1 00:00:06,760 --> 00:00:12,200 Speaker 1: Welcome to Why Not Me? Embracing Autism and Mental Health Worldwide? 2 00:00:12,680 --> 00:00:20,200 Speaker 1: Hosted by Tony Mantor, Broadcasting from the heart of Music City, USA, Nashville, Tennessee. 3 00:00:21,280 --> 00:00:25,360 Speaker 1: Join us as our guests share their raw, powerful stories. 4 00:00:25,880 --> 00:00:29,880 Speaker 1: Some will spark laughter, others will move you to tears. 5 00:00:30,880 --> 00:00:36,479 Speaker 1: These real life journeys inspire, connect and remind you that 6 00:00:36,520 --> 00:00:41,400 Speaker 1: you're never alone. We're igniting a global movement to empower 7 00:00:41,600 --> 00:00:46,640 Speaker 1: everyone to make a lasting difference by fostering deep awareness 8 00:00:47,120 --> 00:00:53,280 Speaker 1: on wavering acceptance, and profound understanding of autism and mental health. 9 00:00:53,680 --> 00:00:57,840 Speaker 1: Tune in, be inspired, and join us in transforming the 10 00:00:57,880 --> 00:01:04,720 Speaker 1: world one story at a time. Hi, I'm Tony Mantor. 11 00:01:05,120 --> 00:01:09,520 Speaker 1: Welcome to Why Not Me? Embracing Autism and Mental Health Worldwide. 12 00:01:09,640 --> 00:01:12,800 Speaker 1: Before we jump in, if you haven't already, I invite 13 00:01:12,800 --> 00:01:15,520 Speaker 1: you to tap follow. It only takes a couple of 14 00:01:15,520 --> 00:01:18,600 Speaker 1: seconds and it helps this show reach more families who 15 00:01:18,680 --> 00:01:22,479 Speaker 1: need to hear these conversations. Thanks for being here today. 16 00:01:22,520 --> 00:01:25,600 Speaker 1: We bring together a group of seven voices, each with 17 00:01:25,640 --> 00:01:30,000 Speaker 1: their own experiences, perspectives, and stories. We will talk about 18 00:01:30,040 --> 00:01:33,600 Speaker 1: something that affects far more people than we often realize, 19 00:01:33,840 --> 00:01:37,360 Speaker 1: serious mental illness in the spirit of Mental Health Awareness Month. 20 00:01:37,600 --> 00:01:40,880 Speaker 1: This is not just a discussion, it's an opportunity, an 21 00:01:40,920 --> 00:01:44,679 Speaker 1: opportunity to listen, to understand, and to bring light to 22 00:01:44,760 --> 00:01:47,880 Speaker 1: conversations that are too often left in the dark. Joining 23 00:01:47,920 --> 00:01:53,080 Speaker 1: us today is Crystal Fox, David Hagar, Laura Crasian, Linda Mimes, 24 00:01:53,320 --> 00:01:58,200 Speaker 1: Judge Milton Mack, Rachel Streithe, and Anne Cochrane. This topic matters. 25 00:01:58,440 --> 00:02:02,600 Speaker 1: It touches families, friends, and entire communities. This is the 26 00:02:02,640 --> 00:02:05,480 Speaker 1: first of a three part series that we'll focus on 27 00:02:05,640 --> 00:02:09,080 Speaker 1: serious mental illness. Today. We are creating a space where 28 00:02:09,120 --> 00:02:12,200 Speaker 1: honesty is welcome, where stories can be shared, and where 29 00:02:12,320 --> 00:02:15,760 Speaker 1: understanding can begin or deepen for all of us listening. 30 00:02:16,200 --> 00:02:18,320 Speaker 1: I'm grateful to everyone that's joined us today. 