23. Reality of Washington Services for the Disabled (1998)

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Out of the institutions and into a neighborhood near you. The Community Mental Health Act evolved out of the administration of President John F. Kennedy and was passed by the U.S. Congress in 1963. Not long after this act had been approved by the President and Congress American deinstitutionalization began in earnest. The care and support for those who were diagnosed with psychological and developmental disorders was now shifted from hospitals and other institutions to community based programs and natural support networks. The new institution would not be a physical building, but instead would be a network of community services, neighborhood programs, professional services, the extended family, and faith communities. Some of these would be supported by federal and state funding.
A couple of years later, medical care and services was added to the network of support for the disabled. In 1965 Medicaid was created by the Social Security Administration, which added Title XIX to the Social Security Act. This was a highly optimistic era the history of the United States, they truly believed the medication that would contain the symptoms of psychological impairments and allow these individuals to successfully manage their lives was very near development. Therefore, it seemed only logical to dismantle the old institutional system and await the soon to be delivered medication.
A good picture of this new reality in care and support of disabled individuals would be the halfway houses that existed from the middle of the 1960’s through the early 1980’s. Throughout this country halfway houses provided a way for disable individuals who were shifted from institutions to community based programs to live independently while participating in professional programs and integrating into neighborhoods. These group homes also allowed disabled individuals to live separately from family members while retaining a supportive community. Some of these individuals eventually moved into apartments owned by Housing Authority agencies or received approval for the H.U.D. Section Eight program and rented privately owned apartment. As a means of filling their days with meaningful activities, many of these individuals spent many hours at a neighborhood day treatment center of some kind and a few found the mental health club houses. There were also options for work for these individuals, shelter workshops and other work-based programs understood the personal benefits that an individual receives from a sense of contributing in a meaningful way. Fountain House of New York is a good example of the benefits of a work oriented day. Also during this period, the poor and disable had very little trouble finding health care, counseling services, and other professional services and programs. In time, some of these individuals developed the ability to move on to volunteering at a variety of agencies and programs in the private sector and a few evolved into traditional employment. Simply put, this period in history may not have been perfect – but it did provide a means in which disable individuals could benefit and have a purpose in their lives.
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A Direct Hit
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In the early 1980’s, President Reagan began the first stage of federal welfare reform. The President convinced Congress to change the concept of block grants and how the federal government would support social and health programs. Through these new kind of block grants the federal government delegated the responsibility for financing and administering domestic assistance programs to the states. A federal block grant was given to a state and the services in the state had to compete for a piece of the grant. Once a state spent the grant it ceased to spend or paid for things from its own budget. It also meant that states lowered the amount they were willing to reimburse professionals, this was done to save money in the state budgets and preserve block grants for services. Because of the financial limitations of these block grants many state social and health programs were either eliminated or seriously reduced. During the 1990’s President Clinton also enacted welfare reform and many programs that survived the Reagan reforms could not continue with the additional reforms under Clinton. The era of great optimism had come to an end and the awaited medication never arrived.
Throughout the 1980’s and the 1990’s, the U.S. Congress continually affirmed that the private sector and faith communities were better suited to offer social and welfare services. This conviction was more of a dream than a reality and therefore these reductions in government supported services seriously affected the lives of those living with disabilities, their families, and those who cared for them.
It was no secret that American deinstitutionalization was heavily dependent upon government funding and assistance. However, the political tide had shifted and the government reduced the funding for welfare and social programs with little consideration of what the impact would be on deinstitutionalization. The Community Mental Health Act remains the rule, but the serious reduction in the funding of those services and programs it relies on, has left American deinstitutionalization in an unhealthy and unpleasant state.
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What Happened to Professional Services?
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One of the dark realities of the welfare reforms during the 1980’s and the 1990’s was the serious reduction in reimbursements by the federal government to those who provide professional services to individuals with established physical, developmental, and psychological disabilities. Many people have asked me from time to time why have so many medical professionals and counseling services have stop offering services to Medicaid clients? The answer is painfully simple, the government reimbursement for services offered to a recipient of the Medicaid programs is seriously below the market rate.
This comes into view when you look at our urban societies which have become very, very professionally oriented and referring individuals to professional services is a standard practice by many people, faith communities, and other professional individuals. The downside to this practice is the fact that many health care providers and counseling agencies do not accept individuals because their primary benefactors are the Medicaid program and other state programs.
Within the human services community this has left many providers wondering how they were going to serve the disable and individuals of poverty within their agency. They want the best possible professional services for those whom they serve, but if it cannot be attained for any reason they are faced with the reality of having individuals in their care who cannot receive these professional services. This often means they must create natural support networks and other alternative means of providing support and care for individuals and this can be very challenging.
Another hardship has been added to the difficulties of providing services, it comes from the insurance agencies that provide liability coverage. Premiums for liability policies that cover private social programs and health care programs have become very costly budget item for many of these programs and yet without a liability policy many are simply not allowed to operate. The result of this has either been the termination of operations for some programs or a serious reduction in services toward those with psychological or developmental disabilities.
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Dual Diagnoses Realities
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Another nightmare in the health care field comes from of the separation of the mental health community and the developmental disability community by the State of Washington. For those who live in poverty and qualify for Medicaid, they must face the fact that government policy has separated these two groups.
