The Post:
Criteria of merit such as the effectiveness of the policy, equity, and their impact on the environment or families can be used to evaluate social welfare policies and programs because they ensure different aspects of the policies are being evaluated before making a decision. Policy advocates such as Social Workers develop proposals to reform specific policies. They typically identify several policy options for addressing a specific problem—and then compare the options to select the best one. They might compare the policy options concerning criteria like cost, effectiveness, and political feasibility (Jansson, 2020).
—
Buckle in, I picked a day for a response to creating policy change through evaluation and I hope this comes across as informative and perhaps helpful 🙂
—
And to clarify – because I recognize where my advocacy gets lost in translation, these are specifically linking to those that are in the “diversion” realm or otherwise for people who have already been falsely accused by police/legal/court systems based on lack of training in how police interrogation and questioning measures harm PTSD-SP/PTSD/C-PTSD/SMI communities at large.
GMH/SU populations are less likely to be harmed/misled by police and COT interventions.
—
Let’s start there.
So, to begin – I am a certified trauma professional. I am SMI disabled. I am a survivor of severe DV/IPV. I have training in DBT, CPT, CBT, IFS, Gottman, Differential Diagnostics, Addictions, LGBT+ Ethical Practices for Clinicians, and Spiritual/Biblical Counseling.
I wanted to express my evaluation of merit for COT policies and procedures.
—
Police measures are “we need an answer and we need it now” which is inherently harmful to survivors. Many survivors not only have overwhelmingly negative memories of police behavior toward them but also meet criteria for one PTSD category diagnosis. This means that… well… see a survivor in trauma, call the cops, force the cops on them, and the cops torment them into an answer and intentionally misconstrue it.
Examples will be police using tactics like “Oh so did you…” or “Well do you know how to….” and then will hover over people and cross arms, roll eyes, and then dissuade them from being able to respond, by standing so close they are pressured to shut down, lean down to assert dominance, and even verbally say “Oh really?” (Note that many of these questions are in a known effort to coerce the mentally ill victim into a pre-concieved notion of what occurred. It is not based on fact or reason, just assumption and bias of faulty data, presentation, and narratives from victim-blaming prosecutors.)
Note that this is a clear violation of power. SAMHSA (2019) issued a whole report about this wherein they acknowledged that it is unethical and an abuse of power to to such behaviors. Such language includes that behaving in such a way toward someone without a criminal charge is unwarranted. Promoting faulty charges to force treatment and to enforce inhumane conditions on someone in crisis is a violation of not only due process, but also non-maleficence (do no harm) and autonomy (the right to choose treatment). It is a clear violation of ADA of 1990 and general civil rights. This thoroughly demonstrates my clinical advocacy toward this step of policy and procedure in COT being dissatisfactory and abusive.
When you fight this in court (and may you be blessed in victory) not only will the fight be very challenging, but prosecutors are offended beyond recourse when you, an SMI human, call out their police for abusing you. This is kind of silly (mostly a stunning revelation). I thus add in many advocacy statements the following sentence, “Are you just privileged enough to be respected under the law?” See, I provided many definitional statements about myself in my opening statement.
What the court will hear, or rather, what the prosecutor uses for someone like me is “you are making up you’re SMI; no one who’s SMI is successful at that; no one with SMI history is like you”. I am an anomaly, sure, maybe? So they go, then, “Well, COT should be a fair middle ground, we don’t feel ok dismissing our abuse of power on SMI people”.
Public Health Services (2024) mentions then my secondary advocacy complaint. Section 51.23, subsection b, expresses how the board in the legal system shall be comprised of competently trained experts in the mental health domain. While my argument rests firm that it began with police being ill-trained, it extends to district attorneys fighting that it can’t be that way; 4 hours of crisis training makes police experts. Then COT programs have an array of professionals.
I again, would like to reiterate, that COT is not harmful in that it exists. It is harmful in how it exists. It is harmful in the policies allowed to enforce it upon people.
Considering COT is for people who were criminalized into treatment, we’re capturing a very finite group of clinical skills. I mean this kindly and professionally. I worked in COE/COT agencies. Very talented and skilled people. Yet, and this not a brag, just a statement of fact, I was maybe the only person out of 60 of us who knew how to treat DID, C-PTSD, PTSD-SP, and psychosis from a standpoint that worked in both a crisis and long term model. My supervisor knew this.
