are allowed to get through
their initial psychotic episode(s).28 The Michigan State Psychotherapy study proves the same
thing.29 The Michigan study also shows that in the short term there are significant cost savings
and the long-term cost savings are enormous.30
Soteria-Alaska, Inc. was incorporated in January of 2003 as a vehicle to create a Soterialike
program in Alaska.31 Shortly thereafter, Jerry Jenkins came to Alaska to be the Executive
Director of Anchorage Community Mental Health Services (ACMHS), the largest community
mental health center in the state, and he was (and continues to be) very supportive of people
being given non-medication choices. The decision was made that it would be easier to try and
develop a Soteria-like program through ACMHS, and therefore Soteria-Alaska, Inc., as a
separate entity trying to do so was put on hold. However, as the 15 month deadline approached
27 While the Mental Health Board is charged with promulgating a mental health plan and making
recommendations to the Trust, it has no operational authority and it controls no funding. In contrast, both
the Department and the Trust Authority have the ability to implement a program that would allow a nonmedication
choice.
28 See, “Soteria and Other Alternatives to Acute Psychiatric Hospitalization, A Personal and Professional
Review,” by Loren R. Mosher, M.D., The Journal of Nervous and Mental Disease, 187:142-149, 1999,
which can be found at http://psychrights.org/Research/Digest/Effective/soteria.pdf and the other studies
located at http://psychrights.org/Research/Digest/Effective/effective.htm. In addition, Dr. Mosher's book,
Soteria: Through Madness to Deliverance (published posthumously) is an incredibly good book about
Soteria and gives one the feeling of what Soteria House was like.
29 See, The Michigan State Psychotherapy Project, by Bertrom P. Karon and Gary R. VandenBos, which
can be found at http://psychrights.org/Research/Digest/Effective/MIPsychProj.pdf. Also, see,
Psychotherapy of Schizophrenia: The Treatment of Choice (Jason Aronson, 1996), by Bertram P. Karon
and Gary R. Vandenbos, which has the most complete description of the Michigan study.
30 One of the things that happens is that people who get caught by the system are channeled onto
SSI/SSDI/Medicaid as a way to get them basic living funds and medical insurance. However, as the
Budget Summit Report points out, "the Medicaid/SSDI/SSI eligibility and funding mechanism is
essentially a one way ticket to permanent disability and poverty."
http://akmhcweb.org/Docs/AMHB/2003BudgetSummitReport.pdf, page 8. This approach is part and
parcel of the erroneous view that people don't recover from serious mental illness, especially a diagnosis
of schizophrenia. This means droves of people unnecessarily become permanent financial burdens on the
government.
31 Soteria-Alaska was not envisioned as necessarily being a Consumer run program, which is in contrast
to CHOICES, Inc., described below.
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for filing for tax exempt status approached with no concrete progress towards ACMHS
establishing a Soteria-like program, Soteria-Alaska filed its application for tax-exempt status in
the spring of 2004 in order to be in a position to move forward, itself.32
In the summer of 2004, there was an indication of interest in Soteria-Alaska from at least
one member of the Trust Authority, and it was suggested a proposal should be put together for
presentation to the Alaska Mental Health Board for its recommendation. The Consumers
Consortium had a modest amount of funding available for planning and an agreement was made
with Dr. Aron Wolf for assistance in preparing such a proposal.33 A proposal was prepared and
submitted to the Alaska Mental Health Board, which recommended it for funding to the Trust.34
The prospect of a Soteria-Alaska has generated a lot of interest and support from outside Alaska.
For example, psychiatrists Ann- Louise Silver,35 Peter Stastny,36 Dan Dorman,37 Luc Ciompi,38
Nathaniel Lehrman,39 and Grace Jackson,40 all of whom have experience in treating people
without drugs have indicated a willingness to help. Non-psychiatrists who have also indicated a
32 Probably the biggest concern with ACMHS implementing a Soteria-like program is whether it would
remain faithful to Soteria precepts. As a traditional community mental health center, it has historically
been very oriented toward requiring its clients to take medication, which is its corporate culture.
33 Dr. Wolf has been Ionia's psychiatrist for many years, has been practicing psychiatry in Alaska since
1967, was the Regional Medical Director of Providence Health System, and holds a Masters of Medical
Management Degree, which is the equivalent of a Masters of Business Administration for medical
management. Especially exciting from our perspective is Dr. Wolf had experience at Chestnut Lodge in
Maryland, which pioneered psychotherapeutic treatment of people diagnosed with serious mental illness.
Dr. Wolf's CV can be found at http://choices-ak.org/grants/05TBGIOperating/AWolfCV.pdf.
34 A copy of the proposal can be found at http://soteria-alaska.com/Soteria-Alaskawapdx.pdf. The initial
business plan can be found at http://soteria-alaska.com/grants/05TBGI/SoteriaInitialBizPlan.pdf
35 Dr. Silver practiced at Chestnut Lodge when it did not use medications and has written a number of
articles about treating people with psychosis without drugs. For example, she has reported that when she
first worked at Chestnut Lodge, her schizophrenic patients were not medicated. Later, all of her patients
were medicated as a matter of policy. In the premedication days, she had patients who got romantically
involved, got married, had children, and related to their spouses and children. None of her medicated
patients ever formed a new relationship. See, http://psychrights.org/Articles/KaronMedication.htm.
36 Dr. Stastny is a driving force behind the international effort to create more programs like Soteria-House
through an organization known as International Network of Treatment Alternatives for Recovery
(INTAR). See, http://www.intar.org/.
37 Dr. Dorman has treated people diagnosed with serious mental illness without drugs for many years and
is the author of the fantastic book, Dante's Cure. Dante's Cure is a compelling, true account of a young
woman's descent into psychosis and then, through hard work, understanding and most importantly, having
a psychiatrist willing to spend the time and have a true caring relationship, her journey back from
madness into full recovery.
