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26 Jan 2022

Category: health issuesCategory Archives:

Solid Ground and the Rescue Line

Peer specialists risk getting bit in the ass. If it is not the illness, it is the people we are supposed to be helping. How much do we disclose to them? What is the limit on honesty and openness?

I disclosed early on in my career. I just could not be bothered hiding the fact that I was just as “out there” as the people I helped. The difference was that I had gone through training and learned how to live with the “normals”. I knew how to talk with them. I competed with them on their academic turf. In short, I straddled both worlds. They were sometimes howling in the hospitals, other times having drinks and finger food with the boss.

My first time having my diagnosis shoved in my face was with a woman in one of my groups.

Everyone knows you have problems

EMB

Peer workers work in two dimensions. On the one hand, peers get paid to use their experience effectively with the clients. On the other hand, they go home to live somewhat marginalized and jeopardized by the illness. If not correctly put in its place, the insidious, dangerous condition threatens to wreak havoc with hard-won economic, social, and psychological gains.

I supervised peer interns from Howie the Harp. For the most part, they were terrific. I met my match, however, in a wild little devil that insisted on reporting me as unfit because I had told her to comb her hair and button her shirt. Luckily, the staff had my back.

I had had enough. The next intern insisted on going over my head to the director and workers she considered more competent because they weren’t peers like I was. So I went offline and waited for her internship out in the psych spa. I came back when she was gone and told my director I was through supervising peer interns. I knew my limits.

Peer workers are people who somehow pull themselves out of a hole. Now they stand on solid ground and throw a rescue line down into the abyss. Jealousy, resentment, and rage get in the way.

No matter. It is a crazy happy day in the neighborhood, and no one is going to mess with my high!

The Communication and Support That Allows Progress in Treatment

To make progress in life, maintaining a presence in mental health treatment is needed for many people. Personally, I know there are barriers to maintaining a presence in treatment. The goals of a practitioner and someone receiving treatment do not always coincide. It is interesting to determine at what point the purposes of the consumer and practitioner intersect. I know that treatment is beneficial in my life, but communication has become very difficult with service providers. For this reason, support needs to be established with common goals in a therapeutic alliance. 

Goal setting in treatment may be one way to establish a common ground and language. However, varying temperaments in a therapeutic relationship will slow the road to meaningful therapeutic gains. There are inevitable conflicts, with baggage on both sides hindering real productive communication and goal setting. Ironically, sometimes it is the practitioner that carries more weight and credence to drive treatment forward. Objectivity is difficult whenever people and perception are involved, as everyone has the best idea.

All too often, treatment gets disrupted, many times, without warning and naturally throughout care. When progress and accurate work in treatment unravel, establishing or resetting a goal and kickstarting the momentum of the work is almost impossible without a social worker communicating the clinical play by play when cases have robust moving parts. When personal ambitions interfere with goals, it also may be challenging to maintain the ethical reins to keep treatment smoothly and without incident.

In fact, specific measures such as more extended unnecessary hospital stays could be avoided in some cases with better communication from the treatment team. Certain attitudes by social workers may exacerbate symptoms rather than give relief when a clinician takes cues from the wrong parties or isn’t truly engaged in their work enough to be a real changemaker and cheerleader in their client care.

All too often, patients are triggered by treatment providers without empathy. These feelings can lead to an ‘episode’ or the unraveling of a patient’s progress to date. Sometimes, these clinical missteps are so critical and negligent they make further treatment and additional clinical services necessary. With proper caution executed, and good listening with precise language, treatment progress can be maintained and preserved during touch-and-go blips that arise during care provision. 

With a well-seasoned treatment team, enrollment and selection of programs and tandem services after discharge can be successful for many years. In the end, treatment at one level of care cannot go on or be maintained indefinitely. With time, everything changes, and someone may show the most signs of relapse when significant progress is being made. 

For this reason, identifying valuable resources for patient education is critical for long-term progress after discharge and incredible natural support for patients to draw from when other artificial supports are inaccessible. Some supports need to be titrated down for the well-being of the consumer. When someone craves independence, but their goals are being withheld, severe conflict may worsen psychotic symptoms.

In cases of serious conflict, the proper change may be medication, but there may be more going on in the environment, or socially that can ease the episode. Changes in both may be needed, but good communication and appropriate support can certainly help to calm an attack. 

In the end, the nature of life is dynamic, mental health treatment should be regarded as such. If life becomes stagnant due to failure to understand the needs of someone, symptoms can flare up. In worst-case scenarios, prison may be an outcome. However, communication and support are more attainable with grasping the history of someone. Responses will be more appropriate, and crises can be avoided with a reasonable, empathetic method of questioning. 

RESPONDING TO A MENTAL HEALTH CRISIS: WHO IS THE MOST QUALIFIED?

The ongoing spirited conversation about emergency mental health reform and community response protocol is getting tired. When I say exhausted, I mean it is about time we reach a consensus.

Today, and I’ve said it before, we stand at an impasse—the boiling point of new reform just around the bend. 

The issue that hinges on the docket today is Emergency Mental Health. More specifically, crisis intervention, crisis calls, 911 mental health dispatches, and other emergent mental health crises in the community. 

I am so fearful that this process (the legislative process that dictates the provision, execution, and law, how it is defined and carried out, etc.) will get hijacked and derailed. We advocates must focus on how all this talk will translate into a workable framework for handling emergency mental health interventions.

This subject has only gotten more controversial over the last few years. In my opinion, the rift between advocates and lawmakers, and mental health professionals have more to do with the definition of response than with how to handle the implementation of theory and practice in the field when responding to a real crisis. This is because definitions vary across disciplines, state lines, and mental health professionals. 

With the reinvigoration of social justice issues plaguing our country, this issue will only get more attention. As our society reevaluates the intersections of disability, mental health, and social inequity, we can be sure the ‘spirited’ nature of this debate will drone on and on without an answer. I only hope all the enthusiasm is put to good use. Hopefully, some of this good use will be through this blog article and real productive debate and reform will come.

For the same reason, advocates argue with each other. Passionate people from all walks of life don’t always agree with the way things are in society or should change in the future.

