IN THE SUPERIOR
COURT FOR THE STATE OF
THIRD JUDICIAL DISTRICT, AT
In The Matter of the
Hospitalization )
)
of )
)
FAITH J. MYERS )
) Case
No. 3AN 03-277 P/S
STATE OF
) ss
Affidavit of Loren
R. Mosher, M.D.
Credentials:
I am born and raised in California, a
board-certified psychiatrist who received an M.D., with honors, from Harvard
Medical School in 1961, where I also subsequently took psychiatric training. I was Clinical Director of Mental Health
Services for San Diego County from 7/96 to 11/98and remain a Clinical Professor
of Psychiatry at the School of Medicine, University of California at San Diego.
From 1988-96 I was Chief Medical Director of Montgomery
County Maryland’s Department of Addiction, Victim and Mental Health Services
and a Clinical Professor of Psychiatry at the
From 1968-80 I was the first
Chief of the NIMH’s Center for Studies of
Schizophrenia. While with the NIMH I
founded and served as first Editor-in-Chief of the Schizophrenia Bulletin.
From
1970 to 1992 I served as collaborating investigator, then Research Director, of
the
In 1980, while based at the University of Verona Medical School, I conducted an in-depth study of
In addition to over 120 articles and reviews, I have
edited books on the Psychotherapy of Schizophrenia and on Milieu
Treatment. Our book, Community Mental
Health: Principles and Practice, written with my Italian colleague, Dr.
Lorenzo Burti, was published by Norton in
1989. A revised, updated, abridged
paperback version, Community Mental Health: A
Practical Guide, appeared in 1994.
It has been translated into five languages. Most recently I founded a
consulting company, Soteria Associates, to provide individual, family
and mental health system consultation using the breadth of experience described
above.
In many parts of the country
thinking about public mental health systems has moved away from the biomedical
model, initially to a psychosocial rehabilitation orientation, and more
recently to a recovery based model. Each
change represents a move toward a more holistic view, increased self-management
in treatment, greater emphasis on independent living and community integration
and protection of rights of system users. As a whole it means much less hierarchical
systems and greater equality of staff and users.
When considering mental health reform
it must be recognized that mental health care is a system. Programs making up mental health systems
share the following characteristics: They are labor intensive, relationship based
and relatively low technology. The system’s elements should include: Prompt,
accessible, client centered, recovery oriented, quality mental health and
rehabilitation services; decent affordable housing; and appropriate, ongoing
self-help focused social supports.
Because they address basic human needs systems that contain an array of
these services have been shown to be both cost effective and voluntarily used.
Such systems must be adequately funded but reform must also include attitude
change and reorganization into less institutional, human sized programs.
Reform to produce co-ordinated community based systems of care needs guidelines:
(1) a shared set of values and (2) common organizational (3) interpersonal and
(4) clinical principles. These four
elements of a systemic organizational framework can guide the committee’s
reform deliberations. Because they are non-specific, they are nearly
universally applicable.
1. PROGRAM VALUES
¨
Do no harm
¨
Treat, and expect
to be treated, with dignity and respect.
¨
Be flexible and
responsive
¨
In general the
“user” (client, patient) knows best. We
each know more about ourselves than anyone else. This is usually a vast untapped reservoir of
valuable information.
¨
Choice, the right
to refuse, informed consent, and voluntarism are essential to program
functioning. Without options, freedom of
choice is illusory. Involuntary treatment should be difficult to implement
and used only in the direst of circumstances.
¨
Expression of
strong feelings and development of potential are acceptable and expected – and
are not usually signs of “illness”.
¨
Whenever
possible, legitimate needs (e.g. housing, social, financial etc.) should be
filled. Without adequate housing,
mental health “treatment” is mostly a waste of time and money.
¨
Risks are part of
the territory; if you don’t take chances nothing ever happens.
¨
Reliable funding
stream
¨
Catchmented responsibility – no “shift and shaft” allowed
¨
Responsible,
multi-disciplinary, multi-function, mobile teams
¨
Decentralized
authority and responsibility to allow on the spot decision making
¨
Use of existing
community resources
¨
Multi-purpose
mental health/social services centers.
¨
Non-institutionalization: Residential care (i.e., hospitals and IMD’s) is expensive and often creates or reinforces problems. They are, by definition, abnormal
environments and should be used sparingly.
¨
Multi-dimensional
outcomes must be monitored and fed back rapidly.
¨
Citizen/”user”
participation is vital for program planning and oversight.
(All help facilitate the
development of relationships)
¨
Positive
Expectations
¨
Atheoretical need to understand – try to find an explanation for
what is going on
¨
Continuity of
relationships across contexts
¨
“Being with”.,
“standing by attentively” – getting oneself into the other’s shoes to better
understand “the problem”
¨
Concrete problem
focus ( problems, in contrast to diagnoses, generate questions and possible
solutions)
¨
Relational
“partnership”, doing together (preserves “user” power)
¨
Expectation of
self-help (“users” need not be so in perpetuity)
¨ Contextualization–
we all have histories that can only be understood by considering the contexts
within which they developed.
¨
Preservation and
enhancement of “user” personal power and control. Mental health professionals do not
necessarily know what is best for their clients/patients – their role should be
to keep them continually involved as the treatment process unfolds.
¨
Normalization (Usualization): Culturally sensitive societal norms should
be applied when treatment plans are developed.
The most “normal”, least restrictive, alternative should always be tried
first. If you treat people as normal
they tend to behave normally.
We have a more than adequate
knowledge base to implement reform. More
studies and dust gathering reports are not needed. What is needed is
the political will, community involvement and financial resources necessary to
make change happen.
___________/s/__________________
Loren R Mosher, MD
SUBSCRIBED AND SWORN TO before me this __5th__ day of March,
2003.
__/s/
Jane M Reilly________________
Notary
Public in and for
My
commission expires: _11-4-04____