38 Dr. Ciompi has run Soteria-Berne in Switzerland for a long time.
39 Dr. Lehrman is the former Clinical Director, Kingsboro Psychiatric Center, Brooklyn, NY and has
published extensively on successful non-medication treatment. See, e.g., The Rational Organization of
Care for Disabling Psychosis -"If I Were Commissioner," which can be accessed at
http://akmhcweb.org/articles/iflehrmancommissioner.htm. Dr. Lehrman identifies having the same
person involved in both the community and acute settings as being extremely important.
40 Dr. Jackson was described by Dr. Mosher as the most knowledgeable person he knew of about the
actual effects of psychiatric drugs. Her book definitive book on the topic, Rethinking Psychiatric Drugs:
A Guide to Informed Consent has just been published.
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willingness to help include Alma Menn, the administrator of the original Soteria-House project,
John Bola, who collaborated with Dr. Mosher in a number of studies and papers and Judy
Schreiber, Dr. Mosher's widow. In addition to myself, Eliza Eller of Ionia and Michele Turner
currently comprise Soteria-Alaska's board of directors.
In September 2004, however, the Trust Authority declined to fund the proposal. The
stated reason was the proposal needed more work. My view is it suffered from being seen as a
late arriving proposal after available funding had already essentially been allocated elsewhere.
Members of the Trust Authority did express support for Soteria-Alaska, suggesting it should
apply for TBGI (Consumer run) funding even though Soteria-Alaska was not necessarily
envisioned as a Consumer run program.41
However, when the TBGI Request for Proposals came out, there was insufficient funding
available to get Soteria-Alaska off the ground. There was up to $15,000 in planning money
available, which was applied for42 as well as $150,000 in capital funding to get a start on
acquiring a facility.43 The planning grant was not funded; no decision has been made yet on the
capital grant application.
The Trust Authority does have what it calls its "Small Projects" grant program, which
awards up to $10,000 for projects of direct benefit to its beneficiaries. The next grant application
deadline is October 1, 2005, and it is anticipated Soteria-Alaska will apply for $10,000 to
continue its planning. Of course, we need to get beyond planning and on to helping people.
41 It does, however, currently qualify as a Consumer run program because a majority of its board of
directors are Consumers.
42 See, http://soteria-alaska.com/grants/05TBGI/SoteriaOperating.htm for this operating grant application.
43 See, http://soteria-alaska.com/grants/05TBGI/SoteriaCapital.htm for this capital grant application.
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B. Community Based Services: CHOICES, Inc.
CHOICES, Inc., which stands for Consumers Having Ownership In Creating Effective
Services (hereafter referred to as CHOICES), was formed at the same time as Soteria-Alaska to
provide an alternative to the drug-only treatment modality in the community. It has been
envisioned as a Consumer run program. On its website, CHOICES describes its program as
follows:44
C onsumers
Having
Ownership
I N
C reating
E ffective
S ervices
CHOICES, Inc., was formed to provide alternatives in the community to the current
medication dominated mental health system. Tax exempt status was received on
March 15, 2005, and CHOICES is now able begin operations.
CHOICES is what is known as a Consumer Run program, where "consumer" means
someone who has been labeled with a serious mental illness and is a past or present
recipient of mental health services. More specifically, Article III, §2, of the Bylaws
requires, "at least 2/3rds of the members of the Board of Directors shall be a past or
present recipient of mental health services of such a nature that inpatient care may have
been necessary."
The philosophy behind CHOICES is reflected in both its name and the words which
create the acronym CHOICES -- Consumers Having Ownership In Creating Effective
Services -- which is people having options of their own creation and choosing.
CHOICES anticipates three primary modes of operation. The first is to provide people
the types of services or other resources they choose to help them recover. The second
is to develop and provide, to the extent possible, the types of community mental health
services described by Loren Mosher and Lorenzo Burti in Chapter 9 of their excellent
book, Community Mental Health: A Practical Guide. The third is to be a conduit for
"pass-through" grants to other Consumer Run programs that do not have tax exempt
status or the administrative wherewithal to do so themselves.
To reiterate, there are three basic components to the CHOICES program as currently
envisioned:
(1) Helping people (and parents of younger children) get what they want.
(2) Providing the types of services Loren Mosher describes in Chapter 9 of his and
Lorenzo Burti's excellent book, Community Mental Health: A Practical Guide,
which can be found at http://choices-ak.org/grants/05TBGIOperating/Ch9.pdf (9
Megabytes).
(3) Being a conduit for pass-through grants for consumer run programs that have not
obtained 501(c)(3) status.
It is not envisioned that Soteria-Alaska would provide community services, but there are
scenarios where CHOICES could/would run a Soteria-like program. In other words, if
44 See, http://choices-ak.org/.
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CHOICES is able to commence operations and moves to a position to accomplish it, it could
establish a Soteria-like program as part of its programming. As mentioned above, this would
have the major advantage of more easily allowing people to retain the support people they have
come to trust, even when they move between acute and non-acute situations.45
Key people include Dr. Aron Wolf, George Stone and Andrea Schmook. Dr. Wolf's
experience has been described above and he has agreed to act as medical director until someone
else can be found. George Stone is a Licensed Marriage and Family Therapist with fabulous
skills in solving problems involving children and keeping them in their homes.46 Andrea
Schmook has tremendous, successful experience with consumer run programs and is currently
working on ACMHS' consumer driven section.47 Mr. Jenkins and she have agreed that Ms.
Schmook could serve as CHOICES' initial executive director on a part-time basis. In addition to
myself, Eliza Eller of Ionia and Michele Turner currently comprise CHOICES' board of
directors.
CHOICES is designed to access current financing mechanisms, such as Medicaid, which
would make it self-sustaining. In order to obtain start-up working capital, CHOICES applied for
$150,000 in TBGI funding for FY 06 (July 1, 2005, to June 30, 2006) and $75,000 in FY 07, at
which point it was projected to be self-sustaining.48 A companion capital grant in the amount of
$25,000 for computers, furniture, phones, etc., was also submitted.49 CHOICES' application
score tied with that of NAMI-Alaska's, at the point where the allocated funding ran out.