31 00:02:18,400 --> 00:02:19,440 Speaker 2: Thank you for having us. 32 00:02:20,000 --> 00:02:22,080 Speaker 1: It's my pleasure. I think one of the first things 33 00:02:22,120 --> 00:02:23,840 Speaker 1: we need to discuss is some of the things that 34 00:02:23,919 --> 00:02:26,160 Speaker 1: might need to be changed. Let's start off with you, 35 00:02:26,400 --> 00:02:27,239 Speaker 1: Judge mac mean. 36 00:02:27,360 --> 00:02:29,200 Speaker 3: I think I said for a long time that our 37 00:02:29,200 --> 00:02:32,480 Speaker 3: mental health codes are how to sync with science, that 38 00:02:32,520 --> 00:02:35,960 Speaker 3: they are in patient models in an outpatient world, meaning 39 00:02:36,000 --> 00:02:39,519 Speaker 3: that the focus is on inpatient hospitalization. On ninety five 40 00:02:39,520 --> 00:02:41,920 Speaker 3: percent of the care is provided outpatient we need to 41 00:02:41,919 --> 00:02:45,440 Speaker 3: convert this system from an intatient model to an outpatient model, 42 00:02:45,600 --> 00:02:49,040 Speaker 3: and we're slowly moving that way now. Michigan has made 43 00:02:49,040 --> 00:02:53,200 Speaker 3: some strides or assisted our patient treatment as a standard order. Now, 44 00:02:53,360 --> 00:02:55,680 Speaker 3: if you end up in winkin a probate court on 45 00:02:55,720 --> 00:02:58,320 Speaker 3: a petition for hospitalization, you're also going to get at 46 00:02:58,800 --> 00:03:03,440 Speaker 3: So problem is our standard or intervention permits you to 47 00:03:03,520 --> 00:03:07,240 Speaker 3: file a petition or someone who's not sick enough for hospitalization, 48 00:03:07,520 --> 00:03:09,400 Speaker 3: but they are second enough for our patient treatment. The 49 00:03:09,440 --> 00:03:11,880 Speaker 3: problem is, in order to use it, I could hospitalize 50 00:03:11,880 --> 00:03:13,920 Speaker 3: first because the system is still backwards. So we have 51 00:03:14,080 --> 00:03:16,919 Speaker 3: legislation pending which has passed the House and Senate, which 52 00:03:16,960 --> 00:03:21,240 Speaker 3: would allow for easier intervention early before someone is so 53 00:03:21,400 --> 00:03:24,200 Speaker 3: sick hospitalized, and then that should be our goal. 54 00:03:24,600 --> 00:03:27,959 Speaker 4: I believe that's a step up. AOT is what you're 55 00:03:28,000 --> 00:03:29,640 Speaker 4: talking about, am I correcting that? 56 00:03:29,880 --> 00:03:32,239 Speaker 3: I'm not sure about that. The way it would work 57 00:03:32,320 --> 00:03:34,360 Speaker 3: with a family member could file a petition of the 58 00:03:34,360 --> 00:03:36,920 Speaker 3: probate court saying my son as a mental illness he 59 00:03:37,000 --> 00:03:40,560 Speaker 3: needs treatment on an our patient basis, and then we'd 60 00:03:40,600 --> 00:03:44,160 Speaker 3: have someone testified on that, and that's the judge health 61 00:03:44,160 --> 00:03:46,640 Speaker 3: that he required it he could order our patient freedment. 62 00:03:46,880 --> 00:03:50,040 Speaker 4: Yeah, I mean that you've just defined something called step 63 00:03:50,120 --> 00:03:53,560 Speaker 4: up AOT. So we have court ordered treatment in Arizona, 64 00:03:53,840 --> 00:03:57,040 Speaker 4: and that's our version of AOT. But in our case 65 00:03:57,120 --> 00:03:59,480 Speaker 4: you have to go into the hospital first. There's not 66 00:03:59,560 --> 00:04:05,600 Speaker 4: an option to have outpatient initiated order for outpatient treatment, 67 00:04:05,760 --> 00:04:08,640 Speaker 4: so that's called step up AOT, and I think that's 68 00:04:08,680 --> 00:04:09,960 Speaker 4: exactly what you've described. 