Fall

I feel Fall and am compelled to her, haphazardly, clumsily.

Beyond August into coolness, peace – a blameless place.

September brings with it cooler mornings and yellows, golds, reds and browns and the kudzu is fading down off the Pines it has strangled with vines.

October my birthday and birthday anniversaries galore and on to Halloween.

Then November. Cooler times. Less struggles and there’s only the question to storm and rain horizontally, all wetness and branches failing.

In the back of everything to me, there is a trail to walk easy green deluxe

She calls me and I go to her.

 

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Dead at 52

With all of the information and smack that’s out there about earlier morbidity and mortality with the <+25 years earlier death to you if you live with mental diversity, receive psychopharmacological and other clinically necessary psychiatric torture in an American Public Community Mental Health treatment provider, then, well, hats off to you, Friend.

The average age of death is 52 years old. Gender not withstanding. Race not withstanding. US regions not withstanding. Frontier. Rural. Urban. None of it matters. Dying an earlier death than the general population is now a given if you fit the population’s demographics.

face-1-copy45% of all people with mental illness, have 2+ physical disorders (co-morbidities).

  • Nearly half (45%) of all individuals living with any mental disorder have two or more debilitating physical disorders further lowering their quality of life and leading to a significantly high rate of comorbid physical issues.
  • Average age of death is now 52 years old for an individual living with an SPMI diagnosis.

 

A medically, clinically necessary diagnosis substantiating the use of psychotropic medication dosing is geared to control and manage exhibited DSM-5 symptomology popularized and normalized by the American Psychiatric Association, the American Medical Association, National Association of Social Work and the American Psychological Association.

Forty-six (46) years ago, in 1967, 1:3 American adults filled a prescription for a “psychoactive” medication, with total sales of such drugs reaching $692 million. In its’ June 2008 report the GAO determined that one in every sixteen young adults in the United States is now diagnosed with an SPMI (Whitaker, R., 2010).

In 2010, $16.1 billion was spent on antipsychotics in the US, to treat depression, bipolar disorder and schizophrenia. $11.6 billion was spent on antidepressants, while $7.2 billion for the treatment for ADHD.

yellow towerSuicide completion numbers worldwide today occur every 40 seconds with injury accounting for 30-40% of excess mortality, and where 60% of premature deaths in persons with a diagnosis of schizophrenia are due to medical conditions such as cardiovascular, pulmonary and infectious diseases. World Health Organization (2016). Retrieved April 11, 2016 http://www.befrienders.org/suicide-statistics.

  • Physical comorbidities are the leading reasons why people with SPMI are dying 25 years earlier than the general population not receiving Public Community Mental Health. There are higher frequencies of multiple general medical conditions that more than double the rate of premature deaths from these conditions.

Many argue that the employment of peer providers is more than a simple addition to the human service workforce, seeing it as a critical means by which to transform services into care that is recovery-focused. But it has also been argued that evidence is needed from studies examining the impact implementing a peer workforce has on access to care, cost of services, participant outcomes, and provider outcomes (Hardin, Padron, & Manderscheid, 2014).

There is also a growing recognition that poor mental health and complex physically related health problems are linked, often with deleterious outcomes for the seriously mentally ill (e.g., Brekke et al., 2012). There is an emerging notion that peer providers are a crucial link in services that are coordinated in Integrated care environments.  Peer providers have a history in stepping up to help with continuum of care in infectious diseases, vector diseases, chronic illnesses to whole health, substance use and health outreaching, educating in communities regionally and nationwide.

clouds-overhead-in-atlanta-sept-1-copy “The Modern Asylum,” Op-Ed piece by Dr. Christine Montross, a Rhode Island Butler Hospital staff psychiatrist, wrote in The New York Times (2015), “… my patients with chronic psychotic illness cycle between emergency hospitalizations and inadequate care treated by community mental health centers (receiving) twenty minutes of attention every three months. Many struggle with homelessness. Many are incarcerated.”

