Gerald:

I’m challenged to discuss this publicly. I’ve let it sit for a while.

One of the most ardent and successful supporters of the ‘PACT’ concept is Ex. Dir. of L.A. County’s Mental Health Assoc. Dick Van Horn. He was and continues to be the chief lobbyist to people like Steinberg, in selling this model of treatment.

I didn’t know this. Obviously it makes my case so much the stronger. If Project Return and the L.A. County Clients Coalition are that much beholden to the PACT agenda, that doesn’t help.

One of the interesting but oblique references in the Little Hoover Report was that this system of delivery, or model, being new, has not shown any definitive difference in outcome versus either [the] medical model (HMO-County M.H. delivered services) or even the kind of non-traditional providers like Lamp, who have single source contracts but are continuum of care. Which [is what] had to qualify you for the RFP for these programs.

The point is that the state is moving in the direction of the ‘PACT’ — either voluntary or involuntary capitated services. That’s x amount of dollars for all the services.

In the early 90s I helped lead a struggle on the CALM Boards where I was working with client activists from around the state who were some kind of ‘policy wonks’ which is what made them hang on on the MHB/C’s and take abuse from NAMI there. Details. I found that there were sympathetic clients leading the Network’s main committees — Public Policy and Self-Help, who had the guts to support the work that I and others (Pat Risser, Maxine Hayden, Carol Moss, etc.) were doing. But the 1995 Forum became the vehicle for

1. the betrayal of the CALM clients’ defense against NAMI’s attacks
2. the political destruction of those two sympathetic clients
3. a broadside attack against any clients who weren’t cooperative with the “PACT is in, NAMI has the upper hand” accommodation scene.

This seemed uncool to me. But others got in a rage and decided it was occasion to try to smash and destroy the Network. That gave the Network leadership something to do, but me, I ducked for cover. I didn’t want to be party to that kind of a negative solution.

The problem is, .. find a positive solution. The present arrangement ain’t it.

What troubles me is that the state will see these kinds of pilots as “successful.” [And] they will, as we already have “cherry-picked the enrollees” to insure they have good ‘outcomes’ to continue leveraged funding.

The problem on the voluntary side is if the state likes the model, and they appear to, it gives more credibility to the programs like the Village ISA in Long-Beach, and they will start to reproduce. The model is very dangerous, and quite frankly, disempowering.

Well I see it like you call it. But others on this list will disagree with us, I guess.  :-(

Van Horn is a good PR man, and has excellent connections. The problem is not what is the best model, as opposed to how the model works. The values, philosophy, respect, and amount of accountability and dignity that can be incorporated into these models is what we fight for.

This is an up-hill battle for reform.

My friend Sisyphus is real good at pushing rocks. [That’s a reference to Camus’ Vision of existentialism.]

The system has to be much more flexible, and it isn’t. The values and philosophy and vision need to be [transmitted] to consumers, to first educate them to what else might be available on the idea table, and encourage them to get involved in the decisionmaking process. My thoughts and feelings about the Council and M.H. Commission are negative, because I see them also as an act of futility — the advice goes nowhere. They take us through a legally mandated process, and that’s about it.

Well it’s a mire, and excruciatingly hard to work productively. We have been well trained to tokenized working conditions. Yuk! You can bet pot-hole advocates would never stand for CalTrans acting like DMH acts with us.

The consumers, ourselves, [we] have to be responsible to educate the masses [and] the politicos. By creating the little cells like the Accountability Caucus, in order to rally the troops and facilitate change.

Well, my Vision is like that. But I’d take exception with the idea that the Accountability Caucus is meant to be a ‘little cell’. It is meant I think to be a spark, a work process so that we = the whole clients movement can transition to a higher level of action & responsibility. I don’t care if this gets called the ‘Accountability Caucus’ or whatever, as long as it is real, and not just a cover story for something else. (Such as, they say ‘recovery’ and they mean ‘more of the same’, with a cosmetic fix.)

You have a good heart, my friend.

Respectfully

Andrew