What does this mean? If you have a developmental disability you can only be treated for your developmental impairments and if you have a psychological disability you can only receive treatment for your psychological impairment. If you have a developmental disability that also causes mental illness you would only be treated for the developmental disability. If you want the psychological impairment of the developmental disability treated you must pay for that service from your own resources, which the poor cannot. It goes without saying, this has caused a lot of creative diagnoses from medical professionals and has been the source of heartburn for many social workers.
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Support Groups
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Throughout the late twentieth century, many support groups were developed to serve disable individuals and their families. Unfortunately, all too often these support groups meet at times and places that are not always convenient for disabled individuals who are dependent on public transportation or have domestic responsibilities.
Support groups also have tendencies to choose times and places that reflect those individuals who started the support group (or continue it) and the group can strongly reflect the demographics of these individuals as well.
Many support groups make every attempt to take additional steps to ensure sensitivity between social, cultural, and economic backgrounds. However, others are not so careful about these key elements. Whenever a person feels like they do not fit into the group because of their income or culture the group has failed to be inclusive.
The key to any successful support group is center in one simple word, inclusive. Once again, if the support group becomes a group of peers from the same income class or social status – it has failed.
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Crises Centers and Hotlines
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The cartoonist Gary Larson foresaw the current crises in social services many years ago by drawing a cartoon of a building with a sign on it that said, “Crises Center,” and this building was floating down a river and about to go over a large waterfall, while being consumed by fire.
The crises centers (and help lines) are supposed to play a frontline role for individuals who are in immediate personal need. However, many of the contact persons at the crises centers are not trained to handle the poor who have seriously compromised mental health and are without a natural support network. Unfortunately, clinical and state social workers are over worked and have more clients than they can reasonably manage, so it is often difficult for someone in crises to contact their assigned individual. This leads them to contact the crises centers and although the crises center answers the phone, it is not the appropriate place for them.
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Rural Life Coming Up Short
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In the State of Washington, it has always been difficult for rural areas and rural cities to recruit and keep qualified social and health workers and it is even more difficult to provide high quality services for those with developmental and psychological disabilities of all ages. Concerning rural school districts, regardless of the size of the community or town, rural special education programs of school districts also struggle to keep good special education teachers, psychologists, speech therapist, and occupational therapist.
There is a strong and positive side of living in rural communities, it is a slower pace of life, a stronger sense of community, a general tendency to help neighbors who are in need, and the lower cost of living (which can be far less than that of metro areas). All of which can be, without question, very beneficial for those living with psychological and developmental disabilities.
Unfortunately, with the major reduction in government social and health care programs many rural areas simply do not have the extended resources needed to provide the kind of privately funded professional services that are needed for disable individuals, especially for disable children. Another reality is the fact that many progressive treatment programs and many colleges and universities that focus on social and health studies and research are in the larger cities; therefore, there is more options for care and services in or near metropolitan areas.
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Domestic Violence Laws, a Great Idea Gone Bad
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Currently there is no greater example of the conflict between American deinstitutionalization and American society than that which is found in the current domestic violence laws. The advocates who are very passionate about domestic violence have created many laws to protect domestic partners and families from domestic abuse through someone’s need to use physical and psychological violence to control and dominate individuals. In their zeal to seek out justice and social reform, they created laws that do not allow for the consideration of an “established medical history” of developmental or psychological disabilities and the symptomatic aggression and violence that often comes with these disabilities. This lack of acknowledgement in the creation of law also creates conflicts between the basic concepts of the 1963 Community Mental Health Act and the anti-domestic violence community.
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Passing On
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Another hash reality for those who live with disabilities comes when their parents die. Often the siblings and cousins of the disabled individual often live in different cities, they are financially self-sufficient, and they have a strong sense of independence. Furthermore, these family members have no desire to participate in a natural support network. They want state social and health services to provide for their disable family member. However, as many of us know all too well the state has deinstitutionalized its programs, cut many social services, and therefore wants the families to care for their disable members through natural support networks. Sadly, this is yet another no-win circumstance for disable individuals.
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Back to the Future? Not Likely
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As it stands today, both the state and federal governments are not showing any desire to reinstate any of the former funding levels that once supported deinstitutionalization and provided appropriate social and health programs for disabled individuals living in poverty. Instead, the government believes that private business, non-profit organizations, and local faith communities should step forward and provide what the government once offered.
With the crippling reduction in so many public social and health services and the dysfunctional state of American deinstitutionalization – there is a real need to create natural support networks. If a disabled or impaired individual does not have a natural support network, they face serious difficulties and are often needlessly isolated. These often lead to a sense of disenfranchisement from society.
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Community
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In closing, considering the reductions in social services and the continuation of the Community Mental Health Act, I believe collective cultures that embrace recovery model concepts can give those who live with either a developmental or psychological disabilities a greater level of care, support, and enhanced lives. Through collectives cultures natural support networks can be developed for individuals so that they can have meaningful and productive lives.
People with disabilities and impairments truly desire to participate in life and want to be challenged by life (in a manner that they can handle). They want to feel like real people and enjoy the blessings that life can offer. But they will need a network that will provide on-going assistance and tolerance to achieve these goals and I believe that collective cultures is the best option for this.

