Friday, December 24, 2010
HAPPY HOLIDAY Season!
May yours be filled by joy and good tidings. We are on the cusp of making change so that ALL people can enjoy the blessings of happiness and community - in full equality. Stay Tuned!!!
Blog Administrator, "Civil Rights in Psychiatric Hospitals"
Wednesday, December 15, 2010
Please feel free to comment on our POLL. I've created a closing date just to put some parameters on it.
I wish everyone reading a most Happy Holiday season, and I hope that future years will see more humane treatment of us and our friends and family; and a decrease in abuses at inpatient psych units and homes. EVERYONE deserves this much.
Jonathan Dosick, Blogger
Tuesday, November 23, 2010
Second Post – What Violations Look Like
This is the second in a series of posts that describe the ONLY law that protects basic civil rights in Massachusetts - a law that has been forgotten. Violations are the rule, not the exception. This post describes the (commonly seen) violations that do happen.
What do you see in your State or Country?
What Violations of the Five Fundamental Rights (5FRs) law look like:
Sadly, many of these violations are based on reality – they happen on a regular basis.
Violations of Fundamental Right #1 - Access to Telephones:
- Phones are in public places, such as hallways or dining areas.
- Phones are located near or at nurses' stations, so staff can monitor conversations; staff members listen in on calls.
- Calls are kept unreasonably short.
- Phones are shut off (often during ‘groups’); or private phone areas are locked.
- Staff will not provide money/assistance to make calls.
Violations of Fundamental Right #2 - Access to Mail:
- Mail is opened without the patient present.
- Mail is read by staff.
- Mail is opened for any reason beside suspected transmission of contraband.
- Staff refuses to provide writing materials, such as pen and paper, or postage, on request.
Violations of Fundamental Right #3 - Access to Visitors:
- Visiting hours and visits are kept extremely short.
- Visits are only allowed in common areas, such as dining rooms or hallways.
- Staff members are present during a visit.
- Visiting times are not flexible enough to accommodate patients and visitors.
Violations of Fundamental Right #4 - Humane Physical and Psychological Environment:
- Denial of a safe, private space for resting and sleeping.
- Observation by staff while bathing, using the bathroom, or dressing/undressing.
- Placement (esp. in group homes) with roommates who may endanger a patients’ health and wellbeing; staff is insensitive to trauma issues.
- Shared bathing facilities (i.e., group showers or toilets).
Violations of Fundamental Right #5 - Visits with Lawyers and Outside Care Providers:
- Patients can’t receive or refuse visits from attorneys, outpatient physicians, therapists or clergy.
- Staff won’t allow such visits to occur outside of normal visiting hours.
- On admission or on request afterwards, the patient isn’t given information about free legal services, or staff doesn’t help patients in contacting these services.
- An attorney, if given permission by the patient, is denied access to the client, his/her record; or staff responsible for treatment and care. Also, if that attorney isn’t allowed to attend meetings where the client is present.
Violations of Other Provisions of “Five Fundamental Rights” Law:
- The “Five Fundamental Rights” are not posted in a prominent place, or they are hard to understand or read. Non-English speakers can’t have the rights translated.
- A copy of these rights are requested, but staff refuses to provide it.
- Patients can’t wear their own clothes, keep possessions and money, or don’t have private storage space.
- Patients cannot refuse ECT.
