Last year’s Orlando shootings followed by the November National 2016 Elections were tantamount to the events that informed my going underground and to a better footing of safety in a dangerous terroristic world changing, shifting, abandoning, losing me.
The Depression ensued and it was terrible.
Winter came and left.
Spring came and left.
Summer was a wash.
Tonight’s Halloween and my forever lover and I will meet beneath the silvery islip of Luna tonight, hence.
I’m returning to Orlando the 1st week of December to meet with my Shaman for cleansing and visioning.
I didn’t believe I could go into the city again.
I didn’t believe I could go away like I did and like how I have been doing.
Hiding from the Trump Administration and seeing the world prepare for implosion is something now akin to a cigarette with 4 AM hot coffee. They are together, one and for always it seems now. He’s the shit under shoe that won’t wash away. He’s stink.
My world is changing again.
You must not ever stop being whimsical.
And you must not, ever, give anyone else the responsibility for your life.
The discovery of an unidentified black male found dead to rope hanging from a tree near the Charles Allen entrance to Atlanta’s Piedmont Park was stated by the PD stated in an emailed statement and was found to be “consistent with suicide” concurrently while there were many reports that the KKK had been in and around the park the day before the man was found dead. Others noted that the KKK was handing out flyers trying to recruit local residents into the group.
At last night’s rally in Piedmont Park held by #blacklivesmatteratl discovered that the dead male was also a Trans person, recognized by members of ATL’s and national queer community leadership.
I am fiercely angry and look to the streets for temperature for personal safety where there may have been a visage of peace amidst ruin in my world.
I look over my shoulders frequently at sunrise twilight daylight night and hear of multiple occasions of violence and hear see voice terror in the voice of my comrades. There is wavering in the otherwise strength and calm of ferocious bravery. I see Spirit in discernment for wonderings on social justice and awake cramping from poor dreaming and interrupted freedom.
At my local CVS on North Charles, Baltimore, a tall black man followed me from the Pharmacy to the front entrance, stopping me and asked me post-Orlando, “MENTAL ILLNESS!!! WHAT ARE WE GOING TO DO ABOUT IT?”
I stopped dead in my tracks and glanced sidelong at his angry face.
“You’re talking to me? You’re talking to me? You’re talking to ME?”
I stopped stunned and about to wring his neck, I put my head down, pulled my sunglasses down onto my face and rushed to my car. His car was beside mine and I quickly got into mine. With a pair of locked windows between us, he pulled out quickly and screeched out of the CVS parking lot.
He continued to look at me from his passenger seat and looked at me for an approving nod for his, “MENTAL ILLNESS!!! WHAT ARE WE GOING TO DO ABOUT IT?” where I shopped safely no more.
That the Substance Abuse and Mental Health Services Administration (SAMHSA) has, on April 18, 2016 released a request for application (RFA) to develop and implement Assisted Outpatient Treatment in the United States is cause for serious concern regarding the direction of behavioral health within the context of basic American human and civil liberties being stripped from people living with a psychiatric diagnosis.
The first line of treatment in US psychiatric care is the prescription of psychotropic medications to an effected individual exhibiting mental diversity symptomology entailing behavioral and/or physical medically descriptive treatment.
The symptoms and prescribed diagnosis, according to the Diagnostic Statistical Manual’s (DSM-5, 2016) symptomology of “Serious Mental Illness” (SMI) includes anxiety or panic disorder(s), behavioral and mood disorder(s) with the more complex or complicated issues being major depression and the bipolar or schizophrenia spectrum disorders. The result then, is a dire public health crisis. Suicide completion numbers worldwide today tragically occur every 40 seconds and injury accounts for 30-40% of excess mortality, where 60% of premature deaths in persons with a diagnosis of schizophrenia are due to medical conditions such as cardiovascular, pulmonary and infectious diseases. Compared with adults without diagnosed mental illness issues, people with SMIhave higher rates of chronic disease, heart disease, seizure conditions, hypertension, diabetes, and obesity.
Physical health problems are a major issue among individuals living with a psychiatric label. 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.
Physical co-morbidities is the leading reason why people with SMI are dying 25 years earlier than the general population. There is a higher frequency of multiple general medical conditions that more than double the rate of premature deaths from these conditions.
Loss of life expectancies in the United States for depression, bipolar, and schizophrenia has lowered total life expectancy by 12 – 25 years as compared to individuals not in the community public mental health system. According to the Substance Abuse and Mental Health Services Administration and NASMHPD individuals living with a diagnosed SMI, limited to receipt of current public mental health care are dying on average 25 years nationwide earlier than those receiving private care for mental illness. Forty-six (46) years ago, in 1967, 1:3 American adults filled a prescription for a “psychoactive” medication, with total sales of this family of drugs reaching $692 million.