But is that true with this conversation? Specifically, why are we still at odds? Why haven’t we reached a consensus and passed the debate phase of how this talk will translate into the new policy. When are we going to reform the way crisis intervention works in the community?

Probably, when more definition is laid out around ‘crisis’. I am a social worker. I am also a person with lived experience. I can tell you that what is a crisis for one person, may look totally different than for another person, even with the same disorder or problem, or diagnosis. Now, imagine, two people are presentation totally differently and then add in location (city versus rural), context (domestic situation), etc., etc. My point is that every situation is different, even for ‘mental health crisis in the community. Therefore, it is so hard to come up with a protocol for each situation and how to train and educate responders is so complex and needed, and urgent.

Without a consensus at the level of language, ‘camps’ have formed. Experts are divided on which mental health professional (e.g., psych nurse, social worker, peer advocate, psychiatrist, paramedic, etc.) and intervention strategy is best equipped to respond to emergency mental health ‘crises’ in the community.

Right now, as it stands today, there are several approaches, both programmatic, and stylistic, depending on the professional bend of the worker and his or her education, training, and experience practicing. 

In terms of programs, some do a prescreen. Programs will screen people in crisis ahead of time either through a provider that calls out of concern or through the person in crisis calling to self-refer themselves in lieu of going to the ER or calling 911.

This sort of ‘soft landing’ in the mental health system is what NYC and other cities are now doing to divert traffic to ER’s and other mental health crisis triage centers across the country. They also act as a hospital diversion competent to systems where hospital beds are short and in cases that are more social than psychiatric which the hospital is an impropriate fit.

I learned much about what it means to be in crisis, and about the systems in place to address them as a social worker, and as a peer advocate. While I don’t think social workers make great first responders in some crisis situations, I think peers make even less of a fit in these situations. Certainly, social workers do not belong going into homes where there is the additional risk of violence without other, auxiliary professionals present.

Social workers need to be part of a larger community response. But right now, the system is limited. 

When it comes to fulfilling the vision of community response there are few options after ER rooms and the few cities with limited and overextended crisis response teams assisting folks in crisis to a softer landing in the system.

When it comes to sending in a wide network of collaterals, organic, paid, and specialized personal, right now, ACT Teams and the CAHOOTS model are the nation’s front runners.

ACT, CAHOOTS, and other interdisciplinary teams) utilize prescreening methods, and go out on crisis interventions with folks already enrolled and in treatment on their census.

For people in crisis and not already on the census of an ACT or CAHOOTS team are new to the systems radar. These folks who are off the systems radar may present a degree and risk of violence to a crisis response team.

Even less clinically prudent, there are crisis’s and no prescreen mechanisms in place to the hand of clinical information to team responding in the community. Talk about a double-blind nightmare. This is also the reality of clinicians every day who respond to mental health calls in the community without enough data to safely handle crisis intervention.

In the end, more work, education, and training need to be invested in the social work education and clinical training before social workers should walk into potentially threatening environments without other seasoned responders.

My recommendation, which is already beginning to become a reality, is to have police and social workers working side by side. Right down the setup of the police station itself, these social workers can be regular members of the police force and community to cross-pollinate intervention strategies with the prescient and its staff.

For nonthreatening interventions, in many states, including my home state of New York, and the county of Westchester, ACT Teams call the local police department for every emergency crisis intervention for patients on their census. In other states out west, CAHOOTS teams respond to non-threatening situations, and even act as a mobile hospital diversion team for many homeless, and substance abuse related issues. CAHOOTS is known to respond to folks that aren’t even on their roster or are new the mental health system. 

When it comes to ‘crisis’ response, the readiness and effectiveness of crisis intervention will require more education, practice time, and to a lesser extent, additional training for all field workers. 

In social work, the Social Work Accreditation Boards, the ASWB: Association of Social Work Boards and other regulatory bodies credential and assess content areas’ rigor in disciplines of education and curriculum. A lot more is lacking but let us start somewhere. Curriculums needs to bridge an academic understanding of what it means to be in ‘crises. We can start with arming peers interested in doing this work with real skills and interventions beyond Social Work 101. I am afraid learning ‘Motivational interviewing’, and basic de-escalation strategies is not a sufficient skillset to take on emergency response calls.

We also need to think about what practice means given the current state regulatory instruments already established for determining if which of these disciplines, IF ANY, are ready and competent to perform the crisis work.  The heart of my recommendation is to advance both the curriculum of the peer workforce and practicum towards readiness in crisis intervention AND social work education in addressing violence and safety issues in threatening environments. 

What would this look like, and how can states, and local agencies roll it out? One pathway forward, on the level of education and practice, is to require peer internships to have a much more elaborate and specific crisis intervention component beyond what is currently offered as a tandem or extra component to their certification. In my opinion, the current broad ‘forensic’ certification, simply isn’t enough when we are talking about peers going into potentially dangerous environments alongside with police.

This just seems like a terrible plan. Before we make a big mistake and prematurely throw both peers and social workers in precarious situations where there can be the potential loss of life, why not pause and reevaluate these aspects of the peer education and social work intervention first? In the very least, lets agree what a crisis is before we intervene in one.

Going to Social Work school with a Schizophrenia diagnosis

Everyone needs to dream big in life. Goals are the waypoints to those dreams. It was always my goal to go to graduate school. After my ‘break’ from first-episode psychosis in undergraduate school, my goal to graduate school was on the brink of failure. My goal was so important to me that I was uncompromising in my recovery to heal and move on with my life. When goals are critical to us, people will do everything in their power to reach them despite the obstacles in their path.

My obstacle was my schizophrenia diagnosis and the residual symptoms that medication didn’t manage. These obstacles didn’t stop me from applying to a social work program two years later when I finally reached my goal of enrolling in a graduate program. Because I was marked as ‘sick’ and mistreated due to revealing my psychiatric history earlier on in my education, I kept my mental health issues to myself in graduate school.