LEGAL ASSISTANCE ORGANIZATIONS IN MASSACHUSETTS:
Mental Health Legal Advisors Committee (Boston)
8:30 a.m. to 1 p.m. - Mondays, Wednesdays and Fridays
Intake LinePhone: (617) 338-2345 press "1" Toll Free Phone:1-800-342-9092 press "1"
Disability Law Center (Protection and Advocacy agency in Massachusetts)
(Main) Office, Boston:
Phone: (617) 723-8455
Toll Free Phone: (800) 872-9992
TTY: (617) 227-9464
Toll Free TTY: (800) 381-0577
FAX: (617) 723-9125
Western Mass. Office, Northampton:
Phone: (413) 584-6337
Toll Free Phone: (800) 222-5619 Voice
TTY: (413) 582-6919
FAX: (413) 584-2976
Center for Public Representation (Newton and Northampton)
Newton, MA Office:
Phone: (617) 965-0776
Fax: (617) 928-0971
Northampton, MA Office:
Phone and TTY: (413) 586-6024
Fax: (413) 586-5711
TO FILE AN OFFICIAL (STATE) COMPLAINT BY PHONE, CONTACT:
Disabled Persons’ Protection Commission (DPPC) 24-Hour HOTLINE:
The next post will look into the history of the law, and how and why it is so brazenly ignored.
The landmark 2000 study “From Privileges to Rights,” published by the National Council on Disability contained these words:
Daniel Fisher, a psychiatrist, testified that some states, such as Massachusetts, had to pass legislation to ensure the human rights of people in institutions who are labeled with psychiatric disabilities, such as the right to make a phone call or have visitors, legislation that would not be necessary if people labeled with psychiatric disabilities did not lose their ordinary citizenship rights.
The law Dr. Fisher refers to is called the “Five Fundamental Rights” law. Sadly, twelve years after its passing, this law is still rarely enforced, and the appeals process is almost nonexistent – leaving thousands with no guaranteed civil rights - in hospitals and group homes.
This post will explain the Five Fundamental Rights (5FR) law. This law applies to Massachusetts only. However, many other states have the same or similar laws and/or regulations. What do you see happening in your State?
In the interest of readability, I am paraphrasing the law, and I’ve added bold type for emphasis. You can read the full language of the law here.
The “Five Fundamental Rights” (5FRs) Law:
Massachusetts General Laws, Chapter 123, Section 23
(As defined by Chapter 166 of the Acts of 1997, An Act Relative to Certain Rights of Persons with Mental Illness):
Rights of persons receiving services from programs or facilities of department of mental health
This law applies to all persons receiving services run or licensed by the Department of Mental Health, including all state and private hospitals, community mental health centers, and/or residential programs. These rights are to be exercised without fear of harassment or reprisal, including denial of appropriate treatment.
(a) The right to reasonable access to a telephone, to make and receive private calls. Assistance making calls must be available when necessary.
(b) The right to send and receive unopened and uncensored mail. On request, stamps and writing materials must be made available in reasonable quantities, as well as help writing and mailing letters.
(d) The right to a humane psychological and physical environment, including privacy and security in sleeping, dressing, bathing and toileting. This right does not require individual sleeping quarters.
(e) The right to receive or refuse visits and calls from an attorney, legal advocate, doctor, clergy member or social worker. These calls and/or visits can be outside of normal visiting hours, and can happen regardless of whether or not that person initiated or requested the call/visit.
ACCESS TO ATTORNEYS:
Facilities must give access to attorneys working for Massachusetts’ Protection and Advocacy agency – the Disability Law Center in Boston; the Committee for Public Counsel Services, a State office; and any agency funded by the State’s Legal Assistance Corporation to provide free legal services. The facility must designate ‘reasonable’ times for attorney visits, and provide help in contacting them.
The facility must provide the name, address, and phone number of the legal agencies listed above on admission and on request at any time after.
If an attorney is contacted, and only with consent of the client, the attorney shall have access to:
• The client;
• His/her medical records;
• Staff responsible for care and treatment; and
• Any treatment/discharge planning meetings with the client.
Proposed sixth right:
(Filed as legislation in 2005, 2007 and 2009; to be refiled in 2011.)
Additional provisions of the law:
POSTING OF RIGHTS
• The Five Fundamental Rights must be posted in appropriate, conspicuous places, in language that is easy to understand. Type size should be readable.
• On request, a copy of these rights must be provided to any client.
• If clients can’t read or understand English, the law must be translated.
• To wear one’s own clothes;
• To keep and use one’s own possessions;
• To keep and use a reasonable sum of one’s own money;
• To have private, individual storage space; and
• To refuse shock treatment (ECT) or lobotomy.