However, NAMI-Alaska was funded rather than CHOICES because NAMI-Alaska had existing
funding.
It has been suggested, however, that the Trust might be willing to fund CHOICES under
its "Partnership" program where it will participate if another funder(s) does. Preliminary inquiry
has been made to the Rasmuson Foundation to pursue this. In any event, I plan to urge the Trust
at its September, 2005, meeting to make funding alternatives such as CHOICES and Soteria-
Alaska a major initiative of the Trust. My view is it has a fiduciary duty to its beneficiaries to
attempt to redirect mental health services into the much more helpful approaches outlined in this
Report, in which a CHOICES type program is central.50
45 It should be pointed out here, however, that the goal and expectation is that people will recover and
come to rely on the mental health system much less, if at all.
46 Mr. Stone's bio can be found at http://choices-ak.org/grants/05TBGIOperating/GStoneBio.pdf and his
CV at http://choices-ak.org/grants/05TBGIOperating/Gscv.pdf.
47 Ms. Schmook's resume can be found at http://choicesak.
org/grants/05TBGIOperating/ASchmookResume-9-24-04.pdf.
48 This grant application can be found at http://choicesak.
org/grants/05TBGIOperating/CHOICESOperating.htm.
49 This grant application can be found at http://choicesak.
org/grants/05TBGIOperating/CHOICESCapital.htm.
50 The Trust did eventually nominally provide some funding for two of the Consortium's 2002 proposals,
Independent Case Management (http://akmhcweb.org/Announcements/2002rfr/casemanagement.pdf) and
Flexible Support Services (http://akmhcweb.org/Announcements/2002rfr/flexible.pdf) last year.
However, the Department was administering the grant funds and the RFP was not faithful to the original
purpose. This was pointed out, but nothing was done about it. Most recently, in connection with the
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CHOICES has also facilitated four "pass-through" grant applications, two of which have
been approved for funding. The two approved for funding are Recovery Center of Alaska's
(RECA) request to start providing WRAP (Wellness Recovery Action Plan) training,51 and the
Consumers Consortium grant to fund their meetings and Meta Services training for peer
specialists.52 The two pass-through grant applications that did not get funding were RECA's
Small Project Grant application to train WRAP trainers and MHAAK's operating application.
C. Housing: Peer Properties
Peer Properties, Inc., was formed by myself and Katsumi Kenaston to provide housing
for people diagnosed or diagnosable with serious mental illness and homeless, at risk of
homelessness or in a bad living situation. Peer Properties does not provide services, but operates
on the peer support principle. The peer support principle is relationships based upon shared
experiences and values, and characterized by reciprocity, mutuality, and mutual acceptance and
respect. The helper’s principle, a corollary of the peer principle, is that working for the recovery
of others facilitates personal recovery.
It has long been recognized that being homeless or in a bad living situation contributes to
psychiatric symptoms and prevents recovery.53 It has more recently been recognized that linking
housing to services can be counterproductive. There is a rather pervasive policy of community
mental health centers requiring "compliance" with medication and/or utilizing certain services as
a condition to receiving and/or being allowed to remain in housing. Peer Properties neither
encourages nor discourages the use of psychiatric medications; instead, it supports its tenants'
choices in the matter.
In 2004, Peer Properties received a capital grant of approximately $190,000 from the
Trust, which combined with a $25,000 grant from the Rasmuson Foundation enabled the
purchase of a four bedroom house.54 After some initial difficulties, four women now share the
house and it is operating very well, although finances are very tight.
In 2004, Peer Properties was also awarded a pre-development grant to apply for a Special
Needs Housing Grant (SNHG). Peer Properties teamed up with a very sophisticated and
experienced developer, the Venture Development Group, and submitted an application under the
SNHG program as well as for Low Income Housing Tax Credits. Peer Properties was awarded
both a SNHG Grant and tax credits to build an 11 unit apartment building, including one for a
resident manager (called "Peer One"), aimed at housing people who repeatedly cycle through the
Alaska Department of Corrections and the Alaska Psychiatric Institute (API).
TBGI process, the Trust is funding technical assistance for consumer run programs, which the
Consortium also proposed in 2002. See, http://akmhcweb.org/Announcements/2002rfr/clubhouses.pdf.
51 See, http://copelandcenter.com/whatiswrap.html.
52 Meta Services in Phoenix, Arizona has done some exciting work and achieved fabulous results with its
peer specialist employment project to the point where half of its employees are peers. See,
http://metaservices.com/. They are now providing training in other locations.
53 In the Myers case described below, Dr. Mosher testified (by affidavit), that "Without adequate housing,
mental health 'treatment' is mostly a waste of time and money." See,
http://psychrights.org/States/Alaska/CaseOne/30-Day/ExhibitRLRMosherAff.htm, emphasis in original.
54 See, http://peerproperties.org/Properties/outside.jpg
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Peer Properties is currently operated entirely by volunteers: co-founder Katsumi
Kenaston and its board of directors, Andrea Schmook,55 Mel Henry,56 Barry Creighton and
myself. It was always assumed paid staff was going to be necessary if the SNHG grant was
awarded,57 but as we have gotten further into the project, it has become apparent there is
nowhere near enough money from rent to cover the necessary infrastructure costs.58 Operating a
tax credit project is very complicated, with extreme penalties for any deviation from strict
compliance. The tax credit investor Peer Properties is talking with is requiring a co-general
partner and an Executive Director.
Having recognized the insufficiency of operating revenue to fund necessary aspects of the
Peer One project, Peer Properties applied for $150,000 in TBGI funds for both FY 2006 and
07.59 The grant was not awarded. Peer Properties also applied for $150,000 in capital funding as
a start on acquiring another property and we understand this was unsuccessful as well.60 The
operating grant is really quite crucial to the success of the Peer One project. Peer Properties is
attempting to find other ways to complete and operate the Peer One project, and there are
reasonable prospects for this to happen. However, even if Peer Properties is able to get the Peer
One project built and commence operations, without sufficient operating funds, it is extremely
risky and failure could bring down Peer Properties altogether. This would certainly be a black
eye for Peer Properties and also a blow to Consumer run programs in Alaska, generally.