69 00:04:10,000 --> 00:04:14,760 Speaker 3: We will permit a psychiatric nurse practitioner testify, or a 70 00:04:14,800 --> 00:04:18,359 Speaker 3: position assistant with a psychiatric background could testify, or a 71 00:04:18,360 --> 00:04:21,440 Speaker 3: psychologist not just a psychiatrist at the airing, so it'll 72 00:04:21,480 --> 00:04:24,400 Speaker 3: be easier to prevent presents the testimony you need. And 73 00:04:24,960 --> 00:04:27,800 Speaker 3: the court being a position to an order for AOT, 74 00:04:28,279 --> 00:04:30,600 Speaker 3: if it was found to be required, may be sent 75 00:04:30,640 --> 00:04:33,880 Speaker 3: to the CMH. May'd be bound to pair the treatment 76 00:04:33,920 --> 00:04:35,839 Speaker 3: plan within thirty days and get it back to the 77 00:04:35,839 --> 00:04:37,680 Speaker 3: probate cross. You're going to make sure they're actually doing 78 00:04:37,720 --> 00:04:39,240 Speaker 3: their job, and we're often running. 79 00:04:39,320 --> 00:04:41,880 Speaker 2: Yeah, in Arizona, at least in some of our counties, 80 00:04:41,920 --> 00:04:44,440 Speaker 2: we have some problems with AOT. We don't exactly do 81 00:04:44,480 --> 00:04:47,240 Speaker 2: it quite right. The court order treatment doesn't at least 82 00:04:47,240 --> 00:04:50,640 Speaker 2: in Maricopa County doesn't involve the judge and it only 83 00:04:50,920 --> 00:04:54,240 Speaker 2: requires like a report to be submitted to the judge, 84 00:04:54,360 --> 00:04:56,640 Speaker 2: But it doesn't put anybody in front of the judge 85 00:04:56,640 --> 00:04:59,120 Speaker 2: and it doesn't create any accountability for our clinics. 86 00:04:59,360 --> 00:05:02,080 Speaker 3: And what you need is to judge involved from beginning 87 00:05:02,080 --> 00:05:05,839 Speaker 3: to end when the petitions filed. So we measure now 88 00:05:06,040 --> 00:05:08,279 Speaker 3: when we get someone who comes in or a pickup 89 00:05:08,360 --> 00:05:10,640 Speaker 3: order to have their loved line transport to the hospital 90 00:05:10,720 --> 00:05:14,440 Speaker 3: for evaluation, we measure how many petitions we get after 91 00:05:14,520 --> 00:05:17,480 Speaker 3: that we're running around twenty five percent. So what happens 92 00:05:17,480 --> 00:05:19,599 Speaker 3: to the other seventy five percent? We don't have the 93 00:05:19,640 --> 00:05:21,320 Speaker 3: answer to that yet. But so where at the front 94 00:05:21,400 --> 00:05:24,880 Speaker 3: end we make sure that the deferment process is followed. 95 00:05:24,920 --> 00:05:28,200 Speaker 3: So what happens is if someone is hospitalized, there's a 96 00:05:28,200 --> 00:05:31,479 Speaker 3: deferment conference with CMH and the individual and a lawyer. 97 00:05:31,680 --> 00:05:34,240 Speaker 3: If they work on a treatment plan, that becomes the 98 00:05:34,279 --> 00:05:37,160 Speaker 3: plan and there's a deferment. But what has happened historically 99 00:05:37,320 --> 00:05:40,400 Speaker 3: is the hospital devestment invites to the table patients signs 100 00:05:40,440 --> 00:05:43,160 Speaker 3: of deferral and it's to deferral to nowhere. So we're 101 00:05:43,279 --> 00:05:45,480 Speaker 3: trying to tighten up the ship all the way through 102 00:05:45,520 --> 00:05:48,839 Speaker 3: the end, and we're measuring things. For example, we measure 103 00:05:49,080 --> 00:05:52,000 Speaker 3: how many people we put on an AOT order are 104 00:05:52,080 --> 00:05:55,560 Speaker 3: getting treatment within thirty days, and we know that number, 105 00:05:55,680 --> 00:05:58,800 Speaker 3: and we know what provider is hitting the target right now, 106 00:05:59,160 --> 00:06:02,520 Speaker 3: the best provider seventy five percent or sun Song great 107 00:06:02,560 --> 00:06:03,640 Speaker 3: but better than zero. 108 00:06:03,800 --> 00:06:07,080 Speaker 1: One of the biggest challenges families and caregivers talk about 109 00:06:07,400 --> 00:06:09,920 Speaker 