Saturday, 21 July 2018

RLC Articles

The RLC produces a newsletter each and every month that offers monthly calendars, announcements and articles. Although old newsletters are archived on the website, the articles - often on important advocacy-related issues - run the risk of being buried and difficult to find. In an attempt to make that information more accessible, we still also list RLC-published articles from the newsletter (and other relevant sources) here for your ease and perusal.


Forced Outpatient Treatment



The public hearing on forced outpatient commitment

has been scheduled as follows:


Tuesday, October 22nd at 9am


@ the State House in Boston, room A-1




About Forced Outpatient Commitment: Forced outpatient commitment can be referred to by many different names. Some people call it ‘Assisted Outpatient Treatment’ (AOT) or ‘Involuntary Outpatient Commitment.’ In some states where it exists, it has been named after a person (e.g, ‘Kendra’s Law’ in New York State). In the United Kingdom, they are referred to as Community Treatment Orders (CTOs). Regardless of what it is called, Massachusetts is one of only six states remaining that do not have any outpatient commitment laws currently on the books. (Connecticut, Maryland, Nevada, New Mexico and Tennessee make up the other five.)

Representative Kay Khan of Newton, Massachusetts has filed a petition to have a bill passed to bring outpatient commitment to our state. You can view the full bill here: malegislature.gov/Bills/188/House/H1792.

Based on established legislative process, a public hearing must be held in order for a bill to be evaluated and have the potential to pass. This is our one and only opportunity to be heard in a public forum by the legislature on whether or not we believe that outpatient commitment should become legal in Massachusetts. If this is something you disagree with, please remember that it is much harder to get rid of a law than it is to stop something from becoming a law in the first place.

What Forced Outpatient Commitment Could Mean for People with Psychiatric Diagnoses in Massachusetts: Outpatient commitment laws vary from state-to-state in terms of what they allow and how they are enforced. However, essentially, an outpatient commitment law would mean the following: If you are found to be at risk for not following treatment recommendations and if (by not following those recommendations) you are believed to be a likely risk for hurting yourself, hurting other people, or going in and out of the hospital, then a petition for an outpatient commitment order could be made. If successful and you are placed on an outpatient commitment order, you could be required to do any number of things related to recommended treatment. At least in some states, these have included (not a complete list!): Taking your prescribed medication; Electroshock Therapy (ECT); Attending all therapy and psychiatry appointments; Attending day programs, vocational programs and/or drug and alcohol treatment programs or groups; Submitting to regular drug testing; Living in a residential program.


If you fail to comply with treatment requirements on your outpatient commitment order, you can be immediately picked up and taken to the hospital whether or not you appear to be doing well overall.


Read more: Forced Outpatient Treatment

Advocates, Inc.: Limiting the Influence of the Pharmaceutical Industry

Advocates, Inc. was founded in 1975 on the grounds of Westborough State Hospital. At that time, they were made up of a group of volunteers who were providing rehabilitative services.

As of 2013, Advocates has become one of the largest human services organizations in the state.  They employ over 1000 staff members and serve over 20,000 people across Eastern and Central Massachusetts (including Community Based Flexible Supports, Emergency Services,Therapy and Medication clinics, and so on).

samplesSo, when Advocates decided that they were going to take a hard look at their practices around accepting gifts and free samples from pharmaceutical representatives, the path that lay ahead of them was neither easy nor smooth.
Potentially, they could have taken a very top down approach and had one or two people in a leadership role proclaim a new policy and expect everyone to follow it. Certainly, that would have been easier in some respects, given their size and diversity of responsibilities. But, this was not their way and not likely to lead to the most ‘buy-in’ of any change that would ultimately be proposed.

Instead, they developed a much more inclusive process that involved the following distribution of the following reading material for discussion:

It also included group review of the following websites:

  • Pharmed Out (www.pharmedout.org): A Georgetown University Medical Center project that “advances evidence-based prescribing and educations healthcare professionals about pharmaceutical marketing practices.”
  • NoFreeLunch.org (www.nofreelunch.org): An alliance of health care providers who “believe that pharmaceutical promotion should not guide clinical practice,” and who hold the mission to “encourage health care providers to practice medicine on the basis of scientific evidence rather than on the basis of pharmaceutical promotion.”

to read the rest of this article, please click below

Read more: Advocates, Inc.: Limiting the Influence of the Pharmaceutical Industry

What Makes a Peer Role 'Peer'?

Originally published in the RLC Newsletter, January, 2013


In a recent Newsletter, we printed an article that talked a bit about the meaning of the word ‘peer'  (original article available here); the definition of ‘peer’ seems to be shifting away from one that is based on relationships with others, and toward a replacement for ‘consumer’ or ‘client’ within the mental health system.  There's also a great deal of debate and misunderstanding about what ‘peer’ means when it becomes a job title.

In our state, there are a growing number of paid peer roles, titled everything from Peer Specialist and Peer Bridger, to Peer Advocate and beyond.  And yet, there remains a tremendous amount of confusion about what makes a peer role a 'peer role'.  The biggest point of confusion seems to be understanding the difference between a traditional role filled by someone who discloses that they have experience being given a psychiatric diagnosis, receiving mental health services, and so on; and a peer role

Read more: What Makes a Peer Role 'Peer'?