D. Legal: Law Project for Psychiatric Rights (PsychRights)61
PsychRights is a non-profit, tax exempt, 501(c)(3), public interest law firm whose
mission is to bring fairness and reason into the administration of legal aspects of the mental
health system, particularly unwarranted court ordered psychiatric drugging. Its purpose is to
promote and implement a legal campaign in support of psychiatric rights and against
unwarranted court ordered psychiatric medication akin to what Thurgood Marshall and the
NAACP mounted in the 40's and 50's on behalf of African American civil rights. When one has
a situation such as exists now in the mental illness system where entrenched and well-financed
interests support an illegal system, litigation may very well be the only path to reform.
In addition to myself, Don Roberts and Chris Cyphers serve on its board of directors.62 I
donate all my services pro bono publico.
55 Ms. Schmook's resume can be found at http://choicesak.
org/grants/05TBGIOperating/ASchmookResume-9-24-04.pdf.
56 Dr. Henry's Resume can be found at http://peerproperties.org/grants/O5TBGI/MHenryResume.pdf.
57 This was reinforced in January, 2005, at an invitation-only seminar co-sponsored by the Trust Authority
and the Rasmuson Foundation regarding the reality of managing a capital project.
58 This could be substantially alleviated if the Peer One project were to receive project based Housing and
Urban Development "Section 8" rental subsidies.
59 This grant application can be found at
http://peerproperties.org/grants/O5TBGI/PeerPropertiesOperating.htm.
60 This grant application can be found at
http://peerproperties.org/grants/O5TBGI/PeerPropertiesCapital.htm.
61 Since this Report is about Alaska efforts, PsychRights' efforts in other states is not covered.
62 Bios of the board of directors and other key personnel can be found at http://psychrights.org/about.htm.
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(1) Development
Prior to reading Mad in America, while I had a general sense of what was happening with
Forced Drugging, I didn't feel I had anything in particular to contribute. In addition to Mad in
America being a great book, to me it was a litigation roadmap for marshalling the scientific
evidence against Forced Drugging. It turned out the NARPA conference that November, 2002,
included as keynote speakers: (1) Bob Whitaker, the author of Mad in America, (2) Loren
Mosher, M.D., of Soteria House fame, and (3) Professor Michael Perlin, the author of "the"
treatise on mental health disability law and over 150 legal articles on the subject.
I wrote the articles Unwarranted Court Ordered Medication: A Call to Action,63 and
Psychiatry: Force of Law,64 attended the November 2002, NARPA conference and arranged for
an off-agenda presentation.65 There I met Mr. Whitaker, Dr. Mosher and Michael Perlin.
Mentioned above is bringing Bob Whitaker to Alaska in December, 2002. I also asked him to
send me all of the articles cited in Mad in America. These articles were scanned and posted on
the Internet to make them more accessible and particularly so other attorneys could download
them and attach them as exhibits when fighting Forced Drugging cases.66
(2) Finances
PsychRights has a general policy against taking government funding because it is felt one
can not seriously challenge what the government is doing with its money. This has certainly
proven to be true with respect to other government funded attorneys in the arena. However,
because of the unique nature of the Trust Authority, $5,000 in funding has been accepted from it
to help present a seminar on Mental Health Disability Law in September of 2003 by Professor
Perlin and Robert Whitaker67 and a $10,000 Small Project grant for representation expenses,
such as filing fees, deposition costs, expert witness fees, etc. Otherwise, PsychRights is entirely
sustained by private donations.68 PsychRights submitted a TBGI systems change grant
application to fund one attorney and assistant, which was not awarded.69
(3) The Role of Litigation for System Change
Litigation as a means for changing systems is a proven strategy. The civil rights
litigation by Thurgood Marshall and the NAACP in the 1950's and '60's overturning segregation
is a classic example. In Alaska, in addition to the Mental Health Trust Lands litigation, we have
had the Molly Hootch case for rural education and the Cleary case for prison administration. In
situations such as currently exists with our mental illness system, where governmental policies
63 http://psychrights.org/calltoaction.htm.
64 http://psychrights.org/force_of_law.htm.
65 PsychRights provided a number of free copies of Mad in America to people who could not afford to
purchase it, which helped with attendance.
66 http://psychrights.org/Research/Digest/Chronicity/NeurolepticResearch.htm
67 See, http://psychrights.org/Education/ak03CLE/Brochure.htm.
68 Regular financial statements may be found at http://psychrights.org/about.htm#financial.
69 The operating grant application can be found at
http://psychrights.org/grants/05tbgi/PsychRightsOperating.htm and the companion capital grant
application at http://psychrights.org/grants/05tbgi/PsychRightsCapital.htm.
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are supported by large economic interests, litigation is often the most effective and quite possibly
the only way to eliminate the abuses. It is certainly true here that almost three years of efforts to
persuade policymakers to redress the situation have failed to result in any meaningful (i.e.,
financial) support.
The Introduction mentions that Forced "Treatment" proceedings are essentially a sham. This is
well known to those involved. Psychiatrists, with the full understanding and tacit permission of
the trial judges, regularly lie in court70 to obtain involuntary commitment and forced medication
orders:
[C]ourts accept . . . testimonial dishonesty, . . . specifically where witnesses,
especially expert witnesses, show a "high propensity to purposely distort their
testimony in order to achieve desired ends." . . .
Experts frequently . . . and openly subvert statutory and case law criteria that
impose rigorous behavioral standards as predicates for commitment . . .
