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Date: Sun, 8 Nov 1998 14:26:41 -0600

Reply-To: MadNation Activism Announcement List


Subject: [MADNATION] STUFF:  ACTION ALERT: PACT/ACT and COERCION

    ***************************************
               STOP COERCION AND
           PACT/ACT PERVERSION NOW

             A MadNation Action Alert
                 November 8, 1998
                www.madnation.org
     *************************************
     Programs of Assertive Community Treatment (PACT)
     have been around since the mid 80s and have
     ALWAYS incorporated consumer/survivor friendly
     service principles.

     And while there have been coercive elements
     of PACT/ACT related to persuasion and manipulation
     PACT/ACT has only infrequently been used or studied
     in situations where consumer/survivors have had their
     civil rights removed by order of the court.

     PACT/ACT service principles are: (from "A Review of Case
     Management for People Who are Homeless: Implications for
     Practice, Policy, and Research" by Gary Morse, Ph.D., in
     press)

     "1/Assertive and persistent outreach to meet homeless
      people on their own turf (as well as their own terms)

     2/Active assistance to help clients access needed resources

     3/Following the client's own self-directed priorities
       and timing for services

     4/Respecting client autonomy

     5/Nurturing trust and a therapeutic working "alliance

     6/Small caseloads for case management staff"

     These service principles are being abandoned as NAMI
     redefines PACT and makes practitioners of this model
     into the mental health militia and the {*filter*} pin
     of a system that is designed to forcibly drug
     people living in the community.

     The New PACT is being lauded as a "Hospital Without
     Walls" and the cornerstone of the program has been
     redefined as medication compliance.

     NAMI has also inserted a focus on satisfying
     family members into the model that has not been
     a significant focus of PACT/ACT in the past.

     ************************************************
     NAMI SUB-CORPORATIONS SUPPORTED
               WITH ANTI-STIGMA
     CAMPAIGN DRUG COMPANY FUNDING
     TO SPREAD THIS PACT/ACT PERVERSION
     ***********************************************
     NAMI has a long history of creating subcorporations
     with inter-locking Boards of Directors as a ruse
     so that they can continue to claim to be a grass-
     roots organization while the real political agenda
     of the paid staff is brought to fruition
     using PAC type funding from big players--mainly drug
     companies and wealthy force zealots Ted and Veda
     Stanley.

     The most notorious of these has been TAC (Treatment
     Advocacy Center) which has no purpose other than
     the dissemination of stigmatizing information about
     people with mental illnesses in order to reform
     the commitment laws in the United States.

     NAMI bowed to intense pressure by state affiliates and
     its Consumer Council and formally severed the
     relationship between TAC and NAMI:  a sham move as the
     two boards continue to have an interlocking directorate
     and coordinate activities closely with each other.

     This same technique has now been applied to form ACTA
     (Assertive Community Treatment Association and PACT, Inc.).

     For those in the activist community who wondered why 7
     drug companies had chosen to finance the NAMI Anti-Stigma
     foundation and why NAMI used that money to develop a
     highly structured regional and state system to achieve this
     goal, the formation of these two new subcorporations answers
     many questions.

     With the drug company financed structure now firmly in place,
     and the initial five year drug company financial commitment
     coming to an end, the NAMI Anti-Stigma Foundation has become
     the financial pass through for drug company money to finance
     a campaign aimed at pressuring state Departments of Mental
     Health to invest in system of forced treatment delivery
     from which the drug companies can expect to make BIG bucks.

     PACT/ACT models have not been widely adopted previously
     largely because of the enormous cost of this form of
     service delivery.  While there has been research
     that has shown that PACT/ACT reduces costs,
     the wide spread adoption of PACT/ACT will provide expensive
     services not only to people who are currently costly
     people to treat, but also to people who are costing
     the system far less money because they are able to
     avoid treatment entirely or use only limited services.

     The PACT/ACT model that has been shown to be effective
     in systems of voluntary (mostly) treatment features small
     caseloads (10:1) and a heavy investment in psychiatric
     services (16 hours/week of psychiatrist time
     for each 50 clients).