RIGHT TO APPEAL
According to the law, any “dispute” regarding the 5FRs must be documented and “subject to timely appeal.” However (and this is the focus of our advocacy work), the appeals process is badly broken.
Exceptions (But NOT the rule!!!)
TEMPORARY Suspension of Rights
Suspension of Rights #1 (Telephones) and #3 (Visitors):
These exemptions apply only to inpatient facilities and can only be temporary. Suspension may occur only in the following circumstances:
• The suspension is on an individual basis;
• Suspension is issued by a hospital administrator or their designee;
• Suspension can only occur if there is a serious risk of ‘harm’ to self or others. The reason for suspension must be documented, and suspension can only last as long as the potential ‘harm’ exists.
• If use of the phone or visits cause ‘significant disruption’ in the functioning of the unit.
Suspension of Right #2 (Mail):
If a hospital administrator or his/her designee has ‘good cause’ to believe that a patient is receiving ‘contraband’ (i.e., drugs or weapons) through the mail, (s)he may open and inspect such mail.
However, if this is done, the mail must be opened in front of the patient, and staff may not read the mail. The purpose for opening must be documented.
Suspension of Additional Provisions of the Law:
Any of these rights can be denied by hospital administrators or their designees, provided that the reasons for denial are recorded in the client’s record.
What do you see happening in your state or country? Your observations are very important - please post!!!
Sunday, November 21, 2010
Wednesday, November 17, 2010
Here are two recent anonymous online posts, found on Citysearch.com, regarding Arbour Hospital, the facility in Massachusetts we are focusing our advocacy efforts on. Please be aware that it may be disturbing.
These are just some stories that demonstrate the egregious and criminal nature of the discrimination the consumer/survivor/peer community experiences.
Should Be Shut Down
If I could give this place negative stars, I would. My husband was in there for several days recently--he was sent because they were the only place that had a bed and took his awful insurance plan--and he was completely traumatized. When he arrived they were fumigating his floor for bedbugs and they put him on another floor where he had no bed and no staff knew who he was.
He was given no information, no one was friendly, he was seen for 30 minutes total in 48 hours, the other patients were all violent and very loud, where my husband was simply depressed. There were fights in the hall that were slow to be broken up. Several patients were doing drugs in his room that one had smuggled in. Security was lax and they forgot to give him his medication for 36 hours.
Further, this place is dirty, dank and disgusting, the staff were extraordinarily rude to me with the exception of two night male nurses and the receptionist who gradually warmed to me. The nurses by and large seemed like they should be admitted.
My husband's case worker took 6 hours to call me back on the first day and then refused to come upstairs and meet with me, saying he was too busy. The second day, when he again refused and I said I would wait in the lobby until he was free, he accused me of harassing him. I don't think my husband's outside Psych received a call back until 8 hours had passed.
The only bright spot in this was the case worker's manager (who I escalated my concerns to) who was very kind, apologized for the case worker, and worked with me to get my husband transferred to McLean. We were very very lucky-- If I had not spent 36 straight hours on the phone and kept on despite being repeatedly told no, I never would have been able to transfer him. As it was, if he'd spent one more day there, insurance would have refused to move him.
If your loved one needs to go into the hospital, research ahead of time and go directly to that hospital. Do not ever allow them to take your loved one to Arbour. It is a mystery to me how anyone could ever get better there. I recommend McLean, which is like day after night.
the biggest mistake I made as a parent
I have never had to bring my child to a mental health facility before. Arbour was the first one we were told was open and to go. The staff not only did not understand a thing I was saying but they treated my child who was so scared like a piece of discarded trash. Their idea of family therapy was to put an entire family of divorced mom and dad and only one extension of my ex's family in the room with my daughter and myself and the social worker led my daughter to actually turn on me as a parent. In addition I will also make it very clear in this posting that the social worker who was supposed to help my daughter who is under aged actually told my child on a one on one meeting that my child should just call someone else and see if she could live with them. Said social worker told my child that she didn't think my daughter should live with either me or my ex husband. It not only disturbed my daughter and limited her trust in people and therefore did not assist in her recovery but it also shows me that it is AMAZING how these people think they know a child in less than 7 days....who does that? Not only do I think that you should refuse to send a loved one to this facility but I think that the adolescent ward should not even exist.