Aside from my girlfriend, a few close classmates in my cohort, and the people who already knew my schizophrenia diagnosis, I kept my mental health to myself. Not sharing and being utterly private about my mental health history meant a few things:

  1. I would have to be ultra-careful about managing my schizophrenia symptoms.
  2. Be mindful of blips or changes (however minor) in my mental status so faculty and other students would not liken the lability to a possible mental health disorder.
  3. Be very careful about who I confide in about my history to avoid information falling into the wrong hands or people that might be stigmatizing and discriminatory.

There were times when I could do it all, be mindful, careful about disclosing, and super self-aware without incident. Other times, I found it more difficult to hide who I was and my history as a person with lived experience. When I was happy, content, and not very stressed, being mindful of all of these aspects of being secret about my identity was easy. When there was an exam or a vital essay due, I found myself becoming sad and pensive. It was during these stressful times that I got angry and self-loathing. I became upset about my history and how I was less than completely authentic about who I was and my past.

Graduate school in social work has a big self-reflection piece. One of our educational goals is to become more self-aware of our ‘stuff’. Together, in class, we unpack the microaggressions and discrimination we’ve internalized our entire life. Meaning, we learn why how our perception is shaped by the societal apparatuses which inform our everyday mindset and way of interacting with our peers and family. So, when this aspect of graduate school came around, and it was my time to reflect and learn about myself, I knew I would have to be very careful about how I went about this process.

I didn’t have the option. I could not openly reflect on my past because I had chosen to keep that piece of me a secret. I could make up a past and reflect on a fictitious history to practice the art of telling a compelling yarn. For a while, this is what I did. At first, it seemed phony. The content of the stories I spoke about my past were all made-up lies. I made up some outrageous stories. When it came to writing my autobiography, an exercise we all had to do, I was left with the creative freedom to enmesh my history into an outrageous, downright hysterical backdrop. Other students laughed when I told these stories, and they were so artfully crafted and congruent with social work theories of human development the professor couldn’t deduct points.

I was relentless about lying when I needed to defend my history. But when it came to being honest, and opportunities presented themselves to be me without any of the phoninesses, I made the most out of it each time. I was brutally honest, so honest. It almost seemed to align with the phony storylines I created earlier on. I still remember a professor talking to us about our dreams to motivate us and get to know a bit of what we were interested in for the end-of-the-year research project just around the corner. I remember the first few responses. “Getting married, owning a big house, being a social worker of the year…” and so forth. No one was expecting to hear what I was about to say.

“I want to move into assisted living,” I told the class. 

My classmates laughed harder than ever. But I was serious this time. They just had no idea why. I was exhausted from being overmedicated and extremely tired from my graduate school program. After all, I was in a state hospital two years before this, and now I was in graduate school and a relationship. It was a lot.

So when it came to my dream in life. It was to finish the program, get my master’s, and move into a setting where the assisted living center took care of my meals and cleaning. I certainly didn’t want to move back in with my parents. They were exhausted from caring for me to this point.

With my master’s in social work and a full-time job, I figured I could pay for an assisted living center to do everything for me. I could then focus on taking care of myself and my reaching my goals. When you are tired and overmedicated, goals seem further away. They might even feel or seem unreachable at times when someone is cooking your meals, cleaning your living space, and basically, managing your ADL’s (Activities of Daily Living). There is more time and energy to focus on goals, a job, and doing everything everyone else does but with some assistance at home.

“What? Max?” Another student said. “You’re kidding, right?” said yet another student. That was when I explained myself. I didn’t disclose my mental health disorder. But I did explain how tired I was a lot and how much time and energy housekeeping can be and absorb. I explained how all this energy could be invested into pursuing my dream career or any goal I set for myself.

When I put it in these terms, ‘energy’ and ‘time,’ suddenly everyone knew what I was talking about with my assisted living response. If I had said my answer was because of a mental health disorder, everyone would have pitied me and felt awful. When I made it about being savvy about how I expended my energy and time, everyone thought I was intelligent, innovative, and so forth. My point is that stigma goes deep, and if people let themselves become blinded by discrimination. Suppose people choose to be more open and nonjudgemental with their thinking. New ways of understanding the world and reaching their dreams might be next.  

This is a PRO Tobacco Use Argument in Mental Health Settings

The growing trend in most mental health centers is banning tobacco products and their use on campuses that deliver treatment and other supportive programs.

This trend defies the age-old image of ‘mentally ill’ folks pacing around outside their treatment center or a hospital smoking like chimneys. What is the result and impact of these bans on the folks in my image?

When I first entered the mental health system in 2003, I was an adolescent in an inpatient unit in New York State, and smoking was already banned for adolescents. After all, you would be hard-pressed to find a smoking section in a restaurant anymore. Adults still could smoke, but only in certain restricted areas and at certain times.

Before the banning, adolescents could smoke outside the building when they were granted outdoor privileges, similar to adults. The rationale, staff told me at the time, were minors weren’t allowed to purchase cigarettes in the community. They shouldn’t be smoking in the hospital. 

I accepted with a giant grain of salt. After all, I was a smoker, irritable, but appreciative enough of logic in a place and time where reason wasn’t readily available. 

However, when I was hospitalized in the New York State Psychiatric Center in upstate New York a mere five years later, smoking was banned for all patients, staff, and visitors on the hospital campus. At this point in my inpatient career, I drew a line in the sand and took issue. 

As an adult in the hospital, I wasn’t just agitated. I was dysregulated, manic, and psychotic. I needed something to self-soothe, and meds and therapy were not cutting it. 

Given how bewildered, uncomfortable, and upset I was back from new active schizophrenia symptoms, I couldn’t understand why I wasn’t allowed to smoke cigarettes.

I needed relief and quickly. To be even blunter, I needed a cigarette. 

My theory about smoking in the hospital is straightforward. My idea is also within the margins of psychology and elementary logic. When a person is so far from a baseline that all previously learned coping skills don’t work anymore, why deny people the use of their existing mechanisms for finding relief in the most challenging moments of perhaps their life? Why take away the only coping skill that has been working to date? Why must we throw additional barriers in someone’s way to deescalating and finding a moment of peace in a disordered mindset when someone is so sick? 

