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Transcript for September 2013

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Everyone welcome, it is the [Inaudible] I know the building's not exactly the same as when you worked here as students, but it's great to have you back. And I'm very happy to have our guest presenters for today, Lisa Turow and Lisa Hurley [assumed spellings] disability rights for California. And as you may know, disability rights for California is the cap [Inaudible] for DOR. And if you lost [Inaudible] work out of that have, that would be the right people with disabilities. So I think in terms of a resource for work that we do to get more knowledgeable about this area, our presenters will give us some very valuable information and specifically working with people with [Inaudible] Hashi [assumed spelling] disability and they get [Inaudible]. So that is being co-sponsored by the [Inaudible] Thompson program. They're also our student association, the [Inaudible] Thompson student association. So if you're currently a student and you're thinking about go to one of these special day shows, we all going to spend some time later today having some presentations about the special day [Inaudible] within our program. And so it's a good chance to learn more about that as well. But again, Lisa, thank you much for being here and so Chlora's [assumed spelling] so whenever you're ready. So welcome.

 

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>> [Inaudible] I just wanted to share our graduate from this program and also we are the facility rights of California is the federal [Inaudible] agency for the state of California. And once I started working for them I discovered like what, how many resources we have. And I realize perhaps it was mentioned when I was a student hear it or didn't really know about it, but I think that in the work that you do and your studies, we can be a real resource. I'll let Alayda [assumed spelling] take it away

>> So we're going to talk about just a little bit of history of protection and advocacy and a little bit about our services here in California. And then Lisa's going to take over to talk about our, particularly our CAL Mesa Project, and then a presentation about [Inaudible] discrimination.

 

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So back in 1975 there was a television news story done by Geraldo Rivera, some of you may have heard about it, and it basically, was a news story about abuse and neglect at Willowbrook, the institution for people with cognitive disabilities New York. And after that, there was a period of stories came out, there was a push from a senator to mandate a [Inaudible] which eventually was called "protection and advocacy" to allow an agency in each state to protect the rights of people with disabilities. And so each state has a agency that is funded through the protection and advocacy funding system. So each state has a PNA, they're not necessarily called protection and advocacy. Once [Inaudible] disability rights California was simply referred to as California's Protection and Advocacy. People refer to us as PNA or PI.

 

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And then, gosh i want to say maybe 4 years ago, we changed our name to "Disability Rights of California." But one of the most important things that the law did, in when it created the PNA funding, I'll refer to protection and advocacy as PNA, it's a lot easier, was to allow the PNA to have access to facilities or programs that are providing care to people with disabilities and to access their confidential records. So our abuse and neglect unit actually goes out and does investigations and they do have access to a record. And this permits us to conduct abuse and neglect investigations. We also have access to go in these facilities to provide information and training about the rights of individuals with disabilities and monitor a facility or program's compliance with respect to the rights and safety who may see their services. We also are unique because the courts have recognized that the broad congressional authority allows us to bring actions in our own names to vindicate the rights of people with disabilities. So in May of 1978, the California protection and advocacy was founded.

 

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And for many years it was governed by 7 member board of directors appointed by the governor and advised by a state pointed review committee. Right now we have offices in Fresno, Sacramento, Oakland, Los Angeles, and in San Diego. But we also have small satellite offices, for example in Riverside and some other parts of northern California, I can't name all the counties, out there, we receive about 2,000 calls a month from people asking us for help. And the range of assistance that we help, is broad and I'll go over that in just a minute. But originally, although we started out with a fund to assist people with developmental disabilities and mental illness, eventually the funding expanded to help people with disabilities, all people with disabilities. And we also have grants that focus on specific issues. For example, the client assistance program that allows us to help people who are clients of the Department of Rehab, and are trying to access service or are getting services and maybe have some issues or questions about their rights to services. Any questions so far? Okay, yes

 

 

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>> You said [Inaudible] address specific issues,[Inaudible] even [Inaudible] facilities like jail.

>> We actually do have a case pending in litigation [Inaudible] know the name of it. I wrote down the name. We actually have a case called "Johnson versus Los Angeles County Sheriff's Department," it's a federal, the status of it here, because "federal court approves class action status for lawsuit by prisoners with physical disabilities against Sheriff Locka [assumed spelling] and L.A. County Jail." So, yes, we have addressed issues in correctional facilities related to disabilities, people with disabilities.

>> Are you able to access those records also?

>> You know, I don't know if that's necessarily what we've done in that particular case or if that was necessary in that particular case, but I would imagine that we do have that right . [Inaudible]. Did that answer your question?

 

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>> Yes.

>> Okay, so some of the assistance we provide, information referral. Sometimes people call us as a resource, as a first stop to find out what can I do about this particular issue. And sometimes it's providing them information and a local resource that can help them. We create a lot of self-help material. If you go to our website, I'm sorry, just feel like I haven't been changing this [Inaudible]. California's Protection Advocacy system carries out our mission statement, advocate, educate, investigate and litigate [Inaudible] and protect the rights of Californians with disabilities. Let's see where we're at. And here's our vision statement. We envision a better free inclusive diverse world that values each individual on their voice. In this world all people with disabilities enjoy the power of equal rights and opportunity, dignity, choice, independence, and freedom from abuse, neglect and disformation. So as an advocate, what the, basically the mantra that we follow when we're providing services.

 

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Okay. Sorry about that. So, as I was saying, we do have a lot of self-help materials on our website, and I did bring our brochures that, it has our toll free statewide number. And it has our website, I'm not sure if it's included in the PowerPoint, but in case it's not, it's on the world wide web, disability rights ca dot org. And there is also a Spanish version. If you look at our website, almost all our publications are translated in common languages in California, Chinese, Korean, Sugali, there's one more, of course Spanish. So we actually have a website completely in Spanish. Because we get so many calls and issue, comments, calls and issues about sort of a thing issue, special education, in-home supportive services, Department of Rehab, we create a lot of publications, fact sheets about those services so people can learn, be informed and understand their rights to act within any of those services. For example, the in-home supportive services, the people have to be able to track their hours or time that they want for each service that they may get funded for. And so there is a publication we created to help find to track that time. We have, we also provide training to the community.

