PLEASE HELP US REACH THE 2020 PRESIDENTIAL CANDIDATES by Dede Ranahan

Sooner Than Tomorrow Readers,

I’ve been working hard the last couple of weeks, with advocates from across the country, in the development of this Five-Part Plan. Individuals, professionals, writers, journalists, and mothers (always the mothers) have been brainstorming and refining this document. Our intent is to get it in front of every 2020 presidential candidate - Republican, Democrat, Independent. Our goal is to encourage them to talk about serious mental illness (SMI) on the campaign trail and in their debates, and to include a SMI plan on their websites. Right now, no candidate is talking about SMI. It’s as if it didn’t exist.

These are baby steps. We can’t address everything that needs to be addressed in our messed up mental illness system, but we have to start somewhere. We’re trying to help the candidates along. If they don’t have SMI on their radar before the election, they probably won’t have it on their radar once elected.

If you agree with the positions in this plan, and would like to send it to politicians of your choice, send me an email and I’ll email the documents (cover letter, plan, an attachment) back to you (dede@soonerthantomorrow.com). The more individual voters the candidates hear from the better.

I, and many others, would really appreciate your support. Dede

A FIVE-PART PLAN TO ADDRESS SERIOUS MENTAL ILLNESS (SMI)
FOR ALL 2020 PRESIDENTIAL CANDIDATES

PLEASE ADDRESS THESE TOPICS IN YOUR CAMPAIGN APPEARANCES AND DEBATES

1. RECLASSIFY SERIOUS MENTAL ILLNESS (SMI) FROM A BEHAVIORAL CONDITION TO WHAT IT IS,  A NEUROLOGICAL MEDICAL CONDITION

WHY RECLASSIFICATION IS IMPORTANT

Reclassification will unlock more research funding and help eliminate discrimination in treatment, insurance reimbursement, and the perception of SMI as “behavioral” condition. SMI is a human rights issue. NIMH ranks SMI among the top 15 causes of disability worldwide with an average lifespan reduction of 28 years.

PRESIDENTIAL ACTION

* Create a cabinet position exclusively focused on SMI.

* Push for Congressional appropriations to include schizophrenia in a CDC program that collects data on the prevalence and risk factors of neurological conditions in the US population.

2. REFORM THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPPA)

WHY HIPAA REFORM IS IMPORTANT

Overly strict HIPAA laws make it extremely difficult for families and caregivers to partner in the treatment of their loved ones, resulting in important life-saving medical information gaps. By eliminating this barrier, family support will be strengthened, reducing the chance of relapse, homelessness, imprisonment, and death.

PRESIDENTIAL ACTION

* Work with legislators to change HIPAA law to ensure mental health professionals are legally permitted to share and receive critical diagnostic criteria and treatment information with/from parents or caregivers of SMI.

3. REPEAL MEDICAID’S INSTITUTES FOR MENTAL DISEASE EXCLUSION (IMD)

WHY IMD REPEAL IS IMPORTANT

IMD repeal will increase the availability of psychiatric inpatient beds. The IMD exclusion is not only discriminatory of those suffering from neurological brain disorders, it is a leading cause of our national psychiatric hospital bed shortage. It prohibits Medicaid payments to states for those receiving psychiatric care in a facility with more than 16 beds who are 21-65, the age group with the most SMI.

PRESIDENTIAL ACTION

* Work with legislators to repeal the IMD exclusion.

4. PROVIDE A FULL CONTINUUM OF CARE

WHY A FULL CONTINUUM OF CARE IS IMPORTANT

A continuum of care insures that SMI patients receive early intervention at all stages of their illnesses, long-term care when needed, and follow-up treatment (medications and therapies) when they’re released. It reduces visits to jails, ER’s and hospitals, homelessness, and morgues. A continuum of care provides life-time management.

PRESIDENTIAL ACTION

* Create federal incentives to states which are addressing a full array of inpatient, outpatient, and supportive housing care. 

5. DECRIMINALIZE SERIOUS MENTAL ILLNESS (SMI)

WHY DECRIMINALIZATION OF SMI IS IMPORTANT

People suffering with other neurological conditions like Alzheimer’s and dementia can get treatment promptly without being kicked out of their homes to wander the streets until they are arrested and put in jail or prison rather than a hospital. Serious mental illness is the only disease where the doors to treatment are shut unless a crime is committed. This is pure and simple discrimination with the disastrous results we see in our country today — homelessness, incarceration, the disintegration of families, and death.