Montross goes so far as to state that the need for modern Asylum “… is care for vulnerable patients, the severely mentally disabled” citing “… escalating prison and court costs, inpatient hospitalizations… chaos and suffering” can best be treated in a modern warehouse for the mentally ill “citizens.”

Trending talk of reinstitutionalization, trans institutionalization and Asylum warehousing of the “infirmed” are stigmatizing and is an outright example of scapegoating man, woman, child or youth who may live with a psychiatrically label and who is persecuted because of it. This is a promulgation of Recovery. It will unduly increase numbers of involuntary inpatient, forced medication, seclusions and restraints to individuals and create a climate of perpetrated “clinically and medically necessary” psychiatric treatment which inflicts trauma. It will further normalize medical based psychiatric compliance that dismisses Recovery based oriented systems of care and its’ embrace of a strengths-based and self-directed US Peer.

I defer that current primary models for health care delivery are the medical model and the wellness model. Integrated health care delivery carves in the best practices of treating disease, improving quality of life by encouraging healthy life style choices and focuses on preventing disease before treatment is necessary. It collocates behavioral and physical integrated environments and systems of care.

 

As well, trending workforce development is a SAMHSA Center for Integrated Health Solutions (CIHS) priority. To meet the seven core strategic goals identified in SAMHSA’s Action Plan on Behavioral Health Workforce Development, the CIHS elicited the guidance of an array of experts and drew upon published literature.
Goals identified include:
Goal 1: Expand the role of consumers and their families to participate in, direct, or accept responsibility for their own care;
Goal 2: Expand the role and capacity of communities to identify local needs and promote health, and Wellness;
Goal 3: Implement systematic federal, state, and local recruitment and retention strategies; Goal 4: Increase the relevance, effectiveness, and accessibility of training and education; Goal 5: Actively foster leadership development among all segments of the workforce;
Goal 4: Enhance available infrastructure to support and coordinate workforce development effort;
Goal 5: Implement a national research and evaluation agenda on workforce development.

Mitigating rising health care costs, a fundamental shift in reimbursement is occurring. “Patients” and organizations, alike, are inherently required to transition from an episodic, fee-for-service model of reimbursement to a new model that reimburses and encourages money in the pocket wellness and care across the health service continuum.

A wellness focus on prevention and coached self-activated management of chronic conditions that our population experiences with early intervention and prevention, care experience will improve, providers will be better able to deliver quality care seeing an overall reduction in costs.

pablo

georgia in july

jen-22-copyi read poetry in the morning with coffee and jazz and make sense of my aching back, my sore back, my bad shoulder with arthritis already, and I stand straight to find that muscle memory.

I’m usually up for my days early. Body clock.

I catch up on email and work on school. I’m years into doctoral research and study and everybody and I know that it’s now or never.

Now then.

atlanta-forest-at-east-point-copy-copyIn the dark of 4 AM in Atlanta in Georgia, from my study window there is a church with a lot of bright lights on that looks to me like a white shiny beacon in the middle of a hill, a mountain. It shines brightly and I haven’t driven over to see what exactly is there yet.

Georgia in July means that you lay down poison to dissuade snakes off of your property and away from the house. Copperheads. Garter.

Kudzu grows and grows and grows and grows.

Hot. Sticky. Sweaty. A light layer of sweat just stays on me at work but I’m rather busy and physically active at work, but you’re hot and sweaty and tired by 2 PM.

Werk.

triptych 1

cause celebre

It would appear that the US Peer Leadership Team Members are being hit hard with physical deaths, disease, are experiencing loss of personal power, run the gamut of failed coalition foibles, frequently participate in peer cannibalism, lose momentum with false stop/starts, failed releases, lack of national representation… is this is our swan song (even before we fully launch)?

Genius and Madmen. Niche market? What market?

US Peer Workforce? The Certified Peer Specialist (and endorsements)?

