Public Hearing Transcripts Adult Consumers by tpb23050

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 1     WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES

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13        SUBCOMMITTEE MEETING ON ADULT CONSUMES AND FAMILIES

14                           MARCH 8, 2006

15                               - - -

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18   BE IT REMEMBERED THAT, pursuant to the Washington Rules of

19   Civil Procedure, the meeting was taken before Valerie

20   Allard, a Certified Court Reporter, #3040, on March 8,

21   2006, commencing at the hour of 3:00 p.m., the proceedings

22   being reported at Yakima Valley Community College,1015

23   South 16th Avenue, Martin Luther King Room, Yakima,

24   Washington.

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 1   APPEARANCES

 2   JILL SAN JULE, CONSUMER CO-CHAIR

 3   12833 16th Place NW

 4   Everett, WA    98204

 5   BILL HARDY, COUNTY/RSN REPRESENTATIVE

 6   131 basin Street SW

 7   Ephrata, WA    98823-1855

 8   DIANA JADEN-CATORI, CONSUMER MEMBER

 9   311 Champion Street

10   Steiliacom, WA     98388

11   DIANE SCHUMACHER, CONSUMER MEMBER

12   1310 West 6th Ave. #4

13   Spokane, WA 9904

14   BJ COOPER, CONSUMER MEMBER

15   BILL WATERS, OPEN NON-CONSUMER MEMBER

16   2610 North 8th Street

17   Tacoma, WA    98406

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 1   SPEAKERS

 2   Sue Burdett

 3   Marina Covey

 4   Beth Danheart

 5   Christine Gill

 6   Gary Hodges

 7   Freida Morford

 8   Barb Noakes

 9   Becky O'Grady

10   Vicki Rich

11   Michael Schwa

12   Frank Swanson

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 1              (Whereupon the public testimony began at 4 p.m.)

 2   MS. JILL SAN JULE:    Okay.   I guess we'll get going here.     I

 3   want to welcome you all to this public hearing.     My name is

 4   Jill San Jule, and I'm one of the consumer liaisons.      I was

 5   recently hired to work on Washington States Transformation

 6   Grant.    Please excuse my note cards, but to be perfectly

 7   honest, 13 years of psychiatric meds has kind of shot my

 8   memory.   so I rely a little bit on notecase.

 9              I want to welcome you guys all today to this

10   exciting opportunity to testify about mental health

11   services in this area.    And before I introduce you guys to

12   the Adults Consumer Subcommittee members and before I give

13   you a quick overview of the Mental Health Transformation

14   Grant, let me go over just a couple of housekeeping items.

15              The bathrooms are going to be out the door here

16   and to the right, all the way down here.     And then we have

17   services available to those of you, if any of you are deaf

18   or hard of hearing.    Is there anyone who needs those

19   services today?

20              Okay, so why don't we do some introductions.

21   Diana, do you want to start?

22              DIANA JADEN-CATORI:    Yes.   My name is Diana Jaden

23   Catori.   I'm a consumer and advocate, 14 years.    I also

24   have a seat on the Mental Health Planning and Advisory

25   Council for two years, as well as the legislative
                                                                          5




 1   subcommittee.

 2                I welcome you all and look forward to hearing

 3   your testimony.

 4                DIANE ESCHENBACHER:     Just so you know, this

 5   public testimony is being complied as part of the

 6   Transformation Grant.     It will be complied in a report and

 7   used to process, in hopes that we can go further and make

 8   changes to the state-wide Washington State mental health

 9   system.     In doing that, we have the services here of a

10   stenographer.     So it would helpful in you're giving your

11   testimony--it's hard for her to take and keep notes if

12   there's a lot of cross talk.        So try to keep that down to a

13   minimum so it makes it easier for her.

14                Also, you're welcome to put your names in.       We'd

15   love to have your names in.        But if you are uncomfortable

16   and still want to give information but not have you name

17   in, you can have it redacted from the testimony or just not

18   give it at all and ur testimony will certainly be gladly

19   accepted.

20                My name is Diane Eschenbacher.     I'm a consumer

21   advocate and also a registered nurse.        I live in Spokane

22   RSN.   I have served on the Consumer Roundtable for the

23   State of Washington, Ethnic Minorities Subcommittee,

24   Consumer Ad Hoc Committee, and I also now serve on the

25   Mental Health Planning and Advisory Council for the State
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 1   of Washington.

 2                BJ COOPER:   I don't know if everybody knows the

 3   term "consumer".     I know when I first started doing this

 4   kind of thing and volunteering, I didn't know what it

 5   meant.   Consumer, any for people who don't know, it's a

 6   person who has or is currently getting help from mental

 7   health care services.      And you're a consumer, even if it

 8   was in the past.     So, I am a consumer.     And I actually was

 9   the founder and facilitator of a consumer-run program.           We

10   called it the Club House, but it wasn't an official--they

11   have an official type of club house.        Ours was not under

12   the official category of club house, but that's what we

13   called it.     It was really a drop in center and we had

14   educational opportunities.

15                I've been doing volunteer work at the State level

16   and locally for, going on 11 years now.        So I was glad I

17   had the opportunity to be on this subcommittee where we

18   hear from consumers and families around the State about

19   what they would like to see changed about the mental health

20   care system and why it isn't working for them or hasn't

21   worked for a member of their family or someone they know.

22   So that's really a kind of important thing.        And then if

23   you have any good ideas about what you know has worked for

24   somebody or an idea that you think should be tried out, we

25   can get that down too.
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 1               So, we really want all the input we can get for

 2   the people that make the money decisions.          So the more

 3   ideas we have and the more--I'd just like if it's 10

 4   people, it has a bit more impact than one, kind of thing.

 5   So any ideas, we really want to hear them.

 6               BILL WATERS:     Hello.    My name is Bill Waters, and

 7   I'd like to join my other committee members in welcoming

 8   you.   We are very thankful that you're all here.         We want

 9   to hear the feedback you have about how to improve the

10   mental health system.

11               I'm the president of the Washington State Club

12   House Coalition.     I serve on the NAMI State-wide board.

13   And I'm the executive director of Rose House when I'm not

14   doing this.

15               BILL HARDY:    Hi.     My name is Bill Hardy, and I'm

16   the administrator for the North Central Washington Regional

17   Support Network, which is Grant, Adams, and Okenogan

18   Counties.     For those of you who don't know, the Regional

19   Support Network has been around since the early '90's.           The

20   State contracts with the Regional Support Networks and then

21   we subcontract with community mental health providers to

22   provide direct services.

23               So, I'm glad to see you all here.

24               JILL SAN JULE:       Thanks, guys.   Well, I have the

25   privilege of being the co-chair of this subcommittee for
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 1   the past couple of months, and I can honestly say that I am

 2   throughly impressed with the knowledge and the skills that

 3   each of these guys have brought to the subcommittee,

 4   particularly the fact that all of us up here are

 5   volunteers.   And we're volunteering our time to ensure that

 6   your input and our input, you know, is heard.

 7             I'm going to take a minute to talk about the

 8   grant itself, and then we'll begin the public testimony.

 9   So back in October of last year, Washington State was one

10   of seven states to receive this federal grant from SAMHSA

11   to the substance abuse mental health administration and so,

12   like I said, it's a five-year federal grant.    And I want to

13   point out specifically that the grant is not to provide

14   direct services.   It is technically called a Mental Health

15   Transformation Grant, meaning we're going to take the next

16   five years to compile--well, not the next five years

17   completely, but the next year to gather information in

18   numerous different ways and eventually this is all going to

19   be complied into a report that goes to the Governor.

20             How is this going to happen?    Well, basically all

21   of our information-gathering activities,    the public

22   hearings being one of them, is going to get channeled to a

23   State-wide work group.   And the State-wide work group is

24   going to develop ways in which the State mental health

25   system can be transformed, like I said.    I think it's
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 1   important to note that at every step of this process,

 2   consumers, family members, advocates, providers are all the

 3   table, having what we will hope to be as an equal voice.

 4   And these public hearings, like I mentioned, represent one

 5   piece of this information-gathering process.      We are--this

 6   Sub-Committee which represents adult consumers and

 7   families, we are one of seven subcommittees.     The seven

 8   Sub-Committees being Adult Consumers, Children/Youth,

 9   Co-Occurring Mental Health/Dual Diagnoses, Criminal

10   Justice, Homelessness, Older Adult Consumers and Families,

11   and Youth Transitioning into Adulthood.

12             So by the end of this month, each of our

13   Committees will have held three different ones of these

14   public hearings across the State.     And at that point, the

15   University of Washington, their research team is going to

16   take all of the transcripts and compile them and kind of

17   spit them back out to all of our Committees finding the

18   common themes.     And at that point, we're going to look at

19   that information and kind of decide if, hopefully, the same

20   conclusions that we come to will be the same things that

21   the University of Washington comes to.     And then on April

22   7, all the Sub-Committees will get together, and we

23   will--the goal of that day will be coming up with key

24   recommendations.     Those recommendations will go into the

25   final Mental Health Plan and that is going to be presented
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 1   to the Governor later on this year for implementation in

 2   the next few years.    So is that real clear?   Well, if you

 3   want any further information on the actual grant

 4   activities, there are handouts in the back.     Hopefully, you

 5   saw them when you came in.

 6             Okay.    So if there's no questions about the grant

 7   itself, we'll get to the public testimony time.     Just a

 8   couple notes about that.     We're going to be going until 7

 9   o'clock tonight.    At some of the meetings, there have been

10   up to 80, 90 people, so we've had to limit the time that

11   people have had to speak.    This looks like a little smaller

12   group, so unless we have a whole bunch of other people

13   come, we really won't be limiting your time.

14             What we do ask is that you kind of frame your

15   testimony using these four questions.    We would love to

16   hear your feedback on this; however, if you're not

17   comfortable speaking up today, we also have the four

18   questions in written format that you can either mail,

19   there's an address on them; or you can turn them in to one

20   of us, and we'll get them to the grant staff team.     I think

21   that's about it.

22             So the way that we're going to do this is when

23   you came in there should have been a sign-in sheet asking

24   if you wanted to give public comment.    And we'll first go

25   down this list.    Of course, if you didn't sign that, you're
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 1   more than welcome to let us know that you would like to

 2   give public testimony.

 3              DIANE ESCHENBACHER:     Did anyone have any

 4   questions about the first part in the process, the

 5   application grant process before we get into what people

 6   have to say?

 7              JILL SAN JULE:     Do one of you guys want to--

 8              DIANE ESCHENBACHER:     Oh, sure.

 9              JILL SAN JULE:     --look on that list.     There

10   should be yeses on the ones that--

11              DIANE ESCHENBACHER:     Oh, I see.     I didn't

12   realize.   Gary, did you want to go first?        You're on the--

13              GARY HODGES:     I don't want to go first.

14              DIANE ESCHENBACHER:     You want to slide in there.

15   Okay.   Sue Burdette?

16              SUE BURDETTE:     I said, maybe.     Is that okay?

17              DIANE ESCHENBACHER:     Okay.

18              SUE BURDETTE:     I might.

19              DIANE ESCHENBACHER:     Becky?

20              BECKY O'GRADY:     I'll go first.     Do I have to

21   stand somewhere or may I sit here?

22              JILL SAN JULE:     You may sit, stay where you are.

23              DIANE ESCHENBACHER:     Just as long as you keep in

24   mind that she has to be able to hear you.

25              BECKY O'GRADY:     Can you hear me?
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 1                COURT REPORTER:    I can hear you.   Can I get your

 2   first and last name?

 3                BECKY O'GRADY:    My name is Becky O'Grady.      My

 4   friends and I sat down at lunch today and first, there was

 5   one thing that we wanted to talk about.        By the time we

 6   were done, they made me write out list of things we

 7   discussed today.     And since you said there wasn't a time

 8   limit, and since I am willing to go first.

 9                BJ COOPER:   Now, we only have three hours.

10   There's a certain amount of executive--

11                BECKY O'GRADY:    I will be brief.   What is working

12   well in regards to mental health services in Washington

13   State.     These are the things that I know are working for

14   me.     I am a former board member of NAMI Yakima.        I am a

15   consumer.     I have bipolar disorder.     I'm a former special

16   education teacher, so I come at this in several different

17   directions.

18                The things that are working well personally for

19   me right now is what I'm going to address.        I have access

20   to my psychiatrist when I need to.       He is an outstanding

21   doctor, and he provides me with what I need when I need to

22   get it.     He calls me back personally.     He knows me well

23   enough that if I need something, he knows who I am.           I can

24   call and talk to him and say, this is Becky.        He knows who

25   I am.     That's very important to me.     We have that
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 1   therapeutic relationship so that when I'm sick, when I need

 2   to be hospitalized, whatever it is, I know I can trust him.

 3   That works well for me.

 4                Until January 1st, my medication system worked

 5   quite well for me.        I could get all the medications I need;

 6   they were covered; and I didn't have to pay for them.              I

 7   did not have any concerns about getting my medications.

 8   That used to work very well for me.

 9                BJ COOPER:     Does that mean you can't get your

10   meds now?

11                BECKY O'GRADY:       It means I've had quite a bit of

12   difficulty getting my meds lately, but that's question

13   number two.

