I arrive at the Boston State House in the morning with two copies of my prepared testimony in hand. One to submit. The other to read aloud.
I expect there will be lots of waiting while hearing other testimonies since I testified on the same issue in 2013. As I wait, I hear mostly opposition to the Bill. They call themselves "survivors with lived experience." Instead of identifying mental illness as pathology originating from the brain, they berate psychiatrists for labeling people with psychiatric diagnoses. Instead of referring to auditory hallucinations as being a sign of mental illness, they promote the notion that hearing voices not there is simply an extreme state of altered reality (like "alternative facts"). Instead of indicating that psychosis is brain-based, or that no one knows the cause of schizophrenia, one person who testifies expresses her belief that trauma caused her to become psychotic. Instead of pointing to the limitations of the Rogers authorization (enabling administering of medications forcibly) in the community, another person testifying says that the "Rogers monitor is already forced outpatient." Another one testifies that "forced medication is expensive and addictive." Instead of promoting the spread of respite programs that at least administer medications to very ill people (many of whom would otherwise not take these on their own), they request the creation of more peer run respites programs. Who are these people? To be a peer specialist, one must only have experience with being diagnosed with mental illness, or have been traumatized in some way, or have experienced what they refer to as "an extreme state." They encourage people with mental illness to stop taking their medications.* Sprinkles of the belief that mental illness doesn't exist runs amok throughout their teachings.
The state government financially funds this group (including Reiki which has absolutely no scientific evidence showing it to be effective).** Sad, but true.
My name is Lynn Nanos. I am a Licensed Independent Clinical Social Worker with over 16 years of professional psychiatric inpatient and emergency experience in Massachusetts. I'm currently in emergency work. We shouldn't wait for the next tragedy due to lack of Assisted Outpatient Treatment (AOT). I have witnessed many cases in which people with psychosis have mentally deteriorated to such a deficient level that people have been harmed already. Allowing people with psychosis the right to further deteriorate in functioning is not liberating to anyone. Securing mental health treatment for someone who clearly needs this is not a violation of their rights.
Many of the people with psychosis whom I've professionally helped have had no awareness of their mental illnesses, which is called anosognosia. The majority of people with delusions whom I've evaluated have had anosogosia. Anosognosia is not willful. It involves abnormalities in the frontal and parietal lobes of the brain. All of the following cases involved anosognosia pertaining to psychosis.
A man with psychosis stopped complying with his antipsychotic medications immediately following his discharge from the inpatient unit I worked on. Police officers found that he jumped from the Tobin Bridge to his death within a month following discharge. He had been repeatedly admitted to this inpatient unit well over fifteen times during my years there.
A patient on my inpatient caseload who was paranoid delusional was refusing to accept medications. Shortly after getting discharged he killed his mother.
Between emergency evaluations, a man with psychosis who was not complying with his antipsychotic medications jumped off from a high rooftop to his death.
Police brought into my office a man who was yelling bizarre things on the streets. He was not able to provide a next of kin. He was planning to take the next bus to Washington DC because someone was ordering him to participate in the next presidential campaign. He was paranoid and explained that he's been ordered to kill anyone who tries to prevent him from getting on the next bus.
A person with psychosis and anosognosia cannot understand that treatment is needed. Appropriately timed treatment is more cost effective than lack of treatment. With AOT, admissions to inpatient units are more likely to be timely because its recipients have already been supervised by the outpatient system.
Outside of locked inpatient units, Rogers Monitors are meaningless and invisible. It's impossible to restrain and forcibly administer medications to an adult outside of a secured setting. Except for possibly secretly mixing medications in food, the only places where Rogers authorization have been implemented and enforced are locked inpatient units.
Many people with psychosis who refuse to voluntarily seek help end up incarcerated, which is more expensive than community-based treatment. AOT reduces the chances of arrests, incarcerations, hospitalizations, violence, and homelessness. For your review, I attached to this testimony evidence of the financial, and more importantly, the humane benefits to the majority of states in the United States, that have enacted AOT.
*Iserman, Mitzi. “Western Mass RLC | Healing and Recovery Through Peer Support.” Coming Off Psych Drugs, Western Mass Recovery Learning Community, 28 July 2017, bit.ly/2vfutCo.
**United States, Executive Office of Health & Human Services. Department of Mental Health. Recovery Learning Communities. Commonwealth of Massachusetts, 2010. bit.ly/2uGyRcd; “Recovery Learning Communities (RLCs).” Transformation-Center.org, Transformation Center, bit.ly/2u5TESW.