ENTER PERVAIZ AKHTER: Lest We Forget: A summary of the pain and suffering caused by The Arizona State Hospital's clinical and administrative ineptitude. 

Wherein, the conditions at ASH reflect endemically entrenched stigmatism, discrimination, and directly associated sanctioned abuses of administrative and clinical authority over patients, all of which flies in the face of contemporary standards of mental health care and practice. 


A) Introduction
B) Article: "Violence and Mental Illness: The Facts."
C) Discussion 


"People with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime, both in the community as well as in the psychiatric facilities" (Appleby, et al., 2001) 

      "Most citizens (including mental health professionals) believe persons with mental illnesses are dangerous and/or criminal by nature.... Although studies suggest a link between mental illnesses and violence, the contribution of people with mental illnesses to overall rates of violence is small,” and further, “the magnitude of the relationship is greatly exaggerated in the minds of the general population, including in public psychiatric facilities which are assigned the duty  of mental health treatment and patient rehabilitation.” (Institute of Medicine, 2006)
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A) Introduction     

     ON MAY 24, 2011, FOLLOWING AN INTIAL 4 1/2 MONTHS OF HOSPITALIZATION AT THE ARIZONA STATE HOSPITAL, I HAD MY FIRST FORMAL ONE ON ONE CONSULTATION WITH DR. PERVAIZ AKHTER, A PAKISTANI TRAINED PSYCHIATRIST WHO WAS ASSIGNED AT THAT TIME TO BE MY PRIMARY ASH CARE PHYSICIAN. AKTHER WAS ASSIGNED AS SUCH AFTER MY FIRST ASH PSYCHIATRIST, DR. LAXMAN PATEL  EXPRESSED CLEAR RESENTMENT FOR MY SELF DIRECTED ADVOCACY EFFORTS AND ADVISED ME TO REQUEST A DIFFERENT PRIMARY ATTENDING DOCTOR. I AGREED TO THIS IMMEDIATELY (FOR WHO WOULD WANT TO BE TREATED BY ANY DOCTOR NOT DEVOTED TO PROVIDING YOU WITH TREATMENT?), AND DID SO IN FRONT OF MY ENTIRE SEVEN PERSON TREATMENT TEAM, INCLUDING MY PRIMARY THERAPIST KEVIN JESSUP, MEDICAL (non-psychiatric) PROVIDER, DR. MAITREYI KULKARNI, AND OTHER LIKE STAFF WHO LATER ATTESTED TO THE FACT THAT PATEL DID IN FACT ADVISE ME AS SUCH. I MENTION THE PRESENCE OF THESE OTHERS, BECAUSE A FEW DAYS LATER, 

LAXMAN PATEL FLATLY DENIED IT. 

(AS AN ADDITIONAL NOTE, IT NEEDS TO BE SAID THAT  PATEL 

HAS SINCE BEEN PROMOTED TO THE POSITION OF CHIEF MEDICAL 

OFFICER AT ASH….)

THIS IS THE ATMOSPHERE IN WHICH MY RELATIONSHIP WITH PERVAIZ

 AKTHER BEGAN.  AND WITHIN SECONDS OF SITTING DOWN TO 

TALK TO THE MAN, AKHTER, HE TOO EXHIBITED A GRAPHICALLY 

IMBECILIC LACK OF SKILL AS A LICENSED PSYCHIATRIST BY LOOKING 

ME IN THE EYE AND ASKING IN NO UNCERTAIN TERMS:

               "ARE YOU REALLY NOT A FELON?"

AT THE TIME, I WAS MODERATELY FLABBERGASTED BY THIS QUESTION. FOR IT IS NOT AS THOUGH THIS SO CALLED DOCTOR DIDN'T HAVE DIRECT ACCESS TO MY FULL PATIENT RECORDS, FOR EXAMPLE, WHICH I FURTHER CONTEST HE WAS REQUIRED TO FAMILIARIZE HIMSELF WITH  BEFORE THIS CONVERSATION, INCLUDING ANY/ALL PUBLIC RECORDS SPECIFIC TO CRIMINAL PROSECUTION AND RELATED INCARCERATION. 