 

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We provide training to Spanish speaking support groups, support groups of all kinds, a lot of parents that join support groups to help themselves information the rights their children may have in special education and Medical, in home supportive services. We have a public policy and legislative unit where we do do public policy and legislative advocacy. We have advocates at the 8 hospitals actually located there. And one of the [Inaudible] that we also have allows us to also assist people who are clients of the regional centers, so we actually have an advocate at each of the 21 regional centers. Not necessarily located in the regional center, but a regional center San Diego client's rights advocates is located in our regional office in San Diego. But for example, in, we have, although we have a regional office in LA and San Diego, our clients rights advocate for inland which covers Imperial, Riverside, and San Bernardino county is located there in Ontario. We also provide legal advice to people, it could be that people just want to be informed what their right is.

 

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They need to access certain services or maybe what their rights are to question reasonable accommodations in the employment setting, or maybe in the school setting, so we can provide legal advice on those issues. And of course we do direct representation of clients at different type of service agencies. For example, special education, it's possible that we might assist someone at an IEP. It's possible that we might represent someone at the IPP which is the individualized plan for employment, I'm sorry, individualized curriculum center plan who are clients of the regional center, IPP. And we also do [Inaudible] litigation. One of the examples that I gave earlier was Johnson versus LA County Sheriff's Department. And Oscar versus Lightborn we initiated a lawsuit against the 20% across the board cut in home supportive services. If you're interested in knowing about these particular cases, they're all updated on our website in our advocacy services section. And you can see across the state the different types of cases that we're currently handling. So we recently, about two years ago, 2012, we were provided with a grant from Department of Rehabilitation, we bid for it and got it. Which is the client assistance grant.

 

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As I explained earlier, this particular grant allows us to assist clients of Department of Rehab, whether they're trying us, receive services, become eligible for services or if they're currently clients of the Department of Rehab and they call for advice and they call us for representation. And they may call us to just understand what's going on with their case. And originally, the Cap [phonetic] grant was given to the local, independent living center, but as of 2012 we were able to bid for the grant and were able to get it. Another grant that Social Security has given to us that assists people with return to work is Pats [phonetic] grant, protection and advocacy for beneficiary for Social Security. And this grant are able to assist clients who are currently receiving Security benefits and are being trained to work and maybe are experiencing barriers to employment. So this could overlap with a client of the Department of Rehab, who's maybe having service issues with the Department of Rehab or understanding the Social Security work rules. How do, how does working and earning income, how is that going to affect my benefits? So we have a lot of publications on that topic because we do get a lot of calls on that and we do do presentations on that. And that's the area that I specialize in. So I think I went through this list of general CRC services.

 

>> If you want to give examples of them in more, like research,litigation

 

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>> I could give more examples okay, I went on our website and I can paste the names of some of our cases. The Darlene case versus Toby Gezert [assumed spelling], who's the Director of California Department of Health Care Services, we sued when people with disabilities were, their adult day healthcare program was actually taken away, a service that was basically discontinued. In Napper versus County of Sacramento, there's a lawsuit to preserve community-based mental health outpatient clinics. So Sacramento was actually going to terminate these types of services and bring suit to keep that, keep the county from doing that. In Hall versus Mimm [assumed spelling] a case against Fresno jail for its psycho-medical health services for prisoners with disabilities. In AC versus Schwarzenegger, a lawsuit to preserve mental health services for California Special Education students. And in Streets Fellow [assumed spelling] versus Sacramento County, a case to prevent restraints of dialysis patients in Sacramento jail. In this last case, there was inmates who were actually routinely placed in restraints while receiving dialysis at the Sacramento County jail. And then we actually did have a lawsuit against Social Security Administration to prevent denial to people who are suspected of fleeing prosecution, there was a provision in the law that prevented people with outstanding warrants of getting benefits. And there was a lot of mistakes on those

 

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>> People [Inaudible] were getting their benefits [Inaudible]

>> So those are just some of the cases, I mean I could have gone on and on and on but I brought out the ones that I thought you'd be interested in. So does anybody have any questions? So what I bought today, I bought a copy of the presentation that also was emailed to Chuck and was emailed to everyone. I brought our brochure that has all our contact information. It has our statewide toll free number, a little bit of information that I provided here today as well, and then I also brought our client assistance [Inaudible]

>> Thank you, Lisa [laughter]

>> Our program or cat brochure, that specifically is for clients trying to receive services or already receiving services from the Department of Rehab. So, any questions?

>> I know you provide advocacy for people with disabilities, do you ever consult and work with the office of Civil Rights, public positions and community colleges or universities, do you work offer both sides right there?

>> Yes, yes, yes, yes we do.

>> So we might be contacting sides on somebody who is receiving DSER [phonetic] services or sometimes I think a DSS [phonetic] counselor is contacted for questions, both.

>> All right, well thank you, Lisa's going to continue

 

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>> So, hi, I'm Lisa Nurley [assumed spelling] And I was hired specifically a peer self-advocacy coordinator and as such I'm a person with [Inaudible] experience. [Inaudible] as a mental health disability, psychiatric disability, and this, I'm doing two different things. One thing I do is I teach self-advocacy groups at [Inaudible] houses locally teaching people to advocate for themselves. And the other part of my job is to work for is doing stigma and discrimination reduction for [Inaudible] Prop 63, [Inaudible] Prop 63 was commonly referred to as the millionaires tax. It taxed people who were over a million dollars, didn't affect me personally [laughter] a lot of people Social Services were not affected either. What it does is it set money aside for innovative programs and one portion of it is working towards stigma and discrimination reduction. So, this is sort of the objective of this project is sort of to stigma and discrimination by addressing all different kinds of aspects of stigma discrimination.

 

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So one of the things that we might get involved in is the trying to change legislation like we were talking about before. But even changing simple things like language in codes, there are still like in California codes, they're not talking about forensic or criminal code, they still refer to institutes of mental disease, the feeble minded, insane. These are all terms that are still like in the code. That's like one of the things that we're some of the attorneys are working on changing that. that's going be separate and distinct for a vehicle from, there is the criminal term of "not guilty by reason of insanity, "but that's the only time really that that word gets used. We'd like to get that word out of any other space. So we know [Inaudible] discrimination [Inaudible] health services is all different ways culturally relevant, [Inaudible] disability providers as well as the general population. And as such as have, I'm sorry I'm having difficulty, again it's by laws.

