Still Crazy After All These Years: Psychiatric Lock-Down Returns to the US
By Janet Phelan
Without a lot of fanfare or explanation, new psychiatric hospitals are being built in droves across the United States. Facilities are springing up in Indiana, in Delaware, in Missouri, in Dartmouth, Massachusetts, in Colorado, in Washington, and in North Carolina, to name just a few.
This reverses the trend and policy of the last seventy years, which promoted de-institutionalization and community based care.
The question is: why are these hospitals being built? What new policy is going into effect?
Seventy years ago, there were around 550,000 inpatient psychiatric hospital beds in the United States. With the movement towards community based care, these beds were reduced to roughly 40,000, country-wide. In the place of the large institutions, board and care homes and community based outpatient clinics became the norm for housing and treating those with psychiatric problems.
And if the federal government has its say, this trend will shortly reverse.
The Pendulum is Swinging Back
Some of the de-centralization of mental health care was accomplished through the passage of what is known as the “IMD exclusion.” The IMD exclusion is a part of the federal Medicaid statute and bars the use of Medicaid funds to pay for psychiatric care in a facility with more than sixteen psychiatric beds. The IMD exclusion is seen as one of the most potent factors in reducing inpatient hospitalization for psychiatric disorders.
And now, the pendulum is swinging back. The IMD exclusion faces substantial amendment in a bill which just passed the House of Representatives. HR 2646, colloquially known as the “Murphy Bill,” zinged through Congress with a nearly unanimous vote of 422-2.The author of the bill, Tim Murphy, is a Republican Congressman from Pennsylvania who is a psychologist.
The repeal of the IMD exclusion has disability rights advocates concerned. According to the Legal Action Center, “…potential risks associated with a full or partial repeal by Congress could be to encourage inpatient treatment when outpatient treatment is preferable.”
In other words, lock-downs may be coming back.
Not only does HR 2646 provide for more inpatient hospitalization. The Murphy bill will re-enable centralization in mental health planning and forced treatment and in so doing will also gut many of the legal protections for those with mental problems.
Sharon Cretsinger a former Licensed Clinical Social Worker and Director of the Kent Empowerment Center, has called the Murphy bill “a very dangerous document, whether or not it passes, because it indicates the directions of force, coercion and dehumanization” already experienced by those with psychiatric diagnoses.
As you read the following critiques of HR 2646, bear in mind this historical reality: Psychiatry is useful to the state in that dissidents can be labeled mentally ill and locked up. Untold numbers of political dissidents in the Soviet Union were diagnosed with “sluggish schizophrenia” and incarcerated in psychiatric facilities. China has recently come under fire by human rights groups for employing similar tactics against dissidents. Hitler, who drew some of his eugenics concepts from the sterilization and psychiatric incarceration movements within the United States, had the mentally disabled in Germany gassed.
Drawing On the Tools of Other Repressive Regimes
The trend in the US to psychiatrically label and incarcerate activists and dissidents can be seen in the detention of CIA asset and Iraqi War whistleblower Susan Lindauer and the attempts by prosecutors to frame a similar mental health incarceration for Beverly Hills attorney Richard Fine, anti-corruption crusader Cary-Andrew Crittenden and Ohio investigator Linda Leisure.
Fine, who had sued LA County concerning county kickbacks going to state-employed judges, found himself in an orange jumpsuit and detained in solitary confinement in LA County Jail for a year and a half on coercive contempt of court charges. Crittenden has been in jail since Christmas Day of 2015, charged with stalking police officers who in actuality appeared to be targeting him for his outspokenness on Santa Clara County corruption. When the prosecutor trotted a doctor into court to assert that Crittenden was incompetent to stand trial — a doctor who had never seen nor interviewed Crittenden — the public defender objected. A clinical interview with another specialist was arranged, who deemed Crittenden competent.
