Alternatives Program 2-yr
Report
Damon Eaves, LCSW
Program Introduction
• 2003 City & County awarded 2-yr. CA.
Dept. of Mental Health grant to “develop
alternatives for institutions for mental
disease treatment.”
• 2 counties awarded Grants
• Our Primary focus: African-American
males.
African-American Focus?
• 2002 report
“Identifying factors that contribute to longer term
community tenure for L-facility discharged clients
(2002)
2001-2002 Census figures show AfricanAmericans are:
• 7% of population is African-American
• 23% of Adult System of Care
• 28% of residents in IMD’s
• Stay 20% (152 days) longer than non-Af-am
• More likely to return 6 months post discharge
Program Foundation
• Bottom Line: Rarely is anyone in an inpt. or a
locked facility because of their mental illness.
Rather, it’s their behavior.
• Mission: all of our programmatic elements need
to be structured as innovations to
target/change/and resocialize individuals and
support their positive behavioral changes & We
will discover Black culture
• Admin. Agenda: Meet all requirements, get a
budget & have enough left over to make it work.
• Recruitment: Do not rely on system
choice/Dumping
Conglomeration of Risk
Factors
• Primary issue is 80-95% due to social service/family
failures, disparity, inequality & ineffective responses. (for
all race clients).
• Risk Factors: When You interview, you will find:
– Foster Care; Sexual Abuse; Homelessness; Drug
Addiction; Family Separation; Incarceration;
Trauma/Violence/Physical Injury; Medical
Complications; Homelessness; Abandonment;
Temporal Impairment (no future); Dysfunctional
Communities; Incompetent Families; Learning
Disabled; Environmental Hazards; Unemployment
Clients
Engagement, Successes, Setbacks:
B.w. (Housing,Weight Loss, Blackhawk, 290 Reg.)
E.C. (Engagement, Vallejo, Housing, Residential tx. SHA)
D.M.i: (DM Zyprexa, Africa, Crack, Money Mgmt. Meal Purchase))
A.N. (can’t hear $, crack)
L.A. (met couple at airport, College Committee, Program Housing)
E.B. (Zyprexa,Child Molester, Zillionaire)
B.B. (bro at SFGH, hygiene, meth iv)
J.C. (crack baby, lies, drawing, Asperger’s)
M.E.(songwriter, $$, housing, haldol, ran off)
A.P. (haircut resistance, field trips, sense of humor)
I.M. (attacked police car, crack, seroquel, arrested)
W.P, (Wig, 40k & a Cadillac, Soledad Brothers, married.kids, etc)
H.T. (knocked over old man; did anything come through?)
C.V.W.(stable, wheelchair, brain damage (dog))
D.T.(would wander off, family didn’t want in PES, cats have sharp
teeth, rat “delusion”)
Group Types & Cultural
Advantages
• 7 types of groups +special event per month
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Pre-vocational/Vocational Group
Black History Group
Medication/Health Group
Spirituality Group
Black Culture Field Trips
Health & Fitness
• Group Therapy Advantages with African-Americans
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Milieu
Mentorship
Informal Style (worker & client disclosure)
Direct Observation of clients
Relationship building among group members
Semblance to African culture (family, group, clan)
Program Innovations #1
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Mentorship
Breakfast M-F & Meals, (2-3 a week)
Black History Library
Open Door Policy
Vocational Program
Health & Nutrition Initiative/Weight Loss
Integration with Primary Care
Food Bank
Housing (every possible way) SRO, TLC, S+C, SHA, B+C,
Family, Girlfriends, etc
IMD’s
Primary Assessment Criteria: Do they look normal-ish
Primary Discharge Criteria: Do you want to work with us?
Interview them, interview staff, contact family and begin
integration pre-discharge.