 

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And writing policy papers that [Inaudible] to reduce [Inaudible] discrimination. We work with other agencies and [Inaudible] move toward the other stuff, the other agency to work [Inaudible] children and families. Student mental health initiative there's like two site prevention things and try, because one of the things is student [Inaudible] prevents people from seeking the services that they need. So the more we can reduce stigma one of the main things we're trying to do. So this part is going towards prevention and intervention. So, again, some of our other partners are NOMI, which are [Inaudible] mental illness, [Inaudible] America, [Inaudible] association of San Francisco, some of the bigger providers. Dan, like the CRC, we have fact sheets out there. I have a list, sorry, [Inaudible] that's an example of the fact sheets that we have that related specifically to this branch, Cal Mesa discrimination reduction. So we've got fact sheets about employment and landlords and these are some of the groups that it's my job to sort of reach out to, to [Inaudible].

 

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And I only brought one of our fact sheets because we have so many. But this is for your [Inaudible] this is just an example of, as Lada [phonetic] was discussing before you can see very clearly that we have things in multiple languages. So it's really, we're trying to make it accessible to the residents of California. Again, so we've been training that's my job to do some training. Then the SBR filter [Inaudible] language change in language and stuff. And then policy papers about things that we want to change. So these are, again, some of the fact sheets. These are some of the people that we want to do trainings for, employers, those of you, I know we've got people here in the audience here like me work in the employment [Inaudible] for people with psychiatric disabilities. Lots of stigma there, lots of this need for some training. But having providers and there's a host of services.

 

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Public defenders, last Friday I [Inaudible] visitation to Orange County Bar Association. Advanced psychiatric directives. The differences the need for this because there's an area of need for people to have advanced [Inaudible] particularly psychiatric ones are a little different that regular advance directive, they have certain components to them. So these are just again reviewing legislation, regulations and policies, we're looking for things that increase stigma and we're trying to find things that will reduce stigma. And I'm just going to kind of flip through these. These are some of our policy papers in [Inaudible] I don't know if you know what that means. It's "not in my backyard." Big thing with like community mental health centers, big thing with people living in safe border care, or independent living associations, it's this big push back from the community on those type of things. So, again, they're developing a paper on first responders. A lot of people with mental health concerns have said that they have had real negative interactions sometimes with police and sometimes it results in trauma. Have people getting handcuffed and putting back in the car, when really what they needed was somebody to talk to.

 

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[Inaudible] we've got perps, which is the psychiatric emergency service response team which means that it's not just an officer coming out. It's an officer and a trained clinician. So that's a, considered an innovative program and it's been modeled I think in other, it's being taken as a model for other cities and states. And maybe training just general officers a little bit of mental health first aid, reducing stigma stuff. So that they're helping people in crisis and maybe not having to do some of the more extreme things, which are taking people to jail. So this is like another one of our papers talking about [Inaudible] from hospitals and instead of going to the hospitals, [Inaudible] we've got crisis centers and what can you do afterwards, after someone's in the hospital. What kind of things can you do? [Inaudible] the least restrictive environment very much applies to psychiatric disabilities. People integrated as much as possible into their communities. So yeah?

 

>> [Inaudible] at one time referred to law enforcement and educating them on how to respond. [Inaudible]

>> Okay, the question was if I'm understanding correctly, we were talking about like first responders and mental health and you're wondering if PTSD is considered a mental health concern. Is that what you're asking?

 

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>> And [Inaudible]

>> Well certainly, you know, the people at pert are aware of the 10 seconds. PTSD is a psychiatric diagnosis and is a psychiatric disability. And certainly people who have PTSD may not be, in that moment, behaving super what appears to be rationally [Inaudible] also somebody who has PTSD putting them in handcuffs or putting them in physical restraints, putting them in seclusion, there's all sorts of stuff that can really make it much, much worse and trigger flashbacks, stuff like that, so, yeah, that is the thing. I'm not involved with the policy papers currently. That's kind of being done, a lot of the attorneys are working on that. I work hand-in-hand with attorneys. The presentation I did last week. [Inaudible] organization a lot of employees are [Inaudible] because we are a legal agency. Does that answer your question? Okay. So, engaging [Inaudible] communities for reaching out to [Inaudible] communities trying to engage in the LGBTQI. And cultures that haven't been as traditionally served, you know, first of all we've had a lot of stuff in many different languages and try to find culturally appropriate. So this is for example, the DRC, we have a whole Spanish website for this project. And if you can click on it for, from the PowerPoint that was brought in, it should lead you there. And we have all these different fact sheets in quite a few different languages. Because we're really trying to make sure that, that people are understanding their rights even if they don't get, speak English or that they're, [Inaudible] people who are often in even more vulnerable positions because they're kind of isolated because of [Inaudible] barriers. So this is our regular website, again it's on the PowerPoint that you can click to. [Inaudible] stigma discrimination projects that I'm talking about. And there's the advisory group for that. I can go back but again it's on the end. And that's it on this. [Background sounds] Any questions so far?

 

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>> [Inaudible] of all the fact sheet and I'm looking at [Inaudible] accommodations, what kind of issue [Inaudible]

>> Well a reasonable accommodation might be that they can have a no pets policy. I'm [Inaudible] next week a recovery innovation county wide [Inaudible] on the difference for service animals and how people go about it. So it could be an accommodation like that. It's also physical modifications people might want to do to an apartment but not want [Inaudible]. Carpeting is something because they're very sensitive to noise, or take out carpeting.

>> Cars and showers, widening doors

>> Right, but specifically psychiatric disabilities

>> That's the biggest one is the no pet policy and [Inaudible] depending on what the issue is with the psychiatric disability they need the first floor [Inaudible] third floor. And like that.

>> Safety, real strong conveyed from past trauma. So yeah, there are, it's interesting because I know in this program and what kind of work we were doing. Very much talking about accommodations and [Inaudible] that there are accommodations in housing. And this is something that I didn't necessarily know and I think a lot of people don't know. I try to get that information out to providers as well, because I know that I was in a situation where I was forced to move because a new landlord took over the apartment and said no pets. [Inaudible] beneficial to me because they're certainly my animal, [Inaudible] but if you have a psychiatric disability they could be even more [Inaudible]. And I didn't have any idea that it was to say that I could have done.

 

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And I think that the care providers, the psychologists and the therapists who hear about, Oh I have to move because of my animals, they won't let me take a pet. And it's just good that providers know [Inaudible] this and so it's great if they can find out about that. Anything else? On this stuff? Okay, I'm going to go on. So these are the line objectives for this. Explore the impact of stigma and discrimination. Discuss beliefs and actions that foster, perpetuate stigma. And then develop strategies for reducing stigma people with mental health disability. So [Inaudible] is not be very different from all this program is about. Which is serving people with disabilities in a respectful way and they can share that we are client centered.