Did You Know?: Cell Phones, Computers & Other Electronic Devices in the Hospital

Originally published in the RLC Newsletter, April, 2013


People who are hospitalized in any DMH-operated or contracted adult inpatient unit are now entitled to keep their electronic devices with them. Electronic devices can include:

  • Cell phones (including smart phones)cell phone
  • iPods and MP3 players
  • iPads or other tablet devices
  • Laptops or personal computers
  • Any other device (whether or not it is Wi-Fi compatible)

This is true even if these devices contain built-in cameras, audio or video recording devices; and it also applies to visitors.

Former Commissioner Leadholm issued this policy (the Electronic Device Use policy #12-01) on January 4th 2012 and it became effective on January 30th of the same year. Massachusetts is currently the only state in the country that has a policy of this type in place.

The overall purpose of the change, as stated in the policy document, is as follows:

Electronic Devices are often people’s primary link to the community and may be the main way that people stay in touch with friends, family, and employers, keep calendars, pay bills and collect and access other important information. For an individual hospitalized, maintaining connection to natural supports in the community facilitates their own recovery and successful re-integration into the community.”

Read more: Did You Know?: Cell Phones, Computers & Other Electronic Devices in the Hospital

Asking People to Leave Their Residences During the Day

Originally published in the Western Mass RLC's Newsletter, May, 2013


Asking People to Leave Their Residences During the Day:

A Human Rights Violation?key

It can be deceptively easy to fall into patterns,
and do as we have done, without always taking
the time to wonder why.
However, in an era of mental health services where ‘person centered’ and ‘recovery-oriented’ approaches make up some of the most prominent initiatives, it’s vital to examine our day-to-day practices on a regular basis. Comparing practices against values can be challenging, as it often calls upon us to change habits, and sometimes fairly embedded organizational cultures, and invest dollars and time that might not particularly exist to be invested. One relevant issue that has arisen repeatedly over time is that of people being asked to leave their program residence during particular hours of the day.
The question: Is it okay to ask people who are paying rent to live in a program residence to routinely leave between set times every (or any) day of the week? Is it a human rights violation?
The short answer: No, it is not okay. Yes, it is a violation of
someone’s basic rights to live and be in their own home.
But the full conversation is more complicated than that. To fully understand the question, it’s important to make an effort to understand why this practice may have come into being.

Read more: Asking People to Leave Their Residences During the Day

Writing Notes & Peer Roles: A Conflict of Interest

There has been a relative explosion of ‘peer’ roles in the last five years in Massachusetts. StackofFiles

In many organizations, peer roles came to be developed largely because contracts began to require them (though many of these same organizations were already contemplating how to make that move of their own volition, and some had already begun to do so).

While most people see this shift as positive, it comes with many inevitable ‘bumps,’ learning curves, and tensions.

One of the most present and ongoing tensions connected to the integration of peer roles has been figuring out how to make space for a role that operates in a substantively different way, while still needing to meet the basic requirements and needs of the organization within which the position is held. Issues of this sort that have arisen include those around:

  • medication administration
  • involvement in representative payeeships
  • treatment planning 
  • note taking.

We'll be focusing on the last part, the taking of notes.

In its purest form, the ‘peer’ role is intended to be based in mutuality, partnership and the concept of ‘in but not of’ the system. But what does each of these mean? In brief:

Mutuality: Mutuality does NOT necessarily mean exactly equal or identical roles, and still leaves room for some responsibilities for each person to be different. However, it does require that no one be seen as THE expert, and it assumes that the focus is on the relationship rather than one person. 

Partnership: This principle assumes that no one is taking on the ‘doing for’ or ‘fixing’ role, and that there is a sense of shared responsibility and participation that is practiced intentionally throughout the relationship. Power balance is critical.

'In But Not of': This is the trickiest but perhaps the most important of these concepts. The peer role has been developed around the concept that the job is to work in the system, but NOT be responsible to all the system’s systems. Instead, the main priority and focus is to make sure that the individual with whom they are working is supported to develop their voice and be heard. Above all else, the person in the peer role helps to create the conditions (by the language they use, the opportunities they point out, the resources they share, the questions they ask, etc.) to make that possible.

Plainly put, note taking interferes with all of these most basic values.dominoes

  • It takes away from mutuality by requiring one person to write about another.
  • It enhances power differentials that can damage the trust that is so critical to peer-to-peer support. 
  • It moves away from partnership and shared responsibility by creating a ‘reporting back’ requirement. 
  • Even attempts to ‘share’ writing notes WITH the person about whom the note is being written have most recently been foiled by new, computerized note keeping systems that are not accessible where meetings are actually taking place.
  • Finally, it clearly interferes with the ‘in but not of’ principle. Notes are most typically attached to treatment plans, and while it is within the scope of a peer-to-peer relationship to support someone to develop their voice and vision around what they’d like their treatment plan to say, it is NOT within the scope of that relationship to have the person in a peer role be responsible for writing that plan, writing corresponding notes in that plan, to be written into that plan as responsible for some element or intervention and so on.
click read more to continue reading this article here,

Read more: Writing Notes & Peer Roles: A Conflict of Interest


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