No Feedback, Interviewing Elvis, The American Dream, And New Commitment Laws

I have not gotten any feedback yet on my question as to whether or not to cheer for the home teams. Since I am chronically indecisive I am hoping that someone will give me some feedback on this issue soon. If not, I may choose to cheer for any team from Jacksonville, Florida which might be a bad idea overall for many reasons. I know that I am both a sports degenerate and polygamist. Yes, I cheer for more than one team in a given sport. Some folks say that it is wrong to do so. I don't really care. I cheer for my first love (Atlanta) despite the fact that she has ripped my heart out, eaten it, has another man's name tattooed on her chest, set fire to my car, and eaten all of my Cheetos. This behavior is not likely to change and neither is my infatuation and obsession. I currently live in Virginia. I have a rule: Cheer for the home team(s). OK. If I follow my own advice (which everyone who knows me real well knows that I don't), then I would pull for professional and college teams in the metro Washington DC area and in Virginia. I guess this makes more sense than doing several eight balls in one night while watching porn on Cinemax.

I have decided that I want to interview people who are dead. I mean there so many more interesting people out there who are now fertilizer than there are walking around on this nightmare of a planet. I really don't have much interest in interviewing the true ruler of the world, Bill Gates, or the worst and stupidest President in the history of the United States (Current US President Asterisk). I don't want to interview my dog (I don't really have one) or my cat (who is delusional, but has nothing to say) or my doctor (who secretly wants to sleep with my wife). They aren't that interesting. They have one track minds and have nothing of substance to say. Who has something to say out there pushing flowers? Elvis. Elvis supposedly has been dead for the last thirty years. He died on the toilet (bonus points in my book) and he shot his TV (more bonus points) and slept with 1,000,000 women (also huge bonus points). Of course, I am not sure what kind of questions I would ask him. I have a few listed below:
1. What were you watching when you shot the TV?
2. In actuality, isn't true that you are a space alien sent down here to impregnate someone with an alien hybrid that turned out to be Lisa Marie?
3. Is God really watching what is going on on Earth?
4. Do you think that you would be famous if you started singing now or would you have been voted off American Idol?
5. Isn't Bill Gates planning to create the super race of cyborg robots that will eventually take over the world and turn it into the Matrix? Wait a minute we are already in the Matrix I withdraw the question.
6. Whose your pick for the NCAA Tournament?
7. Priscilla has duck lips now and looks like she has had way too much plastic surgery. What do you think of this?
8. Hillary or Obama?
9. What was your favorite drug that you used?
10. If you were still living wouldn't you want to burn Graceland to the ground, start hiding in the woods near Cleveland, and mail pipe bombs to unsuspecting PETA members?
11. Your daughter actually married Michael Jackson (another alien hybrid). Didn't you want to come back down to Earth and kill them both with your bare hands?
This interview would seriously be a killer interview. It would be almost as riveting as his last concert in Vegas. You remember that one where he was wearing outfits that clearly showed that he was doing almost every drug imaginable. No sober person even in the 70's would wear outfits that absurd.

A couple of weeks ago I was at a conference in Fairfax, Virginia. The hotel I stayed at was operated by people who wore name tags that said their first name and the country that they were from. The guy who checked us in was from Poland. The coffee shop woman was from Korea. The woman handing me my beers at the reception was from El Salvador. It goes on and on. I went out to the mall that happened to be right across the mammoth parking lot from the hotel. I ate at a Japanese buffet joint that was only frequented by Japanese people as well as a old school looking diner and the wait staff in both places were all from Puerto Rico (and looked like Pedro from Napoleon Dynamite). All of the hotel guests that I could see were Americans. Hmmm. Was it the American dream for these folks to come from other countries to Washington D.C., end up working for tips in a fancy hotel only frequented by rich Americans?