 

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But there's some additional things that are reminders for individuals with working with individuals with psychiatric disabilities. So we're going to talk about ser type [phonetic] stigma discrimination, again, [Inaudible] lots about this. The effects of stigma, beliefs that foster stigma, actions that discriminate, and strategies. And again, feel free at any point and any time to ask questions. So why is it so important? 1 in 4 adults, according to the National Institute of Mental Health 1 in 4 adults, 25% of people have a psychiatric disability. Now this is going to vary in severity and functional limitations, but you may end up as providers working for or may already be working in a situation with individuals with psychiatric disabilities. I know Elizabeth and Tanya and I have all done that. But the reality is if you're any kind of service provider, even if the primary diagnosis isn't a psychiatric disability, it can often be secondary. I've worked with clients in my psychiatric employment program, who were all surprised with the regional center.

 

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And if you're a, work for DOR, total people who work with you are more and more people are coming in with psychiatric disabilities. Again, often as a primary and then if not, secondary. People who work for, people who work in DSPS, or DFSS are finding that there's lots and lots of people with psychiatric disabilities. So even if you aren't getting the specialization and that isn't your area of interest, just expect you're going to be serving people with psychiatric disabilities. So that's why it's really important. So what are stereotypes? Again, this is something that's discussed in this program a lot. But stereotypes are really, really highly prevalent in mental health. I would argue that they're more prevalent in mental health than in a lot of other disabilities, if not the highest level of. These are some of the misconceptions that people have. Tend to be violent. That gets in the news all the time, above that. And then that people won't get better. That's they're so chronic and with certain diagnoses that somebody will be [Inaudible] doesn't have any chance for improvement.

 

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That they don't, they are able to care for themselves and also that they don't have any insight into their own disability, don't know what's best for them. I mean we've seen that in general with disabilities and certainly I think that these last couple months are a also a big deal with cognitive disability, that's another area where people are, they just don't know what's good for them. There's this tendency towards that. And there's a very high tendency at that with mental illness. And then this last one. People aren't trying hard enough. If only you tried harder. There's still that sort of this is a personal flaw and people aren't trying hard enough, specifically if you see an illness that doesn't have a consistent course. If you have a spinal cord injury and you stay, your physical limitations are consistent from the spinal cord injury on out. Or if you're an individual who identified with [Inaudible] capital D you know, that your [Inaudible] isn't changing. Whereas with a mental health diagnosis you can be really doing well one day and then not doing well the next day. And sometimes there's that temptation, well, you know, not trying hard enough and stuff.

 

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We need to think that sometimes other illness, physical illnesses like chronic fatigue, they'd also have a very varied course of, again, feeling great one day, feeling not very well the next day. It's harder for certain programs to understand things like DOR or if you're in school [Inaudible] really tough, so don't make the assumption people aren't trying hard enough. So some of the cultural needs that have occurred throughout the years about mental illness it ranges from ones that are generally a little more positive, inspired, respected, or different. And then some of the ones that maybe aren't as positive. Certain cultures have, for example, native American culture it's often seen that people were medicine men, traditionally, or shamen, whereas in some Asian cultures it's there's belief in possession, spirits. Very different in different cultures. So what is stigma? Again, if you're in this program, discussed probably quite a bit, belief in these stereotypes but reject and fear they perceive as being different. I would say the reject and fear component is particularly high when we're talking about mental health concern. And the general public does it frequently. And what is discrimination? Discrimination is where people are acting on these [Inaudible] and opportunity. So that wedge between us and them, course this is old hat for people in the program, but it, I think it's really prevalent.

 

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And I don't want to be lecturing here in the sense that I'm guilty of some of this stuff as a person who has a mental health diagnosis myself and has worked in the field to provide. There's times when certain things like we talk about language coming up, that I say language that isn't publicly, completely appropriate. Common terminology, crazy. I say, "I had a crazy day" and I'm actually meaning I was really, really busy, I didn't have a chance to sit down or catch my breath. But it's again, that is a word that has been used as a weapon against people. So just, I think just I'm asking people to be to think again about some of these things. It's like I do for myself as well. And be aware of the impact that it's had on people. So types of stigma, this is something that of course is discussed in this program as well. There's public stigma, there's institutional stigma, there's self stigma, this was a big one. This is really big in mental health. A lot of people don't realize it and of course, self stigma comes from people accepting what's been said and what the institution's done, messages that they've heard and accepted. But I think with a lot of people with mental health I've noticed they've taken that on and that's, you know, you're depressed and you hear negative stories in the press about people with psychiatric disabilities. And you're well, I know in my own past, I took this on and was kind of carrying this around. So it's really [Inaudible] hopelessness and helplessness. Again, getting [Inaudible] language. I do this. Insane it is still in all sorts of documents. If people aren't in a state hospital but they are still deemed unable to take care of themselves they could end up in IMD, institutes of mental disease. Doesn't sound very nice.

 

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Disturbed, abnormal, incompetent, out of control, again, these are things that I think we often take for granted. And I know that lots of we try this person first language and in all cases and it's used I think it's a frontier a little bit with mental health that it's still considered kind of acceptable by people who wouldn't consider it acceptable to do, make other comments. This was a [Inaudible] Cordin [assumed spelling] was sort of the father of psychiatric rehab, very well respected. If you're taking the specialization to psychiatric specialization, I don't know if Marge still uses it as a book, as a textbook, but I got this from this textbook. And I thought that this was a really interesting approach. That he had. And today most Americans would be horrified that it advertises use any version of racial prejudice to promote their product. Yet it is still common to hear radio spots talk about crazy deals that can get you put away, or television commercials that say maniac salesmen out of control. And since I've gotten this job, I started to listen more closely to TV and radio and movies and I'm starting to like go, wow, I'm paying attention more. And it's like, wow, that's really not that cool. And I didn't notice it. Again, maybe that's partially my own self stigma but I didn't even notice it. Some of these words are so common language but it's really, it's still happening. And there is sometimes the when people, when commercials are doing things that are racially insensitive. But the companies hear about it, you know, [Inaudible] but it's still super common with the mental health derogatory terms and stuff. And there's sometimes the public reaction that you would think there would be with it.