Monday, October 25, 2010
So, I have typed up the testimony submitted by the two large lobbying firms for Mass. hospitals AGAINST adding “access to fresh air and the outdoors” as a basic human right, and I present them to you. I apologize in advance if they produce mild feelings of nausea!
Testimony By The Massachusetts Hospital Association (MHA) and the Massachusetts Association for Behavioral Health Systems (MABHS) In Opposition to the “Five Fundamental Rights enforcement/fresh air rights” bill (House Bill #1945/Senate Bill #743)Submitted for September 23, 2009 Hearing of the [MA] Joint Committee on Mental Health and Substance Abuse, State House, Boston.
FIRST, A FEW ITEMS TOO INTERESTING TO IGNORE:
- Enforcement of existing “Five Fundamental Rights” law was a major part of the bill, but this testimony ignores that part entirely – for BOTH lobbyist groups testifying in opposition! A guilty conscience, perhaps?
- MABHS’ testimony was the first presented at the hearing – the rest was in favor - but after reading this testimony, MABHS’ Executive Director left the hearing room, and so was unable to listen to our testimony, despite repeated statements in the past expressing willingness to work with us and listen to our concerns.
- The MABHS testimony is nearly a word-for-word, carbon copy of the previous session’s testimony, given in June 2007.
Massachusetts Hospital Association (MHA) Testimony
MHA opposes HB1945/SB743. This bill would mandate hospitals and other facilities that treat mentally ill patients to provide daily access to fresh air and the outdoors. Although our member hospitals believe that the ability of patients to have daily access to the outdoors is desirable, we are unable to support these bills. MHA believes these bills pose significant safety and operational concerns that would be untenable. Clinical staff shortages, often exacerbated by cuts in state funding, are a primary hindrance to the effective implementation of these proposals. Patient clinical presentation and safety must be the key determinants in any decision process. Potential physical plant and logistic barriers must also be taken into account. As these considerations are not part of the provisions set forth in HB1945/SB743, MHA is unable to support either bill.
Massachusetts Association for Behavioral Health Systems (MABHS) Testimony
On behalf of the Massachusetts Association for Behavioral Health Systems (MABHS), I [Executive Director David Matteodo] appreciate the opportunity to testify before the Committee on Mental Health and Substance Abuse on S.743 and H.1945. The MABHS represents 47 inpatient facilities throughout Massachusetts that collectively admit over 45,000 patients annually for behavioral health treatment. Our facilities provide the overwhelming majority of acute inpatient psychiatric and substance abuse services in the Commonwealth.
Although our hospitals believe that the ability of patients to have daily access to the outdoors is desirable, we are unable to support these bills. It would make the right to “daily access to fresh air and the outdoors” one of the Fundamental Rights of patients, which could only be revoked if certain criteria were met. In the past, we have met with the main proponents of this Legislation to review our concerns, and are willing to continue to meet with them to see if there are alternative ways the hospitals can address the issue. However, we hope that the Committee does not report these bills Favorably for a number of reasons, as summarized below.
- S. 743 and H. 1945, by adding the right to go outside to the Patients’ Rights law, would create real safety issues for hospitals. Many of the patients who are admitted to our facilities come to us because they are a danger to themselves or others. Many of these patients would like to leave; they do not think they should be in the hospital. However, our hospitals are entrusted by families, loved ones, and the communities to keep the patients safe. Since many hospitals in Massachusetts do not have enclosed outdoor areas, escorting every patient outside is not possible. We cannot allow unsafe situations for our patients or for the communities our hospitals are in. How would families react if patients were eloping [escaping] because we were unable to contain them safely? The families and communities entrust the hospitals to keep the patients and the communities safe. If these bills were to pass, that safety could be jeopardized.