In Fairfax, the conference was for Emergency Services staff and administrators. When I speak of Emergency Services in this context I am referring to behavioral health Emergency Services. These are the folks who intervene in psychiatric and substance abuse related emergencies. We learned at this conference about the knee-jerk legislative response to the Virginia Tech tragedy. It turns out that the Virginia General Assembly changed the commitment criteria as well as tightened up the mandatory outpatient commitment statutes. The language for a behavioral commitment temporarily changed from "imminent risk" of dangerousness to "in the near future" risk of dangerousness. Both wordings are vague, which was to be expected. However, the new language will create more temporary detention orders for mentally ill patients in a currently broken system that does not have enough psychiatric inpatient beds to treat those individuals who meet the current criteria. We heard folks in high places try to tell us that it is uncertain whether or not opening the criteria for temporary detention will result in more patients being detained. This notion is absurd. The term "in the near future" is more broad than "imminent" by a long shot. To say otherwise is quite silly. However, changing the laws for involuntary commitment and mandatory outpatient commitment does not address the core problem that led to the Virginia Tech tragedy which was the supposedly the goal in the first place. The biggest thing that was not addressed by the General Assembly was the fact that Virginia Tech failed Cho and failed it's students. Virginia Tech administrators, police, professors, and students knew that Cho was in a declining psychiatric state. He had frightened his professors and fellow students. He did not participate in classes that required classroom participation. He wrote writings that were increasingly more violent and disturbing. The reaction? Allowing him to remain at the school as a student without mandating treatment. Forcing professors to continue to teach him even if it meant tutoring him one on one. Not contacting his family advising them of the situation with their child when federal law allowed for that contact. The university took the PC approach to risk management and it never works. They were afraid of violating his rights that they made lackluster PC decisions that led to fatal results. The university has the right to mandate treatment, to contact family members when their is a risk for violence, and to remove a student from the school if the student fails to follow the mandate for treatment. You can not take a kid glove PC approach to managing risk for violence. It never ever works. In the case of VT, it didn't. As a result, Cho's condition worsened with no true checks and balances in place to assist him. These mistakes were literally fatal. These mistakes illustrated that Virginia Tech failed Cho and failed it's students. In the end, Cho was a victim, the students and staff he killed were victims, and the university as a whole became a victim. The result of all of these victims? New laws that will result in more mentally ill patients being detained unnecessarily against their will in a broken system that doesn't have the inpatient beds to properly and safely treat them and laws that do not address where the true breakdown in this tragic saga occurred.

Is $42 Million More Enough?

Last week, Virginia Governor Tim Kaine announced his proposal for adding an additional $42 million dollars in help shore help the state's mental health system. The money is designed to add more case managers, psychiatrists, and other staff to the work force of the already overwhelmed and jaded public mental health system. This infusion was in direct response to the massacre at Virginia Tech this past spring. To be honest, I am not sure how I feel about this proposal. The Commonwealth of Virginia after years of budget prosperity is operating at a deficit to the point where the state began cutting operating budgets from five to ten percent. These cuts included the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services (DMHMRSAS). People at that department were offered early retirement, positions empty locked, and positions simply abolished. So on one side to hear a proposal that adds $42 million to the system instead of no increases or cutbacks is a welcome sight. But, is it enough to save a sinking ship? Is it enough to eliminate the problem of the lack of inpatient psychiatric bed space for patients who truly need hospitalization who eventually stay in hospital emergency rooms for 24 to 72 hours at a time waiting for a bed? No, because the money is not meant for addressing the issue. Additionally, the proposed changes in the commitment law to lower the standard used to indicate the potential dangerousness of a patient diagnosed with a mental health or substance abuse condition will increase the number of individuals needing a hospital bed. With no increased bed capacity that will lead to patients who are evaluated and judged as dangerous waiting in hospital ERs and in many cases waiting at home with easy access to guns and drugs. Is it enough to significantly improve outpatient service capacity across the state? No, because there are currently forty community service boards (CSBs) across Virginia. If the $42 million was split evenly across all the boards it would add slightly over a million dollars to their budgets. The smaller Boards would be impacted significantly by this in the positive. The larger Boards would have the infusion of new money be just an insignificant trickle in their operating budgets. The money will likely be allocated based on the size of the Boards thus, sending additional money spread out very thinly across the state. It is also quite possible that the increase in funding for case managers could be offset by changes in Medicaid reimbursement for the service from the current monthly bundled rate to a strictly fee for service system that pays based on fifteen minute service increments. One colleague at a small CSB advised me that this change would result in a $2 million reduction in funds. That reduction would be greater at a larger CSB. In the end, the additional money to add more case managers, psychiatrists, emergency services clinicians, and other staff could reduce the long waiting lists for outpatient care, improve the monitoring and support for individuals in the community who suffer from a mental illness or substance abuse disorder, and provide more doctor time available for psychiatric patients. These are all welcome signs, but is it enough to make a difference? Is it enough to totally stop a Virginia Tech-like massacre from ever happening again?

In the end, I will support the increases as the increases are better than the alternatives. The alternatives are continued scant funding for mental health, substance abuse, and mental retardation services that puts Virginia at the bottom of the country in this area. The alternative is budget cuts that will make matters exponentially worse. The alternative is trying to keep the sinking ship afloat with less and less workers willing to stay in the field trying to shore up the holes. The alternative is ignoring the people that will be affected the most by what is decided: our consumers of behavioral health care.

Anyways, my mother taught me to never bite the hand that feeds me.