piano solo

“Give me the simple life…”

I must learn how to live again.

My surroundings meld to gray. Ignore the brilliance of the oranges, the reds, purple, tallowed yellows. They do not exist any longer. May my visual acuity turn bland.

Let my energy focus on turning off life force. I must not linger, too long, over music, my love, my Beloved. They cannot breathe where they used to prevent rain.

The rain outside seeping in and whimpering now where it used to be full-on blue rain no longer. No longer. The sumptuousness of the wet and her smell of the rain no longer exists.

Since the moment of bliss, the thrilling kiss, heaven has shut her door on me for romance on the menu. There is no longer the slide slide slide pushiness of sex to wound through afternoons. That part of me is dead.

Day in. Day out.

Gershwin’s horns and the strings meeting at crescendo mean nothing to me anymore.

It came out of my mouth quickly and without thinking yesterday and it was the opening of a door, “Mary is dead…” and my friend and I both were frozen, grimacing and nodding.

I will promise you nothing and promise myself everything for now on.

The next three months are an end of a season.

I will, I must make the lap to Christmas Eve. Marker

Hello to a death march of trudgery, of plannedness, for wellness to persevere, to a life where nothing at all else marks me, ever again. Never again. Never again. She has killed me already many deaths daily, night sweating into obliviousness, holding on for footing.

The pain and the harm experienced is grievous. Were I to hold unlimited capital, I would correct the crime breaking another’s Beloved heart, but I instead do not.

That I lack a tribe, a community, a family, a prompter, I task, now.

 

 

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don’t

tell me goodnight tonight

don’t

that would hurt

you’re so beguiling

i love you so, so much

be well and love and light

are your mantras

you call yourself a “teacher” now

what do you teach? How to document to fire your Lover?

 

don’t say goodnight

don’t

not tonight. that would be like having a night terror

sweating, into the pillows around my head and in front of

my body

and behind

my body

legs piled on top of each other

do you remember the tangling of legs, limbs, arms, fingers, slippery and slip sliding around and down?

do you?

 

don’t leave tonight

not tonight

the stars are only now coming out and the moon is a crescent over your curls

a tent

a cave

o

fire and light snare me now

 

her hands

yosemite30 days hath september

april, june and november

from what summer did we have, now winter

did it any of it ever take place

any of it

i wonder
it was a dream
perfect realism
i was awake but briefly
belabored breathing
climbing to the top

was it real
was it real
was it real

i have some proof

rocks to hold in my hand

branches of trees touched, in my hand

sand from mexico in a honey jar

in my hand drip drip drip

were it not for the leftover solstice hat

it slumbers, it holds no shape now

far away from mine

remember hers

in them i am

 

 

the tempest

where is my Queen Leah now

carrie-fisher-2

i am forsaken

it is possible that the stars and moon and shapes of the world are behind the pine trees and the old oak in vines and the dogwoods are sleeping in the dark too

somebody let off a stream of fireworks sizzling and popping that stopped at the ground fast with reverb

yosemite

the air in atlanta in august smells like smoke and truck exhaust

it whips at the back of your throat when you inhale it

i am forsaken

after the knowing and lovely loving, there is but a draught of familiarity

of cold

my skin and my mind does touch off rapid fire memories and it’s war again

a high wire of white and silver ring high like lightning and thunder

it roars

my body scan depicts a swollen mind and my cave is empty and cock hard

pablo 3

 

 

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