Program Innovations #2
Vocational Program modification
– No actual budget for the program
– Vocational monies used for
• Subsidized bus pass program (disabled passes)
• Field Trips, Movie Tickets, Admission, Barbering,
Fresh Produce
• Pre-vocational training (6 sessions $5/hr.) &
Vocational
• CVE Previous relationship was $12,000 to get our
clients to “2nd step”(contract in existence)
• Cultural Celebrations: Kwanzaa, MLK day, Black
History Month, Juneteenth, etc
• Cooperation with law enforcement for decompensation
• Contact and release preparation work in IMD’s
(Cooperation)
I.D.E.A. Consulting
Findings
I.D.E.A.
•Both programs have been highly effective at
reducing the total cost of services to these
individuals. (other program male/female, all
races)
•In comparing seven months of services prior to
enrollment into the program with seven months
following enrollment… San Francisco saved
over $450,000 ( at 1 yr. 13 clients).
Medications & Af-Am’s
ALL medications have side-effects. Sometimes the sideeffect is the medication. (Antipsychotics)
African Americans have…
• Higher risk for disease, injury, death & disability
• Older population, longer exposure to typicals/primary
care complications
• 1.7 times as likely to have DM, death rate 27% higher,
and more likely to experience greater disability
• 60% more likely to become obese (higher BMI at
baseline)
• twice as likely to develop TD than Caucasians
• Increased risk of hypertension, stroke, heart failure, and
kidney disease.
What is Schizophrenia?
Psychosis?
• Problematic Dx. Of Schizophrenia
Freud - Dementia Praecox
Etiology
Shared Symptoms?
Objective Diagnostic Criterion?
“Schizophrenias”
Lack of inclusion of effect of social disparities:
Cultural/Social/Economic Impacts; Over & Mis Diagnosis
• Extinct DSM Debate
Multiple formats existed. Other formats perhaps more
culturally relevant.
Stigma: described vs. defined.
Ambiguity has been (falsely) “eliminated”.
Race,Ethnicity & Power
E. Pinderhughes, MSW
• Client/Worker commonality
• Due diligence vs. “Teaching”
• Advantages & Disadvantages of same race
therapist
• Dimensions of Trust (competence & racism)
• Af-Am Clients Tendencies:
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May Push “Boundaries”
Require an Informal Stance
Ask for therapist Values, Backgrounds or Opinions
Attempt to Discern Competence
Will not engage if Judged or Viewed Negatively
• Continuum of Culture: Denial-AcceptanceEmbracing
Counseling & Therapy
Approach
• Directive Approach
Agenda setting, advice, opinions (sensitive and well-timed)
• Focus on Problematic Behaviors
Maintain Community Living
Direct Confrontation
Crisis Response/Outreach
• Search for Meaning and Metaphor
“Poetically Camouflaged Language”
Believe it, Don’t act on it. (delusions, fantasies, psychosis,
narcissism,etc)
Underlying themes
Groups elicit material on various subjects
A Brief History of
Pharmacology
• Mood Stabilizers: March 28, 1948 Lithium
Treatment Began
• Antipsychotics “discovered”: developed in 30’s,
40’s & 50’s as antihistamines. (noted depressant
side effects)
• Thorazine: 1950-51 Henri Laborit (France) first
used Chlorpromazine
“The patients seemed to become totally indifferent
to their surroundings”
• Anti-Depressant: 1950 first anti-depressant
(tricyclics)
• Economic Impact: By 1955 smith klein made
$75,000,000 on Thorazine.
Black History/Esteem
Group Topics
• Over 200 black themed groups, 90min.
• Politics, Culture, History, Biographies,
Current Events, etc, etc
• What did we talk about?
U.S. Institutional Racism
1619-1865
• 1441-1492-1528-1619 first Slaves Arrive in America
• 157 years later, Declaration of Independence. Jefferson’s
condemnation of British participation in the slave trade. “All
men created equal.” ?
• 1787 U.S. Constitution. 3/5ths clause; 20 yr. Ban on
congress; fugitive slave clause; govt. power to put down slave
insurrections
• 1791 Bill of Rights ( Blacks Excluded, not citizens)
• 1857 Dred Scott; blacks are not citizens, so they can not sue
in court.
