Revision. The Status of Mentally Ill Persons In the United States Today. As applicable to public mental health care facilities such as The Arizona State Hospital, Phoenix, AZ.
    
This article was published in its original form in May, 2012.

           Almost immediately after I was initially hospitalized in the first mental facility I that I spent time in, (circa May, 2010 in a Tucson area facility, at the onset of 21 total months in the Arizona public mental health care system), I saw that seriously mentally ill persons/patients are often grossly underrepresented, underserved, mistreated, and effectively denied reasonably decent care; and as importantly, are commonly unable to speak for themselves in regards to the simplest of concerns, this due to the gravely disabling affects of serious mental illness, as it manifests in such persons lives. That said, I sincerely believe that seriously mentally ill adults may represent the most formally marginalized population in the United States (albeit, alongside at-risk children and elderly), and despite numerous reform movements to the contrary which were implemented in reaction to well recognized issues in the context, seriously mentally ill persons (SMI) are still extremely vulnerable to abuse. Bottom line, across the board, and 100% in contradiction to the expectations of all/any reasonably conscientiousness American in contemporary society.
        In this context, one critical feature to my learned knowledge base at this time relates to the simple fact that mentally ill persons are not inherently criminal by nature, and yet at the Arizona State Hospital (and I feel it is safe to presume most/all such public hospitals), state employed staff far too often treat each and every patient as degenerate or otherwise aberrant, as though we the patients are inherently immoral, and therein undeserving of compassionate care that all such public health care facilities are required to provide as per established law and policy across the board.
          Case in point #1 (and this is just one of many such examples of my experiences at ASH): In my first formal conversation with Dr. Pervaiz Ahkter, who had been assigned as my second attending ASH psychiatrist, this Pakistani trained medical "doctor" asked me rather incredulously: 

"Is it really true that you are not a felon?". 

     Akhter posed this question in May, 2011, at which point I had been hospitalized at ASH for over 12 weeks, in spite of the fact that my entire personal records were provided to ASH staff upon my application for admission, as per the civil court order that dictated my right to be provided services at ASH the previous winter, 2010-11.
        I attest to the fact that seriously mentally ill and disabled adults have little to no voice in terms of speaking for themselves, in graphic defiance of the mission of numerous efforts in society today to create avenues of empowerment for mentally ill persons, and that the staff at the Arizona State Hospital capitalize on the their disproportionate power over the patients as a means to preserve egregiously substandard care and practices at ASH. In  public hospitals such as ASH, the stigmatization factor that underlies deeply endemic discrimination against persons affected by serious mental illness and disability is still acutely present; and as per my experiences, behind the fences and doors of the Arizona State Hospital, I further attest to the fact that the most insidious elements of this societal disfunction and related history are still rampantly at work, to the direct and undeniable detriment of all ASH patients, all of it as a matter of standard practice. Many of the most fundamental communications between patients and staff technicians and nurses at ASH are are highlighted by overt prejudices of staff towards the patients, and I literally  encountered staff members at ASH who were willing to treat me like like as something less than human on my first day there. 
     In this context, what I also learned during my 13 long months at the Arizona State Hospital is that most of the patients' interests there are managed by guardians (often the state itself) due to the severity of their given mental illness, which means that they have next to no independent voice or immediate recourse if they are in fact abused or otherwise mistreated by ASH staff. As stated, on top of that fact, many of these guardians are state appointed, and as the situation at Arizona Child Protective Services has proven in recent years, the state guardianship program is a disaster, particularly in terms of the at risk citizens that these agencies are responsible for. At ASH, it is a double bladed reality, due to the nature of the facility with its high level security status, etc., where no sort of objective oversight is possible, in patent defiance of applicable state and federal laws. The patient advocate at ASH, Sonia Serda, once made it very clear to me that anytime a patient is struck or otherwise abused by ASH staff (this, after I reported having seen two burly male technicians face slam a nonviolent patient, Andy B., into a solid steel door), there is nothing that can be done to address the matter if the patient's guardian doesn't report the incident on that patient's behalf. But these guardians, even in the best of circumstances (if and when the patient has loving family representing them in the context, for example), are not immediately available, this as per very limited phone use restrictions and the willingness of most ASH staff to defer the factual presence of patient abuse to clinical and administrative supervisors who refuse to respond. 
     All staff members at ASH know these things well, and the majority of them take full advantage it. The fact is, well documented history has established that seriously mentally ill adults in the United States are extremely vulnerable to abuse, exploitation, and negligence, as well as the fact that public hospitals such as ASH are snake pits of potential abuse in the context; and in this sense, I was shocked to learn in 2011-12, that in a public health setting such as ASH, where we the American people would reasonably expect for the rights and well being of seriously mentally ill persons to be well preserved/protected, the conditions are still operating in 100% contradiction to any such expectations. 
This reality is something that many persons familiar with such facilities acknowledge with little hesitation, and yet these issues still go on, as though the interests of the people- as established in a wide range of public interest law and policy- are of no significance.  
     Ergo, I will continue to assert that such protections and safety, as per established medical ethics, and rights and liberties provided for via the provisions of the Americans With Disabilities Act [ADA] and the Eighth Amendment of the Constitution, etc., are central to the required obligations of any/all public health care facilities, consistent as well with the actual licensure of such facilities, and that of medically certified caregivers, from the ASH psychiatrists, to senior nursing staff, and so on. I can also attest to the fact that one of the most frightening aspects of my overall experiences as a patient at ASH to realize that many of the staff there simply suspend the reality that this is the United States, and that the year is 2012, and that they are openly willing to look patients in the eye and say "You don't matter, you can't do anything to protect yourself from me, you are not human. 
     Case in point #2: In early April, 2011, my first assigned ASH psychiatrist, Laxman Patel, responded to my earliest concerns about patient abuse and staff misconduct at ASH with these exact words:

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

     This from a man who was raised and educated in India, and who is now (2013-14) filling the crucially important position of ASH's Chief Medical Officer. As I have already said in this article, this is only one small detail of my overall experiences as a former ASH patient. The wrongdoing that I was subjected to at ASH is not unique to me (in the first place), and this dynamic alone supports my most basic contention that similar exhibitions of grossly substandard practices and related clinical ineptitude arise on a near daily basis in the experiences of the ASH patient community in general, which I did witness and experience throughout the entirety of my 13 long months at ASH, shockingly illegitimate misconduct that only intensifies the higher up the ranks of ASH staff we go, extending as such into the executive offices of ADHS/Behavioral Health Services. 
     It need be understood that all ASH patients are disabled by virtue of serious mental illness. The willingness of ASH staff to carry on with their systemic abuse of patients day after day is a blatant violation of myriad state and federal laws, and occurs in complicity with various state agencies who are required as per the public trust to protect the rights of all AZ citizens. This  misconduct is condoned simply on the basis of the related fact that ASH patients are hindered by disability- which is patently discriminative in all senses- and only occurs due to the fact in facilities such as ASH (or places like ASH), all patients are affected by gravely disabling illness, which effectively rules out the possibility of any patient successfully reporting these issues as they arise. Only in places like ASH does this sort of abuse so rampantly occur, with the involved staff basically saying in no uncertain terms "You are mentally ill and do not deserve to the same treatment as other people." This is putting it mildly, in terms of how many of the ASH staff act, and in my observations, this was consistently the attitude of the majority of senior ASH nurses, as well as the psychiatric doctors, and once I turned to the administrative staff at ASH, I only learned that much more soundly that abuse(s) of authority and related dereliction of duty is standard practice anytime the needs of seriously mentally ill and disabled citizens are at stake in Arizona's public health care system.  

IN CLOSING: What will it take to bring about the reform that I contend needs to be implemented if these matters are to be addressed, at the Arizona State Hospital, and beyond in the public state health care system? At a minimum, all concerned persons must openly voice such concern to each and every elected state official in the book, as it may apply. I also invite and encourage anybody of like mind to contact me, this in the hope that open and unfettered dialogue can occur on behalf of the seriously mentally ill and disabled patients at The Arizona State Hospital. Well before any such patient was committed to ASH, there were and are still human beings, not inherently criminal or immoral, and deserving of nothing short of all persons' rights in the context of public health care. 

paoloreed@gmail.com