COT/COE and traditional COT captures the GMH/SU populations. This is who it is actually meant for. SMI clinical work is not for the faint of heart, and is not for people who don’t understand that SMI clients have spent oftentimes years fighting to be validated, heard, listened to, and respected. GMH/SU can put up with COT programming. Many of these clients are in the acute disorders category, diagnostically, clinically, and realistically. Acute disorders allow for a plan of treatment to be standardized. It’s generally agreed upon in research for crisis management. (i.e. short term is OK)
SMI clients are in chronic condition. They cannot put up with programming. Group therapy is often going to be worsening, and not always due to the idea of that it’s a group – but that… chronic conditions need more than a blip of processing. Chronic means “I am always turned up to an 11”. That’s the baseline. It’s a different skill set of clinical practice. (i.e. long term is necessary)
SAMHSA (2019) mentions how “Commitment practices should respect the privacy and dignity of the individual. Every effort should be made to minimize trauma. If law enforcement agencies are responsible for transporting individuals proposed for or under order of commitment, they should assign plainclothes officers in unmarked cars, whenever possible. Shackles and other restraints should be used only if necessary, never as a matter of routine” (p 33). This is in respect to transporting of inpatient, yes, however, extending this to practices in holding for assessment is also abusing power.
COT is aggressive in that their methods to ensure people complete it are enforcing abusive patient rights, denying the right to alternate care and citing explicitly false laws and statutes to get out of it. They aren’t trained trauma professionals. It’s OK, but there’s a finite difference between someone who knows behavioral management strategies and techniques and someone who does long term clinical services on a therapeutic level across a spectrum of issues to account for biopsychosocial and outside issues. As it stands, COT (and this is actually a standard of practice) validates reality therapy. This is a method which states that your behavior is always a choice and could never be the byproduct of mental illness or outside influences.
SAMHSA (2019) explicits the following regarding COT: “Civil commitment should never be used solely for preventive detention or community control. Treatment staff should have the authority to terminate commitment without the court’s authorization and should terminate commitment as soon as the individual progresses to the point where he or she no longer meets commitment criteria. No court should insist that a hospital or other treatment provider retain an individual in services at a level of care that the hospital or provider believes is unnecessary. Before terminating an individual’s commitment, treatment staff should arrange appropriate services and supports for the individual in the community” (p 33).
In COT utilizing these practices from start to finish, and me, being an advocate extrodinaire (who is well aware of all of these extremely absurd ideas that are actually quite embedded in legal discourse as unethical and unallowed), I have been advocating across several platforms to be heard, understood, and recognized as someone who was blamed and deserves to not be villainized.
I know many of you (on this interwebs/who follow me across platforms) work in courts and law, and I don’t think you all are bad. I actually think you all have too large a scope of practice for the job as defined. My evaluation is as follows:
- Efficacy? Well – technically, yes it is highly efficable. We are very much 100% effective in getting people to enroll treatment – that’s what involuntary means, tbh. However, if the efficacy is contingent upon a removal of rights and forceful behaviors that cannot be fixed and stay on a permanent record, that is abusive. COT also is full of many people who are nice but very insistent that my lived experience is not true, but I was there, and I lived it, and just because I am SMI does not mean I don’t know what went down. It’s gaslighting the victims of police violence.
- Impact? Mixed bag. Police traumatizing people is horrific. COT helps some people. I’ve seen some people feel heard. At times I felt it was tolerable. COT often provides uninformed ideas of what victims get told from abusers, and then they repeat it to survivors who were victim blamed and re-traumatize them. Advocacy within COT is about as horrific as within hospitals, so the impact is SMI clients get maybe more freedom but less ability to define their treatment.
XOXO,
Dorothy B
—
References
Jansson, B. S. (2020). Social Welfare Policy and Advocacy: Advancing Social Justice Through Eight Policy Sectors (2nd ed.). Thousand Oaks, CA. SAGE Publications. ISBN-13:9781506384061
SAMHSA. (2019). Civil commitment and the mental health continuum of care: Historical trends and principles for laws and practice. https://www.samhsa.gov/sites/default/files/civil-commitment-continuum-of-care.pdf
Public Health Services. (2024). 42 CFR Part 51. https://www.ecfr.gov/current/title-42/chapter-I/subchapter-D/part-51
Just Ask 