In the US, psychotropics are broadly prescribed, the least regulated, and fall in the fastest, biggest-selling class of drugs nationally. In 2010, $16.1 billion was spent on antipsychotics in the US, to treat depression, bipolar and schizophrenia. $11.6 billion was spent on antidepressants, while $7.2 billion for the treatment for ADHD, according to IMS Health, which tracks prescription drug sales (Wall Street Journal, 2011). MH treatment spending between 2009 and 2020 estimates showed a percent contribution of each provider type to the eagerly anticipated $91 billion increase in the treatment for the SMI nationwide. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) refers to SMI as “mental disorders” (i.e., codes in sections 290 through 319).
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. The US SMHA expenditures for mental health treatment alone was $38,098.64 in the millions (2013) which included jails, prisons, MH/SUD facilities, but not did not include children’s services nationwide. 35.5% percent of all US Social Security Disability Insurance (SSDI) beneficiaries live with such a diagnosis. The SSA 2012 numbers of 10,088,739 SSDI beneficiaries nearly doubled from 5,044,388 since 1995.
Kaiser Health Foundation of State Effected SMHA:
Using IMS data for 2012 as a starting point, baseline expenditures representing $/spent for SMI prescribed and purchased psychotropics are predicted using the formula (described earlier):
Δ expenditures = Δ P * Δ Q
where Δ means growth represented by 1 plus the percent change (example: 5.1 percent growth = 1.051), P represents price of services, and Q represents quantity of services. Spending was projected at the molecular level for those products expected to lose patent protection or at the therapeutic class level for all classes where the generic share was higher than 70 percent.
“For quantity of prescriptions, growth in the number of prescriptions for each therapeutic class was projected using the “target growth” technique described in the baseline projections section above. This method uses average growth over 2009–2012 and, in one case, over the longer time period of 2002–2012 to establish the growth rate at the end of the period. An assumption that the growth in volume will change gradually from 2012 to 2020 to hit that target growth rate was used. In addition, patent expiration dates were used to determine points in time when branded medicines lost market exclusivity and would lose volume. The assumption was also made that most consumers would switch from a branded to the generic version, with 70 percent of the switching occurring in the first year after patent expiration and 95 percent in the second year after patent expiration,” (HHS Publication No. SMA-14-4883, 2014).
Source: Substance Abuse and Mental Health Services Administration. Projections of National Expenditures for Treatment of Mental and Substance Use Disorders, 2010–2020. HHS Publication No. SMA-14-4883. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
Social stigma for diagnosis and living with an SMI increases triggers and stressors to an already vulnerable, disenfranchised, marginalized and impoverished population of citizens living with perceived mental illness and physical comorbidity. LGBQT individuals are 2 or more times more likely than heterosexual individuals to have a mental health condition. 11% of trans individuals reported being denied care by mental health clinics due to bias or discrimination. Lesbian, gay, bisexual, gender queer, trans and questioning youth are 2 to 3 times more likely to attempt suicide than heterosexual youth.
Critical Issues Faced by Multicultural Communities:
Culturally insensitive health care system
Higher levels of stigma
Lower rates of health insurance
Less access to treatment
Less likely to receive treatment
Poorer quality of care
Racism, bias, homophobia or discrimination in treatment settings
Trending study on the association of ill health and SMI includes analysis of physical wellness measures and Quality of Life (QoL). QoL has emerged to be an “influential outcome measure in people with psychosis” related most significantly to schizophrenia and major depression. There is a significant relationship between physical health, overall subjective health levels and QoL in pervadive research between illness-related factors with chronic mental health disorders, substance abuse/addiction disorders and comorbidities. Psychiatric and comorbidities ill-health symptoms diminish QoL. Preventable physical health conditions rise out of the lack of exercise due to the high rate of tobacco smoking, poor nutrition and prescribed psychotropic medication side effects, giving way to cardiovascular disease, raised sugar levels (Type 2 diabetes), hypertension, and liver disease.
The physical health of individuals living with a psychiatric and/or substance abuse disorder and comorbidity is currently inordinately neglected in treatment which requires an Integrated care solution. Co-locating behavioral and physical primary care providers to deliver a balanced, whole regimen in assessment, treatment plan and a consistent continuum of care in a public/private health care environment. Drake, et al., (1998) support an Integrated behavioral health and substance abuse treatment in an assertive community treatment (ACT) approach for patients living with a psychiatric and substance abuse/addiction dual disorder based upon clinical and epidemiological data indicating that the rate of the SMI population with comorbidity are significantly higher than in the general population. Reducing the severity of needs for individuals living with an SMI and substance abuse/addiction disorder benefits ensures a higher experienced personal QoL for recipients of public community health services. Predictors of higher QoL stem from lowered needs, having one’s personal and social supports in place, having a higher personal feeling of worth, less substance abuse/addiction disorders and having housing in place increases self-worth and predicts a favorable long-term outcome in schizophrenia with better daily and social functioning.