14                BJ COOPER:     Oh.

15                BECKY O'GRADY:       Okay.   I'll do the medication

16   thing.   Since January 1st, since the changes in Medicare

17   Part B, I have had a lot of problems with getting

18   medications.     And I think I can speak for a lot of

19   consumers who have had quite a lot of problems with getting

20   medications.     I've had medications that were not on the

21   formulary.     I've had medications that were not covered or

22   told I would have to take the generic when the specific

23   name-brand medication worked better.           I've been told that

24   at times, consumers are going to have to wait until we get

25   very ill on one medication before they'll consider changing
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 1   us to another medication.     While that has not happened to

 2   me yet, it scares the hell out of me.     The idea of having

 3   to get sick before anyone will help you, it's a farce that

 4   we should be treated that way.     I don't think any other

 5   group of people has to wait until they have their third

 6   heart attack before someone says, Oh, I think we'll treat

 7   you now.

 8                I know that I've been very anxious.   Anxiety is

 9   one of the symptoms of my disorder.     I've been very

10   anxious, having to find out, having to make phone calls to

11   the doctor, having to make phone calls to the pharmacy,

12   saying what do I do now because this medicine isn't

13   covered.

14                Also, I used to have my medication covered.     Now,

15   I have to pay co-pays.     I have 12 different medications at

16   $3.00 apiece, that's $36.     It doesn't sound like a whole

17   lot, for me it's a week's worth of groceries.      It's not a

18   decision I like to have to make, so I cut back on how much

19   I eat.     That is one of the things that is not working right

20   now.

21                These are other things--I'm sorry.    I going to

22   have to skip around on the questions right now.      My friends

23   tell me that they have gone to counselors--and I have seen

24   this happen too--where one of their identities, whether

25   it's being a person of disability, or being a gay or
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 1   lesbian person, whatever it is, their racial ethnicity has

 2   gotten in the way of the therapeutic process to the point

 3   where they have quit seeing the therapist.     A friend of

 4   mine who is a lesbian went to see a counselor about

 5   depression and anxiety issues.     The counselor was so

 6   focused on her sexuality that she would not address the

 7   depression issues.     In fact, up to the point where she

 8   said, well, maybe you're depressed because you're a

 9   lesbian.

10              I've seen other examples, where a man went to see

11   a therapist for anxiety and depression.     The therapist was

12   an intern who was planning to become a counselor within a

13   particular religion.     Instead of counseling that person

14   regarding his mental health issues, he encouraged the

15   person to pray and become more involved in religious

16   activities.     Again, that's highly inappropriate.

17              There are significant cultural and ethnic

18   differences.    I've talked to people who are being counseled

19   by a therapist who is speaking English as a second

20   language, which is fine except that the counselor did not

21   have the fluency enough in the English language to

22   communicate to build up a therapeutic relationship.       This

23   person spoke English quite well but not to a trust level

24   with his client.     Parity, of course, is something we're all

25   fighting for.
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 1                Again, I'll come back to the issue of physical

 2   illnesses.     Diabetes is covered.       No one here questions

 3   that it's a physical disability or a physical illness and

 4   it's covered.     The idea that still our illnesses are

 5   sometimes second best or--is not acceptable.          My illness is

 6   as much a physical--physiological thing as diabetes is.

 7   The stigma should not be their ethic.          The parity issues of

 8   whether mental illnesses are covered, we shouldn't have to

 9   be faced with that.       The idea that persons with Alzheimer's

10   disease, which is clearly a brain-based disorder, can get

11   coverage and we can't.        That's a serious problem.

12                Let's see.     Our local crisis line sometimes has

13   provided me with significant help in a crisis.          Sometimes

14   has hung up.     Sometimes has promised to call back and

15   didn't.     Sometimes it's handed me off to as many as five

16   different people before I got the help I needed.          I have a

17   friend who called Open Line two weeks ago with a promise to

18   call him back.     As of four days later, they still hadn't.

19   And he needed to be hospitalized, and they never called him

20   back.     I once had someone, when I called the Crisis Line

21   say, "It's not like I can talk to you all night, you know".

22                BILL WATERS:     Becky, is the Crisis Line, the one

23   you tried, is that in Yakima.          Is that set up for this

24   area?

25                BECKY O'GRADY:     Yes.
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 1               BILL WATERS:     Thank you.

 2               BJ COOPER:     Crisis Line, not an One Line?

 3               BECKY O'GRADY:     It's called Open Line here.

 4               BJ COOPER:     Now, see, so that sounds more like--

 5               BECKY O'GRADY:     It is the local suicide, hot

 6   line, crisis line.

 7               BILL WATERS:     The Crisis Line.

 8               BECKY O'GRADY:     Yes.   It doesn't matter if you're

 9   having a bad day, or you're acutely suicidal, that's the

10   line number you're supposed to call.

11               BJ COOPER:     Okay.   Thanks.

12               BECKY O'GRADY:     I have had times when they were

13   very, very helpful and got me through crisis situations.

14   So it's been a wide range, and I'm not sure what the

15   problem is, but I do know it could be improved.

16               Okay.   Stigma is a huge thing that needs to be

17   combated.    I think it's well beyond the scope of what we're

18   doing today, but I think it is probably the biggest fight

19   that we still have before us, is not being second best

20   because we're mentally ill.        And this is a particular thing

21   that has been a problem for the last several years.          The

22   local mental health agency--there's probably several

23   representatives here, but that's okay--has funded a support

24   group for people with bipolar disorder for several years

25   and then it quits.       While later, years later, it decided,
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 1   hey, maybe it would be a good idea to fund a support group

 2   for people with mental illness--or with bipolar disorders.

 3   And we start going to it again.     More than one person in

 4   the group said, you know, this isn't going to last.        It

 5   didn't last last time, and it won't last this time.

 6   Something--it won't happen.     The funding will be cut again.

 7   And seven months later, they took away our funding for our

 8   bipolar support group again.     I was outraged.     I told them

 9   then that more people will become ill, more people will be

10   hospitalized because they cut this funding.        They claim

11   that they could not fund a therapeutic group for people

12   with bipolar disorder.     They would, however, fund a support

13   group which is once a month; whereas, a therapeutic group

14   is once a week.   We need the more frequent support.

15             I truly believe that saving pennies by cutting

16   back on how many support groups you have is going to cost

17   an enormous amount of money by the number of us who have

18   been rehospitalized again since the group stopped.        It's

19   increased our medications.     It's made us sicker.     Cutting

20   small amounts of money is not the answer to improving

21   mental health care.

22             BILL WATERS:     Becky, can I clarify?

23             BECKY O'GRADY:     Please do.

24             BILL WATERS:     So they discontinued the funding

25   saying that that was a group they could provide support
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 1   once a month, but they couldn't provide--

 2                BECKY O'GRADY:     --therapeutic

 3                BILL WATERS:     -therapeutic support.

 4                BECKY O'GRADY:     Therapeutic support which would

 5   be more than once a month.        For some reason, they defined

 6   support groups can only happen once a month.          Any more than

 7   that would be therapeutic, and they're not going to provide

 8   therapeutic services.

 9                BILL WATERS:     Why is that?

10                BECKY O'GRADY:     Funding.

11                BILL WATERS:     Funding.

12                BECKY O'GRADY:     The person from mental health who

13   was providing this support told us that the funding was the

14   problem.     And like I said, I know more than one person who

15   had been rehospitalized because we don't have that support

16   any more.

17                Oh, one more thing I forgot to say.      My

18   psychiatrist has moved to a different clinic in this town.

19   I used to have a nurse that when I called, I said I need

20   this, I need that.     She took care of it, or like I said,

21   the doctor would call me back directly.         He's at a new

22   clinic.     As of tomorrow, I will be out of my anxiety drugs.

23   When I called this nurse, she said, "Well, you have an

24   appointment in two weeks.        You can wait until then".      Do

25   you think my anxiety--my anxiety has skyrocketed, let me
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 1   tell you.     The nurse providing services needs to meet the

 2   needs and she needs to not do anything that's going to

 3   increase my illness or my anxiety.

 4               There, I started off.

 5               BILL WATERS:     Thank you very much.    That was a

 6   good start.

 7               BJ COOPER:     Some of those things you recited, I

 8   have some responses, things I know are going on on some of

 9   the issues you brought up.       So before you go, when we have

10   a break or something, I'll bring them to your attention.

11               BILL WATERS:     Before you--do you have any

12   suggestions then in three and four here that you think

13   would be, that you would like us to capture?

14               BECKY O'GRADY:     Absolutely.   I told you if you

15   asked me a question, I'll answer it.

16               BILL WATERS:     That would be good.

17               BECKY O'GRADY:     A transformed system would be

18   more client based.       I know for quite a while, I know people

19   were talking about consumer-based systems.          I would like to

20   see it happen.     It would ask us what we need.      And when we

21   tell people, they would actually do it.       We have informed

22   comprehensive mental health repeatedly that we need a

23   bipolar support group on a more frequent basis.         They, like

24   I said, have cut our funding more than once.         That is the

25   kind of thing that happens.       They need to listen to us.
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 1   It's nice that you're listening here, but I heard you say

 2   five years down the road.     Something needs to be done much

 3   more quickly.

 4              A transformed system has hot lines, crisis lines,

 5   whatever you want to call them, that have trained people on

 6   the line when you call them.     They don't have volunteers

 7   that say, oh, I don't know.     I'll have someone get back to

 8   you.   I talked to the people or I called the Crisis Line

 9   number this morning, and they said people are currently

10   unavailable, please hold.

11              A transformed system would not look like big

12   institutional buildings.     They would have smaller centers

13   where we feel safer, more comfortable.     Going to a mental

14   health center that's huge and impersonal doesn't help.        It

15   would have a crisis center that is separate from the detox

16   center.   Currently, if you're having a mental health crisis

17   and need to be in a bed but there's not one available in

18   the hospital, you go to the same crisis unit as the detox

19   center, which means those of us having mental health

20   breakdown are in a bed next to somebody who is going

21   through withdrawals.   That is completely unacceptable.

22   Detox is not a mental health crisis and why we're put in

23   the same place, I don't understand.

24              Other outcomes.    I've heard a lot of people say

25   that nurses were not available to them or that they
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 1   couldn't get to doctors and that.     Like I said, my doctor

 2   works quite well with but there are others that don't.      A

 3   transformed system would also be connected to the other

 4   local mental health agencies.     NAMI, for example, the local

 5   Clubhouse, agencies would work better together.     I've

 6   talked to two or three people, and I know there's lots more

 7   out there who have dual diagnoses who get treated for one

 8   or the other, but not both.     I've also talked to people who

 9   have a mental health issue, who have been told they have to

10   go to drug treatment because they were self-medicating and

11   the system cannot tell the difference between somebody who

12   was having a crisis and smoked a joint, if you will, and

13   somebody who's chemically dependent.     And they all get

14   processed through the same chemical dependency program

15   whether it's occasional use or a dependency problem.

16             A transformed system would have therapists

17   available to meet the needs of individuals.     The therapists

18   need to be comfortable with, as I said, with the gay

19   community or with various ethnic communities, various

20   religious communities.   I know of people who are pagans who

21   will not go to therapy because they don't have someone who

22   will judge them because of their religion.

23             A group would be responsive to individual people,

24   as opposed to those of us who are consumers.     It would also

25   stop calling us by different names.     We have been patients,
                                                                        23




 1   clients, consumers.     What else are we?   If you could call

 2   us individuals, that would be really nice, people.

 3             Outcomes would indicate something better.        If we

 4   lived in our own homes, if we were hospitalized less

 5   frequently or hospitalized safely when we needed it.         If,

 6   when I called the Hot Line and told them I was suicidal, I

 7   didn't have multiple police officers show up at my door.           I

 8   don't think that's an appropriate response.      I think

 9   suicide by cop needs to stop.     And I think the crisis--what

10   is it called?    The CIC Program needs to be put in place in

11   every city and county in this State so that police officers

12   are trained to deal with people with mental illness.

13   There's a person in Yakima who died last year.      He was

14   having a crisis.     The police came.   His wife said that he's

15   having a mental illness breakdown.      These are the things

16   that have worked with him in the past.      And they did not do

17   those things.    And the poor man, they tried to take him

18   down, but they could not.     The poor man ran frightened into

19   a nearby lake and drowned because the police officers did

20   not listen to what his wife was saying, that there was a

21   way to treat him that had worked for him in the past.         They

22   didn't listen.     The man is dead.   Every police officer in

23   this State should have the proper training to deal with us

24   when we're sick.

25             BJ COOPER:     Maybe the lady with her daughter
                                                                        24




 1   there could maybe speak for a little bit.         She needs to be

 2   leaving.

 3               VICKI RICH:    I'm Vicki Rich.   I'm a consumer and

 4   I also have children who have small--.       Addressing the CIT,

 5   I'm the consumer advocate for jail diversion for mentally

 6   ill offenders and we are putting in place, in fact, in the

 7   next month some CIT training on rotating shifts for the

 8   officers that addresses the concerns that I have in Yakima

 9   County.    So, just to let you know that issue is being

10   addressed right now as we speak this month.

11               BILL WATERS:    Would you agree with her that it

12   should be across the State?

13               VICKI RICH:    Oh, yes.   I'm in contact with NAMI.

14   I'm on their email lists.      On this list, out of like your

15   seven, all your seven areas, I'm one of each of those being

16   that I'm a co-occurring, dual diagnosed.

17               BILL WATERS:    Worked on the sub-committees?

18               VICKI RICH:    I did all of them.     Basically, I was

19   just going to read over my notes on it.         On No. 1, within

20   Washington State for mental health services private or

21   public what's working well.      I have found for myself, there

22   are several supportive agencies that cater to my

23   multifaceted lifestyle.      I've received numerous ones.

