There but by the grace of God go I.....
Though in some circles I am Dr. / Professor Barrett, with a
Ph.D., there are other contexts where I hold highly stigmatized statuses. In a
medical context, I am a person with psychiatric disability, and even more
stigmatized, I am a person who has lyme disease...also known as a "lyme
loonie."
Because of my life experience, I feel deeply about our
history, the lives of people with MI, and the origins of recovery movement within
psychiatric rehabilitation. I teach because I think it is important to expose
providers to a different way of thinking, or a perspective they may not have
considered. No approach or theoretical orientation will apply in every
situation (e.g., therapeutic use of hallucinations), but as a person who has
skin in this psychiatric game, I also feel strongly that some approaches are
more consistent with recovery than others.
When I am symptomatic, I want someone to listen and validate
my experience. I want to feel emotionally safe. I want encouragement, and to be reminded of
all the things I have made it through in the past. I want to be reminded that I
have the ability to figure it out, whatever "it" is. I need to know
that I have value.
What I don't want: judgement, use of a skeptical or scolding
tone, being told what to do, being told the obvious (e.g., you would feel
better if you lost weight), being mocked and/or humiliated, being physically
controlled, and being asked if I've taken my medication (!). The surest way to
escalate my agitation is to tell me to "calm down," which in my
estimation, is the ultimate invalidating statement. Under certain
circumstances, that response may cause me to behave aggressively, or lash out
in anger. What happens then? My fate as a person with mental illness is sealed.
I am now labelled a problem, "out of control," and potentially, a
victim of the "goon squad" or worse. (Goon squad is a group of nurses
who restrain someone and administer PRN tranquilizers to chemically control a
person).
For example, think of the young
man at the Judge Rotenberg center being shocked remotely while prone and in a
5-point restraint.VIDEO HERE Think of Natasha McKenna,
naked, strapped to a restraint chair, in a jail cell. Ten men in hazmat suits
and gas masks approach her to move her to another facility, and they end up
killing her. We can pat ourselves on the back about how far we've come in
psychiatry, yet there are too many stories of my brothers and sisters suffering
at the hands of providers. The officials responsible for Natasha's death felt
so confident in the way they treated Natasha that they posted a 48 minute video
of the incidents that led to her death. If you are brave, you may watch it
here.VIDEO HERE
How does this happen? What is the story these "providers"
tell themselves? Why didn't anyone object at the time? What might be a better way, according to Shery Mead? Other
recovery advocates? Answer these questions, feel free to post your own, and
then reply to at least 2 of your classmates.
"Understanding that crisis events are full blown flights of fright…. grounds the supporters in understanding that the first priority is to help the person feel welcome, safe and heard…” (Mead & Hilton, (2014), p. 90.
ReplyDeleteHow does this happen indeed? The types of care demonstrated and shown in the videos, literally cannot even be described as care. If one considers that if we are seeing two demonstrations of over-the-top restraint, then one has to assume that this is a prescribed method of treatment approved by psychiatrists, hospital or facility administrators and possibly insurance companies. The only consideration is how to control, restrain, and overcome. One wonders if the employees that carried out the “interventions” would say now that they were just following orders. In Natasha McKenna’s video, the 10 men in hazmat suits and shields wrestled a naked woman to the ground, took an inordinate amount of time to restrain her (in itself – mind boggling), screaming at her through masks to stop moving….It wasn’t until the end that two females came in and covered her naked body with a blanket.
Sherry’s Mead’s discussion of Intentional Peer Support provides a different narrative and perspective for providers to talk to and listen to the patient’s perspective – “Instead of asking “What’s Wrong? The provider learns to ask “What Happened? Peer support and advocacy and sharing stories in a narrative therapy is a prominent feature and several patient stories demonstrate that this type of supportive, non-judgmental approach were seen as beneficial. Development of pro-active crisis planning before a crisis happens allows the person to discuss their needs and hopes for treatment in a safe interactive manner.
“Rather than reaching for safety contracts, we need to become more able to “sit with discomfort” (Mead & Hilton, 2014, p. 92).
Mead, S., Hilton, D. (2014). Crisis and Connection. Psychiatric Rehabilitation Journal
Hi Sue,
DeleteI completely agree. I really like the two quotes you included in your post. Especially the "...we need to become more able to 'sit with discomfort.'" How true. This course has really opened my eyes.
I am not playing devils' advocate here, nor is this a defense of the medical model in any way, shape, or form, but narrative therapy takes time. Pharmacotherapy-driven modern medicine is looking for a panacea. If providers can give someone a pill or two (this takes 5 minutes at the most) rather than listening to their narrative (at least one hour), they may believe that they have absolved themselves of the bulk of their responsibility and can move on to the next patient.
DeletePsychotherapy (in other words, someone who will listen to narratives with an empathic lens) is not recommended often enough to patients with mental health issues. I have not looked at the numbers, but does someone know if there is a dearth of counselors and, if so, could this be a reason for lack of psychotherapy referrals?
Hi Lisa and Heather...
DeleteYup, medication , psychotherapy and narrative therapies etc. all have their place in the treatment of the mentally ill. What ever type of therapeutic interaction happens with a person with MI in crisis, is the establishment of relationship. There has to be someone who can advocate and listen to the person. There may be a place for peer advocates to not only be available to listen but perhaps to participate in some at least introductory sessions where medical decision making could adversely affect the person's long term health and well-being......
Sitting with discomfort is a concept that needs to be taught and valued.
DeleteHello everyone:
DeleteGreat thread going here! I always go back to our training and implementation of the Motivational Interviewing (MI) spirit when we have these conversations: Partnership, Evocation, Acceptance, and Compassion (Miller and Rollnick, 2013). This partnership is all about seeing the client as the expert and supporting autonomy and self-efficacy. We often talk about embracing the MI spirit as slowing things down to go fast. Without having established a partnership, work cannot move forward because the client's ambivalence has not been addressed, and in the context of this course, their story has not been told with someone actively listening and providing reflections. Silence in sessions is not to be avoided, but embraced. Mental health and medical professionals can continue to prescribe and treat clients, but until there is an understanding of clients' underlying concerns, along with their strengths, motivation, and goals, there is this constant, recurring cycle of treatment and relapse.
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). New York, NY: Guilford Press.
Sue,
DeleteYour post highlights a thought I had when doing the readings this week. It seems to me that our current system does do (or attempt to do) many of the same things that these alternative treatment approaches advocate for. For example, you mention the benefits of peer support - something that naturally happens when people are inpatient (or outpatient) in group therapy together or spending time in close quarters sharing about personal experiences. You also mention pro-active crisis planning - anyone who has worked in mental health has developed a crisis plan with a patient. We do this with out inpatient clients. I used to work as a crisis worker (seeing patients in the ER or in the community to determine if they needed to be hospitalized or lower level of care and connect them to services) and know many patients develop crisis plans with their outpatient therapists or at a CSU etc. but still return to the ER. When I was reading the Sherry Mead article Speaking Out I really got this sense that our current system is attempting to do the same things she is advocating for. "talk about things they have been through" so they can "identify some of the things that helped them" "identify the things that have kept them stuck in old patterns." etc. etc. I've sat with patients and helped them complete their crisis plan. So I see a lot of the elements overlapping. It makes me feel that our system could be improved/built up, instead of pushed aside for an alternative approach which seems like it might be reinventing the wheel.
Thanks Jess. I appreciate your response. It's good to hear that your own current practice with those consumers in crisis utilizes those peer support principles. I always appreciate when peer advocates, parents, teachers, etc. participate in client sessions. It 1) lets me know that there are advocates out there for the clients, and 2) it helps me focus on client needs. ER work must be amazing! Its great that you were able to listen to their needs and help clients decide what level of care they needed.
DeleteMost of my client have a crisis plan, we recommend it when we open their case, and I must say it is a god sent, when we have guide lines to help us when a client goes into crisis. We know exactly what helps them, and also what not to attempt to try to do for them, because they have told us it does not help them. So I really feel strongly about clients making their own decisions about how they want to be treated when they have a crisis and we should respect their wishes, because it is what helps them recover.
DeleteHi Sue,
DeleteI also thought that Mead's perspective of asking "What happened?" rather than "What's wrong?" is a great way to think about the delivery of care. People with mental illnesses are constantly asked by doctors and providers "what's wrong?", when so often the answer to that question doesn't really get to the root of the issue, or a deeper meaning at the individual's situation. I think if patient's were given more opportunities to talk with peer supports then treatment could look a lot different. Peer supports could collaborate with providers to ensure positive treatment experiences that are actually aimed at what is going to help each specific person. We can't just assume what people need, we should be asking them.