- Our hospitals provide short term acute treatment. People come to our hospitals for treatment of acute psychiatric illnesses and stay for approximately 9 days. This is much different from the DMH State Hospitals where patients can stay for many months. Our major priorities are safety and treatment and stabilization of the patient’s symptoms. We are trying to treat patients so they can rapidly go back out to the communities as productive members of society. We are not trying to penalize or restrict patients. Just as acute hospitals seek to stabilize general medical conditions and discharge patients back to the community, so do mental health facilities – the difference is our hospitals are treating psychiatric illnesses, and in many cases, patients with both a psychiatric and medical illness. We treat our patients with respect, care, and dignity. The restrictions on patients going outside are not for punitive reasons, but rather for the safety of the patient, the unit, and the community. We do not believe our patients or hospitals should in any way be compared to prisoners or prisons, where the length of stay may be years.
- If these bills were to pass, it would require either additional Capital or Staffing costs for many hospitals. Hospitals would have to either build fenced-in areas; or if unable to do that, hire many new staff to escort patients outside. Already the inpatient mental health units are under extreme financial pressures, both externally and internally within their own hospital systems. Additional added costs will raise questions about the ongoing viability of many units, as hospitals struggle to find resources to fund a new mandate. Access to mental health services could suffer if the mandate forced hospitals to close their units. It is impractical for certain urban hospitals with no secure outdoor areas to allow every patient who asks to go outside.
- Our hospitals in no way would endorse the idea of Outdoor privileges being taken away because of a punishment. We agree that going outside can often be beneficial for patients, and try to allow it when possible and safe. Many of our hospitals already allow patients outdoor access where they can safely provide it. However, unfortunately due to physical plant and safety reasons, not all facilities can allow it, especially units in acute general hospitals. Hospitals are also concerned with the movement towards Smoke Free Campuses and how a mandate such as called for in these bills could be complied with safely.
- In the last Legislative Session, there was suggested Re-Drafted language that took into consideration patient clinical presentation and safety. That language was an improvement over these versions and could be further improved by adding “and the ability of the facility to provide this right safely” as a criteria for providing outdoor access. This would clarify the situations where because of physical plant and logistical issues, a unit simply could not safely allow patients broad access to outdoors.
In conclusion, we urge the Committee to not refer these bills favorably in their current forms. Our facilities are committed to providing as safe and humane environments for our patients as possible. We are willing to work with the advocates of this bill, or with the Committee if it so desires. However due to the above reasons, especially the safety concerns, we are not able to support these bills. Please do not report these bills Favorably.
Saturday, October 16, 2010
In 1833, Worcester State Hospital, the first State Hospital in the United States, was opened. In 1841, Dorothea Dix, considered by many to be the first mental health advocate, discovered and campaigned against cruel and inhumane facilities near Boston. She actively lobbied State Legislatures and the U.S. Congress for the construction and expansion of public hospitals, the first of which was Worcester State. Early on, some such hospitals were based on Quaker ideals of “Moral Treatment” – i.e., asylums meant to be restful and humane places where patients were treated with respect and ample access to fresh air and nature. But despite the lofty goals and good intentions of the concept of “Moral Treatment” fell out of favor, and asylums became notorious “snake pits”.
In 1966, the shocking documentary film “Titicut Follies” exposed conditions at Bridgewater State Hospital. But still, forty years later, the situation for survivors in the criminal justice system here is quite grim.
During the 1970s, and 80s, Massachusetts was home to some of the most well-known mental health activists, including Judi Chamberlin, Dan Fisher, and others. The Mental Patients’ Liberation Front (MPLF) was an early, outspoken activist group, which established the famed Ruby Rogers Drop-in Center in Somerville. A court ruling named for Rogers established the right to refuse treatment.