24   Family Preservation Services, Parent/Child Advocate

25   Program.    I've been through Drug Court that they supervised
                                                                     25




 1   me.     When I got my felonies, facilitated my recovery.

 2   MICA, fully diagnosed in the program.      EPIC, my child have

 3   all been involved with them and have received services.         My

 4   little one here has anxiety adjustment.      And I have an ADHD

 5   high-risk onset of bipolar 15-year-old daughter. I've

 6   received Catholic Family VIP which is Valley Intervention

 7   Program for my daughter.      I didn't want to have to medicate

 8   her.     So I've received a lot of these services.   But I had

 9   to seek out many on my own and force them into action to

10   meet my and my kids' needs.      My kids have been a part also

11   of the Youth at Risk Program which is very time consuming

12   and.     So that's No. 1.   Those services are working really

13   well.     It took many of those services to stabilize me.

14                I've been in the system since I was seven years

15   old.     My father was an alcoholic and he killed my mother,

16   you know, a blackout drunk and us children, the five of us,

17   were put in the system.      And due to all that trauma and

18   stuff, we weren't quite the most well put together

19   children.

20                Within Washington State, for all the mental

21   health services public or private, what is not working and

22   creates barriers or fails to provide quality service and

23   support.     Many of these services are not well recognized

24   and can be integrated to facilitate a more well-balanced

25   and enhanced success rate of recovery.      Open Line,
                                                                    26




 1   definitely it needs more significant consistency and

 2   training.    I had to make calls, and I agree with the lady

 3   over here, my 15 year old, she's having a fit.      She's

 4   arguing with me.    She's throwing things.   The cops comes.

 5   I call the Open Line.    They're like you need to bring her

 6   here.    So how do you get a non-compliant mentally ill child

 7   that is having, you know, she's having one of her little

 8   days, or moments.    How do you get them in the vehicle?    So

 9   when you try to get them in the vehicle, the police are

10   called because she's freaking out.    So I don't understand

11   how that--how am I supposed to do that?      So I think that

12   could be more consistent, more catered to the family's

13   needs.

14               In the criminal justice, providers need more

15   education on special needs and co-occurring mentally ill.

16   Like for Drug Court, they weren't wanting to let me in

17   because I have a mental illness, and one of my medications

18   is an amphetamine, it's for my AHD.    When the weigh you all

19   the time, they don't want anything that's going to mess

20   with it.    In my first year and a half of recovery, I had to

21   struggle to have that focus and control without medication

22   so that I can take care of my four kids.

23               What would a transformed metal health system

24   looked to me?    A more informed provider network to meet

25   each person's specific needs combined sites of care, that's
                                                                      27




 1   where I find it's lacking.     I would like to see more

 2   combined client based and more consumer driven with

 3   employed positions and funding the facility for more

 4   consumer involvement.

 5              I just finished training on peer support

 6   counseling.   It's an excellent program.    I know from all my

 7   12-step stuff, I learn more from others that have been

 8   there and can relate.     With the Mental Pride Program, I

 9   looked at them and said if you walked in dressed like that

10   and tried to address my needs, I would be like uh-huh,

11   right.   And that's coming from when I was really ill.       I

12   don't consider myself ill or labeled anymore.      When I

13   hadn't developed the perceptions and the skills that I have

14   now, three-and-a-half years later.     When I first started

15   out, I remember I had to seek all those services.      In order

16   to be in Drug Court, I had to find somewhere to get

17   childcare paid for because Work First wouldn't pay for it

18   because I wasn't in the work-approved activity.      So how do

19   you go to all these functions without childcare for you

20   children so you can get well enough?

21              I'm a student now, a full-time student and

22   part-time employed.     I have four children.   It's taken me

23   three-and-a-half years to get to this point.      I often hear,

24   not everyone is like you, not everyone is as ambitious and

25   driven as you; but I believe everybody has that potential.
                                                                      28




 1   They just need a booklet that says, okay, if childcare is a

 2   barrier, Family Preservation can take care of that.

 3               I didn't have the living skills.     My Family

 4   Preservation worker came to my house.     While I did laundry

 5   and did my dishes, she would sit there talk to me about

 6   things that triggered my mental illness.       One of them was

 7   inadequacy as a mother.    I never thought I was good enough.

 8   She taught me how to budget.    Often times, people with

 9   co-occurring come from a background where they weren't

10   given a real stable outline living skills.       We're talking

11   shopping.    We're talking budgets.   We're talking, how do

12   you do your laundry and organize it, and how do I get my

13   kids on time in the morning.    I was given that, therefore,

14   how do I transmit that into my children.       So it's kind of a

15   generation thing, at least that's what I see.

16               So I would like to see transformed would be more

17   the sites combined so that a person doesn't have to run

18   around and go how do I get this taken care of, how do I get

19   that, how do I get me electric bill, you know.       There's the

20   basic Salvation Army, the Mission.    There's a few numbers

21   in the phone book.    Other than that, there's so many other

22   program.    You know, the Parent/Child Advocate Program is

23   really good for recovering addicts.    Out of my four kids, I

24   have one that is a sobriety baby, and she has the structure

25   and the life that I wish I could have done for all my
                                                                      29




 1   children, but at least I did that with one of them.

 2                So my story for me, is that there are programs

 3   out there, if they could just combine them to meet our

 4   needs because not everyone is well informed to seek out

 5   those things.     I often get a lot of people going, well, how

 6   come you got that service?      How did you do it?   It really

 7   was, it was hard.     I had to make a lot of calls and seek

 8   things out.     I had to do a lot of humbling things to get my

 9   Family Preservation for childcare.      I had to go and turn

10   myself in and do a self report for having abused my first

11   two when I had been drinking.      I had to go in there any

12   say, okay, if this is how I have to do it to get the help I

13   need, I'll sit here and bare my sole.      And that's okay.

14   That was part of my story to get to where I'm at today.

15                I think the agencies can do it.   There's programs

16   out there.     They just need to combine them and let them

17   know.   I mean I had an attorney that said, Vicki, you know

18   three DWI's in five months, you people don't do those

19   things anymore unless there's something going on.      And he

20   had no idea where to send me.      He didn't want to see me

21   locked up.     He knew I had issues going on, but he had no

22   idea where to go.     So I would like to see some type of

23   catalog put together or something for these services.

24                MICHAEL SCHWAB:   My name is Michael Schwab, and I

25   am a Superior Court Judge here in Yakima.      I just happened
                                                                   30




 1   to be able to come today because some cases I was working

 2   on finished up.    I don't know whether I can come back on

 3   Monday, which is a subcommittee that I'm interested in.

 4               We see a wide variety of people coming into the

 5   system, all different kinds of cases, not just criminal

 6   cases, but all who have mental health issues.     And as this

 7   lady just said, the court system doesn't understand a lot

 8   of these matters and really needs to learn.     So that would

 9   be an important improvement would be somehow providing

10   awareness, not just for judges, but for lawyers, court

11   staff, about mental health issues.    We have a large number

12   of people who are locked up, juveniles and adults, with

13   serious mental health issues and the don't belong there.

14   We would love to have the opportunity to release them if we

15   could, but we're being told constantly that there are no

16   places for people with some of the issues.    I'm talking

17   about the need in the juvenile system to have specialized

18   group homes.    Many of those children cannot be returned to

19   their families because either the families are unable to

20   take care of them properly or unwilling to do so or there

21   aren't any families.    Many of the children we see are

22   homeless.

23               In the adult setting, likewise there are a lot of

24   people who are homeless or don't have families who can care

25   for them, but they come into the system for some behavior
                                                                   31




 1   issue out in the community.     As I say, we would really like

 2   the opportunity to release these people to some kind of

 3   better environment where they can be worked with and

 4   assisted, but we don't have that.     So I would see it as an

 5   improvement to have more of those opportunities.

 6                Domestic relation situations, we have lots of

 7   families where domestic violence is an important issue.

 8   Families are being torn apart.     And you pile on top of that

 9   a serious methamphetamine problem that we're having now,

10   it's not just Yakima, it's everywhere.     So we have these

11   cases where parents are fighting about children, children

12   are being raised by grandparents, great grandparents, aunts

13   and uncles.     And the parents want to be able to reunite

14   with their children, but it's not safe because of mental

15   health issues.

16                But we're not being able, nobody is presenting us

17   any options for services, or we're being told that there

18   aren't any services, or people can't afford to get the

19   services.     We want to be able to direct people in a way

20   that they can get services and then come back to court and

21   be able to have appropriate relationships, but we're not

22   competent in the courts to be able to diagnose those things

23   and know all the resources that are available.

24                So I guess I can come back to what I said in the

25   beginning.     The courts need to be educated and aware and
                                                                    32




 1   better able to help people who come into the system with

 2   mental health issues.    Thank you.

 3             BJ COOPER:    When you say in terms--when they come

 4   into the system with a behavioral problem are there certain

 5   types of behavior problems that would still be criminal

 6   versus needing only mental health care?

 7             I know, I'm not being very clear.     If it's a

 8   sexual offender, would a person, a sex offender be treated

 9   the same as a person who has committed domestic violence,

10   or you know, a person maybe that is speeding that is

11   bipolar and not taking medication?     So things like that.

12   Or you would need to be educated about that?

13             MICHAEL SCHWAB:     First we have to have somebody

14   who is a professional tell us what kind of condition the

15   person has.   Otherwise, we dealing with the police saying

16   this man stole something, this man hit somebody, this man

17   abused somebody.   You know, something like that which is

18   just the bare bones of what we get.

19             BJ COOPER:    So it's the act of what they did that

20   brings them and not what got them there?

21             MICHAEL SCHWAB:     Typically what will happen is:

22   A person will be locked up.     They'll come before the Court.

23   We may start to observe some signs that something is wrong.

24   But what usually happens is the lawyer who is appointed

25   will bring to the Court's attention, they can't talk to the
                                                                     33




 1   individual, or the individual is disoriented, or the

 2   individual is--there's some indication that there's a

 3   mental health issue that needs to be addressed.        So it will

 4   be brought to our attention that way.

 5               JILL SAN JULE:    So you guys have no like

 6   rebooking diversion program?      No one coming in and making

 7   an assessment on individuals?

 8               MICHAEL SCHWAB:    Unless there are some real overt

 9   signs that something is wrong, mental health professionals

10   do come in.    But, even then, the system has to continue the

11   accountability.    We just can't turn somebody loose.      We

12   have to figure out what's going on, what sorts of behavior,

13   what sort of history there is, and what sort of potential

14   there is for the future.      Whether the individual is safe to

15   be at large.

16               As I say, we would love to be able to release a

17   lot of people in that condition if there was some mechanism

18   that could take them in and monitor things and report to us

19   if there are any problems.      Being in the jail is really,

20   it's a negative.

21               JILL SAN JULE:    Do you know, are these

22   individuals who are not hooked up with any types of

23   services.     They're not--

24               MICHAEL SCHWAB:    Lots of times they are.

25               JILL SAN JULE:    They are.
                                                                    34




 1             MICHAEL SCHWAB:     But either they've stopped

 2   medicating, or they have some kind of overwhelming other

 3   things in their lives.     Often times they're families are

 4   taking care of them and the families fall apart so that

 5   system breaks down.     It's just the widest variety of

 6   combinations.   But whatever it is, you know that the judges

 7   and the lawyers, we're not trained, just like this lady was

 8   saying over here.     This lady was giving you some really

 9   good information.     As I was listening to her, it just

10   reminded me of numerous cases that I've had.

11             What's working well?     I don't mean to diminish

12   the wide variety of very good services that are out there,

13   service providers and different programs.     There are many,

14   and they do a great job.     But the ability of the courts to

15   partner with those services and to understand how we can

16   match people up correctly, there's still a gap there that

17   should be bridged.

18             JILL SAN JULE:     There's access, actually.

19             MICHAEL SCHWAB:     Access is a very big question.

20   But there are some wonderful providers, all kinds of

21   providers, although I have to say, and I have some

22   colleagues here from the juvenile division.     When I worked

23   in the juvenile court, I was always looking for a place to

24   send a youngster, a specialized group home.     Sometimes I'd

25   be told, well, we have a place like that in Idaho or in
                                                                          35




 1   Oregon.     And we have a contract with Oregon and so we can

 2   send them.     Why don't we have one in Washington?       What's

 3   wrong with Washington that we don't have a place?            We have

 4   to send a kid to Idaho.       That made no sense to me.

 5                Thank you.

 6                B.J. COOPER:    Thank you.

 7                BARB NOAKES:    Well, what is working well in the

 8   mental health services in Washington State for me is that I

 9   come from Wenatchee and so there are so few psychiatrists.

10   Because before I was in Seattle, so you come over to

11   Wenatchee, and I don't know how many psychiatrists they

12   have, probably two.       So I see a nurse practitioner.       For

13   counseling, I go to the Wenatchee Behavioral Health and

14   that has worked really well.

15                What has worked the best for me in Wenachee that

16   I have been participating in is, we have a clubhouse and

17   it's called the Promise Club.       I go in there.    First it

18   was, I was invited down to the Promise Club.         I was

19   contemplating committing suicide.         I mean I had--my husband

20   was a state engineer.       I had the Cadillac of mental health

21   care.     I had been up in Chelan for three weeks at their

22   trauma unit for battered women.       I come out and there's no

23   connection because when you try to make a follow-up

24   appointment, the doctors say, well you need to follow up.