Strangely, the prosecutor, Barbara Cathcart, cannot seem to try her case against Crittenden, repeatedly pleading that she is not prepared, after her ploy to avoid trial by having him declared incompetent was derailed. The case has been plagued with attempts on the part of the prosecutor to hide public records and other such shenanigans. For awhile, it appeared that Crittenden’s right to a speedy trial would shortly “time out,” mandating his release. However, as of July 25th, the prosecutor refiled the charges against him. According to William Bennett, Crittenden’s attorney, the prosecution now has sixty days to bring him to trial or the charges will be dismissed.
Linda Leisure had worked as an investigator of “cold” murder cases in Reynoldsburg, Ohio, where she was subsequently locked up in a psychiatric hospital and threatened with permanent commitment if she did not “cooperate.” Prior to her investigative career, she had worked in prison ministry.
The Murphy bill will expand the ability of government to use psychiatry as a club, rather than as a tool for recovery. The bill will restrict advocacy for those deemed mentally ill to issues surrounding “neglect or abuse.” Advocacy will be barred for those seeking to stop psychiatric medication.
Section 105 of the bill also prohibits mental health advocacy groups receiving federal funds from lobbying Congress. According to Cretsinger,
The most frightening part of section 8, however, are (sic) the severe limitations placed on PAIMI advocates. (Protection and Advocacy for Individuals with Mental Illness) Not only are the advocates not allowed to be a part of the political process (which at one time was guaranteed to every citizen), they are not allowed to address any advocacy issues other than abuse and neglect. Further, PAIMI advocates are specifically prohibited from discussing with “individuals who lack insight into their condition” to refuse medication or act against the wishes of their caregivers. So, we have other sections of this bill loosely defining who has agency to act on their own behalf and who doesn’t. Now, we have a council that was specifically set up to address the needs and questions of individuals in treatment with its hands tied, except in cases of abuse and neglect. It is very telling that PAIMI advocates are SPECIFICALLY barred from discussing the refusal of medication, or going against the wishes of their caregivers. This shows clearly that Murphy’s bill does not (want) anyone refusing treatment, or even talking about refusing treatment.
More Programs Aimed at Lock-up
Eric Buehlmann, Deputy Executive Director for Public Policy with National Disability Rights Network, a government-funded advocacy group, has this to say about the Murphy bill: “We believe if you are going to spend billions of dollars on mental health it should be in the community.” Buehlmann states, “We did not support this bill. But how do you oppose something on an issue you have already lost?”
Buehlmann insists that the function of advocacy groups has not been entirely gutted by the Murphy bill. “We need to get them turned around. It will be extremely important for advocates to be following this money, going into institutions, making sure abuse and neglect is not going on.”
Besides re-funding inpatient beds, the Murphy bill refocuses spending on other compulsory aspects to mental health treatment. The bill extends and increases funding for “AOT”— Assisted Outpatient Treatment. AOT is defined as “court-ordered treatment (including medication) for individuals who have a history of medication noncompliance, as a condition of their remaining in the community.” It has also been termed “involuntary outpatient commitment.”
The bill also authorizes further spending for “ACT”— Assertive Community Treatment. This enables teams of mental health workers to troll the streets, looking for homeless or other individuals to “treat” in situ. It is hardly a stretch to see where ACT could quickly morph to AOT — indeed, in the much publicized case of Charlie Castle, a homeless man in Redlands, California, that is exactly what happened.
Castle, who was a much loved and well known fixture in Redlands, was approached by mental health workers while he sat reading in a public library. He was escorted to a mental health facility and subsequently put under a mental health guardianship, without ever laying eyes on a judge. The guardians subsequently moved him manically from facility to facility, attempting to obscure his whereabouts from concerned friends. In so doing, they also disallowed him from receiving the court’s finding on his writ of habeas corpus. His guardianship proceedings were top heavy with conflict of interest, including the fact that the same law firm was appointed to represent both Castle and the guardian, while the judge pro tem sitting on the case was a former lawyer with the very same firm.