I understand the need and push to ban tobacco use in community health settings. Sure, teach people to access coping skills free of tar, toxins, and health-compromising chemicals. Instead, we need people to learn how to lean on healthier supports and access community resources. In this vein, I am not suggesting pushing cigarette smoking on people who do not already smoke. We certainly cannot allow tobacco companies to come into the hospital and hand out products to vulnerable people and get them addicted to another chemical they will need to manage moving forward discharge. 

However, for people with existing habits and already smoke. Why limit, restrict, and agitate these folks further when they could be enjoying a smoke outside like at their own home and maybe feel the impetus to work towards discharge to do just that. 

People at the out-patient level are more likely to use other coping mechanisms to find relief instead of smoking or waiting until they get back home at the end of their session or program. Still requiring research is the threshold, that space where the risks of smoking outweigh the benefits of non-smoking and wearing a nicotine patch until that is ultimately discontinued, especially for highly disordered, chronic, and comorbid smokers. 

In my opinion, this new shift in so-called healthier practices and wellness overlooks a part of human nature, personal freedom, and introductory psychology. Some people with cognitive deficits and symptoms are so intense that learning new skills will not outpace the cravings or pleasure of puffing a cigarette. 

These people will not learn new coping skills fast enough to benefit from not smoking and will be even more uncomfortable and agitated during a tremendously already agitating point in their mental health.

When people are pushing freedom and personal choice in treatment, I am genuinely shocked the hospitals were so fast to embrace the smoking ban. I have been so sick that I wouldn’t get out of bed for days at a time. It wasn’t a pill or the promise of deep breathing that motivated me to get out of bed. It was a cigarette and coffee.

When a person is genuinely symptomatic, in terms of coping skills, it is genuinely about going back to the basics and clinging to what works, what you know, and what you feel will make you feel better in the moment. I genuinely hope the hospitals discontinue this movement and revert, at least in part, to an earlier time when life’s pleasures weren’t removed or banned without consent or our choice.

 

 

I am a mental health advocate, but still feel shame about my own struggles at times.

College was a pivotal point in my life regarding mental health advocacy and confronting my own struggles with mental illness. After joining a student organization on campus that aimed to raise awareness for mental health and open dialogue, I felt that I could genuinely sit with what I was feeling for the first time. Those four years were not always easy on my mental well-being: I struggled with anxiety, depression, body issues, and loss while balancing a social and educational life. While I had been an open advocate for mental health since my freshman year of college and grew up in a family where “mental health days” were valued, I still found myself keeping my struggles to myself. 

I noticed that if one of my friends were having a bad day or struggling, I would be the one to listen, offer resources, and remind them it’s ok to not be ok. But when it came to myself, I was a harsher critic. I didn’t feel the need to lean on anyone because I didn’t want to burden them. I created this narrative in my head that while being President of a mental health organization, I should “have it all together.” Yet, I found myself avoiding going to the school’s counseling center, and when I did, I hoped no one I knew would see me walk in. I didn’t openly discuss my anxiety until my junior year of college and found myself hiding my prescribed medication in drawers so a roommate would not see it. Simply, I was not practicing what I was preaching. Only a few friends knew I struggled with anxiety, and even then, they did not know my history with depression or body image struggles. Sometimes, I felt guilty about keeping my mental health to myself.

I would ask, “how can I be a mental health advocate if I am not being one for myself?” 

It’s a complicated situation. As a person, I do not stigmatize anyone’s mental health struggles. I am well-informed on how mental health impacts all of us. I know statistics and resources, and I genuinely believe that taking care of your mental well-being is crucial and essential. I understand and love so many people that live with mental illnesses, and they are not any less because of them. Yet, here I was, making my mental illness all I was. Here I was, equating strength with suffering in silence. 

I felt debilitated by my struggles at times. I thought it defined who I was, and I was ashamed. I didn’t want to be the girl who struggles with mental health. Because it is not always pretty. There are some heavy days, and I am still learning to navigate them. I am still learning to open up about my issues to the people in my life, and it is difficult. As a society, we often wonder, “why didn’t they tell us how they felt?” when someone loses their life to mental health or their struggles become apparent.

But I understand why people don’t want to talk about it. Some don’t know who they can turn to or who will understand. This was my own experience with grief. As a twenty-one-year-old who lost their brother, what friend can I talk to that will relate? I often felt like an outsider, especially returning to a college campus where everything was so alive, where people were celebrating, partying, loving, and living the “best four years” of their lives. So, I swallowed my grief. But I soon discovered that suffering was a lot harder to hide than my other mental health struggles. Because when you lose someone, it becomes a part of your identity. That heartache has changed me forever, and I am still learning how to acknowledge this new version of myself. 

Other people who struggle with mental health might not know how to put it in words or even want to discuss it because they live it 24/7. Why give more power to something that already has so much power over you? Sometimes talking about your pain makes you relive it. Other times, it allows you to release it. 

Yet, I am slowly learning to talk to friends, family, and loved ones about my mental wellness. I am learning to be gentle with myself and treat myself how I would love anyone who told me, “I am not doing ok.” I am not sure why it feels difficult to give myself that same grace I give to others, but it is. However, when I have written blogs about my struggles or opened up to people about my anxiety, I have always received love, kindness, and warmth. And it truly is those responses, those that say, “I might not get it, but I am here,” that is allowing me to heal in a way I have needed to for so long.

I am a mental health advocate, and I admire this part of my identity. I am proud of how I have grown to truly understand the mental health issues in our world. And I still have more work to do as an ally. But, I don’t want to just be an advocate for other people; I want to also be one for myself. Because I deserve the same love, I give out. I deserve the reminder: “it is ok not to be ok,” because I won’t always be ok and that is a reality I am learning to embrace. Even so, I still am worthy of good things, and I am still myself. My mental health is a part of me, but it is not all of me. 

Vitor Sallys Story according to His siter Vitoria Sallys

Vitor Sallys Story according to his sister Vitoria Sallys 

Brazil has lost its Humanity in the Era of Fascism. Fake news and lies now persist while the vulnerable die by execution, torture, electric shock, and all kind of aggression, physical and psychological, inside psychiatric institutions and so-called Therapeutic Clinics. 