25   Well, my insurance didn't cover the Chelan doctors because
                                                                    36




 1   it was out of the area.     So then you try to get plugged

 2   into Weather, and they say, well, we'll have an appointment

 3   for you in 45 days.     So you go through that.

 4             I came to the Promise Club, and I started

 5   participating in there.     First, I felt pretty safe with

 6   helping Marina do research and everything about the

 7   clubhouses and everything.     But I was still, because I had

 8   been a teacher and also a teacher with Headstart, but I

 9   just felt because of my marriage of 38 years had ended.        I

10   had grown children who were telling me, whatever you say,

11   it doesn't make sense.     So I just totally stopped talking

12   pretty much.    So research fit me pretty well and

13   everything.    Then a surprising thing happened.     When I

14   started everyday going into the Promise Club, and it's

15   voluntary and stuff, I started feeling better about myself.

16   It was like deciding, well, some of these things maybe

17   people that have observed me, and maybe this husband that I

18   have that I dumped, you know.     He really didn't know what

19   he was talking about.     So I have, through the Promise Club,

20   have had less use, I mean I still go to the nurse

21   practitioner, and usually they were going to schedule me

22   once every six months, and I go as needed to the mental

23   health counselor.     From being at the Promise Club, or the

24   Clubhouse, it has made me so that feel so good and

25   everything that I want to get up in the morning.       I have a
                                                                     37




 1   computer at home.     When I want to go to the Clubhouse to do

 2   my research because, I do public speaking and everything

 3   with another group, but it's just the atmosphere in there.

 4   Because everybody is there for you to succeed, and you feel

 5   so good.     And you make friends, I mean real friends.     Like,

 6   I was involved in a church in town, in Wenachee.       I had

 7   done daily vacation bible school in the summer, and I had

 8   gotten a tutor position out of that.      One of the people I

 9   was supposed to mentor, I was supposed to mentor two adult

10   women as teachers.     And one of the woman said, well, you

11   know, people that have mental illness, she had two members

12   in her family, she said, you know, they're just not trying

13   hard enough.     And they're not spiritual enough.    And she

14   said, you know, it doesn't say anything in the Bible.        This

15   is like a month ago.     And she says, I don't see anything in

16   the Bible about schizophrenia or depression or any of

17   these.     People are just possessed.   I said, do you know who

18   you're talking to?     I said I have a mental health illness.

19   I have post-traumatic stress syndrome, you know, from the

20   way I was brought up.     And then being in the juvenile

21   justice for protection and everything and being in the

22   system.     And I said you are just a bigot, and it's not

23   right the way you're saying.     I left the church.   I told

24   them flat out, I said if a woman like that is going to

25   teach young people, I am not going to be a part of your
                                                                     38




 1   church.

 2               So, I think in this State of Washington, I think

 3   throughout the United States, that we have a mental health

 4   system first of all that is in our communities, but it's

 5   marginal.    It's not working real well.    And you either have

 6   to be really poor, you have to be on Medicaid, or you have

 7   to be really rich to be able to afford the services.

 8               So I'm going to go right into what's not working

 9   because there's a lot that's not working.      In the 1950's,

10   the State of Washington got this idea, I think down in

11   Olympia, and everything.    I don't think anybody knew

12   anything about mental health down there, but they got this

13   idea that they wanted to de-institutionalize people and

14   send them back to the community.    Well that sounds good,

15   but you know, they just didn't have any plan to do that.

16   They started closing down Medical Lake or Eastern State.

17   Now they have like 217 beds or something, and 110 go for

18   the population of from 20 to the age of 49.      And then

19   there's so many beds for psychiatric.      And then there are

20   the forensic, you know, for the mentally insane which

21   they're trying to figure out and everything.      And then in

22   the communities, I worked at General Hospital as a

23   financial person in Everett.    We had a beautiful

24   state-of-the-art physic unit in Everett.      And they spent

25   millions on it and whatnot.    And because the reimbursement
                                                                    39




 1   rate was so low for DSHS and everything, that they closed

 2   the unit and they made it into a storage unit.     The same

 3   thing happened in Wenachee.     So what happens is, I wrote an

 4   article for General Hospital, because we were going to be

 5   having--we wanted to have an open heart surgery, and DSHS

 6   goes, oh, no, you can't do that because we have those

 7   services in Seattle.     Well, the article that I wrote for

 8   the paper, I said, why should people from Snohomish County

 9   have to go to King County to get services?     So why in the

10   world would mental health close down your community

11   hospitals, send people across the state, usually your poor,

12   people do work, their family members work.     There's not

13   support system.     So you send them, if there's a bed at

14   Medical Lake because I doubt that, and everything.     So

15   you're sending them away from their community, sending them

16   away from their providers, sending them away from their

17   families; it does not work.

18                So what is happening in our state and across the

19   United States is that we have closed down the big mental

20   health hospitals because we didn't want people to be

21   treated badly.     And then we closed down the community

22   hospitals.     So what has happened is that the criminal

23   justice system has taken on the burden of being a mental

24   health provider.     But in Wenachee, because I just spoke to

25   criminal justice there on Friday, and we met, and they want
                                                                     40




 1   us to come back and speak to the juvenile justice part and

 2   also to the jailers.     Because 70 percent of the people that

 3   are incarcerated in Wenachee or in the United States are

 4   incarcerated for non-violent offenses.     And a lot of them,

 5   16 percent, have mental health issues.     Either they're not

 6   on their meds or there isn't enough treatment provided.

 7   And then the incarceration rate for women is even higher

 8   with women that have mental illness.

 9                And in the wintertime, it makes perfect sense.

10   Like today, we came over in a snow storm.     So if I was

11   poor, and I couldn't get my meds, and I can't get into a

12   psychiatrist, well, why not just break the law and get

13   arrested.     But even when you get arrested, and aren't

14   currently connected with a mental health person in Wenachee

15   or any other town in this State, they can't give you

16   medications because they don't know what disease or

17   disorder you have.     Okay, so let's say that I was having a

18   post-traumatic panic attack, full-blown disorder.      So they

19   arrest me.     I go in, and I don't have my medications with

20   me.   I can't remember my doctor's name or whatever.       So

21   they start talking to me and I become defiant or something.

22   I start talking back to them.     So in Wenachee, what happens

23   to you is that put you in solitary confinement, right off.

24   And then if I get really lippy, or you know I spit at one

25   of the jailers or something, they put you in this specially
                                                                     41




 1   designed chair and keep you locked in place for four hours.

 2   So people go through all of this trauma.     Talk about

 3   inhumane treatment.     That is inhumane treatment.   You can't

 4   go to the bathroom.     You are not released and some stuff

 5   like this.     A lot of the jail people, because I talk with

 6   the probation officers, and they said one of the big things

 7   they're concerned about in Wenachee is a lot of the jailers

 8   that work for the system are there and they don't really

 9   understand, you know, a lot of the mental health issues.

10   They need more education, which is true.     And also, these

11   jailers need to be held accountable because we don't lock

12   people up in a chair, or we don't put them in solitary

13   confinement.     That's only going to make the condition worse

14   and everything like that.

15                So a transformed system would--first of all, it

16   would have a plan.     In this whole state, that the justice

17   system is connected right with the mental health system.

18   And then, people lose their benefits when they go into the

19   criminal justice.     Like if they're longer than 30 days,

20   they lose their medical coupons or if they're on social

21   security, they lose that part and stuff.     So people--they

22   need somebody like me at the jail that can say, okay, Mark,

23   you're going to be getting out on a certain day.      We have

24   this set up for you.     We are going to streamline you right

25   into mental health services.     We have a psych doctor coming
                                                                    42




 1   into the jail, giving you medication you're already on and

 2   everything.    Then to have a person there that's

 3   knowledgable on how to connect with DSHS, and how to

 4   connect with Medicare so that they have some support.     And

 5   then they need housing so that they're not just out of the

 6   building, going around the block, and this happens,

 7   breaking the law so that they can get back into a safe

 8   place.   It's costing a lot of money, and it's not working.

 9   And then when you get into the criminal justice system--

10               BILL WATERS:   Can I ask you a question about what

11   you said just a minute ago?

12               BARB NOAKES:   Sure:

13               BILL WATERS:   So when you said a person like you

14   would be available to somebody just being released, you

15   mean a person who has had a mental illness or setback?

16               BARB NOAKES:   It would be a lot more helpful than

17   what we have right now, which is nothing.

18               BILL WATERS:   So there would be some peer

19   support--

20               BARB NOAKES:   Well, peer support or somebody that

21   is good with handling the system because the people that

22   are in the system aren't good at it.     So somebody that--

23               BILL WATERS:   The professionals in the system

24   don't seem good at facilitating--

25               BARB NOAKES:   No, I mean they're not connected.
                                                                       43




 1   It's like you've got mental health over here; you've got

 2   the criminal just over here and somehow they don't have a

 3   bridge.   You know, it's broken or it's up for the train to

 4   come though.     I don't know.   It just isn't working.

 5                So to have a transformed system, what it would

 6   look like.     First of all, on the State level there would be

 7   a plan.   You just can't say, well, we're going to revamp

 8   the mental health system.     And you need us consumers that

 9   really advocate for it.     We know what works.   We're

10   educated in diseases because we have the diseases.        There

11   needs to be a lot of education in the community.      I'm tired

12   of people have this red-necked-biased-attitude that people

13   who are mentally ill should be locked up and the keys

14   thrown away and all of this and stuff like that.

15                Because a lot of us, I graduated from college in

16   the top 10 percent in the United States.     So we're not all

17   dysfunctional and stuff.     But there's so much stigma in

18   trying to get a job in Wenachee.     You know, we go out and

19   give these wonderful presentations.     Nobody wants to hire

20   you because you're mentally ill.

21                The other part that wasn't working, if you're

22   incarcerated in the criminal justice, you have another

23   stigma of a criminal record so that goes against you for

24   housing, that goes against you because you can't get

25   federal grants for education.     So that needs to be changed.
                                                                       44




 1                So the transformed system, it has to come with

 2   education.     There has to be an incentive in the community

 3   for employers to hire people who are mentally ill.        There

 4   should also be housing.     Do you know what number I am on

 5   Section 8?     I am number 3,324.   When I left the hospital, I

 6   was homeless because my husband, who works for the State,

 7   took all the money out of the bank, savings, checking,

 8   everything.     So I had to go and live in the domestic

 9   violence shelter and go myself to the Salvation Army and

10   different places to try to get funding, you know, to get an

11   apartment and everything like that.      It was really hard

12   because I had no food, I had no clothes, I had no shelter.

13   I had nothing.

14                So it makes it really difficult, and it isn't

15   fair that we have to be traumatized more and everything

16   because your system isn't working.      We can't wait five

17   years.   It makes it really hard right now with the new

18   Medicare B Plan.     I spent a whole week researching all of

19   the 49 plans and pulling down all the screens and finding

20   out everything before I signed up for one.      Then I went to

21   Costco, and I got charged double.      I called the place that

22   I'm getting my prescriptions from, and they said they made

23   a mistake.     But see, they didn't give them the correct

24   information at Costco.     So I had to follow up.   I'm always

25   following up.
                                                                      45




 1               I've been going through a divorce for two years,

 2   and I knew more about everything than my attorney that I

 3   paid $12,000.     He didn't want to listen to me because I

 4   have a mental illness.     So I was writing Judge Bridges, in

 5   Wenachee, letters saying we need to do this, we need to do

 6   that.    And finally, that what they did.     And I finally got

 7   my divorce.                       But it's like, you want to be

 8   traumatized.     I went into the juvenile system when I was 10

 9   years old for protective custody in Wenachee.       I was locked

10   up there for two weeks with the rest of the kids, the girls

11   that were a lot older than I was, and they were in there

12   for prostitution, for stealing, everything and anything.

13   And I was right in there with them and at night, I was

14   locked up in my own cell.     My biggest fear was that my dad

15   would come up the back stairs and kill me.       No one talked

16   to me.    I didn't see any mental health professional.     My

17   brother had murdered by grandmother that day.       Blood was up

18   the wall.     My dad was getting ready to go to the parade.

19   He got arrested when they got back.       And then I was taken

20   out to Waterville and made a ward of the Court.       Was there

21   any counselors or caseworkers?      No.   They just sent me off

22   to a foster home.

23               DIANA JADEN-CATORI:    So would you say that part

24   of transforming the mental health system even as a family

25   member, for you would be identifying needs immediately as
                                                                    46




 1   far as trauma and those types of things?

 2             BARB NOAKES:    Yeah.    I don't understand where you

 3   guys are coming from because as a Headstart teacher, I was

 4   required--

 5             BJ COOPER:     I just wanted to interject something.

 6   I think you came in a little later after we did our

 7   introductions.

 8             We are volunteers involved in the Mental Health

 9   Transformation Grant.    We're volunteers from around the

10   State, other people are administrators, different things,

11   but the biggest percent of us are consumers of mental

12   health care services.    So, we're a part of this process.

13   We are your peers and as well as the people who would treat

14   you, or medicate you, or whatever.      I just wanted you to

15   know that we are volunteers.      We don't work for DSHS, but I

16   was going to say "you people," we're also peers, and I'm

17   not sure if you understand that.

