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South Carolina Client Network: An Initiative to Organize for Respectful, Client-Delivered Services
Fighting IOC
 
 
 
 
 
 
 
 
 
 
 
SELF ADVOCACY
COERCION AND CARE
Dr. Sylvia Caras
Articulate former objects of coercive psychiatry who advocate for system change are often discounted as not representative of the population who are involuntarily treated. To avoid this exceptionalization, when I was encouraged to develop this article I publicized the request electronically to 75 people.

This essay incorporates quotes from several advocates who responded to your request to discuss involuntary psychiatric treatment. Because the themes keep intersecting, the headings below are not mutually exclusive.
Legal Questions
La Fond lays out the legal questions. "States may use police power to enact laws empowering public officials to forcibly confine any citizen considered mentally ill and dangerous to others or to himself. In modern times this special system of social control, which amounts to 'preventive detention,' has generally been applied almost exclusively to persons labeled mentally ill. The criminal justice system assumes a citizen is innocent until proven guilty and generally will only incarcerate an individual who is convicted of a crime or to ensure an accused's presence at trial. In sharp contrast, the coercive mental health system confines a person with mental illness because a mental health expert predicts that, unless restrained, the diagnosed person will commit a dangerous act--such as committing suicide or assaulting an innocent person--sometime in the future." (La Fond, 25) "Here in the United States it's supposed to take two physicians to get you involuntarily committed. But I have yet to encounter a case where one doctor said admit and the other one didn't" (Ventura)
Other Social and Ethical Questions
"As a cultural anthropologist and activist I have personal and legal objections to involuntary treatment and commitment as well as a cultural critique. Institutions by which and in which persons free of criminal convictions are deprived of rights guaranteed to citizens of the United States are extraordinary indeed and must (for the sake of all of us) be looked upon as aberrations to be challenged in a free society. That the challenge to involuntary 'treatments' or 'commitments' comes largely from consumers, survivors, and ex-patients simply demonstrates to what extent the society has permitted these outrageous practices to become naturalized in the language and behavior associated with 'mental health' bureaucracies.

This language (for example, the term 'treatment') inoculates freedom depriving practices with culturally acceptable curds of meaning. But there is nothing natural about these practices. There is nothing necessary about these practices. And there is nothing historically and culturally to suggest that human beings must be protected from themselves and from each other in the ways bureaucracies in the United States have found to be most expedient." (De Danaan)

"Involuntary commitment, forced treatment, and psychiatric control over decision-making are really not complicated issues, despite the efforts to make them seem so. The fundamental question is this: why do we take one group of people, those labeled "mentally disabled," and deny them the basic rights all other American citizens take for granted? We hear talk about "special needs," "vulnerabilities," "at-risk populations," and lots of other terms designed to obscure this fundamental question: is it ethically justifiable to confine people against their will, to subject them to procedures against their will, or to overrule their life choices on the basis of an ostensibly medical diagnosis? I believe that until we frame this question properly, as a human rights question, we will continue to make the simple complicated." (Chamberlin, b)
Paternalism and Self-Determination
"The laws authorizing _parens patriae_ intervention assume mental illness so interferes with patients' rational decision-making abilities that someone else must make treatment decisions for them. Paternalism is the core justification." (La Fond, 26)

The patient's sphere of self-determination has been made very small. "The ethical system (if I can call it that) that drives the involuntary treatment system is paternalism, the idea that one group (the one in power, not oddly) "knows" what is best for another group (which lacks power). The history of our civilization is, in part, the struggle against paternalism and for self-determination. People in power are always saying that they know what is best for those they rule over, even if those poor unfortunate individuals think they know best what they want. The powerful seldom cast their own motives in anything but benevolent terms. The struggle for freedom has always been seen by the powerful as a denial of the obvious truth of the superiority of the rulers." (Chamberlin, b)

"Those who would overrule, on the basis of "incompetence," the dreams of others, are usually concerned with safety issues, with little regard to happiness. If we are truly concerned with protecting people we may deem to be incompetent, surely we must zealously protect their right to pursue happiness as well as their right to be safe." (Chamberlin, b)

