Politics of Bush's New Freedom Commission
The following provocative piece comes from national c/s/x
advocate Laura Van Tosh.
The Politics of Bush’s New Freedom Commission on Mental Health
& The Promise of Olmstead
By Laura Van Tosh
Politics surrounds just about everything, and the President’s New Freedom
Commission on Mental Health is no exception. We in the disability rights
community need to be alert to the political opportunities it offers.
The following ideas about the Commission reflect the need for a smart strategy
that transcends our desire to "fix" problems or fundamentally alter a paradigm.
The Commission is part of the New Freedom Initiative (NFI), a massive program
with resources scattered across numerous federal agencies. The NFI was conceived
by the Bush White House during the first months of his term.
The Commission has a relatively narrow charge: to "improve the system" compared
to similar efforts in years’ past. In this case, this august group of experts
has one year to produce a report to the President under the following mission:
The mission of the Commission shall be to conduct a comprehensive study of
the United States mental health service delivery system, including public and
private sector providers, and to advise the President on methods of improving
the system. The Commission's goal shall be to recommend improvements to enable
adults with serious mental illness and children with serious emotional
disturbances to live, work, learn, and participate fully in their communities.
http://www.whitehouse.gov/news/releases/2002/04/20020429-2.html
While the large national mental health organizations are pleased with the
announcement of the Commission, they should not expect much in the way of major
reform. The Commission’s stated mission and objectives do not lend themselves
towards a fundamental alteration of how mental health services are delivered or
financed. Recommending "improvements" and comprehensive "study" are the
operative words in the mission statement. Wholesale change is not in the
equation.
So, realistically, what will the Commission accomplish in less than a year? What
political impact will the Commission’s findings have? More importantly, will the
Bush administration provide resources where we need them, or will the
administration reinforce the status quo and simply say they have done something
about mental health? These and many more questions will certainly be asked over
the next several months and beyond.
One major reform, the struggle for mental health parity, is not a popular issue
for states that will have to provide more services with little or no increase in
resources to pay for them. Private-sector insurance premiums are also predicted
to go up, leaving many uninsured people to seek help from public mental health
authorities. Yet advocacy organizations such as NAMI, the National Mental Health
Association, and the Bazelon Center for Mental Health Law seem to be holding
their breath, hoping beyond hope that parity will be the victory the mental
health field has been waiting for.
Unfortunately, parity will not solve the problems of warehousing or dumping
people in state psychiatric hospitals because there is inadequate affordable
housing and community-based mental health services. Parity will not solve the
high unemployment rate among people with psychiatric disabilities who are afraid
to risk their SSI because they cannot get commensurate healthcare insurance in a
minimum-wage job. Parity may scratch the impenetrable wall of stigma and
discrimination in the healthcare sector, but it will do nothing as long as
governments continue to perpetuate a system that rewards discontent, despair,
and dependence instead of recovery and well-being.
Implementation of the landmark U.S. Supreme Court decision in Olmstead v. L.C.
is our best hope. It affords us the opportunity to make substantial headway from
a human rights and political perspective. The crux of the Olmstead decision – to
end discrimination and segregation – is the rallying cry of people with
disabilities and elderly people who live in nursing homes rather than in their
communities, people with psychiatric disabilities who are detained in state
psychiatric hospitals but ready to be discharged, and children who should not
become the next generation of "adults with severe and persistent mental
illness."
In Olmstead, the Supreme Court ruled that unjustifiably segregating individuals
with disabilities may constitute discrimination based on disability. The court
ruled that the Americans with Disabilities Act may require states to provide
community-based services rather than institutional placements for individuals
with disabilities.
However, Olmstead, based on the Americans with Disabilities Act, has not yet
been sufficiently addressed by state departments of mental health. Given the
Bush administration’s support of Federalist principles, under which the federal
government cedes most powers to the states, how can community integration, the
basis for the Commission’s work, succeed?