18             BARB NOAKES:    Headstart is a federal program for

19   low income.   And as a teacher for Headstart, I was required

20   within the first 30 days to test and refer children out if

21   they needed mental health services, if they needed speech

22   therapy, whatever they needed.      I don't know--there doesn't

23   seem to be any accountably, like with the justice or mental

24   health, there's just so little of it to access that there

25   needs to be more.   There needs to be like an inpatient
                                                                       47




 1   facility in these small towns like Wenachee, which we can

 2   support.   They had it.     They closed it because there wasn't

 3   enough reimbursement.      When people go to jail--

 4              JILL SAN JULE:     We're going to ask you to wrap

 5   things up here.   We want to get everyone a chance here.

 6              BJ COOPER:     And you can put a lot of this in

 7   writing too.

 8              BARB NOAKES:     It's like when people go to jail

 9   they need to be assessed first off.        You need to have

10   professionals doing that.      And so that the people are not

11   traumatized more, that they get the medication they need.

12   Why should they have to wait until they're discharged from

13   jail?   And they need to be set up with mental health

14   counselors and have services in place so that they don't

15   reoffend and to help these people that need the most help.

16              (Whereupon a recess taken.)

17              DIANE ESCHENBACHER:     Okay.    We have some people

18   here whose time is limited.      We'll start with Frank

19   Swanson.

20              FRANK SWANSON:     Hello, my name is Frank Swanson.

21   I'm the father of an adult son who suffers from mental

22   illness and who resides in Tacoma at the present time.         But

23   I also wear a lot of other hats.      My wife Betty and I, who

24   is right up there, have been advocates for many, many years

25   in several states, in the State of Oregon and the State of
                                                                      48




 1   Washington.     I have served as an officer in NAMI

 2   Washington, I have served as director of the Family Program

 3   in this state, I have taught family to family courses to

 4   many, to some of the folks in the room here.       I have served

 5   on several mental health boards, advisory boards, and I am

 6   presently serving as an advocate on the Quality Management

 7   Oversight Committee for Great Columbia Behavioral Health.

 8   I wanted to simply come and testify to you as a friend of

 9   consumers and as a friend of family members of consumers

10   today, not as anyone of those other people, although I

11   still am a member of NAMI and I serve in a different

12   capacity.

13                What is working well with regard to mental health

14   services in Washington State?        I'll talk about a couple of

15   things.     There are many things.    Financing is not working

16   Well for mental health in Washington State.       The National

17   Association of Mental Health Directors Research

18   Organization has some very interesting statistics on the

19   relative nature of the financing of mental health in the

20   United States.     In Washington, in a per capita basis, more

21   than--for the 2001 figures that they have developed is 18th

22   in rank out of 56.     Well, that sounds pretty good, doesn't

23   it?   Except for some of the other figures.      Washington is

24   high in the cost of its hospitalization.       It is low in the

25   amount of state-only funds.     In fact, it's 49th of 50 in
                                                                       49




 1   state-only funds, other than matching funds for Medicaid,

 2   that is spends on mental health.        So if the State wants

 3   better programs, it better pony up in state-only funds.

 4   And that relates to much of what is said by many of folks

 5   here already testifying about the stigma of mental health

 6   in this state.

 7                What then does not work well with regard to

 8   mental health services?        I'll just mention a few things.

 9   Care for people who are approaching or in crisis does not

10   work well.     Why?     Well, it isn't funded because that takes

11   state-only funds.        You've heard the stories of the people

12   in the room.     My son, after a seven-year stent of recovery,

13   had a crisis.     He missed work at his mental health center

14   for two weeks.        Finally to get him involuntarily committed

15   because he was so psychotic at the time, that when they

16   finally got to him, he had to be involuntarily committed,

17   he couldn't take care of himself.        Okay.   So here he was, a

18   person in the system close to professionals, let him go for

19   two weeks.     What's not working?     We don't have

20   accountability.        You have to be accountable for individual

21   people.   This cannot say if you are supervising this

22   program, if you're going to have it work, oh, that's not my

23   program, that's not my jurisdiction.        It's not in the

24   system and we fund, pay for it.        That's not working and

25   it's costing us bundles.        It's part of the reason why we
                                                                    50




 1   have this high cost of hospitalization, not the only one,

 2   but it's part of it.

 3               What would a transformed system look like?      Well,

 4   a transformed system would look like one that is consumer

 5   controlled.    It's one that would bring consumers who begin

 6   to show symptoms into counsel people that are having

 7   degrading health, and help them find the appropriate

 8   service.    It means consumers being involved in various

 9   kinds of telephone systems so that they are educated so

10   that they know what's it like and that they counsel people

11   to get to the right resources and they know where they are.

12   But in many cases, there is no resources.     Many cases there

13   is no resources for it because we haven't spent enough for

14   it.    We know that.   Finding the right location for the

15   person is critical, as it was in my son's case.     He came

16   out of the community hospital there in Tacoma which is now,

17   by the way, not in business anymore.     He came out of that

18   after two weeks in there and went to a crisis respite

19   center.    Oh, but they were too busy there to keep him very

20   long, probably long enough.     So where did he end up?     In a

21   group home.    Is that the right place for his recovery?      No.

22   Why?    Because there's everybody under the sun in the group

23   home, people with mental illness, people without mental

24   illness, there's no care, there's no consumer support going

25   on there to any great degree.     He gets the basics, but will
                                                                       51




 1   that engender recovery?     No.   I think recovery, and some of

 2   my consumer friends tell me this, I am not a

 3   consumer--actually, I'm a consumer because I have

 4   generalized anxiety disorder, I think largely because I'm a

 5   parent of a consumer.     So I take my pills too.   But I do

 6   believe my son would progress better as my wife has been

 7   talking, with more supports, more consumer supports, more

 8   help along that way.     In fact, he probably would not have

 9   had the crisis had he had those supports beforehand, and he

10   will not have them again if he had it afterward.

11              So finding a way to organize consumer supports is

12   critical to any solution.     A transformed system would look

13   towards clubhouses and other types of organizations,

14   consumer-run organizations, to make that work.

15              Now, what outcomes would indicate that the

16   changes were creating results?      I'll go into that for a

17   minute.   There are a number of widely accepted,

18   professionally accepted outcomes for recovery.      In many

19   states, not Washington State, because Washington was one of

20   the last to even consider it, making recovery an objective.

21   They just did that.     By the way, I serve on the Mental

22   Health Advisory Board for DSHS that recommended that

23   several years ago, but it took them over two years to put

24   that into the objective for the mental health division.           So

25   again, I second the motion that many have made here.        You
                                                                       52




 1   don't have five years.        You do not have five years to make

 2   this work.     One of the outcomes that you must look for is

 3   hands-on management at the mental health division level.

 4   You've got to have hands-on.        These people have got to know

 5   what's happening.     They don't need another commission,

 6   another support group,        another work group.   They need a

 7   director that knows what in heaven's name they're doing.

 8                BJ cooper:   Recovery, since this is the big

 9   question, when you're a consumer, you know what recovery

10   means.    What does recovery mean?

11                FRANK SWANSON:     I'll take the definition of the

12   law.

13                BJ COOPER:   Which is?

14                FRANK SWANSON:     The definition of Washington

15   State law?

16                BJ COOPER:   Uh-hmm.

17                FRANK SWANSON:     Well, I can't quote it to you,

18   I'm sorry to say.     But it's the notion that recovery is a

19   state of the consumer in which the consumer directs their

20   life.    After they have recognized they have the illness,

21   that's step one, after they've sought care, after they've

22   moved outward so that they realize that contact with other

23   human beings is very necessary for their healthful

24   continuance, and then after they've realized that, they

25   have to be interdependent.        They have to relate to other
                                                                      53




 1   people.    Those are the four steps, four phases of recovery

 2   that are used in the State of Ohio, which incidentally is

 3   one of the leaders.      It has a very excellent system in my

 4   opinion.

 5               BJ COOPER:    So that's what you go with?

 6               FRANK SWANSON:    Yes.

 7               BJ COOPER:    That makes sense to you?

 8               FRANK SWANSON:    Yes.

 9               JILL SAN JULE:    I want to clarify one thing

10   because I've heard several people reference the five years

11   that I spoke about.      The grant is for five years.     This

12   plan is technically going to the Governor in June and it's

13   supposed to become implemented over these next five years.

14               FRANK SWANSON:    I understand that.     I think

15   that's a good thing to discuss because I think people want

16   it now.

17               JILL SAN JULE:    Oh, I want it now.

18               FRANK SWANSON:    No question of it, right?

19               JILL SAN JULE:    And I can guarantee you that I

20   have an extremely loud voice.        I'm not sure they know what

21   they've got yet in me for hiring me, but I want it

22   yesterday too.    You can be assured that that is going to be

23   vocalized to them, probably every day.

24               FRANK SWANSON:    That would be great.     I hope you

25   don't have to wait like I did, to have that recovery issue
                                                                        54




 1   become a departmental objective for two years.     I think

 2   people then realized what recovery was in general.      It's

 3   now been codified, put into law, so we have a marching

 4   order and I expect that people will have some irritation

 5   about certain aspects of that.    But if we could just use

 6   that one, we could go a long distance.

 7              JILL SAN JULE:   And I do think there's hope.       I

 8   recently came back to Washington.     I spent the last ten

 9   years doing this exact same thing in Arizona.

10              We were about where you guys are now, ten years

11   ago.   They way the system looks now, the number of

12   consumers employed within the State, the number of

13   consumer-run organizations, the number of family

14   organizations, it's incredible.     I think, I know it's going

15   to happen her.

16              FRANK SWANSON:   So the outcomes would mean that

17   you would have to measure employed consumers, right?

18   Otherwise employed or serving in voluntary positrons

19   because that's often the step up that was with our son.

20   Got a voluntary job, got a permanent job.     So that

21   transition has to be measured.

22              BJ COOPER:   I think--well,I guess I'm not

23   supposed to give you my opinion here.     I was just going to

24   say though, is recovery for someone with a mental illness

25   that may never have been successful at anything their
                                                                          55




 1   entire existence, or could be, and I say that for myself

 2   sometimes, it's like for me recovery is opening my door and

 3   stepping out.

 4                FRANK SWANSON:     Yes.

 5                BJ COOPER:     And I think along with recovery,

 6   there are many of us being sure that our voice is here

 7   about that, that recovery is individual.          It just doesn't

 8   mean that you're employed.

 9                FRANK SWANSON:     I should assure you too, that

10   people at Greater Columbia Behavioral Health are thinking

11   of that right now.        I serve on a committee that's working

12   on outcome measures for consumers.

13                One of the reasons I emphasize aggressive

14   hands-on measurement, because in every RSN, as you all

15   know, some measure, some don't, some don't use a good

16   instrument, some don't.        There's no way to merge this

17   information.     So the State have to have acted on it.          It's

18   beginning to try to catch up.          By the way, I served on

19   Performance Indicators Work Early for several years.             I

20   know what those performance indicators are.

21                That's all I really have to say was those points.

22   Thank you.

23                BECKY O'GRADY:     I have one thing, I just don't

24   want to forget it.        If I may?

25                JILL SAN JULE:     Yes.
                                                                        56




 1                BECKY O'GRADY:     Something needs to be done so

 2   that small town hospitals have the same information and

 3   training, ability to treat people in crisis as other

 4   people.     When I was very sick last summer, I called 911 and

 5   said that I need help.        The police officers came to my

 6   door, weren't quite sure what to do with me.        Took me to

 7   the ER of a very small town hospital.        Went into ER.     A

 8   nurse came in to do triage and watched me.        I was very

 9   manic.     I walked wildly around the hospital.     He walked

10   with me.     He said, I've never seen anybody like you.        I

11   don't know what to do.        In 20 years of nursing, I've never

12   seen anybody like this.        I don't know what to do.   After

13   quite a while with me running wild, he finally pumped a

14   whole lot of Ativan into me and sent me home, instead of

15   driving me 15 miles to the big city hospital here in Yakima

16   where they have a psych unit.        It took me two days later

17   before I finally got admitted and I was much sicker.           Small

18   town hospitals need to have the know-how and the ability to

19   access services.     I shouldn't have had to wait that long.

20   And the nurse shouldn't have had to be treating somebody

21   who he didn't have any idea how to treat.

22                DIANE ESCHENBACHER:     Next, Freida Morford.

23                FREIDA MORFORD:     Well, as like this gentleman,

24   I'm first a mother of a consumer that's unmedicated,

25   somewhat diagnosed.     Secondly, I'm a probation officer so I
                                                                         57




 1   work with a lot of consumer/clients that have mental issues

 2   and varies across the board.          I guess I'm here because I

 3   wanted to hear about some of these things and I also have

 4   some concerns.

 5                I just going to go down the list.       I agree with

 6   the medical coverage for mental health needs to be the same

 7   for mental health as the same for medical.          My son is on my

 8   insurance, but it's like it's just not enough.          If he had

 9   some other disease, he would be able to be covered.             Also,

10   on that same note, when two years ago he was not on my

11   insurance because we were changing policies and he was

12   working and kind of on his own.          When this incident first

13   occurred, I was trying to tell everybody, I will pay for

14   whatever it takes to help him.          Nobody would help me.

15   Nobody.   I work in the business.         I know the people at

16   mental health, and nobody would help him.          He's still

17   undiagnosed.     He's still depressed.       He threatens suicide.

18   Nobody will do anything.       It's the most traumatic thing a

19   mother can go through.

20                BILL WATERS:   Because he's not on Medicaid, is

21   that the issue?