"Reason is _not_ the exclusive property of a class of experts whose training and credentials certify the possession of a special endowment. Reason is a more humble, more universal, more democratic gift." (Yankelovich, p 240)
Need
Policy makers use the language of higher power, authority, and the passive voice to mandate needed services, needed treatments. The very language makes it sound as if the result desired by the intervener is based in a natural order, on natural law as compelling cause. Using the language of imperative distances the policy maker from involvement with particular people and specific situations. Using a word like need as a basis for justifying action hides that this is a personal judgment. Need ignores that there is an object, a value, a goal that is the professional's goal (unstated) or society's goal (unstated), but perhaps not the stated goal of the individual. (Caras)
Danger, Control, and Rehabilitation
"'Prevention of harm' and 'need for treatment' justify enlisting the expertise of 'science' in the armamentarium of social control. 'Cure' is no longer voluntary; instead, it is a coercive technique for controlling the behavior of out- of-control people." (La Fond, 25) Locked hospital wards exist so that the outside world can maintain itself. There are many other forms of power; why is this goal only reachable through coercion? Many of the people who are subjects of coercive psychiatry already have been subject to trauma. Involuntary psychiatry exacerbates their post-traumatic stress, and may in and of itself create that syndrome.

"If psychiatrists want to be like other doctors, I believe they should do as other doctors do: wait for patients to come to them, and treat those patients as free agents." (Chamberlin, b)

"As Karl Menninger wrote in his 1968 book The Crime of Punishment: 'The scientists and penologists I know take it for granted that rehabilitation--not punishment, not vengeance in disguise--is the modern principle of control.'" (La Fond, 30) Because in involuntary psychiatry, the patient is not placed first, users of mental health services may resent the relief from social responsibilities that today's rehabilitative practices offer. Fear of punishment is the fundamental intervention that affects outcomes. Fear could enhance regimen compliance and make a regimen look effective. Fear could diminish stability and make it appear that there was more need for even more coercive measures.
"We should never get sidetracked into defining better or more human ways of doing restraint or seclusion. By doing so we continue the myth that it is a legitimate form of treatment." (Chamberlin, a) Alternatives As Chamberlin points out, it is the task of the persecuted to reveal their oppression; it should not also be their task to develop alternatives. (Chamberlin, b) Even so, consumers, survivors and ex-patients have been developing alternatives like talking some one down in a safe setting (without the fear of locks and meds), using personal assistant care as does the rest of the disability community, creating consumer controlled drop-in centers, and involving themselves in any way possible to reduce psychiatrogenic disabilities. " (A record of involuntary intervention) stigmatizes and oppresses.

Once one has been categorized ... , one loses most of the power to determine one's future and control over one's identity and destiny. "(U)ltimately, self-realization requires the power to shape one's future, to control one's destiny, to choose from a variety of alternatives." (Bosmajian, 142) The Ad Hoc Survivor and Consumer Committee for Health Care Reform has endorsed the position that "No forced or coercive treatment should by paid for by any measures enacted during health care reform." Conclusion An issue for deliberation is the ethical considerations around forcing citizens to be treated in locked facilities. When practicing involuntary psychiatry, physicians are an implementing arm of law. They restrain the liberty of same for the social benefit of many. There is an inherent tension here between beneficence and autonomy. But the medical value of "patient first" is not functioning. The individual is conformed; to say there is benefit is to impose standards which are not made explicit, and may not be medical. Of course harm to others and community disruption must be subdued, in the legal ways to which a society has agreed, through the criminal justice system, not through emergency psychiatric practice. Clay acknowledges the distinction between the sometime necessity for a controlled environment and retaining the right to informed consent. (Clay)

Thompson argues that a genuine right to refuse treatment is fundamental. (Thompson) "Psychiatric diagnosis is, in part, a process of decontextualization, of denying the real meaning that supposedly dysfunctional behavior has to the individual. What is really helpful is contextualization, helping the person to understand that thoughts, feelings, and emotions do have meaning within the context of that person's own life and experiences. Unlike involuntary psychiatric treatment, this kind of real, individualized help is impossible without the active participation of the individual being helped." (Chamberlin, b)
"The language of need is the language of paternalism. It makes room for beneficence and its cost is passivity and dependency. Instead, policy could use language that develops agency and personal power that enables and emancipates, language that minimizes medical and legal paternalism. Policy could look from the point of view of the individual's own life plan and purpose to provide a multiplicity of means for user productivity and user community participation." (Caras)