PRESIDENTIAL ACTION

*Work with legislators to change “must be a danger to self or others” criteria.

*Work with legislators to change involuntary commitment criteria, alleviating the subjective nature of “gravely disabled” and redefining it in objective terms based on scientific medical need for treatment. Psychosis, like a stroke, is a traumatic brain injury and needs immediate treatment for the best outcome.

Me and The Jazz

Me and The Jazz

PLEASE JOIN THE CONVERSTAION ON MY FACEBOOK PAGE by Dede Ranahan

The following is an ongoing discussion on my personal Facebook page - Dede Moon Ranahan. If you’re on Facebook, please click on my page and join the conversation. Or enter your comments through the comment link below. Or send your comments to me in an email: dede@soonerthantomorrow.com

SMI (SERIOUS MENTAL ILLNESS) ADVOCATES AND SUPPORTERS

GOAL: This effort is short-term. To get SMI recommendations for a national SMI plan before the 2020 presidential candidates (Republican, Democrat, Independent). None of them are currently talking about SMI (not mental health, not drug addiction). SMI. The SMI community is looking for a candidate/s who will champion SMI and its concomitant issues. With adults and children impacted and their immediate families, we represent roughly 72 million people in the US.

THE ASK: That candidates talk about SMI in their campaign appearances and debates and post a national SMI plan on their campaign websites.

To encourage them, we'll be submitting a cover letter, one-page outlined/bulleted plan, references and resources to aid them in developing their plan, and if they will read that far, the full list of 18 topic areas.

RESULTS OF YOUR VOTES FOR THE TOP 5 ISSUES FOR A ONE-PAGE PLAN:
1) Reclassification of SMI as neurological brain disorders
2) IMD (Institutes for Mental Disease Exclusion)
3) HIPAA Reform (Health Insurance Portability and Accountability Act)
4) Continuum of Care
5) Decriminalization of SMI

NOW WE MUST REFINE THIS TOP 5 LIST.
PLEASE ANSWER 1 OR MORE OF THESE QUESTIONS IN A FEW SENTENCES:
1) Why is reclassification of SMI important?
2 )Why is IMD repeal important?
3) Why is HIPAA reform important?
4) Why is a Continuum of Care important?
5) Why is Decriminalization of SMI important?

1) Name one specific action a president can take to advance the reclassification of SMI.
2) Name one specific action a president can take to advance IMD repeal?
3) Name one specific action a president can take to advance HIPAA reform?
4) Name one specific action a president can take to advance a Continuum of Care?
5) Name one specific action a president can take to advance the Decriminalization of SMI.

Thanks, Dede

1. RECLASSIFICATION OF SMI
-Reclassify schizophrenia and related disorders as neurological conditions or neurobiological brain disorders. Eliminate “behavioral health” nomenclature.


2. HIPAA (Health Insurance Portability and Accountability Act)
-Reform current HIPAA laws.
-Present patient and family with a social worker to support the family unit throughout the care process including medication and psychiatric treatment.
-Require mandatory training for everyone in the medical profession about HIPAA and a required test on proven knowledge.
-Develop a federal program for the administration of a psychiatric advance directive (PAD) which includes a universal release of information and designates an agent if capacity is lost. Must include enforcement mechanisms to require mental health/illness facilities to follow the directives.

3. IMD (Medicaid’s Institutes for Mental Disease Exclusion)
-Repeal it.
-To prevent warehousing, use unscheduled check-ups on those receiving services.

4. A FULL CONTINUUM OF CARE
-Early intervention at all stages of illness.
-Provide Inpatient (IMD waivers), Outpatient (ACT, FACT, PACT, AOT, Clubhouses), Housing (full array from locked stabilization to unlocked intensive, medium intensive, peer-run PSH, Asylum).
-Require a psychiatric standard of care for various SMI diagnoses like other medical specialties. Diagnosis should be staged as cancer is.
-Provide more long-term care.
-Remove ER’s as entry for mental health hospitalization. The ER process and chaotic environment are not conducive to the well-being of SMI patients.
-Give federal assistance to states providing supportive housing.