 

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So again, [Inaudible] stigma on individuals with low self esteem, isolation, being de-valued, social rejection and shame. This is one of the effects of stigma on individuals by other people, we're talking more about self-stigma. The past side. Over interpretation or misinterpretation of behavior. I still hear this so frequently. For example, somebody who's, most people who work don't want to identify that they have a psychiatric disability, say in the past. 90% of people that I work with did not want to disclose, the exception is if it's a peer position where that's part of the [Inaudible] But even people who work in mental health. I can disclose, [Inaudible] selective disclosure because I was so afraid of the repercussion. If somebody has a bad day or somebody, let's say somebody's just angry about a policy. And then people will say things like they're just being bi-polar. Or that's because, no lots of people get irritated on occasion at work or frustrated or have a bad day. I mean we're all like that. But then this is now part and parcel to the diagnosis and then the person isn't respected. So it just misses maybe a legitimate concern they might have and it's also, it's taking away normal experiences. And this is unfortunate but I see that happen a lot. Opinions are ignored, you know people are afraid they won't get promotions or they say stuff and it's like, well, she's the best, but you know she has a psychiatric disability, right? You know that she was in the hospital for, right? You think that still, I'm kind of over emphasizing the tone.

 

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I think a lot of people say this innocently and with the best intentions and they don't, they're just not thinking about how stigma, what [Inaudible] responsibility, you don't get promotions or you're not getting responsibility in your own life. Not trusted, not trusted [Inaudible] experts in their own life. Victims of violence. We'll talk about this a little bit more later. Sometimes people will make reports to the police and the police will completely ignore it and not take it as a credible thing that's happening because, well, again, this person maybe they shouldn't be able to [Inaudible] and there's also other reasons why individuals can be victims of violence but it's and it's very interesting [Inaudible] assistance. People again won't get the help they need. There's a people who fear this concern they may have some mental health challenges but don't want to go to a provider and they don't want that stamp of stigma on them. But it can also lead to people who are actually already in care, like not coming back for an appointment and even to any kind of service provider.

 

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A DOR counselor or DSPS counselor or their employment counselor. If they're feeling that they're not being heard and not being, they're being stigmatized again. And this is fairly interesting. Many people say that the stigma associated with mental illness or the mental health diagnosis is, or their families, is harder to bear than any of the symptoms itself. They find ways to cope with the symptoms but the stigma lingers and it's the hardest part for people to deal with. And studies have shown that stigmas even prevalent among mental health providers. I've read notes, I've heard people who are professionally [Inaudible] I go wow, you're not person first language, not being super respectful. And I think sometimes people get frustration and burnout and they just aren't aware of it. So even people who are trained and have specializations in this, sometimes are some of the people who do provide [Inaudible].

 

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The knowledge about mental health disabilities is good and [Inaudible] specialization try to find information from reputable sites, National Institute of Mental Health, maybe some consumer and family groups. [Inaudible] I'll have some of those at the end here. So one study of mental health, this is the in the strategic plan on stigma reduction so it's saying that nearly one quarter of the reported stigma was coming from mental health professionals. So just because people are trained and knowledgeable doesn't mean that they aren't inadvertently stigmatizing people. So if you go to mental health professionals and other providers for treatment or support and services and sometimes they will not choose to continue services because a feeling that they're having some stigma. And so again, people will not seek assistance or stop taking assistance. So what beliefs softer stigma? So this is one of the big ones. In the news all the time. [Inaudible] "many Americans report that they believe mental health challenges, people with mental health challenges pose a direct threat of violence to themselves or others." So this is a really, really interesting fact. So from the 1950's to the 1990's this perception of violence linked with people with mental illness has doubled.

 

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Now you would think with number one, all the medications we've developed since the 1950's, all the knowledge we have now since the 1950's and how politically correct and informed we like to be, so this is really kind of sad. And so what do people think? Why is this? Yep, 24/7, so it's the media that is, the media is perpetuating this. We'll talk more about that later. But so the vast majority of people with mental health disabilities are not violent by far. And people talk about shootings, mass shootings and stuff, well so many of them have mental health diagnoses. Well, I can also say so many of them are young males, usually Caucasian and who play video games. But would it be if I said, all people who, all transition aged youth who play video games are, it wouldn't be considered are you kidding? So it's a very, very small percentage that are violent. In fact, the reality is that people with psychiatric disabilities are 2 ½ times more likely to be victims of violence rather than perpetrators. And some of this may be because they've been issues with homelessness, it may be vulnerable to situations like this, so again, overwhelmingly not perpetrators but actually victims. And this brings up, I was talking about self stigma, I was talking to a client that was telling me that she had impending homelessness because she had been, hadn't been able to get a job and she hadn't had income for a while. And she said, you know, I'm just so paranoid because last time I was on the streets I got raped so I'm really scared to live on the street.

 

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She's calling herself paranoid. And like, instead of like, wow, that's a real, it is dangerous living in the streets and face it, your past experience, you know, of first hand experience violence, is that paranoid? But she's labeling herself as paranoid for having what sounded to me like a really legitimate fear. And so, again, the violence but also [Inaudible] stigma. And [Inaudible] mental health disabilities and violence is promoted by the entertainment industry and they have made how many [Inaudible] Halloween time. How many of those movies starting with 'Psycho" and "Halloween" and I don't ever watch those, but how many movies do we think portray a mentally ill person/killer? It's really frequent. And on primetime television, characters with mental health disabilities are often [Inaudible] the most dangerous of all demographic groups. [Inaudible] 60% of images of, or stories, any kind of representation of people with mental health disabilities prime time television and movies is [Inaudible] with violence.

 

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Not even [Inaudible] it's like violent. Which doesn't bear out with the facts. And the vast majority of new stories on these 24/7 [Inaudible] individuals with psychiatric disabilities focus on negative characteristics. How often do, we're a general society that focusing on good news and we're living in fear and that's a whole other discussion. But how often do you hear stories about recovery? You know, somebody who was on a conservatorship because they were having so many [Inaudible] when they were younger and now is a doctor, a lawyer, whatever, there's some famous people like Ellen Stacks [assumed spelling] is a professor of law and psychiatry, I think, at USC and she's written a lot of papers on trying to limit seclusion and restraints and non consensual behavior that's being perpetrated against individuals with mental illness, against forced treatment. And she also happens to be an individual who has been diagnosed with schizophrenia. Hayward Field Jameson [assumed spelling] is a fantastic author and she is a professor of psychiatry at Johns Hopkins hospital.