Medicine could restrict its reach, diagnosis more narrowly, refuse to collude; society better could tolerate eccentricity. "It isn't strange that those persons who insist on defining themselves, who insist on this elemental privilege of self- naming, self-definition, and self-identity encounter vigorous resistance. Predictably, the resistance usually comes from the oppressor or would-be oppressor and is a result of the fact that he or she does not want to relinquish the power which comes from the ability to define others." (Bosmajian, 9) "In my 13 years experience as a peer advocate, what I see is it is the people who take responsibility for their own recovery who are the ones who get well. Choice is very important." (Clay)

Contributors: Sylvia Caras is the owner of PeopleWho, an electronic information and advocacy list for people who experience mood swings, fear, voices and visions. Judi Chamberlin is an Associate of the National Empowerment Center, a technical assistance center federally funded to serve the needs of the consumer/survivor/ex-patient movement nationally. She is an author, serves on many boards, and speaks internationally. Sally Clay is President, Support Coalition International, a coalition of advocacy and support groups for people with "mental disability" labels. LLyn De Danaan, Ph.D., is an anthropologist, activist, researcher, and faculty member, Evergreen State College, Washington State. Ron Thompson is a Washington DC area attorney who argues relentlessly against the principle of forced treatment. Rosemarie Ventura is a consumer with 19 years experience.
Submitted by Sylvia Caras, 146-5 Chrystal Ter, Santa Cruz CA 95060-3654.
Sources
Ad Hoc Survivor and Consumer Committee for Health Care Reform, c/o Bazelon Center for Mental Health Law.
Bosmajian, Haig, The Language of Oppression, Lanham, MD, University Press of America, 1983.
Caras, Sylvia, "Need."
Chamberlin, Judi, a, ThisIsCrazy e mail July 28, 1994.
Chamberlin, Judi, b, Choice and Responsibility: Legal and Ethical Dilemmas in Serving Persons with Mental Disabilities, Albany, New York, June 21-22, 1994.
Clay, Sally, ThisIsCrazy e mail July 26, 1994.
De Danaan, LLyn, private e mail July 29, 1994.
La Fond, John Q and Mary L Durham, _Back to the Asylum: The Future of Mental Health Law and Policy in the United States_, Oxford University Press, 1992. Thompson, Ron, "Comments of a departing Trustee of the Bazelon Center for Mental Health Law," 1994.
Ventura, Rosemarie, ThisIsCrazy e mail July 28, 1994.
Yankelovich, Daniel, _Coming to Public Judgment_, Syracuse University Press, 1991
 
 
 
 
 
 
 
 
 
 
 
 
Parity and Force Dilemma

True parity includes parity of choice. Force and coercion are abuse, not treatment.
Article Concerning Parity and Rights

The dilemma of parity: If it prescribes force it isn't medicine; if it pays for force it isn't parity. Yet true parity includes parity of choice.

The right to be drug-free
A Times Editorial
St. Petersburg Times July 11, 2003
Forcibly medicating someone with powerful antipsychotic drugs is not something the law should allow lightly. As the U.S. Supreme Court has repeatedly acknowledged, individuals have a significant "liberty interest" in avoiding the involuntarily administration of medication. But the court has not gone far enough in protecting this interest in personal autonomy when the state is seeking to force medications to advance its own interests. In the case of Sell vs. United States, decided last month, the state sought to involuntarily medicate a mentally ill defendant in order to make him competent to stand trial. In a ruling written by Justice Stephen Breyer, the court permitted it, but only under narrow conditions. Charles Sell had a long history of mental illness. A dentist by profession, Sell was charged with Medicaid fraud in the late 1990s. His prosecution was put on hold when it was determined he was "not competent" to stand trial without medication - drugs Sell refused to take. The question before the court was whether the state's interest in bringing Sell to trial outweighed Sell's right to be free from the involuntary administration of drugs. In its 6-3 decision, the court could have held that in cases where the sole interest of the state is to hold a trial so as to exact a punishment, it is never appropriate to medicate someone against his will. Psychotropic medications are often bruising regimens that can leave subjects exhausted and somewhat addled, depending upon a patient's individual reaction. Only where it is necessary to prevent a person from being a danger to himself or others should the government be able to override the autonomy of a defendant. But the court wouldn't go that far. Instead, Breyer set up a series of conditions that the government will have to meet in order to forcibly return psychotic defendants to competency for trial. Each, no doubt, will spawn new litigation. According to the court, the antipsychotic drugs have to be in the defendant's best medical interest and unlikely to cause side effects that will adversely impact the ability of the defendant to assist in his own defense. In addition, the government will have to show that no less intrusive means are available; and the government's interest in going to trial has to be "important."
Ruling.
The ruling conceivably sets the stage for the court to take up the highly disturbing case of Charles Singleton, a death row inmate in Arkansas. A federal appellate court has ruled that the state can forcibly medicate Singleton in order to make him sane enough to execute. Singleton has appealed and the high court has not yet decided whether to accept his case. Breyer's ruling seems to indicate the court has little interest in allowing the government's criminal justice interests to trump an individual's control of his body and health concerns. That is certainly a step in the right direction, but it could have been a more forceful step.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Choosing a Therapist