This combination . . . helps define a system in which (1) dishonest testimony is
often regularly (and unthinkingly) accepted; (2) statutory and case law standards
are frequently subverted; and (3) insurmountable barriers are raised to insure that
the allegedly "therapeutically correct" social end is met . . .. In short, the mental
disability law system often deprives individuals of liberty disingenuously and
upon bases that have no relationship to case law or to statutes.71
The psychiatric profession explicitly acknowledges psychiatrists regularly lie to the courts in
order to obtain forced treatment orders. E. Fuller Torrey, M.D., one of the most outspoken
proponents of involuntary psychiatric "treatment" says:
It would probably be difficult to find any American Psychiatrist working with the
mentally ill who has not, at a minimum, exaggerated the dangerousness of a
mentally ill person's behavior to obtain a judicial order for commitment.72
Dr. Torrey goes on to say this lying to the courts is a good thing. Dr. Torrey also quotes
psychiatrist Paul Applebaum as saying when "confronted with psychotic persons who might well
benefit from treatment, and who would certainly suffer without it, mental health professionals
and judges alike were reluctant to comply with the law," noting that in "'the dominance of the
commonsense model,' the laws are sometimes simply disregarded."73
70 This is perjury, a crime.
71 "The ADA and Persons with Mental Disabilities: Can Sanist Attitudes Be Undone?" by Michael L.
Perlin, Journal of Law and Health, 1993/1994, 8 JLHEALTH 15, 33-34
72 Torrey, E. Fuller. 1997. Out of the Shadows: Confronting America's Mental Illness Crisis. New York:
John Wiley and Sons. 152.
73 In other words, "we can't let people's rights get in the way of us doing to them what we know is good
for them."
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It is also well known that:
Traditionally, lawyers assigned to represent state hospital patients have failed miserably
in their mission.74
The sham nature of Forced "Treatment" proceedings, supported by the meretricious and
overwhelming financial juggernaut of the pharmaceutical industry, has resulted in Forced
Drugging being by far the "path of least resistance."75 In the Myers case described below, Dr.
Loren Mosher testified by affidavit that as a therapeutic principle, "Involuntary treatment should
be difficult to implement and used only in the direst of circumstances".76 PsychRights’ goal is to
accomplish this therapeutic goal by making Forced "Treatment" more trouble than the more
helpful alternatives that are currently eschewed. In that way, PsychRights hopes to create an
environment in which these more helpful, more humane alternatives can flourish.
Of course, to the extent the system recognizes people have the right to decline
medication77 and provides the choices to which they are entitled before they can legally be
forced to take these drugs, litigation would/will not be necessary. In the absence of this,
however, there has been some litigation already undertaken and other contemplated.
(4) Undertaken Litigation
(a) Myers -- Forced Drugging
The first case, Myers, now waiting for decision from the Alaska Supreme Court, directly
challenges Forced Drugging as currently practiced.78 There, the trial court, after receiving
testimony from Dr. Loren Mosher and Grace Jackson, as well as the State's psychiatrists, found
as a factual matter:
[T]here is a real and viable debate among qualified experts in the psychiatric community
regarding whether the standard of care for treating schizophrenic patients should be the
administration of anti-psychotic medication
74 Competency, Deinstitutionalization, and Homelessness: A Story of Marginalization, Michael L. Perlin,
Houston Law Review, 28 Hous. L. Rev. 63 (1991).
75 While court ordered involuntary psychiatric drugging is the most dramatic, coercion to take these
harmful drugs is pervasive. As mentioned before, people are told they will not get or will lose their
housing if they don't "comply." Other services will be denied. People will be "violated" on parole (i.e.,
sent back to prison to complete their sentences) if they do not comply. Children are taken away from
their parents if they are not given drugs. Children are taken away from parents if the parent(s) don't take
the drugs and then they are taken away because the parent takes the drugs and becomes too mentally ill.
And, of course, all of the current financing systems are primarily for medications.
76 See, http://psychrights.org/States/Alaska/CaseOne/30-Day/ExhibitRLRMosherAff.htm.
77 One normally sees this phrased as the right to "refuse" medication, but I find that a misleading and
pejorative term that assumes exercising the right is a bad thing. People have the right to decline a
medication recommendation and it should be phrased that way, in my view.
78 See, http://psychrights.org/States/Alaska/CaseOne.htm for more information on this case, including the
briefs and transcripts of some of the hearings. A video of the oral argument before the Alaska Supreme
Court is also available upon request.
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and
[T]here is a viable debate in the psychiatric community regarding whether administration
of this type of medication might actually cause damage to her or ultimately worsen her
condition
yet ordered involuntary drugging because the relevant statute only requires a finding of
incompetence to decline the medication.79 We argue the Alaska and US constitutions require at
least that there must be a finding the medication is in the person's best interest. More
importantly for changing the system, we also argue involuntary medication can only be
constitutionally administered if no less restrictive alternative could be offered. The state's
failure to fund such an alternative is not a legal excuse. There is a lot of legal support for this
position and we are hopeful the Alaska Supreme Court will rule in our favor. The point here is
this legal effort, if successful, can be an important element in the creation of alternatives by not
allowing people to be locked up and Force Drugged as easily as they are now. However, in order
to accomplish that, people need at least a reasonable level of legal representation.
(b) Wetherhorn -- Ineffective Assistance of Counsel
Started just a couple of months ago, the Wetherhorn appeal is primarily about ineffective
assistance of counsel, although there are a few other issues in the case.80 If people actually had
vigorous representation, only a small fraction of those currently subjected to Forced "Treatment"
would be “treated.” We are hoping to establish some minimum standards for the performance of
counsel, and also that people are entitled to have an "expert witness" paid for, because without an
"expert witness" to counter the state's "expert witness" (the psychiatrist), it is not a fair process.
Even if we win on the issue that the constitution requires a best interests finding and no less
restrictive alternative, without adequate representation and an expert witness, the hospital
psychiatrist will just meretriciously testify it is in the person's best interest and there is no less
restrictive alternative and that will be that. Other issues include the legally insufficient nature of
the proceedings.