5. DECRIMINALIZE SMI
-Eliminate solitary confinement in jails and prisons.
-Support nationwide civil mental health courts and expand criminal ones that are already established to keep SMI out of jails and prisons.
-Establish mental health courts on a federal level, and coordinate federal courts and state-run mental health facilities.
-Move crimes that SMI commit in the federal system into state courts.
-Provide a digitized system to connect county/hospital medical records to jails and prisons.
-Mandate a way for families to provide medical history to jail/prison doctors to inform treatment.
-Provide uniform psychiatric screening of the incarcerated and use standardized protocols for medication of SMI prisoners.
-Require strict limits on waiting for trial time.

BEYOND MY UNDERSTANDING OF WHAT BEING HUMAN MEANS by CJ Hanson (PART TWO)

To my twin sister, Linda Rippee,

I just came on Facebook, after taking a nap. I could barely read through your post without tears flowing down my face like a stream from a mountain top. A stream that never ends. I didn't think I had this many tears left. I feel so helpless, with my own illnesses, that I am unable to help with a physical presence. The responsibility and the experience of actually interacting with Mark have fallen on your shoulders.

Is there such a thing as survivor's guilt without having actually lost someone? I can't describe the pain I feel any other way, so I’m at a loss. I’m at a loss at the pain and suffering he endures every day on the streets, knowing that we have no legal right to force him to live with the few of us left, nor is it even possible. Knowing that we have fought for 32 years trying to help him and make his life better, and knowing that he blames us for allowing him to live as the doctors didn't believe that he would. Knowing that the laws in this county, state, and nation are against families of loved ones who suffer from traumatic brain Injury and serious mental illness. Knowing that, no matter how hard we’ve fought every day to change minds, hearts, rules, and laws, so far we have failed. We have failed.

I have such a hard time believing that we’ve failed, but we have. It matters not that we have fought every day. Every single day for 32 years. Yes, for a while he was able to live a somewhat normal life until the mental illness set in. The doctors said it would happen eventually, but what has happened to him since? The apathy of people with the power to change policies, rules, and laws is a clear indication that, not only have our efforts failed, but the lawmakers have failed. How many potential bills have failed over and over as the lawmakers insist there is more legislation now for the seriously mentally ill than ever before. That may be true, but they keep failing. Failing the sufferers. Failing the families. Failing society. No human being should have to live without options like our brother. I am having difficulty understanding anything anymore about this travesty.

Facing my own mortality only makes me feel more like a failure. I still have in my mind that 12-year-old boy who tracked me down at a friend’s house after I had moved away from home at 18, and clung to me begging me to move back home. I still have in my mind seeing Mark that day of the accident, barbecuing at Mom and Dad's house and telling us how he wasn't going to keep that motorcycle but was putting it up for sale. I still have in my mind that he was on his way to my home, in Fairfield, that night to see me when the accident happened.

Did I fail him, Linda? Did I fail him by making the decision to let the doctors try to save him? Was I wrong to want him to live? I thought I was making the right choices while I actually had power of attorney back then. I'm not so sure, now. What are we to do now? Lawmakers and officials have tired of our continued efforts and have turned their own blind eyes away from the situation. No one, who has any power to give families back their rights, or to change the laws preventing us from helping him, cares. Not really.

I have no faith in lawmakers’ motivations anymore. Not one has proven that they care enough about the families of the seriously mentally ill to truly push through what needs to be done to make a real difference. I can't stop crying — for Mark, and how he lives and suffers; for you, being the last one in our family to be able to go out and find him; for myself, for being so helpless in my own infirm condition and disability; for Mom, who will leave this earth knowing her youngest child will most likely die on the streets; for all the ignorant and uninformed people who find such joy in blaming our family; for those in the community who do care and have tried to help Mark and us for so long; for our society; for this very world.

My despair and tears are beyond my ability to explain anymore. Beyond my understanding of what being human means.

See Linda’s story yesterday, June 26, 2019. “Rewind and Erase.”

Mark

Mark

REWIND AND ERASE by Linda Rippee (PART ONE)

Today, I went and found my brother, Mark. He was lying on the sidewalk at a busy entrance to a shopping center. Cars were whizzing by. Another man was sitting there with him and, as I approached them, I could see that Mark was giving him money and asking him to count it. I was immediately suspicious. I asked my daughter to remain in the car.