President Bush called for "the swift implementation of Olmstead" when announcing
the New Freedom Initiative on February 1, 2001. The NFI connection is perfect.
It gives us the opportunity to bring the Olmstead mandate to the mental health
community, at least on par with the effective advocacy efforts of ADAPT, the
American Association of People with Disabilities, the Disability Rights
Education and Defense Fund, ADAWatch, and other disability organizations.
Olmstead gives us the chance to develop a real game plan with a long-term
political strategy that is winnable, not simply political.
The time to implement Olmstead is now! Politically, the Bush administration is
vulnerable on several fronts, including the atrocities of homelessness, large
urban jails that are now called state hospitals, decaying mental health
programs, and policies that promote dependence. Admittedly, these problems have
plagued every presidency; but the problems are now on the doorstep of the Bush
administration, and the administration must take on some of the responsibility.
Hence the birth of the NFI and the subsequent creation of the New Freedom
Commission on Mental Health.
One can clearly see the Federalist principles reflected in an Executive Order
issued by the White House on June 18, 2001. The following passages from
President Bush’s order clearly lean towards giving states discretion in
implementation. For example, states "must avoid…discrimination," but are not
told that discrimination is prohibited.
(c) Unjustified isolation or segregation of qualified individuals with
disabilities through institutionalization is a form of disability-based
discrimination prohibited by Title II of the Americans With Disabilities Act
of 1990 (ADA), 42 U.S.C. 12101 et. seq. States must avoid disability-based
discrimination unless doing so would fundamentally alter the nature of the
service, program, or activity provided by the State.
(d) In Olmstead v. L.C., 527 U.S. 581 (1999) (the "Olmstead decision"), the
Supreme Court construed Title II of the ADA to require States to place
qualified individuals with mental disabilities in community settings, rather
than in institutions, whenever treatment professionals determine that such
placement is appropriate, the affected persons do not oppose such placement,
and the State can reasonably accommodate the placement, taking into account
the resources available to the State and the needs of others with
disabilities.
http://www.whitehouse.gov/news/releases/2001/06/20010619.html
As stated below, the Commission is required to follow Federalist principles
in making recommendations to the President. Two members of the Commission are
directors of state mental health departments and represent important states in
the Electoral process (California and Ohio), and one of these two individuals
chairs the Commission. It is also noteworthy that both of these states will have
gubernatorial elections this fall.
(e) The Commission shall follow the principles of Federalism, and ensure
that its recommendations promote innovation, flexibility, and accountability
at all levels of government and respect the constitutional role of the States
and Indian tribes.
http://www.whitehouse.gov/news/releases/2002/04/20020429-2.html
If states "must avoid…discrimination" but are not strictly prohibited from
discriminating against people with disabilities, and Federalism is driving the
process, what hope is there to see Olmstead fully implemented? In other words,
if some people can be let out of institutions and others cannot, how will we
protect Olmstead from becoming a fragmented promise for freedom?
Get Involved
Politically, people with disabilities must get involved in the process. As
Justin Dart said, "Get into politics as if your life depended on it. It does." A
strong turnout by people with psychiatric disabilities can set the bar for the
presidential election in 2004. Get trained to register voters, work the polls,
and volunteer for good candidates. In September, three counties in Maryland will
be using touch-screen-voting technology. Find out if your voting place and
voting machines are accessible now!
Getting involved in politics makes a difference. I am working to help elect Mark
Shriver (D), running in the 8th Congressional District in Maryland, because I
know he cares deeply about our issues. He also has a solid grip on other issues
of concern to all voters, such as healthcare, economic justice, and national
security.
We are six seats shy of a Democratic House and we have not been in the majority
for a very long time. The elections on November 5th may result in major changes
for Democrats and our nation. If this is the case, a Democratic House and Senate
will be more likely to embrace disability rights, among many other issues we
care about, such as confirming federal court judges and Supreme Court Justices.