BUT AS IMPORTANTLY,  I WAS TAKEN IMMEDIATELY ABACK BY AKHTER'S  QUESTION BECAUSE SERIOUS MENTAL ILLNESS DOES NOT INHERENTLY HAVE ONE GODDAMN THING TO DO WITH CRIMINAL CONDUCT OF ANY KIND, MUCH LESS SO IN TERMS OF FELONIOUS MISBEHAVIOR. 

THIS IS COMMON SENSE, BUT I CAN ALSO ATTEST TO THE FACT THAT NEVER DURING THE PROCESS OF BEING REFERRED TO ASH BY THE GOOD CARE PROVIDERS AT UNIVERSITY OF ARIZONA MEDICAL CENTER (TUCSON, AZ, FORMERLY KIN0/UPH) HAD I GOTTEN THE IMPRESSION THAT MENTALLY ILL PERSONS WERE INHERENTLY CRIMINAL BY NATURE.

LIKEWISE, NEVER DURING ANY OF MY EXPERIENCES IN THE ARIZONA HEALTH CARE SYSTEM TO THAT POINT IN TIME HAD I HEARD THAT IN ORDER TO RECEIVE TREATMENT AT ASH ONE HAD TO BE A FELON.

I MADE MY LACK OF UNDERSTANDING IN THIS CONTEXT VERY CLEAR TO DR. PERVAIZ AKHTER  AT THAT TIME, BUT HE REFUSED TO COMMENT FURTHER. I HAD BY THAT TIME  ALREADY WITNESSED AND/OR PERSONALLY EXPERIENCED VERY ALARMING DISCRIMINATION BY VARIOUS ASH STAFF IN THE CONTEXT OF THEM TREATING ME AS THOUGH I WAS MORALLY DECREPIT OR OTHERWISE UNDESERVING OF FUNDAMENTAL TRUST/RESPECT AS A HUMAN BEING, THIS ON THE BASIS ON NOTHING OTHER THAN THE FACT THAT I WAS AN ASH PATIENT. BUT IN TRUTH, I HAD NOT YET REALIZED THE TRUE NATURE OF THE ISSUE, AS IT STOOD THEN, AND- GIVEN THAT THESE INDIVIDUALS CONTINUE TO FUNCTION AS PRIMARY CARE PROVIDRS AT ASH- STILL STANDS TODAY. IT LITERALLY TOOK AKHTER'S STATEMENT, IN COMBINATION WITH HIS MISCONDUCT AS IT PLAYED OUT OVER THE NEXT FEW  MONTHS, FOR ME TO FULLY COMPREHEND THE FACT THAT AT ASH, PERSONS AFFECTED BY SERIOUS MENTAL ILLNESS ARE SUBJECTED TO THESE FORMS OF DEPRAVED MISTREATMENT AS A MATTER OF STANDARD PRACTICE.

I ATTEST TO THE FACT THIS REALIZATION CAUSED ME HIGHLY UNDUE STRESS THAT VIRTUALLY TRANSCENDED ANY OF MY OTHER FEARS AT ASH, INCLUDING IN TERMS OF MY PATIENT-PEERS, ACROSS THE BOARD. IN THIS SENSE, IT IS SUCH STAFF- AND NOT THE PATIENTS- WHO CAUSE THE MOST TRAUMATIC EVENTS AND CONDITIONS AT ASH. 

  

GIVEN THE VERY REAL FACT THAT ASH IS THE ONLY LONG TERM PUBLIC MENTAL HOSPITAL IN ARIZONA, AND THE RELATED FACT THAT PERSONS WITH NO OTHER OPTION(S) IN LIFE BEYOND BEING REFERRED AND COMMITTED TO ASH HAVE EVERY RIGHT TO BE PROVIDED WITH OPTIMUM TREATMENT, AS PER ESTABLISHED STANDARDS OF MEDICAL CARE READILY AVAILABLE IN CONTEMPORARY HEALTH CARE LAW AND ETHICS, I AM COMPELLED TO SHARE INFORMATION IN THIS CONTEXT, WHICH I HAVE BEEN RESEARCHING IN ORDER TO CLARIFY MY MOST CRITICAL CONCERNS, INCLUDING SPECIFIC TO THE GRAPHIC DISCRIMINATION EXHIBITED BY DR. PERVAIZ AKHTER, AND OTHER SENIOR CLINICAL STAFF AT ASH. BELOW IS ONE CLEAR EXAMPLE OF DATA SUPPORTING MY CONCERNS, PROVIDED BY THE RESEARCHERS AT THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION. AKA "SAMHSA", THIS IS THE AGENCY WITHIN THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES THAT LEADS PUBLIC HEALTH EFFORTS TO ADVANCE THE BEHAVIORAL HEALTH OF THE NATION TODAY, WITH THE ATTENDANT MISSION OF REDUCING THE IMPACT OF SUBSTANCE ABUSE AND MENTAL ILLNESS ON IN CONTEMPORARY AMERICAN SOCIETY.