Certified Peer Specialist, Community Health Worker Promotora, Forensic Peer Recovery Specialist, Transition Age Youth Peer Specialist, Recovery Coach, Wellness Coach, Family Peering, Vet-to-Vet, Disease and physical comorbidity Peering (Integration) + more?

We are cartographically lacking and we’re unorganized for the most part. Times are slippery and couldn’t be worse. President Trump, the WH, the people and towers of power in place, the guns aimed at us, trending budgetary and programmatic dessimation of SAMHSA/CMHS, the defunding of peer program initiatives in Rockville, the stalemating in the hallway to the SAMHSA Tsarina’s office, the New Century Bill (2017) and well, people dying “unexpectedly” and unexpectantly conspires to our realizing we must breath slowly, slower to catch up to climbing in elevation, running it pedal to metal.

Huh?

Those of us who receive US Community Public Mental Health services nationwide are still dying 25+/-> years earlier of those of you who share lived experience but can afford private mental health services.

The haves and the have nots. Certainly.

The average age of death for a service recipient of Community Public Mental Health services is now 52 y.o., gender notwithstanding. Color of skin is unvaried according to the numbers dying early deaths who apparently are long-term psychiatrically treated with psychotropics and who received clinical or medically necessary invasive psychiatric “care” for what appears to be upwards of 40 years/per life and physical death. People of color are dying in mass and we’re dying quicker than those who come from a place of White Privilege.

The rest of us fell into peer support and servicing the community while working underemployed or working probono and are paid on average $12/hour nationally. A buck less per hour if you’re a dickless wunderkind. The CPS seemed like a good idea back in Georgia back in da day with Fricks, Filson and the State of Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) Medicaid impresario(esse) who so heroically crafted the language for Peer Supports and Services to bill Medicaid for psychosocial rehabilitative and mental health rehabilitative peer support deliverables (that do vary state by state with no uniformity).

Currently <46 states in the US and 3 Territories hold space for the Certified Peer Specialist certification (and endorsements) rapidly making grounds in psychosocial rehabilitation, mental health rehabilitation and expectant Integrated environments.

I will continue to address the phenomena of Peer Cannibalism in peer supports and services. I’m referring to the whackadoodle malbehavior exhibited by particular malcontent bad seeds who claw and hiss at the national community. Typically there is enormous variation in mood, pressured speaking, emotional volatility, forgetfulness, increased ingestion of mood altering substance(s), impulsivity and a general DSM-V related descriptiveness to a tee, unfortunately, because I must unequivocally agree with the symptomatic nature of the, well, disease.

Ridiculously, the eventual and apparent rabid virus of Madmen co-exist with us.

Typically Cannibals run by the seat of their pant(s) with a gross inability to muster basic focus or practice inherent skill set to self-manage business preferring instead social media dessimation blurring fact/madness supporting their delusion de jeur.  

Cause Celebre.

Don’t know about you, but I’m looking for higher moral and ethical ground. I need that.

I aspire to work with nice and good people. I remember when a handshake was a contract. White Privilege conspires at the national level. Am I mistaken or do most of the national trainers (m/f) look lean, if not skinny, tanned, rested, have dispensable income, travel on their contractors’ dime, frequently charge $2500+/training opportunity for WRAP (R), IPS (R), ECPR (R) and/or utter ridiculous rates for Dialogic Training (R) and get away with it?

I know how the +2% in our “national” community of trainings and trainers de jeur live.

At Alternatives 2017 in Boston next month, I at least say I’ll be taking step by step slowly, and I will be wearing sunglasses to avoid flying spit aimed at me by Madmen, with the sole intent to attend AltCon17 peacefully. I continue to have faith in the work. We attend heroically en masse. I’m seeking the peaceful. The mindful. Eye contact. The truly powerful. I am saying no to desperation. I need community. I need to dig and remember why I got into the death business before the fat lady sings.

We’re dying quickly. Life is short. A mentor of mine, Steve Harrington, signed every one of his postcards, letters, notes and our calls with “Live It Up!”

 

 

 

 

 

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