Castle did not last very long under this guardianship, expiring under circumstances that could best be described as suspicious.
Attorney Jim Preis, Executive Director of Mental Health Advocacy Services, Los Angeles, asserts that: “We need to continue to respect the rights of persons with disabilities.” When asked if this is furthered by the Murphy bill, he replied, “We do not support involuntary extended inpatient treatment.”
The bill also authorizes grants for “programs for infants and children at significant risk of developing, showing early signs of, or having been diagnosed with mental illness including serious emotional disturbance.” Those eligible for these services are defined as “a child from birth to not more than 5 years of age.”
One really must let that sink in. It does appear that there is now an effort to diagnose babies and funnel them into drug treatment programs. According to the New York Times, almost 20,000 prescriptions for antipsychotic medications were written for children under two years of age in 2014. For anti-depressant medications, the figures are even higher. According to the Times, over 83,000 prescriptions were written in 2014 for this same age group for the anti-depressant drug Prozac. The IMS national health database for 2013 reports that over 8 million children were on psychiatric medications. Many psychiatric medications have not been FDA approved for young children.
Writes Cretsinger, “Any well (or even poorly) trained clinician would find the idea of diagnosing a child as young as 0 (!) as ridiculous.” She goes on to state that “…drugging children for these diagnoses is already increasing. The theme of engaging younger people in treatment is also repeated in the large amount of re-funding given to children’s recovery from trauma programs, as well as new funding for screening at-risk youth…”
Other Protections Gutted by the Murphy Bill
HR 2646 also weakens HIPAA, the law which protects a person’s mental health history from public disclosure. Section 403 of HR 2646 permits the disclosure of protected health information to a caregiver, family member or “other individual involved in the care of the patient,” without obtaining the consent of the patient. As some people receiving mental health treatment are in abusive relationships — which may have contributed to their mental state — this alteration in the standard of what can be disclosed can be seen as potentially harmful.
The bill also seeks to redefine “peer support.” The peer support movement in mental health parallels the AA paradigm, where those in recovery can offer strength and support to someone in a similar crisis. However, the mandates of the Murphy bill would move peer support into a category that is in alignment with psychiatry and the medical model and begins the process towards training and certification for peer support specialists.
According to Ken Jones, “The legislation will set back the recovery movement.” Jones, who served on the Ohio Empowerment Coalition, on the PAIMI council under Disability Rights, Ohio and on the Hamilton County Recovery Centers Board of Directors, has extensive experience in working in peer support.
Jones is dismayed at the bill’s definition of peer support.
Murphy isn’t trying to do away with peer support but is trying to change its very essence. He wants to create a national certification for peer support workers. Why? Then you have one training, one methodology. The bill therefore allows peer support but controls it. They hold the purse. They want no competition to the medical model.
And herein lies a core concern. Experts disagree as to whether psychiatric medications have any real effectiveness. Despite the push to map the human brain, much of this territory remains uncharted. In spite of this, the Murphy bill seeks to direct national mental health in a manner that will tie it irrevocably to the medical model and to the pharmaceutical companies.
HR 2646 now goes to the Senate, where it is expected to pass without dissent.
Janet Phelan is an investigative journalist whose articles have appeared in the Los Angeles Times, The San Bernardino County Sentinel, The Santa Monica Daily Press, The Long Beach Press Telegram, Oui Magazine and other regional and national publications. Janet specializes in issues pertaining to legal corruption and addresses the heated subject of adult conservatorship, revealing shocking information about the relationships between courts and shady financial consultants. She also covers issues relating to international bioweapons treaties. Her poetry has been published in Gambit, Libera, Applezaba Review, Nausea One and other magazines. Her first book, The Hitler Poems, was published in 2005. She is also the author of a tell-all book EXILE, (also available as an ebook). She currently resides abroad. You may browse through her articles (and poetry) at janetphelan.com
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