Vitor Vinicius Sally was a Brazilian 21-year-old gay man who needed help and support with his many emotional and psychological issues. He Struggles constantly with his sexual orientation because of society’s hatred, ignorance, pressure, and discrimination against gay people. Vitor kept to himself his feelings and fell into substance addiction. His sister told me Vitor’s life history. She told me how Vitor’s death happened. The family is seeking justice, and I am advocating for Vitor’s and his family. They want justice, all involved in Vitor’s death should be held accountable for participating in this heinous crime.

According to Brazilian law 10.216 of 2001, the mental health system brutally violated Vitor’s rights. They neither protect nor respect the law forbids any ill-treatment, action, and discrimination against a person with a behavioral mental health diagnosis. Law 10.216 of 2001 prohibits institutions and individuals from acting or discriminate against people with a history of mental illness. There is also another Brazilian law, 7.716 of January 05 of 1989, that guarantees Vitor’s rights which states that under this law, all crimes resulting from discrimination based on race, religion, ethnicity, prejudice against sexual orientation, and homophobic practice. These two laws did not protect Vitor’s life and neither his rights as a vulnerable person. These violations are punishable by two years in prison. 

Five years ago, young Vitor Vinicius Sally’s mother had to commit him to a psychiatric institution for drug misuses treatment, Nina Rodrigues hospital of Sao Luis, MA. After three days in the Nina Rodrigues Hospital, he was transferred into the Neuropsychiatry clinic of São Francisco. Right after Vitor and his mother arrived at the Sao Francisco Clinic, the clinic’s psychiatrist and a nurse told Vitor’s mother that she could not stay with her son and that her presence in the facility would only interfere with his recovery. However, the clinic staff told the Victim’s mother that she could come back to visit him after 15 days. 

Vitor’s mother could not wait 15 days to see her son, so she went to the clinic several times to see her son, she tried to look at him even if was from a distance, but her effort was in vain she was never able to see him because the clinic staff would not allow her to see her son. They refused to let her in to see him. After 15 days, Vitor’s mother returned to the clinic. Upon arriving there, one of the nurses said it would not be possible for her to visit her son because, according to them, Vitor was doing very well, and he even gained some pounds. He has even become a little bit chubby. If she saw him, she would be interfering with her’s son treatment and recovery. 

Vitor’s mother feeling powerless, cried and begged them to let her see her son, even if she could not speak to him. She won’t see him from a distance. She even promised the clinic staff that if they let her see him, she would leave and would not let him know that she was there. So once more, the clinic staff did not allow her to see her son, not even from far away.

Vitor’s mother did not give up seeing her son, so she walked around the clinic outside to see if she could see Vitor, but unfortunately, all her effort was in vain. Again, she couldn’t see Vitor. Three more days passed in a total of 18 days that he had been in Sao Francisco Clinics. The Victim’s sister said, “They called our neighbor saying that my brother was very sick at the hospital of Socorro II. Saying that he had pneumonia, they fabricated all kinds of lies to justify their crimes.”

When the Victim’s mother arrived at the public hospital Socorrao II, in the emergency room, “everyone there was already aware that she was the mother of the boy who had was admitted there already lifeless. They tried to make a fool of my mother. When she arrived at the hospital around 6:30 pm, they all denied that he was there. Only around 10-pm did my mother locate my brother’s body”. 

“All of Socorrao’s staff nurses told my mother that Vitor wasn’t there.” The Victim’s mother kept looking for her son from 6:30 pm to 10 pm. Even the hospital’s doorman told Vitor’s mother that her son was not there while she was looking for him all over the hospital. Finally, the same doorman of the hospital, seeing my mother there at 10 pm, still unable to find Vitor, told my mother to speak with a specific nurse who would tell my mother where she would discover Vitor. 

“The nurse tried to brainwash my mother’s head, telling lies after lies after lies about my brother’s condition. She even told my mother that my brother had been involved in a fight with the other patients. She also said that my brother had suffered two cardiac arrests. He had died of pneumonia. She then said that the hospital had done everything they could to save my brother’s life, telling my mother that he had been in the ICU, the operating room, then in the infirmary. After that, he passed away.  

“My mother was in such distress when hearing that my brother was dead, that she got to the point that she was carried by one of our neighbors who had gone there with her”. She was carried by one of our neighbors who had gone there with her”. When reaching the morgue, she opened the black bag in disbelieve at what she was seeing in front of her.

My brother’s body was badly beaten with black eyes, broken nose, broken teeth, broken ribs, one arm broke, the other arm was purple with electric shocks from top to bottom, his toenails were ripped off, his private parts full of marks of electric shocks. My mom said that “his head looks like that was a smash because it was all sawed up with stitches.” My mother said that he already had a rotten smell. They couldn’t even say that he was already dead when he was admitted to the hospital. 

 “We buried Vitor”, said his sister, “We gave interviews to all the newspapers in the state of Maranhao. We held a demonstration in front of this clinic. While we were doing the protest, my mother could come in to talk to the psychiatrist who admitted my brother. The first day that he got into the clinic before her son was killed. My aunt came in and spoke to her. The other clinic staff told their version about what had happened to Vitor. 

“The psychiatrist even had the nerve to say to my mother and my aunt they were silly and dramatic about Vitor’s death. The psychiatrist of Sao Francisco Clinics said that “Whatever they were doing would not bring Vitor back from the dead.” Vitor’s mother replied to the psychiatrist, saying, ‘No matter what happened inside the clinic, that was not a justification or reason to rip his toenails, electrocuted his private parts, break his ribs, break his teeth, his arms and head’. Vitor did not deserve to die, and even worse the mental health system dehumanized him in the ways his body was left and what was done to him. After the brief conversation, the psychiatrist told Vitor’s mother, ‘Oh, but he was gay, and he had HIV.’ She was implying that what they did to him was because he was gay.”

Vitor’s sister asked me if this was why they tortured him. Did they do that to his body because he was gay, and he had HIV? 

“Is that really the reason why they kill my brother? These were no reasons for the clinic’s staff to mutilate his body and electrocuted his private parts for any reason? They killed him and they never gave us the test with the AIDS results. I don’t even know if he had HIV. Now I wonder what about the others who suffered there and the others who are still at risk of losing their lives inside that clinic. Will they die too? 