In 1977, the court ruling Brewster vs. Dukakis (also known as the Brewster Consent Decree) was one of the major steps in what is known now as deinstitutionalization, resulting in major discharges at Northampton State Hospital.
Many of the country’s most celebrated literary figures have written about their experiences in the Massachusetts mental health system, especially at psychiatric hospitals, including: Susanna Kaysen (Girl, Interrputed); Lauren Slater (Welcome to my Country and Prozac Diary); Augusten Burroughs (Running With Scissors). Authors Sylvia Plath and Anne Sexton spent time at McLean Hospital, as did musicians James Taylor and Ray Charles.
And to this day, many top names in mental health advocacy are based in Massachusetts, including Dr. Fisher, Pat Deegan and Robert Whitaker.
Friday, October 15, 2010
Tuesday, October 12, 2010
Sadly, things haven't changed much.
(Thanks to Dr. Fisher for permission to reprint.)
Daniel Fisher, a psychiatrist, testified that some states, such as Massachusetts, had to pass legislation to ensure the human rights of people in institutions who are labeled with psychiatric disabilities, such as the right to make a phone call or have visitors, legislation that would not be necessary if people labeled with psychiatric disabilities did not lose their ordinary citizenship rights. It is important to note that both in institutions and in community facilities, rights are referred to as "privileges" that must be earned, generally by compliance with treatment. Such so-called "privileges" as using the telephone or having access to fresh air must be recognized as basic rights that may not be infringed. Just as it would be intolerable and unacceptable for people to lose their rights when they enter a hospital for medical treatment or surgery, such policies should be similarly unacceptable in psychiatric facilities.
Sunday, October 10, 2010
This report highlights the continual problems we face and asks for improvements. It's been ten years since the report's publication, but still most of the problems it highlights are still occuring. What do you think?
Saturday, October 9, 2010
Wednesday, October 6, 2010
This $3.1 billion deal would result in a for-profit chain of over 200 hospitals in about 40 States, with approx. 22,000 psych. beds and placements. Both systems have a horrible reputation for human rights abuses, and have been repeatedly investigated by the U.S. Department of Justice - in fact, at least one of these companies (if not both), are currently under investigation.
A report published in 2007 by the Service Employees Industrial Union Local 1107 in Las Vegas detailed a long history of rights violations at UHS, and the site ProPublica has done a series on abuses at Psychiatric Solutions.
Despite the history of horrific abuses resulting in injury, trauma and many deaths at both companies' facilities, each is doing extraordinarily well financially, especially at the behavioral health facilities. An illustration of this is the extraordinarily large sums of money being paid to PSI's departing executives:
- PSI Chief Executive Officer Joey A. Jacobs will be given over $50 million.
- Five other top PSI executives will receive over $40 million.
Another sad example of how the mental health hospital system makes enormous profits at the expense of human rights.
- Thanks for this article from my colleagues at "Keep An Eye on PSI!" on Facebook!
Tuesday, October 5, 2010
Monday, October 4, 2010
This blog has been created to serve as a forum for the very important work being done in Massachusetts (specifically) and nationally.
We are extremely concerned about violations of Basic Human Rights at psychiatric hospitals. Although the State of Massachusetts has a law that specifically spells out five legal rights, this law is routinely and systematically ignored.
Our charge, therefore, is to demand change. This blog will introduce information of the law, the nature of violations, raising awareness of the abuse and mistreatment of people who are seeking help.
It is PAST TIME that our institutions charged with "healing" own up to the gross negligence that has become routine. This is nothing less than a Civil Rights violation. The discrimination visited upon the mental health consumer/survivor population is a national shame, and only by exposing the problem will we be able to make progress for our population, which deserves the utmost dignity and respect.
As the United States Declaration of Independence says,
"We hold these truths to be self-evident: That all men are created equal."
We must uphold these words. Our population needs justice and dignity, and the profit motive must never stand in its way.
I look forward to the development of this blog, the exchange of ideas, and the CHANGE that is inevitable.