(c) Bavilla -- Forced Drugging in Prison
In the Bavilla case, which challenges the procedures for Forced Drugging in prison, the
Alaska Department of Corrections admitted to facts constituting violations of the United States
Constitution.81 However, the trial court dismissed the case on sovereign immunity grounds,
meaning we should have sued the Commissioner of the Department of Corrections, rather than
the state. It is very unclear the judge was correct about this, but we had successfully prevented
Ms. Bavilla's Forced Drugging up to that point, the prison was putting intense pressure on her in
its attempt to "break" her, and Ms. Bavilla declined to file an appeal or recommence the case.
However, at an opportune time when we have the resources and a client, we have the admissions
of the State regarding their illegal procedures and can commence a new case challenging Forced
Drugging in prison here.
79 See, http://psychrights.org/States/Alaska/CaseOne/30-Day/Order.pdf, pages 8 and 13.
80 More information on this case can be found at http://psychrights.org/States/Alaska/CaseFour.htm.
81 More information on this case can be found at http://psychrights.org/States/Alaska/CaseThree.htm.
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(5) Prospective Litigation
We also have a number of prospective issues identified for system changing litigation.
(a) Kids in Custody/Out of State Placements
The state takes custody of a large number of children, and is paying for over 400 in out of
state facilities.82 Based on what is happening in other states, one can assume well over half are
being subjected to psychiatric drugging. Polypharmacy, which has never been approved, is
rampant with kids as well as adults and most of the drugs have never been approved for pediatric
use. We know these drugs create structural changes in the brain,83 but no one has any idea what
these drugs are doing to the developing brains of our children. Whenever children are given
drugs they are being Force Drugged because they have no choice. It is especially egregious that
those responsible for the well-being of children are blaming the children and subjecting them to
the horrors of psychiatric drugging. When the resources are available to litigate, an appropriate
case to challenge child in custody drugging practices may present itself. For example, is it legal
for the state to drug kids in its custody with drugs that are not approved for pediatric use?
(b) In-State Residential Treatment Centers
In addition to kids who are in out of state residential treatment centers, many children are
drugged on inpatient units or other residential settings in Alaska. North Star here in Anchorage
is notorious for heavily drugging kids and engaging in polypharmacy. An appropriate case to
challenge such practices when the resources are available to do so may present itself at any time.
For example, is it child abuse to medicate kids with drugs that are not approved for pediatric use
in the way it is now done?
(c) Elder Drugging Abuses
It has become increasingly common around the country for the elderly to be so medicated
they can't get out of bed. It is not unlikely that this occurs in Alaska also and an appropriate case
may present itself when resources are available.
(d) Informed Consent
A choice to take psychiatric drugs is truly voluntary only if people are told the truth about
the drugs. This is called informed consent. The truth, however, is uniformly withheld, which
constitutes a lack of informed consent. Alaska has a relatively explicit statute on informed
82 See, http://www.mhtrust.org/documents/BringtheKidsHome.pdf. The Trust has instituted a "Bring the
Kids Home" initiative, but if that just means locking them up and drugging them in Alaska, rather than
somewhere else, it is not a real solution.
83 In fact most of the neuroimaging used by proponents of the drugs for the proposition that people with
mental illness have brain differences really show the effects of the drugs. See, e.g., Broken Brains or
Flawed Studies? A Critical Review of ADHD Neuroimaging Research, by Jonathon Leo and David
Cohen, The Journal of Mind and Behavior, Winter 2003, Volume 24, Number 1, pp 29-56, which can be
accessed at http://psychrights.org/Research/Digest/NLPs/criticalreviewofadhd.pdf.
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consent in an inpatient setting.84 We have had a complaint against API drafted for over a year
now waiting for a suitable plaintiff.85
(6) 42 USC 1983 Civil Rights Action(s)
Under the federal law, 42 USC §1983, it is illegal for anyone "acting under color of law"
to deprive someone of their legal rights.86 This law grants the right to injunctions and damages.
In other words, API and its psychiatrists are liable for the way they violate the rights of their
patients and an injunction against such violations should be available.87 To the extent these
illegal behaviors are not corrected through the other efforts outlined here, resort "Section 1983"
in federal court to seek redress will be indicated.
(7) Strategy/Attorney Recruitment
The cases described above are designed to set precedent and consequently be system
changing in that way. In addition to this, however, just having one serious representation of an
API inmate88 per week, or even per month will substantially increase demands on state resources
to involuntarily commit and Force Drug its inmates. In other words, make Forced "Treatment"
not necessarily the path of least resistance. Serious representations involve depositions of the
psychiatrist(s) and other treating personnel as well as potentially other witnesses, filing motions,
etc. I make it a practice to elect the hearing be held in a real courtroom under AS 47.30.735(b)89
and, in my view, a jury trial should be demanded under AS 47.30.745(c)90 for every 90-day
commitment petition. The trials should last at least hours, if not days, rather than the
approximately 15 minutes they do now. Objections should be made to unfavorable Probate
Master recommendations.91 Requests for emergency stays against Forced Drugging should be
made.92 Appeals should be taken when appropriate.93 In 2004, I met with the Public Defender
84 See, AS 47.30.837, which can be accessed at
http://touchngo.com/lglcntr/akstats/Statutes/Title47/Chapter30/Section837.htm.
85 See, http://psychrights.org/States/Alaska/CaseTwo/draftInformedConsentComplaint.htm.
86 This is a simplification and more information about "Section 1983" rights can be found at
http://psychrights.org/Research/Legal/1983/1983.htm.
87 Yesterday PsychRights filed a Reply re: Motion for Attorney's Fees, which detail such illegal
deprivation of rights in that case. This can be found at
http://psychrights.org/States/Alaska/CaseFour/AttysFees/attyFeeReply.pdf. It is apparent such violations
of rights are pervasive at API.
88 The American Heritage Dictionary, Fourth Edition, defines "inmate" as "A resident of a dwelling that
houses a number of occupants, especially a person confined to an institution, such as a prison or hospital."