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Written by Dave Pflueger in January of 1998 (c) copyrighted by Pflueger. Dave is state certified for peer counseling and a past member of the Rehabilitation Counsel (DSHS-DVR).

6. Clash of Realties

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Notice to the reader – the following is a challenging read and may be troubling; therefore please read with care and wisdom.

As it stands today, those who commit any act of domestic violence must face the laws of the state and are punished through the criminal justice system. Acts of domestic violence could be physical harm, psychological harm, or environmental harm (intimidation). In other words, striking someone, playing mind games with someone, or destroying property to ensure conformity.
Now that we have reviewed public law, let us review a segment of society that is challenged by the laws. Individuals who live with developmental and psychological disabilities face many challenges and barriers in their daily lives. One of their greatest struggles is their mental health, when their mental health is compromised they often become emotionally unstable. When they are like this they also can become unpleasant and vulnerable to the intermittent explosive disorder (a common co-occurring condition with developmental and psychological disorders).  When this happens in private homes and in the city parks the police are called and this often means they are arrested. This is an unintended and real consequence of the anti-domestic violence laws and has led to the institutionalization of disable individuals as criminals. When they become inmates they do not receive the professional care needed for appropriate stabilization and management of their disabilities. In other words, they are separated from their network of care and support.
Therefore, many individuals who live with establish disabilities must contend with anti-domestic violence laws that cast such a wide net that they often find themselves entangled in its webbing.

Those who are very passionate about domestic violence have created many laws to protect domestic partners and families from domestic abuse through someone’s need to use violence to control and dominate individuals (as if they were property). In their zeal to seek out justice and social reform these advocates against violence did not offer any kind of consideration towards those who have an established medical history of developmental or psychological disabilities and the intermittent explosive disorder that is often associated with these disabilities. This lack of acknowledgement also creates conflicts between the basic concepts of the 1963 Community Mental Health Act and the anti-domestic violence community.