22                FREIDA MORFORD:    No.     It's because won't accept

23   he has a problem.     He denies the problem.       So basically,

24   excuse me.     The thing that I want changed more than

25   anything is the immediate services for a parent to give to
                                                                         58




 1   their child.     Because James didn't tell me he was going to

 2   kill me, because he didn't tell me that he wasn't going to

 3   harm himself or others, and the he could take a shower by

 4   himself, they wouldn't take him in.       That should not be the

 5   only criteria.     If he were able to get in at that time when

 6   he first came home and was psychotic, I think he would

 7   recognize that there is a problem and get some sort of

 8   assistance.     He got none.

 9                BILL WATERS:   So you're trying to help him get

10   him assistance even though he is not recognizing he needs

11   help?

12                FREIDA MORFORD:   Right.   He needed to be

13   hospitalized.     We don't know what the problem is.      He did

14   go to a psychiatrist with me who sat there for 15 minutes,

15   20 minutes and the psychiatrist said he has bipolar.            I

16   said, how do you know that.      You've only seen him for 15

17   minutes.     Well, because you've talked about it.     Anyway, he

18   diagnosed him within 15 minutes as being bipolar.         Great.

19   Now what do we do?     And he says, James, what do you want to

20   do?     And James says, I don't have a problem.    You're the

21   problem.     And he walks out of the office.    And the doctor

22   says, I can't do anything.      I said, he is psychotic.        He's

23   been out there telling me--I'm not going to get into the

24   whole situation except that he was very psychotic.         He

25   thought people were after him, the government was talking
                                                                      59




 1   to him, Hollywood, people were talking to him on the TV.

 2   He could hear voices.    There were all these other things

 3   going on, and yet he would not be hospitalized.        They would

 4   not hospitalize him because I was stupid enough not to say,

 5   he said he would hurt me.     You know, that ridiculous.       And

 6   then if I did say that, there would not have been a mental

 7   health professional come out to take him in, it would have

 8   been the police.   He would have been arrested.       And as

 9   Judge Schwab was saying earlier, we have so many people in

10   our system right now that have mental health issues that

11   are not being addressed.     What they're being addressed

12   through is the criminal justice system.        We can only do so

13   much, and we do not have the ability to give

14   psychiatric--or assessment.     That's not our field of doing

15   that.

16             We are working really close with mental health.

17   I think we've come a long way from where we were.        I've

18   been in this business 15 years, 16 years now, and we've

19   come a long way working with the mental health system and

20   the criminal justice system in trying to get some system to

21   work together on that.     It's not perfect.

22             What would a transformed system be like?        Exactly

23   what somebody said, I can't remember who it was.        Somebody

24   said being assessed immediately.     It's just a 10 question

25   questionnaire, you know, have you ever thought about
                                                                     60




 1   suicide?    Have you ever had depression?     You know, those

 2   sorts of things.    Has anybody ever said to you, you need

 3   some mental health?     Those are just simple questions that

 4   could be asked in the jail setting.     The wrap-around

 5   services that we're talking about, rather than having the

 6   police come out to help somebody that going though an

 7   episode.    We don't need the police.   We need    professionals

 8   to come.

 9               My son now lives in California.     They have a

10   program in California right now that, if I were to call,

11   which I did, they didn't go out because the psychiatrist

12   actually called him because I--I'm working deals with my

13   son to get him to go.     They're able to out to home, three

14   or four individuals would go there in plain clothes,

15   they're mental health professionals and they would talk to

16   him.    If they felt there was a need, they would have him

17   institutionalized, or they would take him to the hospital,

18   or they would contact a doctor immediately.       They do follow

19   up.    They did do follow up with me the following day.       This

20   is something I didn't get here when my son was going

21   through that in Yakima, in Washington State.

22               Like I say, I work in the system, so it was very

23   difficult for me to accept this.     I told them--I thought

24   this was kind of ironic and funny--I did get my son to go

25   to Comprehensive Mental Health.     As we're going down there,
                                                                          61




 1   he said, mom, I know that there's one good person and one

 2   bad person.     The good person is Jeff, that's his older

 3   brother.     He said, I can't figure out who that bad person

 4   is, but I do know he has red shoes on.         And I'm like, has

 5   red shoes on.     I said, where does that come from?        He said,

 6   I don't know.     He just has red shoes.     We go into

 7   Comprehensive Mental Health, the person that is going to

 8   see him and does see him has red shoes.        I tell the

 9   counselor that.     I said he is not going to stay in here.

10   He's not going to say anything to you.        Sure enough, James

11   didn't say anything to him.     They guy came out and thought

12   I was crazy.     He said, I think you're making too much out

13   of this.     I said, no, I'm not.   I couldn't get out of the

14   car, because he said if I got out of the car, the

15   helicopter that just drove over us was somebody that was

16   watching us and the were going to shoot me, because I was

17   in danger and he would have to run.        And he would be a

18   runner now and have to run away from everybody and

19   everything because he's afraid that I would be hurt.           How

20   rational is that?

21                The medical coverage, the stigma.     Again, yes,

22   I've been in the field.     Yes, I've worked with a lot of

23   people.    You can I say I don't have that stigma, but you

24   do.   Everybody does because nobody wants to be crazy.          It's

25   not crazy.     It's like I told my son; it's a disease.        We
                                                                         62




 1   don't ask for these things.       My granddaughter has CF.     We

 2   didn't ask for her to have CF.       James, I didn't ask you to

 3   have bipolar.     It just happens.    We have to get rid of the

 4   stigma from mental health issues.       It has to be just as any

 5   disease is.

 6                JILL SAN JULE:    What do you see is the State's

 7   role in doing that?     What types of programs do you see?

 8                FREIDA MORFORD:    We have--I don't see a lot of

 9   advertising.     I don't see a lot of things out in the

10   community.     Mental health is a disease.    It's an issue that

11   starting to come up.     People are talking more about

12   depression on TV, but I think that's a federal think.

13                JILL SAN JULE:    Yeah, it is.

14                FREIDA MORFORD:    I think every state is doing

15   that.   But even locally, we have to get out there and say

16   it's okay, it's okay to take medication.       I have a friend

17   that has gone though his whole life unmedicated.       And just

18   the last few years, I had an anxiety attack.       I have no

19   idea why it happened.     They said it might be the post

20   traumatic stress disorder, I don't know.       But I went

21   through an anxiety attack, and this was prior to my son

22   going through his bipolar.       I couldn't leave the house.

23   This only lasted for a week and a half, two weeks, but it

24   was enough for me to know something was wrong.       So I went

25   to the doctor, and they gave me some medications and I went
                                                                         63




 1   through and I've never had another problem.        I took

 2   medication for eight months.        She said I could go off it; I

 3   said no, I feel safe on it.        So I continued for about a

 4   year and a half and I haven't had it in three years.          I've

 5   never had another problem like that.        So I don't know where

 6   that came from or what happened, but I know I never want to

 7   be there again.     So, with that said, I just think we need

 8   to let people now that these things happen.        The gentleman

 9   that I was talking about, the friend, once I started

10   sharing that with him and talking to him about his

11   problems, he started going to the doctor and got on

12   medication.     He has never had--he said, I didn't know life

13   could be like this.     And why?     Because of word mouth.

14   People caring for another person to let them know that

15   mental health is not something that has to be a bad thing.

16   You can still function.     You're still a great person.        You

17   still have a mind.     You can still do anything you want.

18   Mental health should not stop a person or allow another

19   person to discriminate against them because of it.

20                The chemical versus alcohol, when people come in

21   that are on my case load, granted, I've seen this so many

22   times, and actually my son is a dual diagnosis.         He drinks

23   because it helps him stay qualm.        But they will not help

24   him--and that's another thing.        He smokes pot.   That's what

25   caused it.     He's drinking, that's what causing this.       And
                                                                       64




 1   I'm like, it may be but lets's find out if it is.        Let's

 2   get him to some help so we can figure out what's going on.

 3   I have clients and that's the same thing.     They are

 4   definitely--have been previously diagnosed schizophrenic or

 5   bipolar or depression or different things.        They cannot get

 6   the same assistant--they can't get on their medications.

 7   They can't get into the system through mental health until

 8   they have been clean for 60 to 90 days.     In 60 to 90 days,

 9   that person's mental health is going to deteriorate even

10   more.   They need help immediately.    You have to do it as a

11   dual--if it's a dual diagnosis do a dual.     You can work

12   these things together.     I know that drugs are not

13   effective the same way when somebody is drinking and they

14   can actually cause harm, but if you are monitoring an

15   individual, it can be done.     They need both.     Combine the

16   programs.    There a lot of programs out there.      Some of them

17   need to be combined.     Somebody was saying earlier, there's

18   a lot of fingers in the pie.     I think the pie is split too

19   many ways.    It needs to come together.   They need to have a

20   program that is accessible, not to have to be searched for.

21                Again, the mental health issues for criminals

22   that are in the system.     We need to be able to work

23   something like maybe deferring, having deferred sentencing

24   like that for someone that has a mental health issue and

25   does a crime.    What we could do is possibly defer
                                                                     65




 1   sentencing then if they comply with these conditions which

 2   would be to get assessed from mental health services.      We

 3   need to be able to have a Court order in misdemeanor areas,

 4   not just Superior Court.

 5             In Superior Court--I should back up.     A Superior

 6   Court order will allow conference with mental health to do

 7   an evaluation or an assessment on an individual.

 8   Comprehensive Mental Health will not do an assessment or an

 9   evaluation on a person if it's Court ordered on our

10   misdemeanor cases.   So, I've learned how to work around

11   that, but a lot of people don't know how to do that.     So

12   they just say, we can't do it because it's a Court order.

13   They don't follow Court orders.   I think they need to.       And

14   I think we need to have a deferred sentencing so that if

15   they follow through with the mental health, if they're

16   getting the assistance they need through mental health,

17   they're not becoming engrained within the system.     I would

18   say I have a very high percentage of returning clients

19   that, the only reason they're returning is that they've

20   gotten off their meds, they've done something that the

21   behavior has caused them to come back into the system.        Had

22   they been on their meds, had they been following through,

23   they would not be back in the system.

24             BJ COOPER:   Are you familiar with the system in

25   King County through the courts?   That's the thing.    Around
                                                                     66




 1   the state, there's a lot of different things going on.

 2   They're pilot project so to speak.      In King County, they do

 3   have mental health court system.

 4               FREIDA MORFORD:   I'm sorry, yes, I do.

 5               BJ COOPER:   And then in the western part of the

 6   state, they have a Medicaid integration project where the

 7   person gets all the variety of services as needed, they get

 8   access to all those services when they're first treated.

 9   And people who are already getting mental health services

10   can opt to be in the program.     It's also a pilot program.

11   There's a lot of things being tried around the state.         You

12   can go on to the Washington State website.      I think it's

13   like through Access Washington.     They have some different

14   programs.    If you have some ideas--

15               FREIDA MORFORD:   I am familiar with the mental

16   health court.    We have a drug court here.    I know that they

17   start pilot projects and not they're popping up all over.

18               BJ COOPER:   This isn't just for drugs.

19               FREIDA MORFORD:   They've also started a domestic

20   violence and a family court.     They're starting to

21   individualize each of those things, which is fine.      But

22   now, you're going to get so spread out.       I know this is all

23   going to come together at some point.      I'm just saying any

24   case, anywhere, it doesn't matter if it's mental health or

25   whatever, you could still do those things.      If somebody has
                                                                        67




 1   an issue with mental health, a parent or somebody comes in

 2   and says my child has mental health issues, or the cops

 3   says the defendant was acting--

 4                BJ COOPER:    Delusional or something?

 5                FREIDA MORFORD: Yeah, very manic, very hyper.

 6   Could be meth, could be something else, but at least the

 7   Court could say, let's have a mental health evaluation.

 8   Let's look at this closer as Judge Schwab was saying.

 9                Family communication is a big, big problem.       I

10   know that there's the HIPA Laws and that's a big issue with

11   people who want to be able to say what they want and who

12   they want.     I understand that.    When somebody's in crisis

13   or delusion, they cannot think.       They do not have the

14   ability to make to competent decisions.       Those need to be

15   made by a competent individual who's close to that person.

16   My son was very psychotic and he was not able to make the

17   decision on his own.       I mean I had to tell him to take a

18   shower.     I had to tell him to eat.    Eventually, he would

19   start to come in and out of it because I was babying him

20   through this stuff, but he would not have done it on his

21   own.   He would not say I need help.      People that are in

22   phytosis or manic, they don't know they have a problem,

23   everything is cool.       Depression, oh, my God.     You can't go

24   get help.     You can't even get out of bed sometimes.       It's a

25   very difficult thing for people to do on their own.
                                                                      68




 1                So, it's very important that we change the

 2   ability for a family member to make the decisions for

 3   somebody else, even if they haven't had signed over the

 4   release previously.

 5                Don't wait for the worst to happen.    The

 6   gentleman back touched on that earlier.     His son, they

 7   waited two weeks before they would do anything because it

 8   was emergency response.     We can't wait that long.      I think

 9   we should have the opportunity to be on the road to

10   recovery rather the road to who knows where.       He goes in

11   and out so quick, he could be the kid that gets shot.        And

12   why?     Because he did not get the services immediately when

13   he needed them.     So we can't wait for the worst to happen.

14                Mental health, transferring from one county to

15   another.     Oh, my goodness.   I have clients that live in

16   Yakima County who want to move over to Seattle.       They are

17   told they can move over there, sure, you just have to go

18   get signed up with the other mental health agency.        They

19   will not make a phone call.     They will not do the transfer.