 

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She also happens to have had bipolar disorder, herself. Of course there's probably people you can think of that have been highly [Inaudible] do they know people in the entertainment business, or the arts industry. [Inaudible] creativity, some people get the creativity, some people just get the mental health diagnosis. We've got Abraham Lincoln, it's thought that he had very severe depression, Winston Churchill. You can become president. You can become one of the people who, prime minister, who arguably such a great orator and such a motivational person had a real battle with depression. So again, we don't hear that. A lot of people don't know that. Because that's not [Inaudible] focus on the violence and the negatives and the chronically ill, those types of things. So now I'm going to talk about what we can do as service providers. What we're doing that might be fostering stigma and the things that we're doing here to stop that. And I know we talk a lot about medical model versus the recovering model. And the medical model is seeing people with their diagnosis and things like that, whereas the recovery model, particularly recovery model with mental health, [Inaudible] hope, this is a big one. We'll talk a little more about that. Personal empowerment. Respect, social connectedness, and self responsibility. As with many disabilities, even more so like social connections, people are really isolated with mental health.

 

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A lot of it is because of that fear that the public has. And hope is a big, big thing. Some of the people who have lost hope because they've been in the system so long and it sort of it's kind of our responsbility as service providers to keep on doing that hope and to kind of hold onto it for people when they don't see it. Tell them stories about the people who would be diagnosis very, very successful. Diagnosis is a guide, it's not a fact that rules people's lives. It used to be this thought that somebody with [Inaudible] can never have a, can never live by themselves, could never have a job, was always going to be chronically ill. And [Inaudible] example of all these things. Of course, like with any disability, it shapes and affects who people are. But it's not being definition, but I see that probably more so than in other things service providers may refer to people as their diagnosis, they may forget that person first language that we're trained to do. I know that maybe as recently as six or eight years ago, I was guilty of this. Schitzophrenic or something like this rather than a person with schitzophrenia. I think that we all have to remind ourselves of this in general. I think this program is right about teaching person first language. I still think there's a lot of room for growth in this, particularly with mental health diagnoses. Okay, so people have the ability to understand and identify their own ability.

 

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People are often thinking that people lack insight. One of the things on this is that when we're talking about like medications, that it's this is the latest slide that I want to talk about it now. When somebody's saying that they [Inaudible] out taking their medication, or they don't want to take their medication anymore, it's still often assumed that they are being unrealistic, unreasonable, and they have a lack of knowledge about their own disability. Rather than acknowledging some of the very real reasons why people might not want to take medication. Really significant side effects, gaining 100 pounds, people losing their sexual identities, having sexual dysfunction, having huge motor tics, you know, facial grimmacing that can become permanent. Acataphasia feeling this need to move all the time. These are things that I kind of challenge people to think about. If you gained 100 pounds on a medication, wouldn't you have thought about not taking it? Or maybe decided that it wasn't worth it? So, that's something that I see people, like not really thinking about.

 

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And oh, they just don't know how sick they are. And so, again, and people have the ability to take care of themselves. They have the ability to understand their illness. At times they can get benefit from learning and understanding through you. I know as an employment consultant, sometimes I would have to acknowledge to somebody I'd have to do a little bit of presenting that, well I know you really want this job but this job does, let's look at the Craig's list ads and all the different ads for this job. It really does require a Bachelor's degree in psychology. All these jobs do, which you can have as an example. So, but to not, oh, they're so this and they're so, I hear that. I hear professionals saying that kind of thing. I heard a professor once say, well those people with personality disorders, you don't ever want to work with them. And just kind of shocking stuff. Again, being person-centered and letting people, I don't know why this one [Inaudible] service providers is what I was talking about. People are experts in their own experience.

 

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There are a few people who really don't have as much knowledge about their own illness, but that's really rare. Most people are really know the kinds of things that help and you explore with them what kind of supports they would like. And they actually know quite a bit. So they choose what's best for them based on the information and guidance and support services that you give them. So, again, people can and do get better. We've got examples of that. I think a lot of times there's this assumption that well, that person wasn't that severe. And even people with mental health challenges themselves will say, well that person was able to get their graduate degree, but they never were, they were never on conservatorship, they were in and out of hospitals. But the reality is that some of us don't share that we have that in our background because of stigma, but yeah, people have mental conservatorships and then live in a, what used to be called, a half-way house. And then live on their own and get graduate degrees and work full time and write books and are professors, this stuff.

 

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So sometimes the severity at a given point does not, is not really limiting with the right supports, people can do all sorts of stufff. Recovery is unique to each individual. What one person might consider recovery won't be necessarily what another person is. But I have found that sometimes what people think they can do when they accomplish something, then their goal for what they consider recovery might move out a little bit more because of what they want, because, like wow, you build on success just like sometimes when people have a series of disappointments and not being successful. They don't, you start feeling worse and worse and worse, but the success is still the common self too. And it's interesting that, for example, when I talk to individuals with psychiatric disabilities who've even been in school, so many of them don't know that they would even qualify for GSPS services. Think about. It's like oh, if I was a wheelchair user, or oh, if I was visually disabled, or deaf, I would [Inaudible] use those services. And to start thinking about,

 

 

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>> We get a lot of [Inaudible] when we have a fair, policy and service [Inaudible] and [Inaudible] like no, that's not for me. And they go somewhere else like you said, oh, I don't have a wheelchair, I don't use a wheelchair. I don't have a broken arm or something. So many disabilities that

>> And if people don't realize that they can get the support. I mean sometimes they're not seeking help because there's a stigma, but they just don't even know. I've told multiple clients that, like when we tell clients that they can have an accommodation at their job that that would be something, they're like, well, I know, they understand the physical disabilities but they don't realize that they applied to them, they don't know about, maybe many of you probably already know about Ask Jan and that website and the searchable online accommodation resource. Great resource for people. I showed it to clients and it's like let's start talking about what kind of things might help you. But it doesn't occur to people and so when people know about what kind of services are out there, and that things are chronic, so once you have a mental health disability, let's just say lifelong sentence that you [Inaudible] you can't accomplish things. And it's not true.

 

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And this [Inaudible] before and this is from the Canadian Mood Disorder Society and it says "hope is one of the most valued ingredients in a professional client relationship and the strongest predictor of positive outcomes." So when, if you're working with someone and you're frustrated, feel frustrated because they're having a harder semester than last time. Hold onto that hope for them. And remind them that people have rough semesters and they can get better. And that I really feel, ultimately, we're all responsible for ourselves and you want to encourage hope in others, but I encourage you to hold onto hope for people when they can't and keep planting that seed. When we know that there are people who have a diagnosis of schizophrenia who are professors of law. Remind them of those things. So with hope anything's possible. [Inaudible] stigmatized talking down to people, ignoring what people want, assuming again, assuming that people lack self knowledge. Lots of times people have a very aware of what their strengths are as well as what [Inaudible] their vulnerabilities are. I talked about this earlier. On my bandwagon on this a little earlier because I feel a lot of it. [Inaudible] non compliance is kind of offensive.