You are a consumer, a client of services for which you pay through insurance or out of pocket on a sliding scale or both.

Keep in mind that you are a consumer and you are paying for a service. Therefore, when shopping" for a therapist, you must ask the right questions and feel comfortable with the person you choose.

When possible, inquire ahead of time about the therapist's education, experience with your problem, theoretical orientation, and how long the therapy might take. If you have read a self-help book you found particularly helpful or relevant, ask the therapist if he or she is familiar with that author's books, ideas, and approach. Don't feel intimidated by therapists that you meet.

It is also a good idea to bring a trusted friend or relative into your first few therapy sessions until you are confident the psychiatrist or counselor you have chosen is trustworthy, will respect your wishes and preference, honor your life goals and help you work toward recovery that is optimal for you. It is your right to bring to therapy sessions anyone you trust who will help become comfortable and feel safe as you get to know the therapist or counselor and develop a cooperative partnership in the process. If a therapist, psychiatrist or counselor refuses to allow a third party of your choice to attend the therapy sessions, if that is your preference, then find another therapist. A mental health professional who fears witnesses to what occurs in the office may be trying to hide something about his or her practices or to intimidate you, and intimidation and concealment are not healthy therapy practices.

Look around until you find someone whose style and answers are comfortable for you. Just because you are having some problems doesn't mean that you don't know what you want, what you need, what sounds right to you. Be honest with yourself and trust your own judgment. If you find that the therapist you have chosen is not listening to your needs and ignoring your requests for alternatives to what does not work or what harms you, then find another therapist who will heed your requests, respect you and your preferences and cooperate with finding what is best for you. You do not have to put up with disrespect and refusal to meet your needs simply because you are a client of psychiatric services. Many private therapists will take Medicaid patients, and getting out of the public system to connect with a therapist who isn't just getting a paycheck without having to be accountable is often the best direction to go.

And, ultimately, no strategy is failproof. If you find that the therapy isn't going the way you feel it should, discuss it with the therapist. If it continues to feel wrong, you might want to consider changing therapists. Some points to keep in mind: *It is important to choose a therapist who is a good match with you. This is a very personal decision. Even the most professionally respected therapist in the world will not be a good match for everyone.*
Source: Counseling & Mental Health Center The University of Texas at Austin, 100A W. Dean Keeton St,. Austin, TX
78712-5731
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
You Have Rights:Know and Insist on Them

Your doctor or health care provider is doing a service, just like the person who installs your telephone or fixes your car. The only difference is they have experience and dealing with issues of medication and treatment.

Your doctor or other health care provider should: 1) listen carefully to everything you say and answer your questions 2) be hopeful and encouraging 3)plan your treatment based on what you want and need 4)teach you how to help yourself 5)know about and be willing to try new or different ways of helping you feel better 6) be willing to talk with other health care professionals, your family members, and friends about your problems and what can be done about them, if you want them to.

In addition to the personal rights described below, your health care rights also include the right to- decide for yourself which treatments are acceptable to you and which are not, a second opinion without being penalized, a change health care providers—although this right may be limited by some health care plans. You also have a right to have the person or people of your choice be with you when you are seeing your doctor or other health care provider.