“You know, various former Sao Francisco Clinic’s staff, after Vitor’s death, came by to our home and told us that the patients in the clinic are denied food, water, clothes, they sleep on the floor, and women are full of lice. They let the patients have intercourse with the male participants. They beat the patients. There is no breakfast, only coffee in the morning for everyone. There are no female personal hygiene products. Everything is dirty. There are no mattresses, so the patients sleep on the cold floors. When they asked to speak with their families, the Clinic staff would not allow them to make a phone call.

“According to former staff of the Sao Francisco Clinic of Neuropsychiatric, the patients in the clinic are mistreated and dehumanized by the institution. Vitor’s family stated that during the demonstration, for justice, some of the clinic staff were leaving the facility with attitudes that indicated no remorse for what they had done to Vitor. Upon leaving the clinic’s grounds, the psychiatrist who looked at Vitor’s mother and threw a kiss over her shoulders and started to smile at Claudineide Sallys.” Vitoria said, “It looks like she was mocking our pain.”  

Vitoria told me that while her brother was hospitalized in the Sao Francisco Clinic, “My mother would take fruit, clothes, a towel, toiletries, a new slipper, for her brother, but he never got any of these items. And yet, he still died in an old slipper with a hairpin underneath.” She explained to me that “the lawyer we had handling Vitor’s case, he initially was interested and told us that would be easy to win my brother’s case.

“However, suddenly, the lawyer went missing for about a year. Later, he showed up and told us that Vitor’s case was not a winning case. To make things worse, we didn’t have any more news about Vitor’s medical report that was supposed to get in a month. We could only get it after a year. Vitor’s horrifying death in the medical reports only states that his violent death was only bacterial pneumonia.”   

Vitor’s sister says, “My brother had suffered so much while he was alive. He was humiliated and tortured. To make things worse, they only delivered his body to us in states of putrefaction. Yet, they are still claiming that he had just died in the emergency room. He was being beaten day and night and killed as the result of these beatings, he was tortured to death, and nobody helped us get justice. 

“The Socorro staff and the media later had the nerve to tell us that Vitor passed away from an acute infection and did not explain his broken body and the signs of torture. Some former clinic staff told us that inside this Sao Francisco clinic is a hell on earth, and they asked not to mention their names as they are afraid of threatens, intimidation, and being murdered.”   

Vitoria said that “My mother and I want justice. It’s been five years since Vitor’s death, and nothing has been done about it”. 

She mentioned that she could only imagine the ill-treatment inside the clinic in question remains the same as before her brother’s murder. According to her, “These abuses continue to take place daily. The inhumane treatment continues to happen, and nobody has done anything to stop it. My brother was not the first to be killed there. I am quite sure that he will not be the last.” Vitoria says. She tells me that she wants justice to be served. These slaughterhouses shut down for good. To conclude this narration, Vitoria says that “Her brother’s body has gone missing from the place where he was lied to rest. To this day, nobody knows where the body is. The suspicious fall over the Sao Francisco Clinic, but there is no proof (Vitoria).

We all asked these questions:

Why was Vitor tortured to death?

Was it because he was gay?

Was it because they suspected he had HIV?

syringe floating near person s hand

Healthy fascinations went awry

With thoughts moving at breakneck speed, at 16, I did not see an end to the downward spiral. I was on a band trip with my high school in the nation’s capital. In 1998, I was without sleep for at least 14 straight days. The antics of my hotel roommates were no solace for the turmoil I found myself in. The Greyhound took me and the high school band from place to place- from The Lincoln Memorial to the steps of the Washington Monument. I shot pictures of friends that must have been lopsided.

I was clearly out of focus. What would have been a joyful experience was tainted by moods which confused fear with joy. I had spent the whole spring before this trip exploring the local woods, sometimes as early as the break of dawn, sometimes while barefoot. My healthy fascination with the sunrise had become an obsession, as I started to lose sleep to catch the sunrise regularly in the summer of 1997. I was manic and psychotic. The nurses and doctors at the hospital caught it upon my dramatic admission in late April 1998. Immediately the staff thought that I had been traumatized while on the school trip.

Due to my rapidly moving thoughts, the staff Immediately administered the antipsychotic Haldol. In drama club, track. and wrestling, people had admired me for my speed and energy. However, These were telltale signs of my mania, not caught until guided inside the hospital emergency room. The first referral was my pediatrician to a psychologist, then the hospital emergency room due to the urgency of the situation, It was hard to know where to go since things were so sudden, and in the 1990s, mental health was rarely discussed.

Throughout my week’s worth of no sleep in Washington DC, terror was rampant. I hurt myself for the first time arriving home from this trip but caught myself before going too far. The newer generation antipsychotic Zyprexa administered in the controlled setting of the hospital allowed my foggy thoughts to meaningfully coalesce. After a week or so, the real game-changer was making art with chalk pastels in occupational therapy. My brain cells rewired, creating original natural scenery during discussions with others in the unit. Healing occurs naturally in the arts, and in my life, Medicine is secondary.

To this day I make art, with occupational therapy on the psychiatric unit as the precedent. The psychosis WAS the substance of my art. My subconscious came to life in the throes of confusion. Elusive Figures from my past have come alive with poetry and storytelling in artistic expression. Songs on guitar have expressed romantic adventures and provided entertainment to crowded nightclubs. As I recount dramatic stories with creative expression, a new life takes shape.

Human Rights Coalition for Latin America Mental Hygiene & Social Justice

The human rights of the mentally ill are violated in Brazil every day. The crimes continue without end. I am writing to introduce Dr. Marcelo Henrique, the founder, and CEO of OBDH. 

Dr. Marcelo Enrique has a long history of human rights activism in Brazil. He is a scholar, a lawyer, an advocate for social justice, and a strong voice for public health reforms. He and his colleagues created the institute of The Right of Defense to assist judicially the incarcerated population and those with behavior mental health history behind bars. In addition to being a lawyer, Dr. Marcelo has written articles and a book about Human Rights and Health Accessibility in Brazil (Directions Humanos e Accesso a Saude No Brazil). He is also the founder and the CEO of OBDH, the Humanitarian Organization that judicially helps and supports the less fortunate Brazilian population. Through the OBDH professor, Marcelo and his colleagues have been helping a lot of people throughout Brazil.