89 See, http://www.touchngo.com/lglcntr/akstats/Statutes/Title47/Chapter30/Section735.htm.
90 See, http://www.touchngo.com/lglcntr/akstats/Statutes/Title47/Chapter30/Section745.htm.
91 Under Alaska Statutes, the State must go to the Superior Court for involuntary commitment and Forced
Drugging Orders. However, under the Alaska Court Rules, they can be assigned to a "Master" to conduct
the hearings. (See, Alaska Probate Rule 2 & 2(b)(2)(C), which can be accessed at
http://www.state.ak.us/courts/prob.htm#2. The Master, however, has limited authority, which is primarily
to make recommendations that have to be approved (or not) by a Superior Court judge. The
recommendations can be objected to (See, Probate Rule (2)(e)&(f)). It appears these recommendations
are virtually never, if ever, objected to by the Public Defenders.
92 Under Alaska Probate Rule 2(b)(3)(D), a Master's Forced Drugging order is effective prior to approval
by the Superior Court, but under Alaska Probate Rule 2(f)(2) a stay may be requested. I question whether
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and the Assistant Public Defenders who normally handle these cases. I gave them copies of Mad
in America and informed them what I thought it took to adequately represent psychiatric
defendants. It does not appear anything changed and when the opportunity arose, PsychRights
appealed an involuntary commitment and Forced Drugging Order to try and obtain more than
sham representation.94
I think it is fair to say the all-out, four month legal battle that was the Myers case at the
trial court95 has had at least a minor impact. I have gotten people out or stopped Forced
Drugging with a phone call or an e-mail in a few situations since then by suggesting the person
did not meet the legal criteria in a way that let the hospital know I would be getting involved in
the case if they proceeded. If even a relatively small number of cases were vigorously defended,
it could go a long way toward changing the "path of least resistance" to support choice.
There is, of course, a limit to what I can do by myself. If PsychRights' TBGI grant
application to fund an attorney position, mentioned above,96 had been approved, this could have
been undertaken.97
(a) Alaska Pro Bono Program
The Alaska Bar Association has a program to recruit pro bono attorneys to represent
indigent people or people who otherwise can not afford legal representation. We have
established contact with the Alaska Pro Bono Program and are working with it to try to recruit
attorneys.
(b) Private Bar
In my view, psychiatrists and organizations who are harming people through their
prescribing practices, including not telling the truth about the drugs, should be held accountable
for such harm. The Internal Revenue Service does not consider damages cases (suing for
money) to be a "charitable activity" appropriate for PsychRights and has indicated if I took such
cases in my own law practice they would consider that I was using PsychRights' tax exempt
status to further my own financial interests. In essence, I am prohibited from representing people
in such cases. However, I can encourage and even assist other members of the private bar to do
so. A member of the Alaska Academy of Trial Lawyers has been contacted about making a
presentation to them regarding such opportunities.
it is proper to make a Forced Drugging recommendation effective without a proper Superior Court order
and this is a possible subject of appeal.
93 An example of the lack of representation provided by the Public Defenders office is they have never
appealed any involuntary commitment or Forced Drugging order.
94 See, http://psychrights.org/States/Alaska/CaseFour.htm.
95 See, http://psychrights.org/States/Alaska/CaseOne.htm.
96 The grant application can be found at http://psychrights.org/grants/05tbgi/PsychRightsOperating.htm.
97 It is unsurprising, of course, that funding was not provided by the Trust, which is a State agency, to
seriously challenge what the State is doing. In my view, of course, the Trust should support its
Beneficiaries' rights being honored, and it has in the past made a modest grant to pay for representation
costs (as opposed to legal services).
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(c) Attorney’s Fees.
In the Wetherhorn case, which is an involuntary commitment and Forced Drugging case,
we are asking for enhanced or full attorney's fees to try and establish that as a precedent as a way
to discourage API's illegal practices and encourage other attorneys to take these cases.98
(8) Educational Programs
Part of PsychRights' program is to provide information and education to attorneys, mental
health system personnel, and the public.
(a) Website
PsychRights' website is very deep with information, including posting full articles and
studies for use by attorneys and other people. Its Scientific Research by Topic99 and Articles100
web pages are particularly replete with important information from accepted sources. There are
many other sections of the website, which is hopefully organized in a user-friendly manner and
includes a section with information about various states.101
(b) Mental Health Disability Law Conference
In September of 2003, with support from the Trust Authority, PsychRights brought up
Robert Whitaker, author of Mad in America, and Professor Michael Perlin for a two day seminar
on Mental Health Disability Law.102 This seminar was well attended with a mix of mental health
providers, mental health lawyers, judges and psychiatric survivors participating.
(c) Presentation on The Courts’ Potential Role in Transforming Mental
Health Care in Alaska
In April of 2005, I gave a presentation at the annual Alaska Consumer & Family
Leadership Conference on the Courts' Potential Role in Transforming Mental Health Care, which
tracks to some degree the material presented here.
VII. FINAL THOUGHTS, ACKNOWLEDGMENTS, AND PERSONAL NOTES
This Report seems far too much "me, me, me," "I did this" and "I did that" and I fear it
doesn't adequately credit all of the other terrific people who have been tirelessly working on
these issues and projects, such as Michele Turner, Katsumi Kenaston, Andrea Schmook, Barry
and Cathy Creighton, Eliza and Ted Eller, George Stone, Dr. Aron Wolf, Mel Henry, Carl Ipock,
98 See, Reply Re: Motion for Attorney's Fees, which can be accessed at
http://psychrights.org/States/Alaska/CaseFour/AttysFees/attyFeeReply.pdf.
99 http://psychrights.org/Research/Digest/Researchbytopic.htm.
100 http://psychrights.org/Articles/articles.htm.
101 http://psychrights.org/States/States.htm.
102 See, http://psychrights.org/Education/ak03CLE/Brochure.htm.
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Kelly Behen and Scot Wheat, Don Roberts, Esther Hopkins, Jamie Dakis, Roslyn Wetherhorn,
Aleen Smith, Jerry Jenkins and Richard Rainery. I have no doubt failed to mention people that I
should have.
I hope this Report conveys the urgency of addressing the situation. The scale of harm
being done every day is enormous. Having become aware of this great harm, I am personally
unwilling to stand by and am resolved to do everything I can to reduce, or better yet, eliminate it.