The Commission will be several months into its work after the elections but not
quite finished. The likelihood of holding House hearings on the final
recommendations will be greater if the Democratic Party leads the House. The
work of the Commission may take on a different spin after the elections, and it
will be important to keep tabs and relate preliminary findings to your local and
state political leaders and policymakers. Don’t forget your public housing
authorities, too.
Olmstead planning at the state level is nearly complete. Implementation of state
plans should be well under way. Get involved. Attend meetings in your state that
are relevant to implementing Olmstead. Go to meetings with your peers and
discuss strategies in advance. While Federalist principles diffuse national
policy until perhaps the 2004 election, use your home state as the playing field
to make Olmstead real! Our lives depend on it.
Useful Web Sites
http://adawatch.org
The ADA WATCH campaign provides support to the ADA WATCH coalition, a network
of disability rights, service, and consumer organizations united to protect and
strengthen the Americans with Disabilities Act (ADA). ADA Watch continues to
monitor the threat of Federalist ideology and it's impact on civil rights and
the enforcement of the ADA.
www.Olmsteadcommunity.org
The National and Statewide Coalitions to Promote Community Based Care
supports state participants in this federal initiative, and to provide useful
information to other individuals and organizations involved in efforts to
promote community based care for adults with serious mental illness and children
with severe emotional disturbances.
http://www.aapd-dc.org
American Association of People with Disabilities
AAPD's Disability Vote Project advocates for meaningful election reform. The
Disability Vote Project gets out the disability vote, focuses on polling place
and voting system access, encourages disability service providers to comply with
the provisions of the National Voter Registration Act, and encourages people
with disabilities to run for office and to get involved in the political
process.
http://www.adapt.org
Nationally ADAPT focuses on promoting services in the community instead of
warehousing people with disabilities in institutions and nursing homes.
Attendant services (help with things like eating, dressing, toileting, moving
from wheelchair to bed, etc.) are the cornerstone to community based services
for people with severe disabilities. ADAPT is working to get 25% of the Medicaid
long term care funds redirected to pay for a national, mandated attendant
services program.
http://www.hhs.gov/newfreedom/final/
New Freedom Initiative Final Federal Agency Reports from nine agencies
including Department of Housing and Urban Development, Department of
Transportation, Department of Education, Department of Health & Human Services,
among others.
http://www.dredf.org/
The Disability Rights Education and Defense Fund, Inc. (DREDF) is a national
law and policy center dedicated to protecting and advancing the civil rights of
people with disabilities through legislation, litigation, advocacy, technical
assistance, and education and training of attorneys, advocates, persons with
disabilities, and parents of children with disabilities.
http://www.democrats.org
The Democratic National Committee’s Disability Outreach Initiative reflects a
renewed commitment to work closely with the disability community to preserve and
build strong, enforceable, disability civil rights legislation, to ensure that
people with disabilities can participate in all activities and levels of the
Party, to build a communications infrastructure that allows the DNC to talk to
millions of Americans with disabilities about the issues that they care about,
and to ensure that the voter turnout of individuals with disabilities across the
country in upcoming elections is at its highest level ever.
Source:
http://www.madnation.cc/issues/freedom/vantosh.htm
This "Mental Health E-News" posting is a service of the New York Ass'n of
Psychiatric Rehabilitation Services, a statewide coalition of people who use
and/or provide community mental health services dedicated to improving services
and social conditions for people with psychiatric disabilities by promoting
their recovery, rehabilitation and rights.
To join our list, e-mail us your request and, where
appropriate, the name of your organization to
NYAPRS@aol.com.
Save these dates!
September 10 - 13, 2002
NYAPRS 20th Annual Conference Celebration
'Now More Than Ever: Hope, Healing and Recovery'
at the Nevele Grande Resort, Ellenville New York
contact: Mary McLaughlin, NYAPRS
1 Columbia Place Albany, NY 12207
(518) 436-0008; fax: (518) 436-0044