OBDH is an organization that juridically helps and supports the less fortunate Brazilian population and the rights of people being violated and tortured just because of their mental illness. At the root of it, OBDH is a human rights organization fighting for Social Justice, Helping the less fortunate, Educating for Justice, and Advocating for Reform for the Public Health system.

It was an honor to attend the live session on August 12, 2021, hosted by the OBDH, a Brazilian non-profit organization fighting for Human Rights in Brazil. The OBDH (Observatorio Brasileiro de Diretos Humanos) have been working intensively ever since its creation helping and supporting all Brazilian people who at present are in great distress. 

Max E. Guttman, LCSW, was one of the guests of honor of the live broadcast. He shared his experiences and insights into mental health systems and the treatment of mental health disorders. He spoke on how different Brazil and the United States are regarding their treatment of people with mental health diagnoses. 

“The disparities are staggering, and the need to globally address this crisis is more urgent than ever,” Mr. Guttman commented on the crisis plaguing Brazil and much of South America.

I was very proud to be part of this event. I am also looking forward to contributing more to OBDH. For this reason, I have created a virtual group that aims to work with many American professionals. Each professional assists and supports, helping alleviate the pain and the suffering of the Brazilian population by sharing their expertise and work experience to help save lives in the South American nation.

Brazil is in crisis, and people with behavior mental and dual diagnoses are facing great peril. These people are marginalized and treated like animals are considered dangerous people to Society in the South American Nation. According to Blogs like G1, O Cubo, Maranhao do Povo, and others, this population has published the atrocity that these populations are suffering. The Brazilian news has shown the lack of humanity toward this particular community. These populations are subject to oppression and discrimination. They are being raped, tortured, and starved to the brink of death.

People are in cages!

Thirty-three women in Ceara in Crato, Brazil, were kept imprisoned in small enclosures that are no different from human cages. People killed inside Brazilian psychiatric institutions. 21-year-old Vitor Sally was found dead inside the Clinic Sao Francisco with ribs, broken arms, and teeth.

In the spirit of seeking justice for the marginalized community, I have created the Human Rights Coalition for Latin America Mental Hygiene & Social Justice with one of my colleagues. 

This social justice group’s mission is to create awareness about the uncountable Human Rights Violations against the most vulnerable populations living with due diagnosis (Mental Health Disabilities), forensics issues, and Gender-Based Discrimination and Violence in Latin America, especially Brazil. We aim to create a coalition with a diverse group of professionals with expertise in different fields to assist and support our voluntary work. Brazilian and American bloggers who have published Vava history, Francisco history, Vitor Sally history.

We are standing up for justice and humanity.

Cases in which families have experienced their relatives tortured and killed by Therapeutic Clinics in the country. Vitor Sally’s case, a 21-year-old young man, had his body broken, mutilated, and his private parts electrocuted. All while inside a psychiatric clinic for substance misuse treatment. 

Vava’s case (Jose Vandeilson Silvina de Sousa) was a 17 years old boy denied help when he had a mental health crisis—mistaken for a person who was drug-addicted and not a teenager who was having psychosis. He went missing for ten months. 

And the-less fortunate, Francisco Osvaldo, like Vitor Sally’s, was a victim of the same Clinic that Vitor Sally was killed five years early( according to Vitor’s relatives’ story). Francisco, too, suffers ill-treatment due to the torture and starvation he was forced into while inside the clinic for treatment for his Bipolar disorder. When delivered to his family, Francisco was very feeble, disoriented, and with an abnormal belly. Three days later, he passed away. Therefore this great scholar is doing all these work free of charge to the victim’s family. 

One of his earliest works in the country is where he and his colleagues created the entire SUS diabetes protocol designed in the light of regional actions, cooperation, and the partnership that Dr. Marcelo made with the Federal Public Ministry.

Through the work of Dr. Marcelo and his friends who believe in his career and together with his many friend and supporters, the OBDH was created on February 20, 2021. The day of Social Justice. 

Before creating OBDH, Dr. Marcelo Enrique and his allies and friends worked to charter the Principle for the Rights of Children and Adolescents with Type I Diabetes. The entire SUS protocol was designed and created by him and his allies and friends. This cooperation & partnership was signed between him and the Attorney for Citizens’ Rights, at that time under the command of Dr. Jefferson Aparecido Dias.  

The Brazilian Observatory of Human Rights is the light and beacon of hope for many Brazilians. The Brazilian Observatory of Human Rights’ primary mission is to alleviate Brazilians’ pain, suffer, support, and help the less fortuned judicially throughout Brazil. The organization operates, offering its services to all with no cost, totally free of charge. OBDH never asked anybody for a financial contribution.

As I continue to learn about his work, Dr. Marcelo has a long history of humanitarian work. He has been doing this for a long time throughout the country, helping the vulnerable groups and the underserved, marginalized population in the Brazilian Society. 

This article commemorates his achievements. 

Peers betraying Peers, and Relapse

I am an extremely disillusioned peer. I have spoken up about issues in the peer community on this platform and face to face with other peers. One of the most important issues to discuss is relapse. There is a lingering taboo surrounding relapse when living and practicing as a peer.

While practicing in the peer world, I have observed that peer support stops almost in its tracks when peers get sick or decompensate. When a peer relapses, other peers turn their back.

Worse, when there is suspicion or a situation in which a peer may be relapsing, no protocols are put into place to ensure the intervention or investigation is completed without harming the peer further.

It has happened to me. I have been marked as relapsing, even when I was quite well.

I wasn’t even in distress.

A colleague and I were up for the same promotion at the agency at which we both worked.

I sent her an email, but I inadvertently had a typo, or God forbid, two of them. My heart dropped when my coworker responded with an email reading, “Max, are you OK??” Because at that point, I knew this coworker wanted to mobilize her knowledge of my lived experience to make a case I was unwell or unfit and therefore not a good candidate for this position for which we were both competing.