     The costs associated with this staffing pattern could
     bankrupt most Department of Mental Health budgets
     and will increase the amount of federal Medicaid and
     Medicare spending on mental health care.

     The most likely scenario, should PACT/ACT mandates
     be adopted, is that prevention and early intervention
     services will no longer be available through publicly
     funded programs as money is redirected to provide
     intensive levels of services for the people served
     by PACT/ACT programs.

     Not surprisingly the people PACT/ACT would serve
     are the same people that parity legislation
     covers.  Many people do not realize that parity
     legislation can actually limit or eliminate
     services for people unless they are given
    (whether "earned" or not) a short list of very
     specific diagnoses, usually schizophrenia,
     manic depression, major depression recurrent,
     obsessive compulsive disorder, and schizo-affective
     disorder.

     Another likely outcome is that the states will
     be unable to fund the housing and employment
     programs that consumer/survivors define as essential
     to their recovery.

     The original PACT/ACT model has emphasized
     the importance of housing and employment
     services and has often incorporated
     housing and employment specialists as part of the
     PACT/ACT service delivery team.

     Perversion of PACT/ACT by providing housing
     through HUD funded programs that are bundled with
     services so that people face housing loss if they
     are not complaint MUST NOT HAPPEN.

     HUD and the Center for Mental Health Services
     Division of HHS are looking for opportunities
     to implement joint programs. We may very
     well see, in the not too distant future, a bundling of
     housing and services so that consumer/survivors
     served by PACT/ACT are eligible for housing
     assistance that is unavailable to people outside of
     the PACT/ACT service delivery system.  HUD has had a
     similar initiative bundling services and housing
     for homeless people with disabilities called Shelter
     Plus Care.

     In bundled programs such as this, people who do
     not choose to receive mental health services can
     become homeless for this reason alone.

     **************************************************
     PACT/ACT IS (ALMOST) FOREVER
     WHAT ABOUT RECOVERY?
     **************************************************

     While there have been some studies that suggest
     that PACT/ACT services can be discontinued after
     five years and some people can then be moved to
     a less intensive service delivery model,
     There is substantial evidence that the treatment
     gains disappear when those services are ended.

     The PACT standards, in fact, require that people
     continue to be enrolled in PACT/ACT for two years
     after service delivery has ended.

     And, of course, if all the money in the system
     goes to PACT/ACT, there will not be money in
     the system for less intensive services anyway.

     The end result is that recovery under PACT/ACT
     looks surprisingly like chronicity.

      ************************************************
       WHAT WILL THE SERVICE DELIVERY SYSTEM
              LOOK LIKE IN THE FUTURE?
     *************************************************
     The system may very well look something like
     this:

     **People will increasingly be diagnosed with the
     most stigmatizing diagnoses as parity legislation
     funds treatment for people with those labels
     and those labels only.

     **Labeled individuals will be committed to
     in-patient facilities (many of them in the
     For Profit world) under expanded commitment
     laws that provide for forced treatment even
     when the individual presents no danger to
     anyone and is living peacefully in the
     community.

     **Discharge from these facilities will be
     tied to court ordered outpatient commitment
     and community residency will be predicated
     on treatment compliance.

     **PACT/ACT teams will be the method by which
     the treatment compliance will be monitored
     and enforced.

     **PACT/ACT services will erode the availability
     of early intervention, prevention, and less
     intensive voluntary services.

     **States that cannot pay for the *real*  PACT/ACT
     Service delivery elements such as employment
     services, lengthy outreach and engagement
     processes, the provision of supports of the
     clients choosing will selectively implement
     those elements of PACT/ACT which will are
     related to coercion and force such as monitoring
     and enforcement of medical model treatment
     compliance--forced drugging.

     **Essential elements of recovery such as
     adequate housing and job programs will
     be bundled with treatment through PACT/ACT.

     **Treatment refusal (if and when possible
     at all) will result in the loss of housing
     and an inability to access other services
     the individual wants and needs.