You provided a lot of great context in your post and I love the parts you took from Mead. Peer support is such an important part of the treatment process that not everyone may consider, it really does provide a great support to them and can bridge the gap between making assumptions. When i did case management we had a peer support on staff it provided a lot of great insight that the case managers might not have thought of.
DeleteI think incidences like these happen because our society stigmatizes mental illness to such a high degree. People with MI are the "other." Providers tell themselves that they are the experts and that they were doing everything in their power to help this "unfortunate individual." Sociologically, there is a group mentality, where people feel the need to follow the group. Some of the individuals may have felt like their behavior was not right, but the group persisted on, and so did they. You can see this happen to these poor individuals, or on a larger scale like the Holocaust. It is a disturbing part of our human history.
ReplyDeleteI loved Mead's discussion of the Intentional Peer Support. This removes the hierarchy of the provider/patient model, and furthers to open the conversation between two people who may have something to learn from each other. Breggin asserts that psychosocial techniques of counseling are the most effective even among the most severe cases of MI. Having a caring therapeutic relationship with a client can be more effective than treating them with drugs or any of these kinds of torturous treatments seen in the videos (that I have not been able to view).
I think you are right Heather about how society stigmatizes those with mental illness, considering them the "other." Until the other affects their own family, community, etc. As we know in VR and DVBI, caring therapeutic relationships and good community and family support systems, can help individuals transform their life patterns, and make different choices. Having good peer support systems is critical. I guess the Peer support model could include Peer Advocates participating in Mental Health decisions with clinicians present....one step beyond participating in groups....
DeleteI liked Breggin's ideas and how there are other often more effective approaches than medication to help persons with a mental disorder. I find the core conditions of a therapeutic relationship to offer a beginning on how to create a caring and therapeutic relationship. The nothing about us without us is so important. I have on more than one occasion hit a brick wall on this issue in working with the VA in terms of my husband's both physical and mental health care. While I have called Susan Collin's office a number of times, I have found that it is important to speak up when decisions are made that do not include us and clearly are based on a lack of understanding of Maine geography.
DeleteWhen a population is the "other," they are typically oppressed and marginalized. With this oppression and marginalization comes a stripping of human dignity and basic human rights. As I stated earlier in the class, of the three contributing factors to mental illness, I continue to believe that society is the greatest contributor -- as a society, we continually, whether or consciously or unconsciously, seek to beget "others." Think, African Americans, Native Americans, people who are homosexuals, people who are transgender...all of these folks have been marginalized and oppressed at one time or other in our society, some still are.
DeleteLisa
DeleteI am finishing up my 4th week at Blueberry Harvest School. I have worked there for 7 summers. I think that many of our students are from Mexico, Cape Breton Island- First Nation, and for some their first language is Spanish or Mig'maw and the challenges of living in the U.S. include becoming fluent in another language-English while still retaining their culture. It is also difficult for them as they are often marginalzed in a white Eurocentric society.
Nancy
Mi'Kmaw- I do phonetic spelling in other languages too.. (sorry)
DeleteI remember reading about tasers being used at Riverview (a state psych hospital) not too too long ago (2013?). Keep in mind some of those are forensic patients - if that makes any difference to you. And I remember the need to use tasers was cited as being due to low staffing making it difficult to safely manage the patients. I feel like staffing constraints are a common reason for treatment that is less than ideal. For instance, staff are burned out or over worked. I've heard of facilities not allowing staff to leave when their shift is over because they don't have enough workers coming on shift. Also, low staffing means that the staff to patient ratio may make it very difficult for staff to give a patient as much attention as they may like or as say the Sotereia or Crossing Place could. This doesn't justify anything, but it does certainly point to contributing factors of what is a consistent theme in the shortcomings of the mental health treatment throughout time: poor funding & overcrowding. Makes one wonder - if we adopt alternative treatments as new and improved more patient centered care - would they too suffer the same eventual deterioration as say Dix's asylums and deinstitutionalization did?
Deletehttps://bangordailynews.com/2013/09/15/news/augusta/increased-violence-at-maines-psych-hospital-prompts-reform/
Heather, you make great points about societal stigma and treatment of individuals with MI as "other". I always go back to where this comes from; how do we get to a point of seeing individuals as other than human? Is it our upbringing, what society defines as healthy as good, what serves us best in our desire for wealth and status? I recognize that there is no one answer, but it does give me pause to consider how situations like Natasha McKenna and Andre McCollins occur so recently.
DeleteI also think about comments from Breggin, Deegan, and Fisher around the importance of establishing a equal, respectful, loving relationship with the client. The word "engagement" is often used in terms of this relationship. What I am always cautious about is balance between respecting an individual's choice in working with staff vs. dismissing someone in their process because they did not engage with us. We have work to do as professionals to provide an environment in which the client feels safe, respected, and supported so that this relationship can occur in the first place. I think that an individual can be assumed to be non-compliant if there is not engagement as defined by the staff. I really liked Judi Chamberlin's article (2013) , "Confessions of a non-compliant patient" because it highlights that a "good" patient as defined by mental health professionals is incompatible with recovery and empowerment. Further, it is the individual's own process in recovery to determine if medication is part of this solution, not medical professionals to define what is best because they decide that individuals with MI are unable to determine this independently.
I totally get what you are saying Lisa, and agree, that alot of people have been marginalized and oppress in the past, leaving most of these people with scars they can not overcome. This is why it is important to advocate for people when we see things like these going on around us. Too, many people are effected by what others do or say, and it has a lasting impression in their lives that they are unable to shake. Society is not always kind and we need to try and make change.
DeleteHi Heather,
DeleteI agree that stigma is a huge part of why things like this happen. People with mental illnesses are usually made out to seem dangerous, unsafe, and uncontrollable. If this is the image we create for this group of people, then it's no wonder that staff are able to carry out acts like this. They just see someone who has been labeled "dangerous", which makes it easier for them to justify to themselves that their actions okay. It's definitely frustrating and difficult watching these videos and knowing that these actions could have been prevented and the situations could have ended differently.
Heather,
DeleteI too had a very difficult time viewing this video. I found myself looking away and listening to other things, so I didn't have to hear how Natasha was being treated. I have been present to see one incident where a behavioral interventionist was holding down a child in a school. Today, I still can't get that picture out of my head. In most of these video's you don't hear anyone speaking to the individual about what might be helpful and asking how they can help. I'm beginning to think people aren't trained or they are burned out and start to label everyone the same, due to past experiences. I need to focus on how I'm helping and try to be the one that creates hope and offers unconditional support. Thank goodness for VT and the focus of motivational training that is provided.
This class has been an eye opener and something that I needed!
Cindy
The article, "Crisis and Connection" by Mead and Hilton addresses the issue of discomfort and our cultural aversion to it. As such, we are continually trying to "calm people down" (p. 90) -- in a nutshell, we are trying to appease them to make ourselves feel competent. In reality, we should be doing the complete opposite, which is to engage and understand what is happening with them. Rather than "fixing" the problem, we need to listen empathically and share our common stories. We need to be supportive because we are not the experts on what the other person is going through, they are. By providing peer support to their experience, we are validating their experience, which can be empowering.
ReplyDeleteChamberlin, although discussing different recovery elements, eloquently describes her time as a "good patient" and a "bad patient." Time where she bid her time as a good patient, only to be able to live her true life outside of the institution. Her description of her participation in her medical treatments, but her virtual exclusion from her psychiatric treatment, is stark and shocking. Moreover, her description of the word compliance and patients' "unmotivated" states when they in fact did not have an opportunity to determine their own destiny speaks to the stories that providers tell themselves. Why should patients be excluded in decisions that directly relate to them? As Chamberlin eloquently states: "Nothing about us without us." It is definitely time for the stories providers tell themselves to be challenged and changed.
I found the Chamberlin video to be so enlightening. I wonder how many people are able to regain their freedom once lost? The stories that providers tell themselves that include ones that place themselves in an all knowing position need to be changed. The basic human rights that are non- negotiable should not be taken away as they are the basis for recovery.
DeleteNancy.
Hi Lisa,
DeleteI like how you emphasized that people with MI are the experts of their own lives. Too often, doctors both psychiatrists and medical doctors (in my opinion) are put on a pedestal. I've seen this with my own grandparents, who assume their doctor knows best and as a result, they do not try to play an active role in their health care.
I often find that we have a story that tells us that doctors are the experts in care of those with mental illness. I think we need to begin to value the opinions of those with SPMI. I find that the stories need to be rewritten to change the way we treat persons with mental illness.