I walked down to her office and started to explain away my typos, trying to make a joke about the email and how I could understand how it must have been extremely troubling and distressing to read an email with typos. That was when she said: “Max, I don’t like your tone. It is alarming. Please calm down!” It seemed that I was calmer than she was, and the interns around us looked highly puzzled at the interaction.

I wasn’t puzzled or confused. The words “alarming,” just like “problematic” and “distressing,” are often used to describe those who are perceived as threatening. Since these words have so little clinical value and inherent meaning, I can understand why she used them. Words like “alarming,” “problematic,” “troubling,” are often used when a person can offer no real language with real meaning or clinical value to describe a person’s behaviors.

Then she closed the door to her office with us both inside and said, “Max, you don’t seem like yourself,” and then, “I think you are decompensating on us.”

My peer attempted to build the grounds and make a false negative claim about my mental status, claiming I was relapsing. She said as much to our direct supervisor.

Our direct supervisor knew I wasn’t decompensating. Unfortunately for me, our supervisor was leaving her position. So, the duty to investigate my colleague’s claim went up the ladder only to get stuck with some mid-level executive who couldn’t point me out of a lineup.

Although I was working for a large and established agency in NYC, my job was in a small satellite clinic in the Bronx, with very little oversight from the agency’s auspices.

I attempted calling this executive to handle the allegation over the phone because I was much too embarrassed and frustrated to go into the agency and talk face to face. Also, I was fearful. Fearful of even more vicious and outrageous claims could be made against me. After all, the act of lying is a slippery slope. Who knows what my colleague’s endgame was?

In the meantime, I was forced to take a leave of absence after the workplace became a hostile environment in which everyone questioned my ability to do my job.

The executive in charge of ascertaining if I was fit to keep working was not answering the phone and time was elapsing. I was not willing to come back to work until there was a clear resolution to the question surrounding my fitness to keep working.

I had too much dignity and valued my work product too much to continue working at an agency that didn’t respect me enough to look into this matter with a professional and humane approach. I felt slighted by the claim, and also that the higher-ups didn’t care enough about what was happening to the peers working for them.

I wanted to put distance between myself and peer work until I could make more sense of how this situation devolved so much. My dignity moreover my self-worth felt squashed. I felt like I wasn’t valued anymore.

At this point, a few weeks had elapsed. I didn’t want to go back to the office. So, I emailed the agency, resigning.

This entire debacle is when I started to become so disillusioned about the peer process.

I was disturbed on several levels. When I first had my break due to schizophrenia, I did not know I was sick, a feature of the illness called anosognosia. Now, here I was, far into my recovery, ten years later, working in the field, and a coworker makes a false claim that I was sick when I wasn’t.

After the office incident, no one, not one other colleague at the agency or administrator, stepped in to say this sort of transgressive way of handling inter-office communication was frowned upon. Moreover, the void in the office left a gaping vacuum where other peers could have been supportive and intervened, making it clear I had behaved appropriately. Despite my colleague’s response being unwarranted and completely false. There was none of that, so I left the agency shortly after.

I am writing this so other peers aren’t left in the same lonely void I was left in, where peer support would have been genuinely welcome and needed.

Of course, there are going to be times when a fellow peer asks if you’re OK. There are going to be times when your coworkers are concerned about something changing in your attitude. The paradox here is that we need to keep talking about relapse, but it’s no longer acceptable once it becomes accusatory.

Once my colleague started spreading her conviction that I was relapsing, the whole agency began scrutinizing my behavior. After all, as a peer, you’re under constant suspicion—the slightest indication of relapse might mean (to those in power, those who have never experienced it) that you can’t do your job anymore.

That’s why I think there needs to be some system put in place to protect peer workers when someone expresses concern. We’re the vulnerable ones in that situation, faced with losing our jobs, our livelihoods, and there’s little we can do to defend ourselves if every minor interaction is overexamined by the whole agency.

We need clearly defined protocols in place on how to respond to this very specific set of incidents: peers relapsing in and out of the workplace and how the agency should respond at different levels to make sure safety, decency and respect are all in place for everyone in involved.

I fully believe that, in a profession based on living out and healing from a disorder, we should expect and be prepared for our fellow peers to relapse. Every agency should have active protocols for when this happens, from HR to agency-wide discussions and conversations around this very natural part of living with a mental health disorder.

An agency can handle this in several ways. I am recommending one possible approach. HR sets the tone of what is expected and frowned upon in terms of behavior. HR usually has guidelines associated with the agency. The agency could amend the guidelines to include how agency members can handle a peer crisis or relapse. The policies can be reviewed during orientation to the agency, with refreshers throughout the year at HR events.

Most importantly, if an internal claim is made against another peer at an agency, there must be some sort of third-party review. All peers have the potential for relapse. We all can’t go around speculating on each other’s health during a time for promotions to knock another candidate back into the unemployment line.

A third-party administrative review needs to enter the conversation to address behavioral concerns. I recommend outfitting HR departments (with well-researched data and studies on how to support staff relapsing at work) to oversee the review process.

The third-party, in my opinion, shouldn’t know either party involved. During the third-party review, the administrator reviews all work documentation, new HR issues, supervision, and agency-wide concerns from the staff member making an allegation of “relapse.”

The third-party review might include interviewing the person relapsing and the person who is making the allegation. Thus, determining if there is sufficient data or evidence to point to recent unproductive changes in behavior, lapses of judgment, and decision-making errors. Changes in these domains might point to further problems expected in the future.

In the end, unexplainable harmless errors are made all the time at mental health agencies. However, the purpose of the third-party review is to recommend additional supports and accommodations at the agency made available to peers (e.g., extra time for respite).

Years before this betrayal, my first peer supervisor taught me how I was more powerful than lousy peers at our agency. My lived experience could one day be a model to others to be agents of change and a testament to the upper limits of success and career growth that a peer was truly capable of during their career. My supervisor also reminded me how important it was that I came out and stayed out as a peer and someone with lived experience.

But she also told me that my ability to work and my health would be under constant scrutiny from everyone around me in the agency. Peers need to be protected from this scrutiny so that they can succeed as being helpful agents of recovery for others.

Mental Health Affairs 2022

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