 

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I personally find it very offensive so I don't know how other people feel about it, but you're not behaving right, you're being non compliant. Instead of acknowledging that it might be a measure of choice, you might encourage somebody to talk to their doctor about getting a medication change and taking a different type of medication maybe the same kind of category that wouldn't have the side effects. But that's something in the self advocacy group I might help people practice rehearse talking to their doctor. But try not to use that term. It's a special term if used in the psychiatric industry a lot. Acknowledge that people may have legitimate reasons for not wanting to take stuff and help them realize there might be alternatives. And certainly don't be angry or frustrated with them that they've chosen something. Because they may have reasons for it. Maybe they can do something else, so.

 

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People experience trauma as a result of a mental health commitment, [Inaudible] against their will. There's a lot of trauma. There's trauma in sometimes in the actual system itself, being put in restraints is very traumatizing. If people have stigma, most people don't want people to know that they've ever been in the hospital. People will make up elaborate stories. I have a friend who, she's in the hospital back in the '80's in the hospital for a very long time. And she's like, well, I used to tell people I went to Europe but then people would start asking me about Spain or something. So I just got Googling everybody knows it got really hard. So they can have another person [Inaudible] left school, they were a team, they left school and made up this elaborate story how their parents sent them to a private boarding school but they ultimately after a year chose to go back to public schools because they didn't like the private schools.

 

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Because there's so much shame and stigma that people are doing, they make up elaborate stories because they don't want to admit to it. Because people do stigmatize, you know that person's been to a mental hospital, right? So what can we do? What can we all do to help reduce this? Using plain language, not using lingo, I think this is true for any disability, not using your language specifically. Sometimes some people with psychiatric disabilities, sometimes their communication skills are somewhat affected and with understanding language, many do stop slower, so make sure, check in with them. Do you understand, [Inaudible] to you in another way. Make sure that people are understanding what you are saying, all about communication. Again, use people first language. And it's something that we're all learning and [Inaudible] but again, skills being used [Inaudible].

 

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But treat the people with respect. Listen to clients [Inaudible] to say and really listen to them. This is not different from other disabilities, client centered services. But there is again, [Inaudible] the cognitive disability there is the tendency to kind of discount what people are saying. So empathize with them but don't tell them what they feel. And identify and acknowledge that self stigma. Self limiting belief that the person may have and encourage them with the hope that we're talking about. And so we as service providers are consultants and we do want to make you be able to rely on us for information [Inaudible] and be conscious of the power of diagnosis and the white line process. Again, people with schizophrenia that sound, a lot of people have so many negative associations but that is one of the more serious, it's considered a serious mental illness that can have a lot of functional [Inaudible] a lot of functional limitations. But again, people are thriving that happen to have that diagnosis. As long as they aren't given that as a, this is doomsday, this is the rest of your life, this is the hope and encouragement.

 

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These are kind of review for people because this is what we're all learning about in this program for all [Inaudible] disabilities that least restrictive, [Inaudible] working with a client right now in my self advocacy group that would like to [Inaudible] long time is now putting together a plan to live out in the community again in apartment of their own. So doing that, focus on what people can do. You know, they're telling you all the things that they can't do. That's part of that hope thing. You know you did this, and you had a really rough semester this last semester but do you forget how well you did the semester before? So let's go back to what was working then. What can we, how can we recreate that for you? And teaching self advocacy. Teaching people how to help for themselves and teaching people how to speak up for themselves. Again, that's the group that I have at the [Inaudible] house that's what I do. And what might be rehearsing with somebody how to talk to their doctor about a medication change, might be there's people I've worked with in the past too, get off a conservatorship. Because they want to have more choices in their life and, because often when people are conservator, they really aren't [phonetic] in the drivers seat of their own care. And a lot of [Inaudible] being determined for them.

 

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So, again, surprise people with their rights, what their rights are. Helping them understand, knowing what procedures are, they want to get off a conservatorship that's where we're great because we have all of these resources at our website. So now I want to talk about one last thing really and this is peer support services. Here, so I did being one of our fact sheets, which is it says the peer support services are integral to mental health recovery. This is becoming an evidence-based standard that having individuals work with peers, other people with the experience, has been shown to be very, very helpful for individuals. So, again, you know what people choose to call themselves, I've always been comfortable with the term client, lately the term consumer has come of the more recent thing. Personally I don't care for that because when somebody calls me a consumer I feel like I ate a lot or bought a lot. That's just me. So I know people who prefer that. I know that some organizations use the people with [Inaudible] experience which I think is really nice.

 

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And a little longer to say. But what do people, how do people identify, how do they want to be called? So, peer services is now being mandated in a lot of the county programs like if you're familiar with the Act models which is community service treatment which is sort of the all-encompassing whatever works. We'll do what it takes, what it works, you'll have an employment counselor, you'll have a psychiatrist, a nurse, a therapist, a case manager, and you'll have a peer. It's on that [Inaudible] because lots of times people are more willing to interact with peers because there's more trust. There's more feeling, particularly someone that's been maybe through the system and had some things that really made them lose trust before. And peers are of course, they can be inspiring. Like, wow, I was having that problem too, and look where I am now. And the other thing that's great about peer services is that it's also providing employment for people. If they get their peer supports services certification through recovery innovation and then they go out and they work in these Act models or other county programs, people are keeping work that's meaningful to them and they really feel like they're paying it forward and they're seeing a purpose and so this is a great way to, it's also a great way to sort of shape mental health care from the inside, from the consumer out to have people on staff.