Rights of Psychiatric Patients
To participate in developing an individual plan of treatment.
To receive an explanation of services in accordance with the treatment plan.
To participate voluntarily in and to consent to treatment. To object to, or terminate, treatment.
To have records protected by confidentiality and not be revealed to anyone without my written authorization.
Confidentiality may only be broken under the following conditions (state laws will vary): If the therapist has knowledge of child or elder abuse. If the therapist has knowledge of the client's intent to harm oneself or others.
If the therapist receives a court order to the contrary.
If the client enters into litigation against the therapist. To have access to one's records. To receive clinically appropriate care and treatment that is suited to their needs and skillfully, safely, and humanely administered with full respect for their dignity and personal integrity.
To be treated in a manner which is ehtical and free from abuse, discrimination, mistreatment, and/or exploitation.
To be treated by staff who are sensitive to one's cultural background. To be afforded privacy.
To be free to report grievances regarding services or staff to a supervisor.
To be informed of expected results of all therapies prescribed, including their possible adverse effects (eg.- medications).
To request a change in therapist.
To request that another clinician review the individual treatment plan for a second opinion
Source: Dr. John Grohol's Psych Central
 
 
 
 
 
 
 
 
 
 
 
 
 
Hospitalization

There are times when treatment is unwanted but deemed necessary by family members or mental health authorities. In such cases, you may have a right to refuse treatment while in the hospital, and you always have a right to informed consent, which requires the medical personnel treating you to provide complete details about the pros and cons of the proposed therapy or treatment, the possibilities of adverse, paradoxical or unwanted effects from medicines and also the alternatives to treatment that you consider more harmful than helpful.

Times when right to refuse may not apply fully can include involuntary civil commitment, which can be for either outpatient or inpatient treatment, as well as forced medication. In some states, patients have the right to refuse medication or other therapy they consider useless or damaging. Laws about commitment vary by state. If you have questions about the commitment process in your state, contact your State P&A program or consumer or family organization.

Informed consent refers to when a patient agrees to undergo or participate in a medical or surgical procedure, treatment, or study after learning what is involved. Informed consent requires that a person know and fully understand the risks and benefits of a certain treatment or procedure. People generally have the right to consent to or refuse treatment. However, under certain conditions-such as when a person is considered a danger to self or others-he or she may be required to seek or receive treatment. As a general rule, it is wise never to merely take a drug because the treating physician tells you to do so. Before agreeing to any medical treatment or procedure, ask questions about the possible consequences or results, and if the risks outweigh the benefits for you, make sure to request alternatives to what doesn't work for you or produces damaging or unwanted effects. If you feel you have been wrongfully imprisoned or incarcerated, call your local Protection and Advocacy or an advocacy group like the Mental Health Association to obtain help being discharged as soon as possible.

When community services exist that would allow you to recover without being restricted in a mental institution, it is your right to access such services if you are not violent or liable to harm yourself or others. Again, if you are refused by mental health authorities a referral to community based servcies without evidence of dangerousness, call your local P&A or Mental Health Association to get some direct advocacy.

If you are committed against your will and no community services are available for you even though you are not dangerous to yourself or others, it is also important to report the incident to your local P&A agency. If your state lacks community based services and cannot make a referral for care in your community of choice, then the Department of Mental Health in your area is in violation of the Americans with Disabilities Act, which requires availability and access to community based for qualified persons as alternatives to acute care revolving door syndromes and long hospital stays. Report the lack of community services immediate to your local P&A and request an investigation of the Department of Mental Health's ADA compliance status and its failure to provdide adequate community services to prevent hospitalization and unnecessary confinements.

If your local P&A asks you to testify in a federal court action against the state DMH for failure to provide adequate community care, you do not have to fear reprisal, and if the idea of testifying in a federal lawsuit scares you, there is always support from other clients who have been denied services or who wish to see the mental health system reform itself to become response to the needs of clients. Don't hesitate to agree to testify, and don't hesitate to ask other clients for support in the process of preparing for court.

It is also important to remember that simply going along with a therapy or treatment that isn't working for you can waste your time and harm you emotionally and sometimes physically. So always be informed before you agree to any course of treatment, and always ask about alternatives to treatments that may be harmful in the long run.

If you sign in to a mental institution voluntarily, then you have a right to sign out if you feel the therapy is not helping you or if you sincerely believe you are able to return to your home or community and remain stable and comfortable in your own personal environment.

If you decide to sign out of a voluntary hospital stay, and mental health officials threaten you with involuntary commitment for requesting a discharge, it is your right to request an independent evaluation and to call your local P&A or Mental Health Association to obtain direct advocacy for a violation of your rights as a voluntary patient to leave the hospital setting as soon as you are ready to return to community.