DeleteNancy
Lisa,
DeleteThe part of the Chamberlin article comparing interactions with her medical provider and psychiatric providers stood out to me as well. I think in part because I felt that psych providers do many of the things she appeared to approve of that medical providers do: partner in treatment, talk through decisions together, provider is expert but needs information from patient about body and experiences to guide treatment, etc. But also because I disagreed with her in that, I've found medical providers to also be dismissive of patient concerns, neglectful of reviewing side effects, and lacking in empathy or compassion. That might just be my own experience but I have seen some literature lately about how doctor's don't listen to patient's concerns about pain, etc., especially around endometriosis. The difference being that I (as a patient of medical care) can refuse treatment. But I also hear those stories of medical providers not taking their patient's endometriosis experiences seriously and denying them treatment. So, it makes me wonder how much of the issue stems from problems within the medical model and how much stems from the stigma and perceived incapacity of mental health patients.
Lisa:
DeleteYour comments about being a "good" patient vs. "bad"patient from Chamberlin's article remind me of one of the patients from the "Bellevue: Inside Out" movie we watched earlier this semester. Connie talks with her roommate who describes how the CIA are after her; she tells her that she can't talk like that and needs to take her medication so she can go home. There is part of me that wonders if Connie also understood how the system worked, in that she needed to be compliant and a "good" patient so that she could get out of the hospital. There were also comments about needing to "take your medication and calm down", or "you can never get out of here saying that". At no point during that video do I recall conversations about people's long term goals and supporting their autonomy; I recognize that the hospital was for individuals who are in crisis, and yet the treatment and environment provided by the mental health professionals do not reflect Breggin's "caring havens to go when we're in desperation". Self-determination is the desired outcome, not compliance (Deegan, 1995).
I totally agree, Jessica, that often times the medical model is the issue. As I state somewhere above (I believe), there are not enough psychiatric providers to assist the many patients who need assistance. Also, managed care and limited visits and subpar payment adversely affect the ability of providers to spend meaningful time with their patients. For sure, the issue is multifactorial.
DeleteHi Lisa,
DeleteThank you for sharing your thoughts. I think of the same that that it is being vulnerable or uncomfortable that people have a problem with. No one needs to be the authority or more powerful in a counseling relationship. It needs to be a bend and flow type of thing. How can a counselor or doctor tell you whats wrong? The patient needs to tell you and the doctor needs to understand. And understand that the counselor or doctor may not be right. I think it is difficult for individuals to admit that they are wrong and maybe the best thing is to be comfortable with the idea of potentially being wrong. Thanks!
Lisa,
DeleteYou have made such a great point about how society is accepting to having someone calm therefore when one is not there is discomfort. I think of the many times in our office when someone comes in disruptive it is so difficult to deal with on many levels. One may not be well, but generally there is an issue within the system of care that has created discomfort for them. What I've been able to learn is to ask questions about what could be helpful for them.
Vermont has had extensive training in motivational interviewing, this has helped me in not feeling as though I haven't been effective. I chose to let the consumer set the goals and tell me how they are going to reach their goals. I'm there to be there to be their coach and cheerleader. I always try to offer hope and support them in the way they want to be supportive. This is been instrumental in my practice and the outcomes I'm seeing are amazing. I'm seeing what people describe as their recovery...they get to take full ownership.
Cindy
I just finished watching the videos of the young man being shocked and the video of Natasha McKenna and it brought to mind the concentration camps of Nazi Germany. It also brought to mind a quote from Victor Frankl " It is very difficult for an outsider to grasp how little value was placed on human life in the camp." I would guess the stories that these providers tell themselves is that these patients are seen as a problem and it is their job to fix or control the problem. I also think that they tell themselves that these patients are not people that they are not deserving of human dignity. They do not see these patients as real people but as mental patients. I would guess that the norm was to follow orders and no one wanted to question those in authority. In the closed to public view setting, the providers become all powerful and patients become more like objects than human beings. The why people did not object at the time reminds me of cases where bystanders see a crime and /or beating and if there are one or two people present they often act, but if there is a crowd they tend to ignore the victim's cries for help. Certainly a better way is to treat the patient as person with dignity and to make a human connection. It is by making a human connection that we open the door to hope and recovery. I do think the idea that providers sometimes tell themselves that this could never happen to me and these patients are not like me. Yet I think we know that disability can and does happen and it happens to people like me. I attended my 48th high school class reunion a little over a week ago, and I truly saw that many who were no longer living in what was a small class, had been impacted by both physical and mental illnesses. My husband is a Vietnam veteran who was exposed as a 20 year old to Agent Orange and worked on aircraft in a high risk position. He has both physical disabilities and mental disabilities. For many years he was medicated by the VA and did not do well in terms of living a full life in the community. He takes no medication for PTSD or OCD and other mental disorders. He currently is doing well with interests, hobbies, and a strong social network and has regained a sense of agency. I do think the reason that these kind of abuses occur is largely a result of stigma and a them/ us mentality. The NIMBY is a form of racism that impacts persons with mental illness. Our reading this week offers some new approaches that may run counter to the medicate first and then look for alternatives if the medication does not work. They further tell themselves that the patients need to be motivated and do what staff tells them to do.
ReplyDeleteYour reference to the concentration camps in the Holocaust is an interesting one. As you mentioned, clearly those involved in committing those heinous acts against Jewish people must have truly believed that they were not worthy of human dignity and deserved to be treated that way. I wonder how much of that kind of mentality is involved with the providers we watched on the video. Sometimes the human race has the tendency to fall in with the groupthink and not come up with our own conclusions and I think that can be another barrier for trying to reduce stigma for people with MI.
DeleteHi Nancy:
DeleteThanks for sharing your husband's story. I find I learn so much from hearing individual's experiences.
Your comments about his experiences with medication really resonated with me. It is reflected in Judi Chamberlin's perspective (2013) that "each individual needs to discover for himself or herself whether or not the drugs are part of the solution, or part of the problem" (p. 2). Medication is a tool that could part of one's toolbox in recovery or not, but ultimately it is for the individual to determine and not the medical professional. Mary Ellen Copeland's experience with lithium toxicity supports this, as does Patricia Deegan's "Principles of a Recovery Model Including Medications" (1995). "People with psychiatric disabilities need to assume the dignity of risk and the
right to failure and this must be understood and supported by mental health
professionals and mental health systems". This can be in reference to any type of treatment, tried or not.
Hi Nancy, I appreciate your passion about this. As you know, I work at an inpatient facility, so I do what those fellows in the hazmat suits do on a regular basis, i.e. restrain patients (minus the tasers). We do have some safety gear like hockey masks, kevlar, spit guards, etc. Because patients have suffocating when in restraints before there are all kinds of rules and safeguards in place to ensure patient safety eg. nurse assesses patient every 15 minutes, staff is 1:1 with patient while patient is in restraints/seclusion, doctor must be present within an hour if patient is restrained/secluded, etc.
DeleteI also medicate patients against their will frequently. I think it is interesting that you compare this to not questioning authority (made me think of the Stanford Prison experiments). When I first started in this line of work I questioned it. I was disturbed at how quickly staff would decide to "go hands on" as we call it. I wanted to talk to the patient. I wanted to give them time to calm themselves down, you know, use those coping skills and all. I remember on multiple occasions being frustrated that another staff moved a situation to hands on before I felt we needed to. But now, I feel that my thoughts back then were naive. Perhaps that is experience talking, having never once succeeded to deescalate the patient or having been punched and seen numerous coworkers injured. Or perhaps, like you suggest, I have become comfortably numb to the status quo.
I will say, after the patient is medicated it is so often a complete 180. A patient screaming about her hallucinations for weeks, refusing medications until she was hitting another patient with a coffee carafe and then trying to stab herself with a pen because of her delusions and then after medication the next day she is drawing a thank you card to the staff and is no longer yelling or responding to internal stimuli. So, I could really relate to Frederick Goodwin's response in the Mosher Betrayal article when he talks about patients who have had significant success because of medications as a rebuttle to Mosher's anti-drug rhetoric stating: "tell that to the thousands of social workers, psychologists and psychiatrists who work with the seriously mentally ill every day and who know from their own experience that without medications, their patients could not engage with them in the difficult psychological work of recovery."
Perhaps it is an example of Chamberlin's "playing the good patient" but I've seen it happen like that so many times, it's hard to believe that is true. But I know patients do do that. But I think it is only once they are "stable" and calm that they can then start to have the important conversations with their providers about what their goals are and build relationships with staff and engage in the therapeutic activities that are offered.
Hi Nancy,
DeleteI think it's interesting that you bring up concentration camps in your response. I see the connection between the two when it comes to those in power carrying out terrible acts, and removing themselves from the situation enough so that they don't feel badly about what they're doing. It's crazy to me that the people in charge thought that their actions were justified even though they had killed someone. I don't understand how you can get that far removed from your own actions. I suppose maybe if you're that person in charge and maybe in that moment your actions seem justified, but in a case this extreme I just don't understand.