Since policy makers have been totally unresponsive in any meaningful way, I don't feel I have
had any choice but to sue over illegal aspects of our mental illness system. These gross
violations of rights contribute greatly to the problem, because it is the initial involuntary
commitment and Forced Drugging that channel so many people into lifelong disability, largely
caused by the debilitating drugs they are authoritatively, but erroneously told they must take for
the rest of their lives. The failure of the system to address the problem reminds me of the
reaction of the Alaska State Legislature in the late 70's when we told them, their "redesignation"
(theft) of Mental Health Trust Lands was illegal. Their response was essentially "We don't care
if it is illegal -- sue us." We did. This situation is far more important.
Of course, litigation is not a goal, it is a means to achieve a goal -- the goal of honoring
people's right to choose a non-medication alternative to drugs that so many find debilitating,
harmful and counter-productive. Instead of litigation, it is greatly preferable to work
cooperatively towards achieving this goal. CHOICES and Soteria-Alaska are directly aimed at
achieving this goal with Peer Properties playing more of a supporting role. It is my fervent hope
we can begin taking these enormously important actions sooner rather than later. The stakes are
too high, the human toll too great, to fail to do so.
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VIII. GLOSSARY
• "ACMHS" stands for Anchorage Community Mental Health Services, also known as
Southcentral Counseling Center.
• "Alaska Mental Health Board" is "the planning and coordinating agency for the purposes of
federal and state laws relating to the mental health program of the state of Alaska. The
purpose of the board is to assist the state in ensuring an integrated comprehensive mental
health program." See, AS 47.30.661, which can be accessed at
http://www.touchngo.com/lglcntr/akstats/Statutes/Title47/Chapter30/Section661.htm. The
Alaska Mental Health Board is one of the four boards which provide funding
recommendations to the Alaska Mental Health Trust Authority. See, AS 47.30.666, which
can be accessed at
http://www.touchngo.com/lglcntr/akstats/Statutes/Title47/Chapter30/Section666.htm.
• "Alaska Mental Health Trust Authority" See "Trust Authority" below.
• "API" stands for the Alaska Psychiatric Institute, which is the sole state psychiatric
hospital.103
• "Beneficiaries" means the beneficiaries of the Mental Health Lands Trust, which include (1)
the mentally ill, (2) the mentally defective and retarded, (3) chronic alcoholics suffering from
psychoses, and (4) senile people who as a result of their senility suffer major mental
illness.104
• "Budget Summit Report" is the report by the Budget Committee of the Alaska Mental Health
Board, adopted by the full board in August of 2003. See,
http://akmhcweb.org/Docs/AMHB/2003BudgetSummitReport.pdf.
• "Consumer" means someone who is or has received mental health services, normally after
being diagnosed with a serious mental illness.
• "Consumers Consortium" is the statewide group consisting of all Consumer run programs in
the state. See, http://akmhcweb.org/Announcements/2002rfr/consortiumproposals.htm for its
initial set of proposals to the Alaska Mental Health Board.
• "Corpus" as employed herein is the principal amount of the Trust's endowment, as contrasted
to the earnings or income. The corpus is not to be spent.
103 There are, however, some "designated beds" in other hospitals and psychiatric units at other hospitals
in Anchorage, Fairbanks and Juneau.
104 See, AS 47.30.056(b)&(c), which can be accessed at
http://www.touchngo.com/lglcntr/akstats/Statutes/Title47/Chapter30/Section056.htm. See, also
http://mhtrust.org/index.cfm?section=about_trust&page=Beneficiaries.
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• "C/S/X" stands for Consumers of mental health services, Survivors of Psychiatry and eXpsychiatric
patients and refers to people who have received mental health treatment. There
has never been a consensus on what term should be used. Other terms that have been used
include "users," "recipients," "patients," and "psychiatrized." In Alaska, because of the
Mental Health Lands Trust, they are often called "beneficiaries."
• "Department" means the Alaska Department of Health and Social Services.
• "Mental Health Board." See Alaska Mental Health Board.
• " Mental Health Lands Trust Litigation" refers to the 15 year long litigation over the state of
Alaska's "redesignation" (theft) of the one million acres of land granted to it in trust for
Alaska's mental health program. http://www.touchngo.com/lglcntr/spclint/mht.htm.
• "MHAAK" stands for Mental Health Advocates of Alaska, a new member organization for
Consumers intended to have substantial statewide membership.
• "NAMI" stands for the National Association for the Mentally Ill, which touts itself as "the
Nation's Voice on Mental Illness." NAMI was founded by parents of people diagnosed with
serious mental illness, is heavily financed by the pharmaceutical industry and vigorously
pushes for more Forced Drugging.
• "NAMI-Alaska" is the statewide Alaska affiliate of NAMI. A majority of its board is
currently Consumers, which allows it to access funding for Consumer run programs. NAMIAlaska,
as most of NAMI's affiliates, does not understand the extent to which NAMI is
controlled by pharmaceutical funding nor the extent to which NAMI pushes Forced
Drugging.
• "NARPA" stands for National Association of Rights Protection and Advocacy. See,
http://www.narpa.org/.
• "Polypharmacy" is defined as the use of several drugs or medicines together in the treatment
of disease, suggesting indiscriminate, unscientific, or excessive prescription. See,
http://classes.kumc.edu/som/amed900/polypharmcay/polypharmdrug.htm.
• "Rasmuson Foundation" is the largest private foundation in Alaska and has made a number
of mental health related grants. See, http://rasmuson.org/.
• "RECA" stands for Recovery Education Center for Alaska, which was formed to teach Mary
Ellen Copeland's WRAP (Wellness Recovery Action Plan) program in Alaska. See,
http://copelandcenter.com/whatiswrap.html.
• "RFP" means Request for Proposal, which is a notice of opportunity to apply for a grant.
• "SNHG" stands for Special Needs Housing Grant, which is funded by the Trust Authority
and administered by the Alaska Housing Finance Administration.
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