The idea of treating everyone who commits any kind of domestic violence in the same way is another way of seeking a one size fits all approach. If a one size fits all approach is the direction that society wants to go, then we need to completely change the criminal justice systems on both the federal and state levels and remodel many correctional buildings. This kind of major change is grounded on the fact that correctional facilities are currently designed for the detainment of those who have committed a criminal act and are not designed to be the primary care and treatment centers of those who have developmental and/or psychological disabilities. This is especially true for city and county jails, they often do not have the staff and funding that would allow them too properly care for those with these kinds of disabilities. Sadly, this lack of resources has already led to abuse and even death of those with disabilities.

As a rule, I do not have a disagreement with the process and punishment of those who have harmed their domestic partner for the sole purpose of controlling, dominating, and perversely coveting them. However, I strongly believe that the criminal justice system is the wrong place for those who have been professionally diagnosed with a developmental or psychological disability. Instead, I believe that they need to be dealt with by the health and social services community, so that they may receive a thorough mental health evaluation and inpatient treatment. In addition, if they cannot be stabilized they need to be confined for an extended period to a facility for those who have seriously impaired mental health.

Concerning medication. Science has not kept up with the general concerns of society and Federal and State laws; the development of medications to control the genetic based behavior of the intermittent explosive disorder and other similar disorders that often co-occur with developmental and psychological impairments is still in its infancy. It will be a long time before medications are developed that will successfully control this behavior in all individuals with these impairments; as it stands today the only way medication can pacify the impairments of an individual is to be in a high enough dosage that it renders a person into a zombie state.

Criminalization. When anti-domestic violence laws do not take in consideration the medical science of the symptoms of developmental and psychological disorders and make provisions for them, there is only one out come, the criminalize of the genetic nature of these disabilities. Without consideration and provisions in the laws, the impaired DNA that is at the center of the disability and the cause of the symptomatic behavior, will make disabled individuals candidates for criminal prosecution by virtue of their genetic code.

Another serious matter. What makes things really difficult for those who work with those with these disabilities is the fact that all “First Responders (police officers, mental health counselors and case workers, teachers and so forth)” must to report any “person to person violence (verbal, attempt and actual).” This has forced advocates and supporters of those with either with psychological and developmental disabilities underground or into the shadows of society.

What would go a long way in reconciling all these parties and bring them together would be an acknowledgement that the current domestic violence laws need to be reformed and work together to bring about a revised code of law that acknowledges that violence committed by those with established psychological and developmental disabilities is a symptom of these disorders and not a criminal act.

Written by Dave Pflueger March 2012 © copyrighted by Pflueger

Dave Pflueger is certified for mental health peer counseling

3. 1963 Community Mental Health Act – After 50 Years

It has been almost 50 years since the creation of the Community Mental Health Act of 1963 and the creation of the Medicaid program in 1965. The Mental Health Act deinstitutionalized the care and support for those who were diagnosed with psychological and developmental disorders and Medicaid provided a means for the disabled to receive professional medical care. During this fifty year period, American society has gone from a workable network of support and services for those who live with psychological and developmental disorders to a point where the network is fractured and services have been reduced to dysfunctional levels. The Community Mental Health Act is still the norm, but the broken network and lack of services creates serious public safety issues; if a nation is going make deinstitutionalization its gold standard, it better provide the highest levels of public funding for community based programs or acknowledge to the citizens that public safety and health is not a priority. In our nation we have a real crisis facing us and if we do not address it, things are going to become very dangerous; because when a disability has destabilized the mental health of someone without a network to provide them with pro-active treatment and services, something very bad can happen in the city parks. As a nation we need to decide if we want to continue with deinstitutionalization or start building secured facilities with professional staff members to operate them. Failure to decide is an unwise and unhealthy option. As faith-based communities, Christians need to decide what direction they are going to take on this serious matter and take steps towards their decision and promote it. For Christians this is an issue of social justice and a matter of social morality.

Before us we have three options: deinstitutionalization (fully funded community based programs), public institutions (secured facilities funded by the government), or make no decision (the most dangerous option).

Written by Dave Pflueger May 2012  © copyrighted by Pflueger