B) Article

Violence and Mental Illness: The Facts 
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES 
ADMINISTRATION, 2010

The discrimination and stigma associated with mental illnesses largely stem 
from the link between mental illness and violence in the minds of the 
general public (including in psychiatric hospitals), according to the U.S. 
Surgeon General (DHHS, 1999). The belief that persons with mental illness 
are dangerous is a significant factor in the development of stigma and 
discrimination (Corrigan, et al., 2002). The effects of stigma and discrimination
are profound. The President’s New Freedom Commission on Mental Health found 
that, “Stigma leads others to avoid living, socializing, or working with, renting to, 
or employing people with mental disorders - especially severe disorders, such as
 schizophrenia. It leads to low self-esteem, isolation, and hopelessness. It deters 
the public from seeking and wanting to pay for care. Responding to stigma, people
with mental health problems internalize public attitudes and become so 
embarrassed or ashamed that they often conceal symptoms and fail to seek or 
otherwise engage in treatment for their given illness (New Freedom Commission, 
2003).”

   






The discrimination and stigma associated with mental illnesses is often promoted by the entertainment and news media. For example, Mental Health America, (formerly the National Mental Health Association) reported that, according to a survey for the Screen Actors’ Guild, characters in prime time television portrayed as having a mental illness are depicted as the most dangerous of all demographic groups: 60 percent were shown to be involved in crime or violence. Also most news accounts portray people with mental illness as dangerous (Mental Health America, 1999). The vast majority of news stories on mental illness either focus on other negative characteristics related to people with the disorder (e.g., unpredictability and unsociability) or on medical treatments. Notably absent are positive stories that highlight recovery of many persons with even the most serious of mental illnesses (Wahl, et al., 2002). Inaccurate and stereotypical representations of mental illness also exist in other mass media, such as films, music, novels and cartoons (Wahl, 1995).                                                                                                            

  Most citizens (including mental health professionals) believe persons with mental illnesses are dangerous and/or criminal by nature. A longitudinal study of Americans’ attitudes on mental health between 1950 and 1996 found, “the proportion of Americans who describe mental illness in terms consistent with violent or dangerous behavior nearly doubled.” Also, the vast majority of Americans believe that persons with mental illnesses pose a threat for violence towards others and themselves (Pescosolido, et al., 1996, Pescosolido et al., 1999).

    As a result, Americans are hesitant to interact with people who have mental illnesses. Thirty-eight percent are unwilling to be friends with someone having mental health difficulties; sixty-four percent do not want someone who has schizophrenia as a close co-worker, and more than sixty-eight percent are unwilling to have someone with depression marry into their family (Pescosolido, et al., 1996).

    But, in truth, people have little reason for such fears. In reviewing the research on violence and mental illness, the Institute of Medicine concluded, “Although studies suggest a link between mental illnesses and violence, the contribution of people with mental illnesses to overall rates of violence is small,” and further, “the magnitude of the relationship is greatly exaggerated in the minds of the general population, including in public psychiatric facilities assigned the duty of mental health treatment and patient rehabilitation.” (Institute of Medicine, 2006). For people with mental illnesses, violent behavior appears to be more common when there’s also the presence of other risk factors, including physical abuse and emotional abuse (including in psychiatric hospitals), and directly related recent stressors such as being a crime victim, getting divorced, or losing a job (Elbogen and Johnson, 2009).