The absence and lowered levels of personal needs, having a sense of daily hope, lessened social exclusion, greater safety to self and a measureable, identified personal benefit to living are directly involved with greater personal QoLshowing value in ensuring a higher QoL in this disenfranchised population. It has been argued that “… fostering hope and positive self-concept should be central components of recovery-oriented services and interventions…” and is strongly linked to individuals experiencing increased QoL. An effective early intervention method to improving the physical health of adults with SMI to achieve higher overall QoL’s and meaningful Physical Health Quality of Life (PHQoL) is to develop and implement effective, culturally attune and sustainable lifestyle interventions.
In the scientific literature, there have been several reviews of randomized controlled trials (RCTs) on Peer providers (Certified Peer Specialist, Forensic Peer Recovery Specialist, Recovery Coach and Community Health Worker) for mental health services. Controlled studies substituting people with lived experience for providers of direct or adjunctive mental health services generally find the same impact on service user outcomes as other mental health providers, with improved treatment outcomes in some instances with no additional risk of harm to service users. There is also theoretical literature which addresses the challenges and benefits of hiring consumer providers in mental health agencies and a long history of activist writings on the importance of leadership, community-building, and mutual support among people with lived experience of the mental health system.
As of February 2016, 43 States, two Territories (Guam and Puerto Rico), the District of Columbia and the Veterans Administration system have established programs to train and certify Peer specialists is in process of developing and/or implementing a program. Appalachia Consulting contracted proprietary CPS curricula is used in 23 states. Recovery Resources free CPS curricula is used broadly by the Department of Veterans Affairs and a limited number of states. Recovery Innovations / Recovery Opportunities (Ashcraft, 2015) contracted and proprietary CPS curricula is also broadly purchased and contractually provided.
Given the groundswell of perspectives that endorse the growing prominence and importance of Peer support in mental health and human services, it is essential that we document evidence to examine the impact the peer support workforce has on access to care, cost of services, participant outcomes, and system and provider outcomes. Included in this must be rigorous research on the particular approaches and philosophies of peer support workers that make them an addition rather than a substitute for clinical and social care disciplines.
The real horror is that Western “medicines” were “supposed to make one feel better” and is juxtaposed with the overwhelming intention that psychotropics are chemical restraints designed to alleviate psychiatric symptomology. It is in the authors’ opinion that mental illness and the disease model rarely takes into consideration cultural bias, white privilege, trauma, re-traumatization or hate ofthe other. For the mentally ill, psychotropic medications hold the illusion of controlling (mal)behavior in that the individual is molded to meet public acceptance levels of socially accepted cultural mores, inherently white, male, patriarchal, heterosexual Judeo-Christian based and is hierarchical.
The caveat then, is that psychotropics are often not prescribed to improve apatient’s QoL alone, but rather, to shape neat predictable cookie cutter shapes of people with shared life experience or to fit antiquated sociocultural stereotype and meet appropriate biased social expectation and roles of compliance.
 Substance Abuse and Mental Health Services Administration. Projections of National Expenditures for Treatment of Mental and Substance Use Disorders, 2010–2020. HHS Publication No. SMA-14-4883. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
 SAMHSA, 1996 (Coffey et al., 2000; Levit et al., 2013; Levit, Kassed, Coffey, Mark, McKusick, et al., 2008; Levit, Kassed, Coffey, Mark, Stranges, et al., 2008; Mark et al., 2000; Mark et al., 2007; Mark and Coffey, 2004; Mark, Coffey, McKusick, et al., 2005; Mark, Coffey, Vandivort-Warren, et al., 2005; Mark, Levit, Vandivort-Warren, Buck, and Coffey, 2011; Mark, McKusick, King, Harwood, and Genuardi, 1998; McKusick et al., 1998; SAMHSA, 2010; SAMHSA, 2013).
 National Alliance on Mental Illness (NAMI) (2016). Cited statistics provided by the National Institute of Mental Health. http://www.nimh.nih.gov, the Substance Abuse and Mental Health Services Administration, New Evidence Regarding Racial and Ethnic Disparities in Mental Health and Injustice at every Turn: A Report of the National Transgender Discrimination Survey.
 Pitt, V., Lowe, D., Hill, S., Prictor, M., Hetrick, S. E., Ryan, R., & Berends, L., 2013; Chinman, M., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Swift, A., & Delphin-Rittmon, M. E., (2014).
Profiling is wrong. It comes from misunderstanding, fear which all eventually make their quick leap into hatred. That hate breeds hurt, lossed lives, 20:00 security checks at any US Airport but especially in the State of Texas, and frankly my dear, I’m done. Your free and wild expressions saying profiling is a civil and human violation of my rights are welcome here. Please use appropriate language.