• 1865 Black Codes; employed, movement, speaking, virtual
slavery
• Reconstruction: Tunis Campbell, 40 acres/mule
• Civil rights Act of 1866 & 1875 desegregation. (overturned in
1883 (Harlan dissent). Power given to states, Whites had the
right to discriminate)
Institutional Racism
1866-1991
• 13th 1865 (freedom), 14th 1868 (citizenship), 15th
amendment 1870 (vote)
• 1870-71 Enforcement Acts: protected blacks' right to vote,
hold office, serve on juries, and receive equal protection of
laws.
• 1880 Strouder v. West (Juries: axe murder)
• Plessy v. Ferguson 1896 (street car), “separate but equal”
(Justice Harlan)
• Gaines (1938, U. Missouri)
• Sweat v. Painter (1950 U. Texas)
• 1954 Brown v. Board of Ed (I & II) “with all deliberate speed”
• Civil rights Act of 1964 Outlawed Segregation (for the 5th
time) renewed
• Civil rights Act of 1991 (re-affirmed & strengthened) right of
recovery
Institutional Racism
From Slavery to the P.I.C.
• Prior to 1865, blacks constituted the minority of inmates, after
1865, they were the vast majority with convict leasing. 25-45%
yearly death rate. 1878, 92% of leased in Georgia were black.
– Black are 12% of the population and & 13% of drug users. In
2001, comprised 38% arrested for drug offenses, 44%
prosecuted, 59% convicted, sentences 49% longer (than whites).
– 500% rise in incarcerations in last 30 years, 41% are Black
– Black rate of incarceration more than 6 x’s of whites nationwide
– 1 in 3 Black males destined for prison
– Black youth receive life without parole 10x’s over White youth
– Powder Cocaine 5 grams =5 yrs mandatory vs. 500 grams
powder (over 1 lb.)
– Strategic targeting of street level crack use to ensnare blacks
– Whites vs, Blacks: 5x’s cannabis, 4 x’s cocaine, 3x’s crack
[80% vs. 33%]
Institutional Racism
Propaganda & Conspiracy
– Slavery Profit: 500 Millionaires/Mansions in Natchez,
Mississippi
– Felony Disenfranchisement: voting, Grants, Ed. Loans,
Weapons, Jobs.
– Racial Profiling: 1996, New York Superior Court, Blacks 5 x’s
as likely
– Ghetto Creation: 1930’s Redlining, “Little Harlem”; equity
– Suspensions/Expulsions: Nationwide, 35% of black students,
grade 7-12 had been suspended or expelled, vs.15% of whites;
equal offenses
– “Gifted”: Yale University showed that Black students 40% less
likely to be placed in Accelerated classes, and 2.5 times more
likely remedial
– Dropouts to Prison: In New York City 90% of all male prisoners
dropouts.
– Cointelpro: Polictical Assasination, Illegal Wiretaps, Frame-ups,
Domestic Black Ops.
Institutional Racism cont’d
Government & Academic
– Social Security Discrimination (domestic and
agricultural exclusion, Benefits age)
– 2005 NBFA EWG Report: National Black Farm
Workers: USDA 1997 settlement; USDA admission of
denied loand 1982-1996. Black Farm Ownership
decreased from 54,367-29,090. $2.3 Billion Award: but as
of 2005, 81,000 of 94,000 claims denied, (64,000 filed
“after deadline”)only 25% funds distributed. New $20.5
billion suit currently pending.
– 2003 NAACP Report: Normal Af-am boys dx. With mental
disorders; 11 times more likely to be placed on adhd,
psychosis, depression meds; 32% of mild retardation are
Af-am; netherlands report, 62% significant improvement in
diet change within 3 weeks.
– GRE, ACT, SAT: GPA; Gratz & Grutter Decision: No
challenge to lower scoring White Students
Recommended
• ROBERT F. WILLIAMS: Radio Free Dixie, -Tyson
• OLAUDAH EQUIANO: The Interesting Narrative of
the life of Olaudah Equiano
• MALCOLM X: The Autobiography of Malcolm X -Alex
Haley
• FREDERICK DOUGLASS: My Bondage, My Freedom
• SOLOMON NORTHRUP: Twelve Years A Slave