How does this happen, I can not comprehend, because this whole thing was unreal and really hard to watch. To think that no one thought of stopping this and going about it a different way, so she does not get hurt and is able to cooperate. How so many grown men can hold one women down and not think she will not get injured some how, is unreal to me. Just the amount of tazing is overwhelming for a women. What these people tell themselves, I can't imagine, just watching it made me want to tell them they needed to stop, so I can not understand why the people standing there watching didn't say anything either. Have they become so hardened by their work, that they no longer care?
ReplyDeleteI feel that if a crisis plan had been in place they would have known how to handle these episodes. because with a crisis plan, the client is the person who decides how they want to be treated if an episode does occur. And when you talk with them during the crisis they remember what was agreed to in their crisis plan and this usually helps with calming the client down. They could have also given her something right off the bat, to help her relax, so they wouldn't have to take it that far. There was no dignity or respect shown for this women. And I feel that Sherry Mead, would agree to talking to the client first and making a plan ahead of time before they moved her. This was one of the most awful things I have seen in a while, and the video of the boy is terrible also. They are very lucky that boy is not my child, because I would work the rest of my life to have that whole team brought to justice. But justice is not always fair either and at times people get away with things like this, sadly. This is all just heart breaking, and proves to us that change is needed for everyone, and we must be the ones to advocate for our clients.
Hi Beatrice- The videos, the stories are so hard to take...they speak of an injustice we do not experience on a daily basis. Now that it's been a couple days since I've seen the video, I'm starting to mix in the stories about the children of immigrants who have been separated from their families. Mead's work provides a framework to see a better way to help those with MI...This is the type of work that needs to become legislation so that it never happens again..to anyone.
DeleteThe videos are hard to watch and I think raise awareness that this kind of treatment is not something that happened in the past. The need for breaking the silence about this kind of treatment is a step to help create change.
DeleteNancy
There must be some aspect of becoming hardened or desensitized to be able to carry out those kinds of actions. Maybe they watched other people treat patients that way so they just fell in line with that kind of activity as if that's the accepted norm. It's really just such a terrible thing that I still find it hard to believe that this actually happens.
DeleteI think this reminds me of some of the stories from WWII camps in which guards became so hardened that they placed little value on human life. I wonder what the stories were that would justify that kind of cruelty.
DeleteNancy
It may be that the camps fro WWII got their ideas from how patients with mental illness were treated.
DeleteNancy
Hi Beatrice,
DeleteI like that you bring up using a crisis plan in situations like these. This is the whole reason we create crisis plans with people! So that when a crisis occurs, everyone is on the same page about what to do and they don't need to take extreme measures, such as those seen in the videos, because they already have a plan of action. Like you, I had a hard time watching the videos and found myself wanting to change so many things I was seeing. I can understand that sometimes in the moment we make decisions that we think are right and follow through with them, but I don't know how something this extreme could seem like a good idea at any time.
Beatrice-
DeleteI agree with you in that this was hard to watch and that it is beyond comprehension (at least for some people) that this sort of thing could happen and nobody did a thing to prevent it. A lot of it, I think, is institutional mentality. I think these guards did not get to know Ms. McKenna. 5 grown men tackling a naked women to the ground - there was no dignity in those actions, no respect for Ms McKenna.The whole situation played out with polarizing actions and thought processes. These workers did not have a connection to Ms. McKenna. She was just another non-cooperative, violent inmate. The gurds went in on the defensive, assuming the worst. They did not think of how their actions would be interpreted by a naked, young women in a state of mental crisis. Was she in fear of them when they came at her, trying to subdue her? Did she have any rational understanding of the situation?
In the Mead and Hilton article, the authors stated “Although most support people don’t go into a crisis situation determined to control the other person, their own sense of discomfort may make them become overly directive and controlling, driving the direction of the interactions while building a power-imbalanced framework for future interactions.” They added “At its worst, crisis response is controlled by a fear of liability” (Mead and Hilton, 2003). Those who stood by, not getting involved - that may also have been institutional mentality; a sort of numb response to things, because they were ‘just how things go typically.’
References
Mead, S., & Hilton, D. (2003). Crisis and Connection. Psychiatric Rehabilitation Journal,
27(1), 87-94. http://dx.doi.org/10.2975/27.2003.87.94
I think the key question of how does this happen is one that has both historic and current implications. While our definition of " normal" has evolved, it also has resulted in new and different ways to treat mental illness. I am not sure what it will take to change a system of care that is often based in old deas about mental illness.
ReplyDeleteNancy
Change, it seems, comes at a glacial pace. Not nearly quickly enough for those in the gravest need.
DeleteLisa,
DeleteI think change in systems related tocaring for those with mental illness are slower than most to change.
Nancy
Part of effective system change is making sure the solution proffered is not actually an act that promotes system failure (i.e. No Child Left Behind sought to improve school performance but actually introduced a policy that facilitated education system failure through "success for the successful"). The system we need to alter first may not even be the protocols in a psychiatric hospital. The system we need to alter may not even be the patriarchal hierarchy of medicine. The system we need to alter may be our tax structure. For instance, capital gains tax is exceptionally low. Increase capital gains tax and restructure the way we tax offshore corporate holdings may release an estimated $90 billion into the U.S. Treasury. Part of why violent means of control are used today in prisons and psychiatric facilities are attributed to low staffing. Not only is there not enough revenue to properly staff psychiatric units but the pay is not competitive with other health care fields. In addition, seven men without a lick of effective training in safe and proper restraint could have been properly trained (and retrained and retested, frequently) so that they wouldn't need to rely on tasers, had there been funds to competitively hire the best and most well-trained peace officers. Change is possible but only effective if we're exerting the right solutions on the right part of the system.
DeleteAny hospital, provider, agency or really anyone providing service and care to people with mental illness should really have clear written policies and systems for checks and balances to ensure ethical and humane treatment. I'm assuming this is the case in the vast majority of places, but I don't know. These policies should also be reviewed with patients and families. Beatrice made a good point in her post about crisis plans and how that might be explained, reviewed and agreed upon with people in advance as a way of providing informed care. It's really discouraging and heartbreaking to think about situations where people are being abused and treated as less than human.
ReplyDeleteThis was from Joe Hayes by the way. I'm not sure why it's not adding my name on the post and I can't seem to figure it out since I know I am signed in. I have 2 responses above that are also listed as "unknown".
DeleteThis is Gary's post (Blogger refuses to play nicely for him):
ReplyDeleteIn viewing the video of how Andre Collins was being treated at the Judge Rotenberg Center you can’t help say to yourself how is this even happening in 2002. The Judge Rotenberg Center was founded in 1971 as a behavior research institute is a facility in Canton, Massachusetts the center makes $52 million dollars annually probably through state funds. Watching the video makes me question why hasn’t the Judge Rotenberg Center changed its treatment for its patients who have severe mental disorders. These children who are under the centers care should not be punished for having a mental disorder. In order for a facility to carry out its care for patients written guidelines, protocols and standard of operational procedures must be signed by the director or administrator of the facility. It is unbelievable that after rotations of administrators at the Judge Rotenberg Center no one cared to sit down to take a deep look at what type of care the agency is providing and how it is providing their care to children who have MI or SMI. It appears that the facility is still delivering care as it did in the 1970’s. It is believed that shock therapy eliminates unpleasant habits and is used as a way to correct a patient from their aggressive behaviors. The video we watched was about a teen named Andre McCollins who went through aggressive shock treatment in 2002. Andre, can be heard screaming for help restrained face down for shock treatment he states no, no, as he was shocked 31 times that day. An article written on 2016 by Sukhoterina, Y, states that a student can receive up to 5,000 shocks a day at the center. Ask yourself how can anyone be normal after that? According to Sukhoterina’s article the practice of shock therapy at the Judge Rotenberg Center is still occurring today.
The Judge Rotenberg Center really needs to update their policies and procedures and account for a patient's rights and their right to refuse treatment. Is it because Meed's method of building a relationship with a patient to help him/her take control of his/her life takes too much time and/or effort than shock therapy? Is it not having the proper training to embark on this type of interactive treatment?
DeleteLisa after I saw the video about the center policies and procedures about this facility came to mind. It is a mystery how it is able to go so long with its current methods of treatment. Shock therapy gained popularity as a non drug aversion therapy. It is time for the Judge Rotenberg Center to modify their treatments and look at other alternatives. Lisa, thank you for sharing.