 

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So these are some of the organizations that you could lead clients to if you think that to get them more involved in the peer movement. Get them help from peers. Of course, we have our peer self advocacy unit which is the unit I work for at Disability Rights. National Empowerment Center and National Self Help [Inaudible] these are consumer or clients or persons with experience that run organizations. And then what was the recovery action plan, raf with a w. This is a really, really, a great tool and we're very fortunate in California, in San Diego here that we have people who teach this for free throughout the county. A woman named Mary Ellen Copeland who was herself somebody who had experienced long hospitalizations and then who was like deemed to be chronically unwell, she started looking around and seeing like what people were doing, the people who were getting better. What is it that they were doing that was helping them? What did they have in common? And she came up with this resource which is the wellness recovery action plan, which is a great complement, it doesn't say that you don't need to take medication or you don't do therapy. Some people choose to just do this, but some people choose to do this in addition. And it is a really great tool. It's some of the things they would do is what do I look like when I'm well? What are the things I have to do on a daily or weekly basis to take care of myself? Is it that I need to spend, it's very, very individualized. People will do their own book but they do it in a group. I need to meditate for 10 minutes every day. I need to make sure I get 3 meals a day. I need to make sure I get some sleep. I need to spend 15 minutes petting my cat. These are the things I need to do to stay well. And then you also might talk about what your triggers are.

 

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Sometimes [Inaudible] a trigger might be an anniversary of a death of a loved one, or the significant break up. So when we talk about a trigger, then you also talk about the action [Inaudible] what are you going to do? So somebody who experiences great sadness on the anniversary of the death of a parent for example, they might say, okay, you know what? On January 12 of every year, I'm going to spend it with my best friend. Or I'm going to rent all the silliest '80's movies that I haven't watched, back-to-back. Whatever it is, it's for them that's going to work. And some triggers are things you can't necessarily plan when they're going to happen, but you know you might be exposed to. For example, you're watching a movie and [Inaudible] there's a really negative depiction of somebody with mental illness. Or maybe there's somebody who's using drugs in the movie and this is the trigger for you. So what's your action plan? What do you do? Do you call, do you go and spend that time with your cat? What is it that you do? This is how people are helping themselves avert crisis. And there is a crisis planning in there. When things are breaking down, what do I do? And when do I need more additional help and who do I want to be the provider of that help? If I'm not able to reach out and you're seeing me and I'm having a really hard time I want you to call [Inaudible] and have her help you. Help figure out what's in my best interest. If you put all of this stuff down, it's good complement to advance psychiatric directive. But here in San Diego the recovery interventions, you may have heard them, they used to go by the name RICO, the [Inaudible] the initials. They train people, they teach rap and then they train people to be an employ people as rap facilitators.

 

 

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And it's offered at clubhouses throughout the county and various other places. There are, I know there's at least two rap houses that are taught in Spanish as well to [Inaudible]. It's a great organization. We have it, it's free here. I encourage you to let clients know about it because I'm stunned at how many providers who may be not county providers, don't know about this still. And people can even make it specific to their school plan or to their employment plan. When this happens at work when I get stressed out and then anxiety ratcheting up, what am I going to do? Tanya and I worked with a client and we helped develop a little iPhone app where she could look at slides of her pets and messages from her cognitive behavioral therapy. Assisted technology. Who says assisted technology can't be used you know, something they already have to be used to help strengthen and to help alleviate symptoms of anxiety. So I encourage you to tell clients about that. And this is just again who we are in Prop 63 and all that. So, does anybody have any questions? None? [Laughter]. We do have some brochures if you're interested. You can have a brochure with the peer self advocacy program. And the stigma hurts everyone, the stigma and discrimination reduction thing. We also have business cards. Both of us. Or I do. Did you bring some? Yeah, if you want to contact either of us, now or later.

 

 

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>> Do you guys set up for internships? Or someone do an internship?

>> Well we have [Inaudible] and you could have some volunteers. But the majority of the people that come to work for free are paid by the law clerks. How they get paid I don't really know, how many, but we do have volunteers. And I don't think internships. The reason I know we don't have internships is if you didn't want to have one that we don't have the type of supervision that interns need to get particular kind of hours that they need.

>> Our organization, the vast majority of people who are on internships are law clerks. But there are lots of great agencies out there working with individuals with psychiatric disabilities and I advise interns [Inaudible] specifically like psychiatric disabilities in employment and stuff. [Inaudible] love to have an intern [laughter] do that. So anything else anybody wants, yeah?

 

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>> Hi, someone's under conservatorship, and they don't want to be. Do they come to the ARC and the ARC actually represent them in probate court to

>> So the question was, before I threw this stuff on the ground, the question was if somebody is on a conservatorship do they come to Disability Rights California for assistance in getting off the conservatorship? We have all these fact sheets about conservatorships and the different processes on the website. Our website is such a resource for information but then as far as like, Alada [assumed spelling]

>> So there's a lot of issues that, let me give you an easy example, that we don't work on where maybe there's legalaze, for example, family law, we don't do family law, we don't get involved in cost custody issues. Conservatorship is one of those things where there is a unit that does work on that within the court system, so we don't necessarily assist people getting in or out of conservatorships to provide information and guidance in the process and sometimes we could be involved if a person calls us, let's say an attorney who needs assistance with someone maybe trying to get out of conservatorship. So we might give some help with that particular, depending on what the issue is. So we don't, we usually have a referral list of attorneys who work on those type of issues or an entity that we can refer them to for conservatorships.

 

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>> And then in my in the peer self advocacy group that I've had individuals work on that, we'll provide them with information, we'll go through the information, we'll talk about stuff like who are the people who might oppose you getting off a conservatorship. What are their concerns? How are you going to address those concerns? Who are the people who support you? Can they write letters of support? There's various, conservatorships come up for annual renewal, so that's an opportunity to give, to request for it, not to be renewed and there's all the different writs that you can, because sometimes it's sort of [Inaudible] corpus because you're being confined against your will at times. So that can be involved. That answer your question? Anyone else? You can think of stuff later. Jenny?

>> No.

>> So if you would be so kind as to now take the post part of this survey and then we have one more survey which [Inaudible] just general survey. This other one is done by Rand and it's required as part of our contract. So I do appreciate it.

>> Feel free to pick up any of the information put out, brochures and PowerPoint. We brought the PowerPoint, copies of the PowerPoint, didn't have time to print it up. You want to take one to somebody,

[ Background Sounds ]

>> I strongly encourage you to check out our factsheet, stunned at how much information is there.

[ Background Sounds ]

>> Well I think as you guys are completing that, I want to thank Leo Lisa, both for our wonderful presentation. I learned a lot about DRC that I didn't know. I'm sure we all have. And it's a wonderful agency and really appreciate your time and your information. So we'll have rounds

[ Applause ]

>> So as you're wrapping up the surveys we're going to transition between those here to talk about the special [Inaudible] so if you're in the program, you're interested [Inaudible] learn more about special additions, we're going to do that [Inaudible].