20   They will not give them medication.     They're going to run

21   out of medication and they're not going to see this other

22   doctor over here for another 45 to 60 days.        Sorry, you

23   don't get any meds because now you're not on our case load

24   anymore, and you're not quite there yet.     So you're in

25   limbo.     When they're going to transfer from one agency to
                                                                        69




 1   another, there needs to be some sort of ability of the

 2   person not to be lost, to be able to get that medication,

 3   to be able to get the transfer done smoothly and not them

 4   having to do it themselves.      I mean that's okay.     You can

 5   call each other, it's not very difficult to do.         We do it

 6   all the time.    Laws need to be changed for crisis

 7   intervention.    That's on the top of my list.

 8               What is working well in regards to mental health

 9   services in Washington State?      I don't know all of them.

10   Washington State is not working all together.       I can't say

11   anything is really working well for the full state.

12   Possible county to county, it may be.       We need to all work

13   together.

14               What would a transformed system look like?       If

15   somebody needed assistance, they would get it immediately

16   no   matter what, when, how or why, for whatever reason, if

17   it was mental health, or anything.      I am a die-heart

18   republican, and I know a lot of people say, well, that's

19   why you think that.      That's not true.   I think everybody

20   that needs assistance should have assistance.          Should you

21   get somebody to help themselves, unless they have that

22   ability, unless they are given something, you have to give

23   somebody the assistance so that they can help themselves.

24   Otherwise, it's not going to work.

25               BJ COOPER:    Are you familiar with Advance
                                                                        70




 1   Directives?

 2                FREIDA MORFORD:   Yes.

 3                BJ COOPER:   You have to be in--

 4                FREIDA MORFORD:   You have to be somewhat of a

 5   recovery.

 6                BJ COOPER:   Right.   There is now that option in

 7   this State.

 8                FREIDA MORFORD:   But that can be revoked at any

 9   time.

10                BJ COOPER:   They can choose to revoke it

11   themselves.

12                FREIDA MORFORD:   Right, exactly.     When he was in

13   California and when he went to see a psychiatrist, he got

14   mad at me.     So he called up his psychiatrist, I don't want

15   my mom talking to you at all.         So those things can be

16   revoked at any time.

17                DIANE ESCHENBACHER:      I have one quick question

18   for you too.     Have you ever been in any position where you

19   could take you son, like have him stay with a different

20   family member, different RSN?

21                FREIDA MORFORD:   I'm sorry.     Withing a different

22   what?

23                BJ COOPER:   Regional Support Network.

24                FREIDA MORFORD:   I live in Yakima.     He lives in

25   California.     California has actually been working well, as
                                                                       71




 1   well as they can, because he will not allow anybody to work

 2   with him.     He doesn't accept that that's a problem.     He

 3   keeps telling me that I'm the making him have the problem.

 4                JILL SAN JULE:     What types of services is he

 5   receiving?     I'm just trying to visualize what types of

 6   services you would foresee would help him.

 7                FREIDA MORFORD:     I think what would--I know I

 8   can't keep going back--but I think when he originally came

 9   down with bipolar, when this originally had occurred, if he

10   had been hospitalized.        Could it have been because he hit

11   his head?     He came home for Christmas and he had some major

12   knots on his head, and that happened at our house a few

13   years ago, that was pre the bipolar.        Could that be the

14   cause of it?     I don't know.     I would like to have a handle

15   on this.     I think if you had the services, been

16   hospitalized, we could have looked at everything to find

17   out exactly what it was.        He would have been on medication.

18   He would have come out of psychosis at some point, made

19   some realization that there is something wrong.        Maybe he

20   would not have.     Maybe he would have said, you know, you

21   guys are all crazy, which I doubt because he apologized to

22   one of his friends about his actions and how he reacted.

23   So I know there was some concept there.        I think if he

24   would have been able to come down immediately after this

25   manic phase it may have made a difference, I don't know.           I
                                                                     72




 1   think if he could get the services needed, that he would be

 2   made to actually get at a level rather than be so out

 3   there, have somebody that would be able to talk to him

 4   about what bipolar is, how it reacts and make him feel

 5   comfortable.   That it's okay to have a mental illness.

 6   It's okay to have a problem.     You're sick.   It's like

 7   anything else, like diabetes and cystic fibrosis.      Theses

 8   are things we don't ask for, it happens and that's okay.

 9   You just need to take care of it and you'll be okay.

10             MARINA COVEY:     I'm with the Promise Club in

11   Wenatchee, Washington.     I think I come here today wearing a

12   couple of different hats.     One is as the director of

13   rehabilitation of the programs that I have been lucky

14   enough to be involved with for the last couple of years.

15   The other one is as a parent of a consumers.

16             I just wanted to talk today about what a

17   transformed mental health system would look like.      There

18   are a number of ways, I think, our State, our system, our

19   Country fails consumers.     Primarily, I think by treating

20   mental illness as a separate distinct problem that is not

21   worthy enough to be treated in the medical care.      You know,

22   the fact that these are brain diseases, Brian disorders.

23   If you had a brain tumor, the doctor would treat you and

24   refer you to other services that would be helpful whether

25   that is a support system, whether there's other treatment
                                                                      73




 1   options.    What else is available in the community?      What

 2   else is available out of your area?

 3               I think I've heard from a number of people today,

 4   and I agree, that when you have a loved one that is

 5   suffering and needs help, you don't care what it costs.

 6   You're going to find the help that you need.        You're not

 7   going to leave any rock unturned.     We have our daughter

 8   that we drove all over the state for years and years and

 9   years, to get little pieces of services and paying 70

10   percent of our gross income to pay for those services

11   because our insurance doesn't cover it.     And we want

12   Medicaid.    And the services, even if you could get them,

13   you couldn't pay for them.

14               I think that mental health care delivery in this,

15   in our State isn't going to get any better until we start

16   looking at educating our primary care physicians and our

17   emergency room physicians, our psychiatric nurse

18   practitioners, our triage nurses, the police department,

19   the jailers, the justice system, probation, substance

20   abuse, and we all start working together.     And we start

21   treating mental illness and substance abuse and everything

22   else just as it is, any other medical condition, any other

23   disease or disorder.    And we eliminate the stigma every

24   day.   When we start providing services that you can access

25   and everyone is knowledgeable about it.     Okay.     This is
                                                                    74




 1   really not possible and I know that.     I get accused of this

 2   at work everyday.   They tell me that I just dream too big

 3   and too far away, but if we don't every aim there, we're

 4   never going to get there.

 5              We start treating these disorders that same as

 6   any other disorder, and we're all knowledgeable about where

 7   to go for help and how to work together, people are going

 8   to get better.   Probation Department can't get any help or

 9   relief from all of the people that they're serving with

10   mental illness because the mental illness isn't being

11   treated.   And once the mental illness can begin to be

12   treated, people in probation and the court systems are

13   going to see fewer people reoffend, fewer people

14   incarcerated, fewer people put in prison.

15              Same with substance abuse.    When people with

16   substance abuse issues get mental health issues.     People

17   serving the substance abuse community are going to see

18   fewer people needing those services.     And when you're

19   serving people and working towards in a recovery model,

20   people require fewer services and the services that they

21   require are less costly to provide.

22              These services should be available to each and

23   every person regardless of their ability to pay, regardless

24   of what program they're on, even if that means they have to

25   pay for it and can't afford it now.     We made payments for
                                                                    75




 1   years and years to try to make sure my daughter got

 2   services.    We owed money to everybody.   But we paid for it

 3   because she needed it.    Regardless of the ability to pay,

 4   regardless of what programs you qualify for, these services

 5   need to be available to everyone, medical management.

 6               And then also, I have personally seen in this

 7   system, in our community and all over the State and

 8   Country, the tremendous success the clubhouse programs have

 9   had in the recovery of individuals with mental illness.        I

10   know that in our community where we have tried to work

11   together and make sure that people are educated and all of

12   the different systems know about what we're doing and how

13   we can help them and help the people we really care about,

14   the consumers.    By working together, we will all experience

15   success in educating people so that they do make referrals

16   and people do get involved in our programs.     I have seen,

17   in our own community, crisis calls, the necessity for

18   crisis calls reduced.     We've seen among our own membership

19   incarcerations reduced.    We've seen people be released off

20   of probation early because they're doing wonderfully.       Now,

21   that's not the typical thing.    And we've seen people return

22   to work and gain more than we could have ever imagined in

23   just participating in our program.

24               So I would envision a transformed mental health,

25   in addition to involving everybody, is not just a
                                                                        76




 1   transformed mental health system.      It's a transformed

 2   system period, for the people we're here to serve,

 3   available to everyone regardless of their ability to pay

 4   involving clubhouse.

 5                SPEAKER:   I'm a consumer and a mother of a

 6   consumer.     We have an excellent family physician.    He knows

 7   the family very well.      He's educated yet isn't educated.

 8   He tries to find other services for you and goes to bat for

 9   you.   So we have that in our corner.     The other thing, the

10   clubhouse model, I'd be lost without it today.      I've been

11   able to return to full-time work and am living a productive

12   individual life supporting two children.      So that's what

13   working well for me.

14                What's not working well is being trapped in

15   between not qualifying for Medicaid or insurance to cover

16   medications.     Not being able to get the help you need.      I

17   think that's the main one.      The second one would be not

18   being able to get the counseling because you don't qualify

19   for the Medicaid services to get into services that require

20   only Medicaid.     Yet, if you have insurance there's a cap on

21   it and it's not covered so you stuck between a rock and a

22   hard spot.

23                A transformed system, I'd like to be able to see

24   all them working together with all the services.       Doesn't

25   matter what you have.
                                                                       77




 1               BJ COOPER:     I just wanted to say something.    A

 2   lot of people have mentioned parity, which is that mental

 3   illness is treated the same way as a physical illness by

 4   the insurance industry.       The Parity Bill has passed in the

 5   State.    The only thing, it's over a period of time and it's

 6   not as good as everybody wanted.

 7               MARINA COVEY:     It's put in over a period of time.

 8   It's gradually being enacted.

 9               BJ COOPER:     Gradually.

10               MARINA COVEY:     Only for employers that employ 50

11   or more people.    So that means the majority of people

12   working in Washington State, who have private insurance but

13   they work for a small employer, fewer than 50 people, do

14   not qualify.

15               BJ COOPER:     Well, there is something they're

16   working on this year, and I don't know where it stands

17   right now to change that.       I'm not sure where it stands,

18   but it was before our legislators this year to make that

19   change.

20               SPEAKER:     The Federal government back in 2000,

21   they took Parity because I was a Federal employee back

22   then, and full Parity--

23               BILL HARDY:     But I think what your' taking about

24   is that real catch-22, where you're not offered any help by

25   your employer but making too much to qualify for Medicaid
                                                                      78




 1   or for other type of coupon, what we call the working poor

 2   who cant' get--you make too much to get one, but you don't

 3   qualify for the other.       That's the real bind.   In Parity is

 4   going to impact that.

 5               MARINA COVEY:     Even with being covered on

 6   insurance, you know you plan only covers six visits a year

 7   and you're seeing--

 8               BILL HARDY:     It's not adequate.

 9               MARINA COVEY:     It's not adequate.

10               BJ COOPER:     But it is supposed to change.   That's

11   one of the things they were changing this year is that

12   they're not allowed to put a cap on it, that they have to

13   be equal.    And I don't know--

14               BILL WATERS:     But it doesn't change her issues.

15               BJ COOPER:     What I mean is they're not going to

16   be able to say you can only have six visits.

17               MARINA COVEY:     But like I said, that's only for

18   employers with 50 or more.

19               CHRISTINE GILL:     It concerns number one, what is

20   working in regards to mental health services.        I have to

21   say the Clubhouse, the Promise Club.       They have a program

22   there that has scores of things to help people.        One of the

23   things that really helped me was the employment.        They have

24   transitional employment.       When I first started the Promise

25   Club, I was in pretty poor shape.       I had just moved to
                                                                      79




 1   Wenathcee and I didn't know anybody.       I was suffering a lot

 2   from depression.     What this job has done for me is changed

 3   my life.     I have something to get out of bed for in the

 4   morning and it's helped with my sell-esteem.       I've met new

 5   people.    I have lots of friends at work.

 6                There's a problem with it.    Not with the Promise

 7   Club.     I lost Medicaid when I got the--I just work part

 8   time, 20 hours a week and make minimum wage.       I lost

 9   Medicaid because of that.      So my services at Behavioral

10   Health, I no longer can see a psychiatrist, I had to see a

11   nurse practitioner.     I wasn't able to have any counseling

12   with just Medicare.     I know about HWD, but I think it's too

13   expensive.     It would be over a $100, and think it's just

14   too expensive.     So the Promise Club has helped me out a

15   lot, but I run into roadblocks with no Medicaid.       That's

16   it.

17                GARY HODGES:   Hello.   My name is Gary Hodges and

18   I'm a member of the Rose House in Tacoma.       And that's my

19   director right over there, Bill Waters; and my supervisor,

20   Diana.

21                What works for me at the Rose House--the Rose

22   House has been there for me for 15 months.       They did a lot

23   for me.    They helped me out with problems that I had.       And

24   also, this stuff that I cannot pick up real fast.       I have a

25   lot of help on it.     I'm doing as much as I can.    I try to
                                                                    80




 1   help out as much as I can.     I go to these meetings and the

 2   first coalition, yesterday.     I really love the Clubhouse.