DeleteGary's Post Part Deux:
ReplyDeleteThe video about inmate Natasha McKenna is another video that can be used as a lesson learned. Ms. Mckenna appeared to have mental issues and the correctional facility was probably not the facility she should have been booked at. Ms. Mckenna should have been admitted at psychiatric hospital where she could have received better health care. This goes to show our nation needs to take a deep review should a person with mental illness be locked up at a correctional facility immediately after being arrested. An article written by Jackman, T, states that the four taser shocks may have resulted in Ms. Mckenna’s death. As taser shocks can disrupt the hearts beats and arrythmias which can also cause shortness of breath. One of the interesting points from Jackman’s article is that a patient does not need to be treated like a suspect. All professionals that are in contact with patients who have a mental disorder need to be aware that excessive force kills and every life needs a chance of fair treatment. It is understandable that some interactions with a patient who has a mental disorder is not pleasant to interact with, but an encounter with a patient should not result in death. According to Sheryl Mead it could be helpful in engaging in a dialogue to create a connection with your patient which can enable a new vantage point from a different angle. Opening up a dialogue with a patient can explore new ways of treatment and create trust between the patient and health care representative. Opening up a dialogue can lead to a compromising solution and can assist in deescalating a person who is having a meltdown or who is going though an episode of distress. As we saw on Natasha’s video she came out stating “You promised you were not going to kill me”, Natasha sensed that what was about to occur did not sit right with her so she put up a fight which ended her life. Could things have worked out differently if a dialogue was opened up with a trained psychiatrist? I really enjoy this week’s modules, it shows that anything at anytime can happen when treating or interacting with a person with mental illness.
ref:
Sukhoterina, Y., ALTHEALTH Works (2016), “I just wanted to die” Kids with autism treated with controversial shock therapy retrieved 8/14/2018 https://althealthworks.com/9921/i-just-wanted-to-die-kids-with-autism-are-being-treated-with-controversial-shock-therapyyelena/
Jackson, T., Washington Post (2015), The death of Natasha Mckenna in the Fairfax jail: retrieved on 8/14/2018, https://www.washingtonpost.com/news/local/wp/2015/04/13/the-death-of-natasha-mckenna-in-the-fairfax-jail-the-rest-of-the-story/?noredirect=on&utm_term=.c0daa6daca0c
Mead, S., Hilton, D., Crisis and connection, https://bb.courses.maine.edu/bbcswebdav/pid-3987846-dt-content-rid-9405199_2/courses/1830.UMS06-S.1596./CrisisAndConnection.pdf
Gary -
DeleteFirst, sorry you had so much trouble posting. I have been there myself I the past.
So, you stated “Ms. Mckenna should have been admitted at psychiatric hospital where she could have received better health care.” I am. It sure what “Alexandria” is that the guards referenced they were transporting Ms. McKenna to. In any regard, she was CLEARLY not in a stable mental state. Therefore, appropriately trained staff should have been a part of this transport plan. As I mentioned in my post, perhaps she could have been sedated medically by a trained physician, so her transport could occur much more easily and safer for everyone involved.
There is no excuse for not treating someone with dignity and respect in this sort of situation. Why was she naked? Was she taking off her own clothes? Were her clothes removed because they feared she would use them to hurt herself? Were the removed as a punishment or a means to control her? Thank God this was video recorded, or her family may never have known what really happened.
I would love to know if the officers were reprimanded, charged, or if they even apologized to the family for their actions. How do they feel after the fact? Do any of them feel responsible?
Liz, as one of the articles stated that I referenced, she stopped taking her medication was the reason why she was not in a stable mental state. The correctional facility was not the appropriate place for Ms. McKenna, the correctional facility did not clearly think out their actions or plan. Not sure if the video was a good thing or a bad thing, I surely hope the correctional facility can really learn from this and treat people who are mentally unstable better in the future than how they treated Ms. McKenna.
DeleteOur assignments this week left me with thoughts and feelings that mirrors Dr. Barrett's question. Why didn't anyone object to the painful shocks of Andre McCollins at the Judge Rotenberg Center, or Natasha McKenna as she was being tazored four times and held down by 5 grown men while naked and handcuffed? Didn't someone know it was wrong, and why didn't they do something? I find myself trying to intellectualize all these possible reasons, none of them good enough to begin to explain what occurred to both individuals. Was it that everyone was doing what their supervisor told them to? The psychiatrist and/or sheriff said it was the right thing to do, and no one was to question their authority? People knew something was wrong, but did not want to chance losing their jobs? They somehow had rationalized in their heads that this was an effective treatment?... None of these explain away someone's wrongful death or abuse.
ReplyDeleteWhen we begin to ask these questions, I also start my own questioning of my decisions as a mental health professional over the years. In the early part of my professional career, I have been on teams that gave medication against someone's will, physically restrained someone on the floor who was deemed unable to maintain safety, or helped apply physical restraints to someone on a bed. I never wanted or chose to be in these positions, only found myself being required to assist as part of my role on a unit or in a facility. All of these moments stand out as reasons why I have shifted out of working directly the mental health field as a counselor. I had this sense of unease that I could not help make things better in the moment, thinking that restraints were not beneficial for anyone involved (identified patient, other patients as witness, or professionals) and as a young professional trying to figure out what I could do to make a difference.
When I was in these roles previously, the general philosophy is that we needed to take of people who were unable to take care of themselves because they were so ill; there was a sense of responsibility. Now, as I read about the Wellness Recovery Action Plan (I believe I have heard reference to WRAP while working with the Vermont Center for Independent Living) and Sherry Mead's Intentional Peer Support (IPS) model, this belief system around responsibility that existed in the state hospitals and short-term psychiatric units really sounds a little like an excuse (and I own my role as well). In many ways, it is much easier to physically or medically restrain someone rather than embrace the philosophy as outlined by Peter Breggin and Daniel Fisher. If one were to approach working with individuals with MI with love, respect, and sharing of responsibility, this is a whole new level of equality that does not exist within the medical model. Mead and Hilton's (2003) perspective of our inability to sit with the discomfort and instead trying to avoid that experience is spot on. Members of society try to walk away from someone who is not feeling well, and in some cases, make fun of them while doing it. This then shifts back to taking care of our own perceived needs, including risk management, rather than really seeing and hearing the client and his/her/their painful feelings.
I love the WRAP idea, and think that one could utilize aspects of this model for everyone with whom we work. WRAP is about self-care and taking back control of one's own treatment, and this evidence based approach encourages and supports an individualized support system. Recovery is not about compliance or stabilization, as Deegan and Fisher explain, but about self-determination and establishing a partnership/relationship with another for support.
I mentioned group-think in my post and I think that the group mentality, or following the group, is one way to explain why no one would stop or stay anything. Possibly for fear of standing out or having the attention then drawn to them. My children, grades 5 and 2, are learning up being upstanders, not bystanders, to bullying or something happening that doesn't feel right to them. I really like the message and think we could all use a little tutorial in "upstanding."
DeleteTara,
DeletePart of the reason why I decided not to return to behavioral health programs in the Lewiston area elementary school system was that I was deeply uneasy with the level of coercion and psychological pressure (bordering on abuse) I saw there. So I appreciate why you shifted your career from the psychiatric setting. However, I have often wondered about the broader implications of making my own decision. My question for you (and myself) is - how do systems change for the better when the people that see the failures in the system leave?
I was not brave enough to watch the video. I can only imagine the horror. If the officials responsible for Natasha’s death were confident in the way they treated her, I can only imagine they felt as though they did the right thing. I can’t imagine anyone feeling that a situation ending in death is the right action, but I was not part of the situation. Without watching the video, it sounds as though there might have been some group-think happening at the time, which could be why no one objected to the way Natasha was being treated. In a situation as heated as this one sounds, it could be difficult to step up and stop the treatment from happening when you are surrounded by ten people who are all on board with the treatment.
ReplyDeleteA better way to interact with people with mental illness, according to Sherry Meed is to build a relationship and help people take control of their own recovery instead of dictating what their recovery should look like. Meed also talked about crisis planning being an interactive process, which is best to happen in a proactive manner. Mead writes: “When people are allowed the time and the nonjudgmental atmosphere to talk about the things they have been through, they can often begin to identify some of the things that helped them learn and grow from particular situations and they can also begin to identify the things that have kept them stuck in old patterns and old ways of relating to people.” Helping people get unstuck from the past helps them move forward with new information and often a healthier way of dealing with the past when it does come to the present.
Hi Lisa,
DeleteI agree with you. I watched parts of the video, but were these individuals ever reprimanded for their actions? Or was it because the african american lady had a mental illness? I hope that with displaying this information and the advancement of technology that practitioners will be held accountable for their actions? But on the other hand, I guess it could be a form of treatment. I do not know how that works. I agree with Sherry Meed's ideology!