In addition:

• “Research has shown that the vast majority of people who are violent do not suffer from mental illnesses (American Psychiatric Association, 1994).”
• “The absolute risk of violence among the mentally ill as a group is still very small and . . . only a small proportion of the violence in our society can be attributed to persons who are mentally ill (Mulvey, 1994).”
• In a 1998 study that compared people discharged from acute psychiatric inpatient facilities and others in the same neighborhoods, researchers found that “there was no significant difference between the prevalence of violence by patients without symptoms of substance abuse and the prevalence of violence by others living in the same neighborhoods who were also without symptoms of substance abuse (Steadman, Mulvey, Monahan, Robbins, Applebaum, Grisso, Roth, and Silver, 1998).”
• "People with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime, both in the community as well as in the psychiatric facilities" (Appleby, et al., 2001) 

Researchers at North Carolina State University and Duke University found that people with severe mental illnesses—schizophrenia, bipolar disorder or psychosis—are 2 ½ times more likely to be attacked, raped or mugged than the general population, including in conditions specific to residential psychiatric care.  (Hiday, et al., 1999).  

                (END OF ARTICLE)

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C) Discussion

As a matter of practicality, I will just state here and now that: 

   "Yes, Of course!" ...Pervaiz Akhter will deny this matter, should he ever be questioned about it. That's the norm anytime direct reports of wrongdoing in any context arise at ASH, across the board, standard practice, regardless of how well documented such reports are. But I attest to the fact that many of my patient-peers at ASH, and not mention some number of ASH staff, shared my deep disdain for this man's misconduct, outright rudeness, coldness, and other like behavioral features which I personally found to be utterly insulting to the medical profession in all senses. But that's just how it is at ASH. 

Or as the current Chief Medical Officer at ASH, Laxman Patel, put it to me not long before we parted ways:

"What do you expect? 
This is the state hospital." 

      

VIA MY VERY REAL EXPERIENCES AT THE ARIZONA STATE HOSPITAL, I CAN ATTEST THAT BLANKET DISCRIMINATION AGAINST INDIVIDUALS AFFECTED BY MENTAL ILLNESS WILL ARISE ANYTIME YOU HAVE A ACTIVELY DOMINANT POWER SYSTEM UNQUALIFIED IN TERMS OF GRASPING THESE BASIC DYNAMICS OF MENTAL ILLNESS. AND AS PER THESE EXPERIENCES, AS WELL AS MY ACQUIRED KNOWLEDGE, TO DATE, I AM WILLING TO SAY THAT YOU WILL NOT FIND MENTAL HEALTH CARE PROFESSIONALS MORE LACKING IN QUALIFICATIONS IN THIS CONTEXT THAN YOU WILL AT ASH AT THIS TIME. IT IS TANTAMOUNT TO A RECIPE FOR DISASTER FOR ANY SERIOUSLY MENTALLY PERSON FORCED BY LAW AND POLICY TO "SEEK" CARE AND TREATMENT IN PUBLIC HEALTH CARE FACILITIES SUCH AS ASH. INDEED, AND DESPITE THE PRESENCE OF PATIENTS WHO SOMEWHAT REGULARLY EXHIBIT VIOLENT OR OTHERWISE ABERRANT BEHAVIOR, I CAME TO REALIZE THAT THE PATIENTS ARE NOT THE PROBLEM AT ASH. IT IS- RATHER- STAFF AT ASH WHO ARE FALL FAR SHORT OF GRASPING  THE FACT THAT SERIOUSLY MENTALLY ILL PERSONS ARE PEOPLE, TOO, MANY OF WHOM POSSESS REMARKABLY VIRTUOUS CHARACTERISTICS, INCLUDING FUNDAMENTAL INTELLIGENCE, HONESTY, KINDNESS, AND SO ON. AND IN SHARP CONTRAST TO THIS FACT, AT ASH YOU WILL FIND SENIOR CLINICAL STAFF WHO EXHIBIT FAR MORE DEEPER FORMS IMMORALITY AND LACK OF ETHOS THAN THE PATIENTS DO THEMSELVES.

