Warm and tender feelings abound in the holiday season, occasionally even stirring us to hope that the controversy over Assisted Outpatient Treatment will fade away over time, as the growing mountain of evidence that AOT saves lives becomes harder for opponents to ignore.  When we find ourselves in such flights of fancy, it falls upon people like Steve Miccio to yank us back into reality.

Miccio is the Executive Director of PEOPLe, Inc. (“Projects to Empower and Organize the Psychiatrically Labeled”), a “peer-to-peer” advocacy group in Poughkeepsie, NY.  At a recent anti-AOT symposium at Columbia Law School, Miccio articulated his vision of what should replace the “system failure” known in New York as Kendra’s Law.  A video excerpt of his presentation, posted on YouTube by supporters, simply must be seen to be believed.  We’d make it required viewing for anyone who doubts the zealotry of those who demand self-determination for all patients, no matter how incapable of exercising sound judgment, at any cost.

In an especially revealing moment, Miccio shares a story about a participant in PEOPLe Inc.’s financial skills training program: 

When I first started this, we had a guy that came in, and he was an AOT person [1] …  and we had to control his funds.  And he comes in and he says, “Steve, give me my effin’ money.”

I’m like, “Well … here’s your money for the week.”  It’s ten, fifteen dollars, whatever it was.

He says “No, I want all my money.”  And he threatened and threatened and every month he would come in and threaten.

So I thought about it, and I said, well, what’s the risk?  I know he’s a drug addict.  I know he drinks.  But what’s the risk?  Well, he could die. Well, that’s all right, that’s his choice.  So what’s the risk?

So, the next month, I said you know what, I’m gonna give him all his money, and I did.  He couldn’t pay his rent, because I gave him all his money.

So now the next month he was homeless.  But after I gave him his check, two days later, he came in, drugged out, and said “I’m out of money, you’ve gotta help me, you know, I have no food, I have no money.”

And I said, “How’s that working for you?”  And so, I put it back on him and said “It’s your choice.  You know, you wanted it, I gave it to you.  How’s that working for you?  You like that?”

The next month … he was even worse.  Comes back in, he wants all his money again.  I said, “Well, remember last month? … Here’s all your money again.  See you later.”

Comes back a few days later, same thing.  Drugged out.   “I need more money.”

“How’s that working?  See you next month.”

Six months later he comes in and says “Steve, you’ve gotta take care of my money, I’m not very good at this.”  [audience laughs appreciatively.]

That was his decision.  His self-determination.  His failure.  His right to fail.

*****

Lovely.  If you were only half listening, you might think Miccio was talking about a child who insisted on eating all his collected candy on Halloween night.  But of course, the consequences of allowing this lesson to be learned the hard way were just a tad more dire: loss of an apartment and the toehold on stability it offered, at least eight months spent homeless, extreme substance abuse, malnourishment, and surely other horrors untold.

Let’s breathe a sigh of relief that Miccio’s client survived this ordeal, and hope that other recipients of his twisted brand of tough love were as fortunate.  And while we’re at it, let’s hope that New York State Mental Health Commissioner Michael Hogan, in attendance as another featured speaker at the conference, was duly horrified by this anecdote, and has already taken steps to cut off any state funding of PEOPLe Inc. and ban them from taking part in the treatment of other fragile outpatients.

One might wonder why such an opportunity was granted in the first place to an organization whose very name stands in opposition to the practice of psychiatry.  But groups like PEOPLe, Inc. that seek to turn people with mental illness against their doctors were brought in from the fringes some time ago.  State support and inclusion of them has become commonplace, as mental health officials trip over themselves to prove their openness to alternative modes of recovery.

So, Commissioner … how’s that working for you?

[1] In light of the ensuing narrative, we highly doubt that the consumer in question was enrolled in an AOT program.  If the claim is accurate, heads should roll- from the assigned case manager to the local AOT Coordinator.