If the hospital does not help you develop a discharge plan that includes access to housing, work and family counseling, which is usually needed because emotional crisis is generally a function of social dynamics and not just someone's alleged brain disease, then you may also need direct advocacy from P&A and the Mental Health Association to obtain a discharge plan that ensures you will not be spit out onto the streets with no resources and bad feelings within your family on top of that. Mental health care should not be aimed at controlling or punishing you. The goal should be to assist you in recovery, and nobody can recover without acess to stable housing, work and a supportive social network. If your discharge goals do not include these important elements, P&A and a local advocacy agency can help you obtain these needed services. That's their job.
 
 
 
 
 
 
 
 
Kendra's Law is 'Patriot Act for Mental Patients'
Syracuse Post-Standard OP ED
By Fred Fusco March 17, 2004
If you're Attorney General Eliot Spitzer, Chief Judge Judith Kaye or a member of the New York State Court of Appeals, which Feb. 17 unanimously upheld its constitutionality, you know it as "Kendra's Law." The state legislation passed in 1999, after the tragic death of Kendra Webdale at the hands of Andrew Goldstein, a young man with emotional problems and a psychiatric diagnosis who couldn't get the help he was desperately seeking.

The legislation allows the state to make a pre-emptive strike and force outpatient psychiatric treatment on a person who might commit a violent act. Just as the reasons for war with Iraq have evolved, the current line on why some people should be denied their constitutional freedoms is to force mental health providers to be more responsive to them. But my reason for writing is to be a uniter, not a divider.

To that end I propose we find a name for this legislation all sides can agree on. My favorite is "PAMP" the Patriot Act for Mental Patients. Think about it: What is the primal emotion that drives the federal Patriot Act? Fear. What is the main objective of that legislation? Safety. What is society being asked to sacrifice in order to be free of fear and to feel safe? Constitutional rights. Which sworn defender of our constitutional rights is the leading advocate of this legislation? The attorney general.

Let me elaborate.

PAMP as I hope we all come to call it was born of fear and is nourished by fear. Until 9/11, the most feared population undoubtedly was mentally ill people. (When you consider how we describe terrorists - crazy, mad - and when you think of Saddam Hussein's recent elevation to the status of "madman," terrorists haven't replaced mentally ill people as the most-feared, rather the two have merged.)

Because of the stigma, the perception of danger, mentally ill people already have a far more difficult time finding jobs, housing and friends. PAMP reinforces that stigma. The person with the most challenging job in our agency is the coordinator of our community companions program. She's charged with finding volunteers to spend one hour a week in friendship with one of these "scary" mental patients. Despite the extraordinary flexibility of the program, she must disappoint countless individuals who have asked to be matched with a volunteer because too few people respond.

PAMP is intended to make us feel safe. The whole premise is that if we can coerce mentally ill people whom we have decided could commit a future violent act to "take their meds," then they won't commit the violent act. Ironic. We know for a fact that people with mental illnesses are far more often the victims of violent acts committed by sane people. No one seems to worry about that. How about we extend the scope of PAMP to make life safer for mental patients by forcing sane people to report for their injections?

I'm not a constitutional scholar. But no matter what the ruling from the Court of Appeals, PAMP singles out one group of people, takes away their freedom to determine what is in their own best interest, and does so on the grounds that they might commit a violent act. I have a hard time believing the framers of the Constitution had that in mind when they talked about "certain inalienable rights" including "life, liberty and the pursuit of happiness." But if I'm wrong, let's expand PAMP to include a few other groups where future violence against others is a possibility - like abusive spouses, alcohol and substance abusers, clergy and traumatized veterans. And what about you? What guarantee does the state have that you won't hurt someone in the future?

Since neither the attorney general nor the Court of Appeals appears inclined to protect mentally ill people from the coercive powers of the state, we must turn to the Legislature. Kendra's Law will sunset in June of 2005. Contact your representatives and ask them to commit the one future act of violence that is most needed kill the legislation.

Fred Fusco is executive director of the Mental Health Association of Onondaga County. This 'Mental Health E-News' posting is a service of the New York Ass'n of Psychiatric Rehabilitation Services, a statewide coalition of people who use and/or provide community mental health services dedicated to improving services and social conditions for people with psychiatric disabilities by promoting their recovery, rehabilitation and rights. To join our list, e-mail us your request and, where appropriate, the name of your organization to NYAPRSadm@aol.com.