Hi Lisa,
DeleteI made a similar point in my post how maybe no one stepped up in the Natasha video because everyone was seemingly on board with what was going on. This kind of situation happens a lot, unfortunately. I can imagine that, in this situation, even if someone had stepped up and said something that their actions wouldn't have changed and they would have continued treating her that way. But maybe I'm wrong. Maybe if someone had spoken up, then other people in the room who were possibly thinking the same thing wold have spoken up too. It's a tough call, and we'll never know the answer to this question, but it's something to think about.
I've made my best attempt to provide responses to all these prompts from the perspective of prevailing attitudes and beliefs in mental health care, but this is beyond my imaginative ability. I just don't know what story they are telling themselves. That she's black and a woman, so no one will care? That he's black and a teenager, so he's dangerous? That they're both mentally ill so they're subhuman? I can tell you that there is a tremendous urge for the police to exert physical control over us. They expect us to believe that their authority is absolute. Any dissension will be met with tasers or bullets. Beyond that I don't know.
ReplyDeleteIn Chapter 4 of our text, John Strauss talks about how he knew nothing else but the holistic care philosophy of Meyer and Sullivan and that describing their influence on his own practice is like a "fish writing about the water in which he or she has always lived" (p.105). Well the water in which I live is one of kindness, empathy, and service. I can only focus so much on the actions of those who don't live in that water before I need to move on, just do, and just serve. Horrific things are being done to people, today and yesterday. I don't know why. Trying to argue why Natasha's treatment is wrong, why the treatment in Bedlum was wrong, why mental asylums are wrong is a little bit like trying to argue that breathing is necessary. I'm more interested in how to move forward. The authors of our text state that the "community support movement did not bring about a fundamental rethinking" of person-centered, recovery-oriented care (p.210). So what now? We can continue to fight for the rights of people with psychiatric disabilities but we are currently witnessing an administration that is removing the civil rights of some of our most vulnerable populations. So what now? We can deploy a capabilities approach but social service funding is being continually gutted at all levels of governance; and with higher education becoming prohibitively expensive and salaries remaining stagnant, trained personnel will be in short supply. So what now?
What about the rights of the staff? What would YOU do if you were tasked with moving a patient who had been kicking, punching, biting, spitting, smearing feces and peeing on herself telling you she would give you herpes, strangling herself with a seat belt, accusing people of rape and murder and poison and phone monitoring and on and on. I encourage you to read the details of the events that led up to the incident (link below). It reads like a movie. She was in and out of hospital care and had police called on her multiple times. She was arrested for assaulting an officer.. I am not saying I condone the use of tasers or excessive force, but I'm saying, sometimes the least restrictive intervention is not enough. From the death report, which I acknowledge is likely very biased, it seems like there were many many chances for her to receive help but she was refusing it. It's unfortunate that she ended up incarcerated, but maybe if she hadn't been able to refuse treatment that wouldn't have happened?
DeleteThere is a lot of progress in training police on how to handle people with MI. Maine is really good about that. Many larger police departments like Portland and Augusta, even have social workers that ride along with police to respond to calls. The officers also visit Club Houses to maintain a relationship with people there to decreased the fear that people have about the police.
These efforts are helpful in getting the patient to the hospital. But I feel like until we reduce the stigma that psychiatrists are "bad" and they "don't help" we will continue to struggle to get people the help they need.
https://apps.washingtonpost.com/g/documents/local/report-on-death-of-natasha-mckenna/1735/
I would say to you that if a boxer felt like it was his right not to get hit in the ring then maybe he needs to try a different sport. There is no story you could tell me that justified what I saw in that video.
DeleteThat was Bronte (above). I don't know why it labeled me as unknown. I would add though that Natasha's right to life far outweighed any right they might have not to get hit. I would also say that a refusal to cooperate does not deserve a trial without jury and subsequent death sentence.
DeleteBronte, it was an accident not an execution. They were trying to transfer her to another institution and get her to mental health treatment. I recently saw this episode of Frontline about how jails/prisons are the new asylums (link below). Looks like this type of force is used standardly... I don't think these institutions are equipped to handle such patients. But in all honesty, neither are acute inpatient facilities. We call the police if a patient is beyond our ability to safely manage. Or violent patients are transferred to a state facility if treatment is court ordered. But they have used similar tactics there in the past (tasers, handcuffs)... I've heard of staff having career ending injuries. If we all took the attitude you have "if you can't take a punch, don't be in the ring" there would be no employees at the psych hospitals left.. in fact, they are notoriously understaffed and had to have police officers serve as guards because they didn't have sufficient staffing.. I think it really always comes down to a matter of funding. But I think in order to make the changes that Chabinski talked about or the Open Dialogue program or the Soteria program.. patients like Natasha don't seem ready to participate in such a program... every time she brought herself to the ER she refused medical and psychiatric treatment. I don't think a peer support specialist or a more empathetic approach could have convinced her otherwise. I used to be a crisis response worker, showing up at people's homes, sometimes with police with me.. I could be as empathetic and kind and patient as I wanted, going above and beyond the call of duty. And maybe one day I got them to agree to go the ER, but then the next day I'd come in for my shift and see they discharged from the ER without even going to a psych facility. It's disheartening. People often don't want help. I think getting them help SOONER makes the most sense. I don't think it much matters what exactly that help looks like (i.e. psychosocial or medication) the larger problem is getting them the help.
Deletehttps://www.pbs.org/wgbh/frontline/film/showsasylums/
https://www.centralmaine.com/2013/08/20/tasers-handcuffs-cited-in-20-million-funding-cut-threat-for-riverview/
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DeleteJessica,
DeleteI'm getting the picture that you and I view the world very differently. Which I can appreciate. You have certainly provided me with interesting posts which which to argue.
First, let me say that if you understand the nature of job and you enter that job unable to practice kindness and humanism within the framework of that job, then you need to find a different job. So I disagree with you about there being no nurses left if every held the attitude I espoused in my boxer metaphor. I have an aunt who has worked in the nursing field for 37 years. She graduated nursing school the year I was born. She currently works in a psychiatric unit. She happens to be a Christian and abides by the tenants of Christianity in her home life and professional life. To wit, she takes punches. She understands punches are a part of working in a psychiatric unit, and she remains in the ring. I train mustangs. I understand they come with inherent risks that tend to be greater than working with domestics. I understand that additional physical restraints diminish my relationship with my mustangs even if it makes them more docile. I don't go into a relationship with a mustang hoping they will behave like a domestic.
Second, Natasha's death most certainly was not an accident. The use of deadly force was systematic and planned. Tasers were the standard protocol. They tasered her four times. They bound her face and arms behind her back. That was an execution. An accident is if she accidently tripped over one of their boots, fell into the doorframe, and shoved her nose bone into her brainpan. That's an accident. What happened to Natasha was an execution through manslaughter.
"There but for the grace of God goes I" is a call to empathy. It is a call to understanding. I've been punched before. I've been assaulted. By someone with mental illness. I use caution around the psychotic but I would never diminish their humanity because there but for the grace of God could go I.
The Soteria approach is totally rad. But also maybe unethical. Mosher points out: "It is possible that, if a replication [of Soteria] were proposed as research, it might not receive [Institutional Review Board] approval for protection of human subjects as it would involve withholding a known effective treatment (neuroleptics) for a minimum of 2 weeks" (1999). So if this kind of approach can be viewed as unethical, it makes it seem like it's all a matter of perspective.
ReplyDeleteBut, reading these Mosher articles reminded me of something they teach us in nursing school. Prevention is the best treatment approach. Mosher reported in his findings that regardless of being in the traditional treatment or in the Soteria group, patient outcomes were "predicted by four measures of preadmission psychosocial competence...: level of education (higher), precipitating events (present), living situation (independent), and work (successful)" (P. 6-7, 1999). So, his findings confirm a commonly understood idea that better baseline functioning indicated better outcomes. So, doesn't it make sense that we should as a society try to ensure that EVERYONE has education, work, a living situation and ability to cope with life events? Wouldn't that improve outcomes for everyone? This goes along with our knowledge that poor, urban, immigrant, minority, LGBTQ populations etc., have higher rates of MI. Wouldn't better supporting those populations that are known to struggle with MI increase patient outcomes in a trickle down effect kind of way? I think Sherry Mead would agree with my prevention approach. She quotes White's concern with socio-political factors stating " the problems for which people seek help are so often mired in the structures of inequality of our culture, including those pertaining to gender, race, ethnicity, class, economics, age, and so on..." (White, 1995 as cited by Mead, p. 92).