THESE ABUSIVE APPLICATIONS OF UNDUE POWER  AND AUTHORITY OVER PATIENTS OCCUR AT ASH AS A MATTER OF STANDARD PRACTICE.   THERE IS AN ENORMOUS BODY OF VERY WELL FOUNDED DATA SPECIFIC MENTAL ILLNESS THAT RELATES THE REALITY THAT EVEN IN THIS DAY IN AGE, FULLY CREDENTIALED PSYCHIATRISTS SUCH AS DR. PERVAIZ AKHTER COULD BE SO GRAPHICALLY OBLIVIOUS TO THE FACT THAT MENTAL ILLNESS HAS LITTLE IF ANYTHING TO DO WITH CRIMINAL OR IMMORAL CHARACTER. IN A NUTSHELL, IT'S LITTLE MORE THAN A MATTER OF SELF AWARENESS AND OPEN MINDED SELF EDUCATION IN THE CONTEXT OF CONTEMPORARY RESEARCH SPECIFIC TO THE STUDY OF LONG TERM PSYCHIATRIC PATIENT CARE. WITHOUT FURTHER REFERENCING THE FACT THAT THREE (3) OUT OF THE FOUR (4) PRIMARY CARE PHYSICIANS THAT I WAS UNDER THE CARE OF DURING MY THIRTEEN (13) FULL MONTHS OF HOSPITALIZATION AT ASH WERE TRAINED IN FOREIGN (FAR EASTERN AND MIDDLE EASTERN) SYSTEMS OF MEDICAL TRAINING AND EDUCATION, I WILL STATE MY OWN BELIEF THAT NONE OF THE DOCTORS OR ADMINISTRATORS AT ASH RIGOROUSLY ENGAGE IN ONGOING RESEARCH AND/OR CONTINUING EDUCATION SPECIFIC TO THE STUDY OF LONG TERM PSYCHIATRIC PATIENT CARE. 

VIA MY VERY REAL EXPERIENCES AT THE ARIZONA STATE HOSPITAL, I CAN ATTEST THAT BLANKET DISCRIMINATION AGAINST INDIVIDUALS AFFECTED BY MENTAL ILLNESS WILL ARISE ANYTIME YOU HAVE A ACTIVELY DOMINANT POWER SYSTEM UNQUALIFIED IN TERMS OF GRASPING THESE BASIC DYNAMICS OF MENTAL ILLNESS. THIS IS TANTAMOUNT TO A RECIPE FOR DISASTER IN TERMS OF ANY SERIOUSLY MENTALLY PERSON FORCED BY LAW AND POLICY TO SEEK CARE AND TREATMENT IN PUBLIC HEALTH CARE FACILITIES SUCH AS ASH.

IN CLOSING: Only at facilities such as The Arizona State Hospital are you going to find grossly substandard conditions in direct relation to the sorts of issues illustrated in the above data. ASH is not a corrections facility in any sense of the term, and the patients at ASH are not prisoners. Likewise, the clinicians and administrators at ASH are not authorized to impose constitutionally banned forms of restraint or undue restriction onto patients unless absolutely necessary in times of clearly evident threats to others or to the patients themselves. The Arizona State Hospital is operated in direct defiance of very clear rules and related law and policy, and the patients at ASH are afforded little to no meaningful access to support from the greater public and the resources found therein. Furthermore, the lower level clinical staff at ASH are among the lowest paid medical professionals in the state, and the upper tier clinical staff at ASH are clearly incapable of accepting and maintaining the most fundamental standards established in contemporary codes of medical practice and care. As such, the majority of staff at ASH are no more insulated from the endemically grounded discrimination against mentally ill adults described in the above article than anybody in our culture and society is today, and based on my very real experiences at ASH, I am even willing to argue that some of the very worst behavioral health care workers available on the market today find safe haven at ASH for their utterly abusive conduct.

Please get involved today. Patient Abuse at The Arizona State Hospital is sickeningly criminal in nature and ongoing even as I write this today. Please contact your locally elected representative(s), or go ahead and direct your passionate demands for mental health care reform to Arizona's public officials at the department of health services and beyond. Please see my "Resource Ideas" article (April 30, 2012) and determine the best avenue for you in terms of defending the rights of mentally ill patients at ASH today.

paoloreed@gmail.com