I walked up quickly and called Mark’s name as I always holler his name before approaching him so not to startle him. I waited until he recognized my voice before I began conversation. Mark pulled another dollar bill from his pocket and asked me what denomination it was. I was concerned that maybe he was buying street drugs. No, that wasn’t it. Here sat another homeless person who had talked my blind brother into giving him all his money to buy a gold pocket watch. He laid out $14.00 which was all that he had. Unless that watch could verbally tell time, what on earth would a blind, gravely disabled man need with a pocket watch?

Good thing I had brought him food, water, and clothing. Mark was shirtless, but had a very heavy coat on. Today, the temperature is supposed to reach 98 degrees. I begged him to take off the coat. He refused saying the coat would be stolen. He was extremely sunburned already. The wounds on his face and around his empty eye sockets were still badly infected from two different beatings several weeks ago when he was robbed. Today, all he had with him was a small blanket. His clothing was disintegrating as he wore the same pair of pants all through the winter and spring. He didn’t have a cane to guide him. He has had 11 different canes this past year.  

I sat down next to Mark and, within seconds, it was obvious that he was delusional. He grabbed my hands and slapped them down, hard, on his leg that has a metal rod from crotch to ankle. He held both my hands down with his hands. His hands looked like leather and were cracked and bleeding. Regardless, he continued to hold my hands tightly. His entire body was trembling. He said, “We have to go back and erase each year that has passed since June 21, 1987 (the date of his motorcycle accident). Rewind and erase.”

I was shocked that he still knew that date. Yes, it was Father’s Day, but he still remembered the actual date. He proceeded to say each year backwards to 1987. With each year, he said, “Rewind & Erase!” He shook, violently, until he reached 1987. Then he grabbed and hugged me and said,” Now, don’t you feel better?”

I told him, “Yes, and I hope you do too.” He began to argue with the voices in his head, screaming that the police were implanting and growing people inside of people and controlling them. I tried to calm him and get him to eat the food I had brought him. He would take a bite, chew tiny bites, and then spit it out.

He brought up my twin. Mark doesn’t always comprehend what I tell him, but I continue to tell him the truth. CJ, my twin sister, had gotten bad news about a medical diagnosis. I shared her condition with him. He began yelling at the voices he hears and blaming those voices for all the pain and suffering of those he loves. The intent of his body language was to beat himself up. I hugged him, and once again reminded him that I love him — as I do on every visit. He didn’t want to let go and held on tight for a while. As I was saying goodby, he began crying. He said, “Someone disconnected me from my mother. They’re cutting out pieces of me.”

I slowly walked away, feeling sick to my stomach. If only I could “rewind and erase” all the horrible memories, delusions, pain, and suffering he’s had for the last three decades. Yes, Mark, I would feel better.

Linda adds: Every letter/email I’ve sent out has also been sent to the County Board of Supervisors. I’ve sent out over 1200 emails and my twin, CJ, has sent as many. Each time, we copy agencies and politicians. We’ve saturated them. We’ve sent out thousands of private messages all over the state, and made thousands of posts and comments in over 100 social media groups all over California. CJ authored the petition for AB1971* and we collected 56,000 signatures that went to the full assembly and senate. I’ve made 30 speeches speaking at public meetings. I’ve testified twice at the capitol in support of AB1971.* I’ve gone to the capitol and told my brother's story to support several other bills. There have been 12 news articles and TV interviews. Mark’s story has been published in three national blogs and used at medical conferences. We’ve friended, and are in contact with, several well-known national mental health advocates — Ron Powers, Teresa Pasquini, Leslie Carpenter, Dede Moon Ranahan, and DJ Jaffe to name a few. The Board of Supervisors are ground zero. They are aware of all that we’ve done. They stay silent and do not converse with our family. The next project we are working on is a documentary. I have many, many videos of my visits on the streets with Mark. We will make the videos available to politicians and to the public. They are undeniable. When they are shown, Solano County should hang its head in shame.

Note: Solano County has declared Mark to be competent.

*AB1971. This bill would, until January 1, 2024, expand the definition of “gravely disabled” for these purposes, as implemented in the County of Los Angeles, to also include a condition in which a person, as a result of a mental health disorder, is unable to provide for his or her basic personal needs for medical treatment, if the failure to receive medical treatment, as defined, results in a deteriorating physical condition that a medical professional, in his or her best medical judgment, attests in writing, will more likely than not, lead to death within 6 months, as specified.

See Linda’s story, “I’m Past Anger. I’m in Complete Despair.” June 6, 2019, in the archives.

Mark

Mark