I have enjoyed reading everyone's comments and thoughts about the readings and videos. Both videos are extremely difficult to watch and unimaginable. I am wondering how technology and advances will help or hinder these unethical practices. Maybe doctors or treatment facilities will be more inclined to stop with the social media and other areas. Also, the more patients or family/friends of the patients that share their stories will help. It is almost advocating for themselves and for the future treatment of individuals with mental illnesses. Just a thought!
ReplyDeleteI think part of the reason this happens is because providers have managed to perhaps emotionally remove themselves from the situations they’re in. When part of your job requires you to physically restrain someone and force treatments on them, I can imagine that that isn’t too great on the psyche. Maybe this is their way of dealing with that? Not that this would at all condone the actions like those seen in these videos, but maybe this is one way to interpret that. I also think that another part of the “story” they tell themselves that allows this to happen is that it “needs” to happen for the patient’s “well-being” or “for their own good”. I think the idea that “doctor knows best” is still very much alive for some practitioners, and these cases could be examples of that. I think no one objected at the time for the same reason of “doctor knows best”. It can also be hard to be the one person to speak up when everyone else is content with what is going on. According to Mead, having peer support is a better way to approach these situations. She argues that if people were given the chance to sit down and relate with someone and have their story feel heard and validated, then that can be just as therapeutic as medication. I’m sure that there would be some situations in which this may not work, but I think that for the most part it is a great idea. I’ve worked with people who received peer support as part of their treatment and they would speak so highly of it, saying that they liked being able to relate with someone who had gone through similar situations or felt similarly. I think peer support should be offered at all mental health facilities, as it truly is a valuable resource.
ReplyDeleteMore and more of the large ERs have them now. Small ERs don't even have psych/behavioral rooms.
DeleteThe cool thing about peer support is it can be free. Lots of support groups like AA etc. help give people purpose to help others. I thought it was interesting that things like WRAP seem to have basic therapeutic teachings but they just repackaged it their own way. I think it speaks a lot to how patients do well when they have a purpose of helping others but perhaps also hints at how they don't want to take the information from a mental health professional but perhaps will accept it from peers? I think there is a big stigma that patients believe their providers "don't get it" because they haven't "been there" which isn't true. It reminds me of the rebellious teenager who thinks the world is against them and no one can relate. So having peers they can connect with is nice. We have peers come in to the hospital to volunteer and lead a group therapy session. People like it. If they go... Can't make people go to therapy...
I think you provided an interesting and reasonable insight into what the providers may be telling themselves, there is many jobs that involve mental health facilities where self-defense is learning physical restraint is a big part of the job. I would imagine after doing it so many times you have no choice but to either quit or turn your mind off. Even though this may be the case it's not always the right choice.
DeleteNoelani,
DeleteAfter viewing each video numerous times, I do see what you are sharing. The medical representatives and prison guards to this routinely most across the nation not as extreme as this week’s videos depict. At the Judge Rotenberg Center in 2002 this was quite routine for their staff, being part of their treatment program. It was already built in to their regime so the medical staff went about their daily business in strapping down patients, record the treatment on both video and documentation and record the results later if there was any noticeable change on the patient after treatment. As the medical staffers do this routinely day in and day out it becomes part of the blueprint that they do everyday and yes, I do see how that can affect a person in removing themselves emotionally. I am sure that the medial staffers wouldn’t want their children subjected to the same experience as they put these children through shock therapy. You pointed out a fantastic theory from Mead, as peer support would be an approach that could be explored and have a tailored visit with a psychiatrist with each child to address their dysfunctional behavior. At Veterans Administration they have Peer Support Coordinators who assist patients with their emotions as the patients struggle with their mental illnesses they also conduct peer support meetings weekly. You point out a great alternative from Mead. I enjoyed reading your post.
I just finished the readings for the 1st module and the videos. I want to thank Dr. Barrett for sharing her story. When someone shares their story it has more meaning for me, because I have a better understanding. Dr. Barrett stated when she is symptomatic these are the things that are most helpful to her...she wants someone to listen and validate her experience. She wants to feel emotionally safe. She wants encouragement, and to be reminded of all the things she has made it through in the past. She wants to be reminded that she has the ability to figure it out, whatever "it" is and she needs to know that she has value. What if we took the time to ask every person what they wanted and to listen to them with empathy and as if they are being heard and have meaning?
ReplyDeleteIn the Bellevue video it didn't seem like there was a lot of support around what individuals were experiencing or what they needed feel safe. I know I got stuck on seeing people being restrained, versus seeing a holistic approach. I had to watch the movie twice just to see and hear how the Dr's and others were responding. So I've learned that when something is coming at me that is startling I'm not responding in the best possible manner. I need to be aware of my own insecurities of safety, so I can become a better provider.
I think this can be where society falls down. Fear of one's safety comes in, then they respond our of fear with a flight or fight response rather than slowing things down and trying to hear one's story. Most people want to tell their story and be validated...they certainly don't want to be humiliated or told what to do. We need to give people the space to tell us what they want to do and live up to their dreams and goals.
Most people that I'm working with tell me that the medications don't work, they hate the feelings and the multiple side effects. I wonder why there is so much emphasis on this practice other than there being millions of dollars to be made. Apparently, there is much less to be made on alternative methods, otherwise, the focus would be on mediation, yoga, or psychotherapy. There is not straight line to follow to help someone, but we need to be willing to support the individual in their journey however they want it to look like.
Cindy
Cindy,
DeleteIndeed, patients want to have the feeling of security and not be judged, I like how you shared on your post that subjects (patients) want someone to listen and validate their experience. That is a great take away. One of the experiences that has been coming lately in my interview room where I evaluate veterans and listen to what they have experienced during their military career is (MST) military sexual trauma. Some veterans come right out of service and claim military sexual trauma which is the best time to do make that claim due to all the dates, times and events with names are fresh and if MST did happen during their time in service then it can be corroborated linking the event to military service. A lot of veterans especially males wait 20 plus years before coming forward. It is a dishonoring aspect for a male veteran to come forward and state his manhood was taken in service. As the male veteran is already at a vulnerable state I know it took a lot of courage to finally speak to a stranger and tell his piece of his event in military service. When the interview comes in my que all I know it is military sexual trauma I don’t know the gender of the veteran. When I pick up my status card from the desk I then know the gender of the veteran and I ensure I state Mr. in front of the persons last name ensuring him he is still a man in society. In active service as a Platoon Sergeant I went through SHARP Sexual Harassment/Assault Response and Prevention training. This training with my present training that I go through at Veterans Administration has made me a better listener. On your post when you mentioned that subjects want to feel emotionally safe made me think of my SHARP training I had in my active service years. It is important that when a patient elects to confront their past experience for the first time after many years that the event transpired they want to feel validated that the incident happened and they want to move forward with what they have experienced. This is important for their initial entry to their recovery process. Many young men and women have taken their own lives due to not being believed, then after further investigation the incident did actually happen. Cindy, I enjoyed reading your post.
Cindy:
DeleteThanks for your thoughtful post. I agree--Dr. Barrett, thank you for sharing your thoughts and experience with us.
In all of readings and videos from this course, I keep going back to the point about treating everyone in which we serve with the same level of respect deserving of a member of our community. When we begin to see individuals as a collective group, such as "schizophrenics", "inmates", or "homosexuals", there are assumptions about who they are and what they need (and what they cannot manage without our assistance). This is where the slippery slope begins, as we start to believe that everyone who has that diagnosis, culture, or background is the same way based on past experiences and knowledge.
As Bronte mentioned in a previous post, "so now what?" How do we ensure that our approach always respects the right of the client as an agent and to share the responsibility of the relationship. I believe that individuals can be dismissed for being "resistant" or "noncompliant", when in fact there is a person who has not felt understood or validated. It is our role and human service and health professionals to be empathetic, accepting, and compassionate with everyone, rather than assuming that we know their story before establishing a connection.
Hi Everyone,
ReplyDeletePart of the reason I am asked to teach this course is because I am one of "them." I have strong feelings about how Natasha McKenna was treated, but that is partly because I have thoroughly researched her case, and the events leading up to it. As someone here said, the situation here is "multifactorial"...as are many situations with people in crisis. There are no easy answers. I respectfully ask that you consider this:
1. Diagnosed with schizophrenia at age 14, research tells us that the probability that she has experienced trauma is very high.
2. Breggin discusses a concept that I think is helpful. Rather than describing her as aggressive, or having a psychotic "break," what if we think about her being utterly overwhelmed and fearful, given her situation and her symptoms.
3. People with traumatic backgrounds may react to situations because they are triggered into fight-flight-submit mode. If you have been physically abused, when 6 big, uniformed men with guns and nightsticks approach you...it makes sense that you would react -- she reacted by punching one officer, and trying to bite another.