 3   I think that people who want help and are in crisis or have

 4   mental problems, medication, to call and talk to people who

 5   understand it.     You need to be active and doing stuff, to

 6   get a job or go to school, or whatever.       I want to be

 7   there.   If it wasn't for one of our counselors at the VA

 8   Hospital in Tacoma, I wouldn't be here right now.       I

 9   thanked him real, real much for me to get in there.

10               And also, what's not working in regards to mental

11   health services.     I've seen a lot of times where people

12   will go to talk to their provider, talk to them, and the

13   minute you say something, the thing that they want to do is

14   judge, not hear what you have to say, not do what they

15   think is right for them.     But to take them and put them in

16   a lock-up facility, restrain them to the bed, so they don't

17   hurt themselves.     I think that is wrong.    I think that

18   should at least see what's going on instead of putting them

19   on a lot of medication until they know exactly what is

20   going on.    I don't think you should fill them up with a lot

21   of medicine and get them sick worser than they are now.        I

22   don't think it should be that way, and I think, you know--

23               Another thing, I think you should talk to their

24   family to see the family has to say or whatever, you know.

25   I strongly feel that the professionals in mental health are
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 1   not doing their job the way they should do it and stop

 2   giving a lot of medications until they know what is going

 3   on.   This is the way that I feel about it, myself.

 4              What should a transposed system look like?        I

 5   don't know exactly how to say that one.      I think they

 6   should look over everything that was said and you should

 7   talk about in this system and do what you need to do

 8   without judging the person.      That's the way I feel about

 9   it.

10              BETH DANHEART:     My name is Beth Danheart.     I'm

11   not a consumer, but I run the Drug and Alcohol Treatment

12   Center here in Yakima.      Obviously, we have many clients

13   that are in common.   When we talked about co-occurring

14   disorders and I think this is an issue that I would really

15   like to see more things happen.      I don't necessarily think

16   that funding needs to be combined in order to treat people

17   with co-occurring disorders, but I think that the funding

18   needs to be able to work together.      I ran with

19   Comprehensive Mental Health a dual diagnosis program in

20   Bulla, Washington for a year and it's closed now because we

21   couldn't get the money to work together.      The Drug and

22   Alcohol money was there, but trying to get the money to

23   flow into the mental health system in the program was damn

24   near impossible.   We had our local RSN trying to get

25   assistance from somewhere else and they weren't going to
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 1   send their money out of their local RSN.

 2                What is not working?     The RSN system is not

 3   working as far as I can see.        Some will work for the

 4   client.   Talk about someone moving from one RSN to another,

 5   and they can't.     It's not a seamless system.     It needs to

 6   be seamless.     People need to be able to move around in the

 7   State of Washington.     We all should have that ability and

 8   we can't because there's a big gap, or if you can even get

 9   into the next RSN.     It took me a long time to figure out

10   how the RSN system worked, because I'm used to the chemical

11   dependency system which follows the client, where the money

12   follows the client.     Here, the client just has to stay

13   stuck with the money, you know, where the money comes from.

14   So I think that system is a bad system and impossible when

15   you try to make it work for people with cooccurring

16   disorders.

17                I think that I'm really delighted and hope to

18   hear the word "recovery" when it comes to mental health.

19   You know, recovery has been a word that used in the

20   dependency films for a long time, but it's not equated

21   across the board with people who have mental illness and it

22   should be.     You know, isn't any different--of course it's

23   different to some extent--but it's a brain dysfunction and

24   people can get into recovery, they can lead lives that are

25   compelling and they can participate to their utmost ability
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 1   if they can get the right services.     So I like the idea of

 2   recovery.     I've heard people jokingly refer to the mental

 3   health system as the mental illness system, you know.           I

 4   think sometimes the system itself does not support people

 5   who are going into recovery.     It doesn't support a concept

 6   that, you know, you can get better.     You can function and

 7   feel good and do things to the best of your ability.           The

 8   chemical dependency system uses the word all the time,

 9   recovery.

10               I think in talking about consumer-based programs,

11   I was trying to figure out what that meant.     And then I

12   went, oh, we do that all the time.     We have recovering

13   people all the time working in our program and some of them

14   are run by recovering people, in fact a lot of them are run

15   by recovering people.     And why not because you really

16   understand.     People have talked about, I want to go and

17   talk to someone who understands me and what I'm all about

18   and when I'm experiencing the problems that I have.        I

19   think when we talked about the Clubhouse model, that's a

20   great model.

21               And there's another model called AA.   Why can't

22   we have mental health.     You can't call it AA, but you can

23   call it something, Peer Support.     I think part of that has

24   to do with stigma too.     When you're in recovery, there are

25   other people in recovery.     You know the poster, I don't
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 1   know if you all have seen it, where people who are

 2   addicted.    And it say, what does an addict look like?      And

 3   there're like 10 people on this poster.     Well, they look

 4   like all of us.     What is somebody who is mentally ill in

 5   recovery look like?     Looks like all of us.   I think people

 6   have this idea that it's the bum on the street.      Well,

 7   maybe it is, maybe that person hasn't got to recovery.

 8   But, we're everybody.     There isn't any of us that's not

 9   touched by mental illness or addition.     So I think there

10   needs to be a continuum of care.

11               I think in the transformed system would be a

12   continuum of care.     And you would be able to get the help

13   you when you first need it, when you're in a crisis and

14   that something would follow you through and you wouldn't

15   just be picked up just for the crisis.     You would be able

16   to get the services you need in whatever that continuum of

17   care looked like.     And then, after that happened, there

18   would be something like a case manager who would help you.

19   One of the problems we have in our system is that when

20   people get into recovery and they're doing well, we get

21   them into housing, we house people who have been mentally

22   ill, and then no one follows them.     They maybe still active

23   in the system, but there's no case manager following them

24   because they move.     And then they're in crisis again.     And

25   where's that case manager?     So there needs to be something
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 1   underneath that helps people when things start to fall

 2   apart, unravel.     When you're in the recovery process, and

 3   sometimes the process kind of goes astray from time to

 4   time.    We need to pick it up before someone falls apart and

 5   they're at their bottom most, like she was talking about.

 6   There needs to be someone there so she doesn't need to go

 7   through all of that before she gets some help.

 8                And Medicaid.   I think the funding, you know, the

 9   Feds came through and said there was no Medicaid funding

10   for people on mental health.     I think that the State needs

11   to take a look at the funding that's allocated for people

12   who don't have Medicaid.     You can pull the Medicaid funding

13   out, the matched dollars, and use it for people who fall

14   through the cracks.     There's never going to be enough money

15   to serve everybody.     You know with people being able to

16   provide services for everybody who needs it whenever they

17   need it.     We should always strive for that, but it's not

18   going to happen.

19                I think looking at the mental health funding a

20   little differently, when saying there's some flexibility in

21   this funding.     Yes, we get most bang for the buck when we

22   match the dollars to the Federal dollars which is Medicaid

23   money.     But we have to pull out some of those State dollars

24   and serve the people who don't have medical coupons because

25   most people don't have medical coupons.      Medicaid is a
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 1   pretty limited group of people and it's getting smaller.

 2               And there's a new thing that's come about.     Last

 3   year with the Hargrove Bill, where he wanted universal

 4   screening for chemical dependancy and mental health

 5   problems.    There's a screening, but that's too short, which

 6   was going to be put in place in most mental health programs

 7   and chemical dependency programs.       On those simple

 8   questions said they'd be referred where they need to be

 9   referred and hopefully all of the interventionists will

10   eventually use this.    If that happens, that would be nice.

11   I don't know if it will or not, but that's the goal.       The

12   question is, do they get referred?       They get referred to

13   Central Washington Comprehensive Mental Health who is only

14   going to be able to see people on Medical Coupons, and they

15   don't have a coupon.    They're not going to do one.

16               MARINA COVEY:     We're talking about not being able

17   to see everybody.    We can't pay for everybody.     I wasn't

18   meaning that necessarily that they would provide the

19   services for free, but definitely make them available.

20   Whether they pay for them or they don't pay for them,

21   whatever.    There are clinics and hospitals all over the

22   place that cannot turn anyone down.       Cannot turn anyone

23   down if they cannot pay for services.       So why is mental

24   health any different.       You could have pneumonia, they're

25   going to see you.    You could have a sinus infection,
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 1   they're going to see you.     And they're going to treat you.

 2   For mental illness, they will not.     They same thing should

 3   apply to everybody.    If you need it, you're going to pay

 4   for it, or you're going to get it for free or at a reduced

 5   rate, but eventually--by providing adequate services to

 6   everyone, you're going to save yourself money in the long

 7   run.

 8             BARB NOAKES:    It just amazes me that the head is

 9   connected to the rest of the body and everything and why is

10   it separated?    Do you know what I mean?

11             FREIDA MORFORD:     I just want to say that I agree

12   with what you are all saying today and I think what's

13   working well in regards to the mental health services is

14   that there's a lot of very dedicated individuals who really

15   give it all try to make the system work.     But the system

16   just doesn't work together.     It's too fragmented.   They

17   have to work together.

18             What's not working in mental health is, I believe

19   there's a lot of waste being done because there's so much

20   of a guessing game, like this gentleman pointed out.      I

21   would like to see in a transformed system where we would

22   become more of a part of the medical field and use the

23   instruments that are available to measure brain waves, to

24   see what's actually happening in the brain, instead of a

25   guessing game.    I think in the long run, we'd save billions
                                                                    88




 1   of dollars.     I know a lot of the family members from NAMI.

 2               I can't tell you the medications I've been tried

 3   on, and over and over and over and it's such a guessing

 4   game.   I know there are ways to this in a medical system

 5   where you take a picture of the brain.     They have an EEG

 6   put out now where it works like a heart attack, measuring

 7   for a heart attack; it measures your brain waves.     And then

 8   the can tell you what area of your brain is not functioning

 9   properly.     It would help get rid of the stigma because

10   people can see it instead of it being a guessing game.

11               DIANE ESCHENBACHER:   They already do CAT scans.

12               FREIDA MORFORD:   They have head scans, but they

13   even have things that are cheaper than that and just as

14   accurate.     It's just how is it made known to the general

15   population.     In fact, there's a lab right in the Tri-Cities

16   here invented one.     I went to the research presentation,

17   and it was incredible.     He had two kids he tried it on.

18   One was acting out mental illness.     How did he find out?

19   This showed that this young man, in fact, had a brain

20   injury so he was treated for a brain injury.     Otherwise,

21   it's a guessing game, he might have been treated for a

22   chemical imbalance, but it was because of a brain injury.

23   So I would like to see us have more updated ways of

24   diagnosing people with mental illness and it would help get

25   rid of the stigma.     It would get more people to want to get
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 1   treated and it would save money at the same time.

 2               And the outcomes, I would hope would be we would

 3   have less forensic beds being built and we'd have more

 4   community services being sought.     One thing that I would

 5   like research, because I would like to see if the advance

 6   directive actually works.     I'd like to know how many people

 7   use it.    I don't know of anybody that uses it.    Maybe some

 8   of the more people who are higher in recovery have, but it

 9   doesn't work for the ones--like our son who repeatedly

10   refused to think they're ill and there's no way they're

11   going to use an advance directive.     So I would just be

12   interested in how many people actually use it, follow it

13   through.    Because I don't think it works.

14               Another thing I would like to see happen is

15   there's such a big flexibility of care from county to

16   county.    If you go into our RSN, what Yakima has compared

17   to what Tri-Cities has, I always tell people, you guys have

18   Hollywood, we have ghetto.     I don't know why that it.      I

19   wish everyone had the same access of care.     That would be

20   something I want to see happen.

21               JILL SAN JULE:   We just want to say thank you to

22   everyone who came tonight and gave testimony.      It was a

23   long three hours and a lot of hard work on all of our

24   parts.

25               We will take everything that you've shared back,
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 1   and if you're email is here, we can also email it back to

 2   you and let you know what the final product is.      This is

 3   our third one now in gathering this testimony and

 4   everything has been documented that you've shared.      And

 5   again, we appreciate all of your comments and input.      It

 6   helped make this Transformation a reality, because it will

 7   be.

 8              DIANE ESCHENBACHER:     You can keep track of this

 9   on the website, on the Mental Health Transformation

10   website.   It's all broken out.

11              JILL SAN JULE:   Right now on the website, there's

12   just a filler page on the actual DSHS site under mental

13   health.    But we have--the Grant just hired a web master

14   who's going to be putting together, for the grant, a really

15   thorough website that's going to have everything up to

16   date, interactive.   So if you have any thoughts on what

17   you'd like to see from that too, you can send it to us by

18   email, that would be great.

19              Thank you for coming.

20              (Whereupon the meeting concluded at 7 p.m)

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 1              CERTIFICATE

 2

 3             I, Valerie R. Allard, do hereby certify that

 4   pursuant to the Rules of Civil Procedure, the witness

 5   named herein appeared before me at the time and place

 6   set forth in the caption herein; that at the said

 7   time and place, I reported in stenotype all testimony

 8   adduced and other oral proceedings had in the

 9   foregoing matter; and that the foregoing transcript

10   pages constitute a full, true and correct record of

11   such testimony adduced and oral proceeding had and of

12   the whole thereof.

13

14             IN WITNESS HEREOF, I have hereunto set     my

15   hand this 15th day of March, 2006.

16

17

18   ___________________      _____________________

19   Valerie R. Allard                Commission Expiration

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