The Trouble With Fresh Air (?!)

People are constantly asking me, “why on Earth would anyone oppose fresh air as a basic right?” After which, I often tell them they’d be surprised! However, I often don’t have the time to explain the many reasons (and excuses) our opponents offer. Enter the brave new world of blogging, however, and I can share them, in their own words.

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.

MASSACHUSETTS’ CIVIL RIGHTS CRISIS, PART ONE – BACKGROUND

Massachusetts has long been considered a global leader for medical research, treatment, hospitals, and innovation. For medical care, the reputation is deserved: Beth Israel-Deaconess, Mass. General Hospital, Childrens’ Hospital, Dana-Farber Cancer Center and the Joslin Diabetes Clinic, among others, are world-renowned. However, the State’s progressive reputation still hasn’t caught up with the hard realities its consumer/survivors face.

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.

MASSACHUSETTS' CIVIL RIGHTS CRISIS - A Series of posts

This is a series of posts that will serve as an introduction to the rights issues we are dealing with in Massachusetts. I hope this will put our efforts into sharper context, and will resonate with readers outside of Mass. First, I will cover the basic history of mental health in Massachusetts, and then I will go over the "Fundamental Rights" law: what it means, why it isn't working, and what the hosptal "landscape" looks like here. Finally, I will describe our agenda and action plan. I hope you find this interesting and useful!!

Privileges to Rights - A Passage of Note

The following is an excerpt of the 2000 "From Privileges to Rights" Report, published 10 years ago by the National Council on Disability, in which Dr. Dan Fisher talks about the "Fundanmental Rights" legislation in Massachusetts - the focus of our current struggle.

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.

From Privileges to Rights

I've just added a link to the classic "From Privileges to Rights: People Labeled with Psychiatric Disabilities Speak For Themselves" report, published in 2000 by the National Council on Disabilities.

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?

Sponsors of our effort

Check out the list of organizational and individual supporters of our effort during the 2009-2010 Legislative Session (and beyond...) This will be available on this site as an individual page.

Two enormous and abusive hospital giants to merge

According to news from Tennessee, Universal Health Services, (UHS,) the giant, for-profit hospital chain which runs over 100 psychiatric facilities nationwide, including the large, notorious psych-only chain in Massachusetts, Arbour Health Systems, is moving closer to buying the equally-notorious chain based in Tennessee, Psychiatric Solutions, Inc.

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!

A few links have been added...

Although there may be a relative lack of context posted here as of yet, please note the "Five Fundamental Rights" Law. This is the only law in Mass. that spells out five basic human rights in Massachusetts Hospitals, and unfortunately, it's being violated at an alarming rate.

SITE UNDER CONSTRUCTION

Hello again:

Please note that this blog is under construction; I will be adding to it very shortly and tweaking the settings so people can post. Thank You!!!

WELCOME TO THE BLOG!

Thank you to everyone who is visiting this site!

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.