4. What started this whole terrible incident, was that she was wandering around a rental car agency and then a BMW dealership, she was acting strangely, and talking to herself. Six police officers responded and approached her, and she lashed out. She was taken to a local hospital for evaluation and mental health treatment against her will. Eventually, she was charged with felony assault, and a warrant was issued for her arrest. Some speculate that the assault charges were filed so that she would be taken for treatment whether she wanted it or not.
5. Eleven days later, she calls 911 from a grocery store. She calls 911 because she wants to report an assault. Natasha, at 5'3" and 130 lbs, is only wearing a hospital johnny.
ReplyDelete(I have not been able to find out any details regarding her discharge from the hospital. One article speculated "Was she assigned a caseworker and pushed out the door?" )
6. Upon responding to her 911 call from the grocery store, and interviewing her regarding the assault, the officers discover Natasha has an outstanding warrant for assaulting a police officer in Alexandria.
7. Once booked into Fairfax County jail on January 25, she became much more symptomatic. Isolation often makes people feel more overwhelmed. She was also naked, exposed to all the guards' view. She tried to put a mattress up against the window so they couldn't see, but they took it away from her. Jail staff describe her as "demonic" and report that she threw urine at them. This was the rationale for hazmat suits and gas masks. As an aside -- do you don a hazmat suit when you change a diaper? How dangerous are bodily fluids, really?
8. On the video, at the very beginning, you see a corrections officer discussing incidents over the weekend, where Natasha was restrained in a chair designed for prisoners.
9. There were jurisdictional issues between Fairfax County jail and Alexandria, and Fairfax finally agreed to transfer her to Alexandria where there were more resources.
10. February 3, after she had been naked and in jail for nearly 8 days, the jail staff gear up to transport her. This is what you see in the video. Despite her plea "you promised you wouldn't kill me," they use prone restraint (illegal in most states) and despite her labored breathing, they cover her face with a hood.
11. Her heart stopped after being tased 4 times, which procedurally, is not recommended use of a taser. Though she was resuscitated, she never regained consciousness, and died on February 8.
12. Cause of death was listed as "accidental," due to "excited delirium." She had 2 black eyes, a severely bruised arm, and a finger that had to be amputated.
Imagine big men, dressed in hazmat suits, descending on you -- you are small, scared, losing your grip on reality, alone, and naked. I cannot think of a more frightening experience, and I would imagine that I would fight like hell to survive it too. If I had a history of trauma, people overpowering me, doing things to me, the intensity of my fight would likely increase.
There are no easy answers. My opinion is that this "extraction" and her subsequent death, were no accident. My heart goes out to my sister, Natasha, and her 7 year old daughter who survives her. May we never forget her, and all the others who deserve(d) better. There but by the grace of God go I...
Regarding "compliance" and "adherence" and "refusing treatment:"
ReplyDeleteThe subtext of these words is "Do as you are told," and indicate power and control issues that are very likely inconsistent with recovery. One exception may be when someone completes a psychiatric advanced directive that specifically states what response the person wants if they become aggressive, danger to self or others, etc.
Compliance with all treatment and medications is very low. Think blood pressure medicines, low salt diets, diabetes and diet, etc etc...
Cursory search brought up this article from 2005:
ReplyDelete"Research during the past several decades indicates that, depending upon their conditions and the complexity of the regimens required, as many as 40% of patients fail to adhere to treatment recommendations (DiMatteo and DiNicola 1982; DiMatteo 1994, 2004a, 2004c; Lin et al 1995; Rizzo and Simons 1997; Dunbar-Jacob et al 2000; Laederach-Hofmann and Bunzel 2000; Haddad et al 2004; Haynes et al 2004). When preventive or treatment regimens are very complex and/or require lifestyle changes and the modification of existing habits, nonadherence can be as high as 70% (Dishman 1982, 1994; Brownell and Cohen 1995; Katz et al 1998; Chesney 2000; Li et al 2000). Although patients with HIV/AIDS may be highly motivated to adhere, their medication regimens are particularly complex, often involving multiple drug “cocktails” (Catz et al 2000; Heckman et al 2004)."
Martin, L. R., Williams, S. L., Haskard, K. B., & DiMatteo, M. R. (2005). The challenge of patient adherence. Therapeutics and Clinical Risk Management, 1(3), 189–199.
So, why is nonadherence and/or compliance such an issue when it comes to people with MI? Perhaps society wants us to act in ways that are socially appropriate?
ReplyDeletewhere this gets increasingly complex is when someone is aggressing toward others...so perhaps we need to develop better responses to people who are symptomatic and aggressive -- responses that do not re-traumatize people who are scared and overwhelmed...
My 7 cents. :)
This is such a tragic story and yet it has many elements that may raise questions about how we respond and what are ways that behavior that is considered socially inappropriate can be addressed that does not traumatize persons with SPMI.
ReplyDeleteNancy
This is such a horrible incident to happen to such a young man and will now suffer with the physical and emotional side effects of that incident for the rest of his life. it's hard to even try and consider what the story is those providers are telling themselves to make it seem moral in there corrupt minds. According to Mead "We drug strong feelings, we try to “calm people down,” and we only feel competent if we “make someone feel better.” (We are not a culture that has any tolerance for pain, difficult feelings, or unusual affective expressions" (Mead & Hilton, p. 90) But we should be striving for equality and understanding those with a mental illness to only include them and accept them just as we would everyone else.
ReplyDeleteWell, first I will say I was “brave” and watch the video of Natasha’s death. Where do I start....So, the Sheriff’s staff going in stated they new she was acting irrationally. I’m thinking she’s thriving urging at people...hmm, must be some sort of mental crisis going on. So, she is kept naked, an a isolation cell. That’s helpful....not. I watch as 5 men in white has at suits prepare to enter the cell. Riot shield in place....the men storm Natasha. The throw her to the hard floor. I am watching this and immediately thinking Natasha may not be rationally in the moment. If she is not, what do these men look like to her? What is she thinking they are doing or going to do to her? Is she able to even comprehend their commands “stop resisting”? If you were in fear of your life, and thought you were under attack, would you stop resisting your attackers?
ReplyDeleteI watch as these men (and did it really take 5 grown men to subdue Natasha?) cover her face with a hood. That must have added another level of terror to Natasha. On d in the chair, has they continue to struggle with her, she is told repeatedly “if you keep resisting, we will tase you.” Again , does she understand? Are her body and mind now in a fight or flight mode?
Then, she is restrained, leg still twitching with electrical pulses from the taser. Then, she stops moving. One guard, not in a white suit ( because he was not afraid of getting potentially hit with flying urine?), asks “How you doing Natasha? You OK?” He gets no response, so just goes on as if presuming she’s decided to be compliant. Then they ask for a nurse. Who struggles in the hall to establish vitals. One guard in a white suit says “just wait till we get to the loading dock.” All that time going down the hall, into the elevator, discussing her removal of restraints with transport officials, THEN a nurse come to check her. She cannot find a pulse with the monitor. I already know she is dead, and the nurse manually checks her pulse. Sigh....it was all just so incredibly
This may not have been a better idea, but why could she have not been sedated before transport? She could have had medication administered in her food, or been shot with a tranquilizer gun. That would have at least been far safer for her than what they did. Once sedated, she lucid have been placed in clothing, with perhaps a straight jacket, so she could be safely transported and not a safety threat to herself or others. Then when she got to Alexandria (was that a hospital? Detention center?) she should have been under medical supervision and provided with mental health treatment.
In this case, jail staff presumed she was violent and a threat to them. They did not once look at how she viewed matters. Was she throwing her urine to keep her perceived threats at bay? Was she reacting to a trauma? Were they causing new trauma? They failed to communicate respectfully with her. They failed to try to see things thru her eyes. They failed her with the ultimate betrayal, and it cost her her life.
How does this happen? Preconceived stereotypical judgments, lack of communication and humane treatment. The opening guard’s statement was “we are here to extract inmate McKenna....we have already had to use force on her this weekend...she has been non-compliant, and created a major biohazard situation....she was restrained earlier too...” So, I am thinking he had a preconceived idea of her, and was going in on the defensive, expecting confrontation, and resistance. Again, sedation was not an option? They tell themselves she is inmate _______. They view her less as a person, and do not appear to care for knowing her side of things. Once she died, I am sure they all thought “this is HER fault. If SHE had just listened to us, and not resisted...”.
I think no one objected because of the group mentalaity of the moment. Some may ha e. Not known the situation. Some may have had prior experiences that clouded their judgement.
Tragic is all I can say.