     ****************************************
     CAN ANYTHING BE DONE ABOUT THIS?
     ***************************************

     Yes, yes, yes!!!

     **Insist that your state do a full fiscal note
     BEFORE adopting any of the elements of the coercive
     system outlined above.

     For example, if your state funded Medicaid services
     currently have community support services for
     1000 clients with a client to staff ratio of 15:1
     and that same number of clients will be served
     via the 10:1 PACT size caseloads, insist that those
     costs be disclosed.  If Medicaid is limiting
     services to 24 hours per client/ per month and
     the new model will increase service hours that will
     come from state funds (or even just require more
     state match) COST IT OUT.

     **Make the Department of Mental Health tell you
     what services and supports will be discontinued
     if any of these coercive elements become reality
     in your state.  FOLLOW THE MONEY.

     **Insist on fidelity to the original PACT model.
     That is, insist that PACT/ACT not be {*filter*}ed into the
     Mental Health Militia.  Say you want the real thing--
     comprehensive service delivery focusing on the
     autonomy of the people being served and the
     provision of services the consumer/survivor wants
     and voluntarily agrees to.

     **Fight any attempt to pass parity legislation
     that pays for involuntary (forced treatment) or
     which limits coverage to people with only the
     five or six diagnoses that are most stigmatizing.
     GET A FISCAL NOTE FOR THAT TOO!

     **Say no to bundling.  No one should lose their
     housing or access to vocational rehabilitation
     services because they have decided that they do
     not want or need psychiatric services.  If people
     are initially getting housing only because they
     have agreed to accept services, these housing
     vouchers or subsidies must remain available
     to them as long as they are able to fulfill
     the standard lease requirements for people who
     have not been psychiatrically labeled.  Do not
     allow your state to make use of federally
     funded bundled housing unless there is a plan
     in place to replace that subsidy if services are
     no longer needed or desired.  Again, cost it out!
     BETTER YET, DON'T LET THE FEDERAL
     GOVERNMENTCREATE THESE PROGRAMS AT ALL.

     **Demand civil rights protection and the enactment
     of legislation that enables the development
     and enforcement of advanced directives that will
     be enforced, publicized, and effective in
     both in-patient and out-patient settings when
     the individual is under orders of commitment.

     **Require that implementation of any system changes
     be done only after a full examination of relevant
     consumer/survivor perspectives and preferences
     and that consumer/survivors be involved in meaningful
     ways in system redesign.  This includes paying for the
     consultation by consumer/survivors experts in these fields
     and paying for the ongoing work of local consumer/survivors
     who MUST have mandated involvement in the system
     design, implementation, monitoring, and evaluation.

     **Supplement federal Protection and Advocacy funding
     so that the PAIMI Boards can monitor, advocate, and
     litigate abuses within the entire system of care.
     Include the cost of this in any fiscal note prepared
     as part of the redesign of the mental health system
     that may result in increased use of coercion and force.

     **Develop relationships with legislators, the cross
     disability community, social justice advocates,
     people working within the poverty rights movement,
     media, and others who must be convinced that
     limiting the rights of people believed to be mentally
     Ill poses a threat to the rights of all people.  Write
     letters, make phone calls, send Email and faxes to
     those in positions of authority or who are
     in sensitive positions that affect funding.

     **Expose every abuse in the system.  Shout from the
     roof tops, interrupt business as usual at City Hall
     and the State House if you need to: GET THE MESSAGE OUT!.
     Make sure everyone in your community knows the real
     financial costs, the bottom line benefits to for-profit
     service providers, and the NAMI connection.
     Make sure they also know the history of earlier
     campaigns to limit the freedom and civil rights
     of people officially declared mentally ill.  Wear the
     yellow triangle the Nazi's forced on us in the years
     leading up to WWII and let everyone know what
     it means.

     AND JUST DON'T TALK ABOUT IT, ACT, ACT, ACT!!!

     SNOWBALL THIS ALERT, GET PEOPLE WORKING ON THIS

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