1: is you finally get someone the help they need, You 110 00:06:09,960 --> 00:06:14,240 Speaker 1: get them hospitalized, you get them stabilized, and then sometimes 111 00:06:14,240 --> 00:06:17,240 Speaker 1: far too quickly, they're released. There are time limits, there 112 00:06:17,279 --> 00:06:21,119 Speaker 1: are policies, there are system constraints, and before long they're 113 00:06:21,240 --> 00:06:24,480 Speaker 1: right back out, often without the support that they truly 114 00:06:24,560 --> 00:06:27,359 Speaker 1: need to stay well. So my question, how do we 115 00:06:27,440 --> 00:06:28,280 Speaker 1: break that cycle? 116 00:06:28,800 --> 00:06:33,279 Speaker 5: We get around that well. In California, our AOT program 117 00:06:33,360 --> 00:06:36,960 Speaker 5: is completely voluntary. It's not the gold standard of care 118 00:06:37,440 --> 00:06:41,600 Speaker 5: that Treatment Advocacy Center puts out and is promoting, which 119 00:06:41,720 --> 00:06:45,240 Speaker 5: when done right, is wonderful. We have fifty eight counties 120 00:06:45,279 --> 00:06:49,279 Speaker 5: in California. These programs are all voluntary, and guess what 121 00:06:49,680 --> 00:06:52,839 Speaker 5: the sickest people that they are targeted towards. If you 122 00:06:52,880 --> 00:06:56,200 Speaker 5: have schizophrenia, you have fifty seven to ninety eight percent 123 00:06:56,279 --> 00:07:00,400 Speaker 5: chance of having anasygnosia, which renders the frontal law of 124 00:07:00,440 --> 00:07:04,719 Speaker 5: your brain dysfunctioning, and you are unable to be aware 125 00:07:05,000 --> 00:07:07,760 Speaker 5: that you are ill. So you're not going to ever 126 00:07:07,880 --> 00:07:11,760 Speaker 5: volunteer for services. Why should you? You're not sick. So 127 00:07:12,120 --> 00:07:17,000 Speaker 5: we have this running horrible dichotomy in our state. And 128 00:07:17,040 --> 00:07:21,160 Speaker 5: then we have the disabilities rights people and ACLU fighting 129 00:07:21,280 --> 00:07:24,280 Speaker 5: for people's rights to die with their rights on in 130 00:07:24,320 --> 00:07:28,040 Speaker 5: the street. But you cannot exercise your freedom and your 131 00:07:28,160 --> 00:07:32,440 Speaker 5: rights if you are trapped in your mind, not seeing 132 00:07:32,480 --> 00:07:36,520 Speaker 5: the world rationally. You cannot. Then it's a form of 133 00:07:36,600 --> 00:07:42,280 Speaker 5: imprisonment in your own brain. So I admire Michigan and 134 00:07:42,440 --> 00:07:45,240 Speaker 5: Judge Mack because you guys are trying to do it 135 00:07:45,280 --> 00:07:48,080 Speaker 5: the right way. We almost all of our programs here 136 00:07:48,080 --> 00:07:49,680 Speaker 5: in this state are voluntary. 137 00:07:50,040 --> 00:07:53,160 Speaker 1: I've been hearing this same challenge from people all across 138 00:07:53,160 --> 00:07:57,200 Speaker 1: the country and even globally. Because of this podcast, I 139 00:07:57,280 --> 00:08:01,440 Speaker 1: get to talk with families, caregibbers and professors everywhere. No 140 00:08:01,520 --> 00:08:04,360 Speaker 1: matter where they are, there seems to be a common 141 00:08:04,560 --> 00:08:09,840 Speaker 1: frustration with how systems like AOT are applied. One example, 142 00:08:10,440 --> 00:08:13,160 Speaker 1: I was talking with one father whose son was in 143 00:08:13,200 --> 00:08:16,800 Speaker 1: a clear mental health crisis, walking down the street with 144 00:08:16,880 --> 00:08:21,800 Speaker 1: no clothes on, completely disconnected from reality. Thankfully, the officers 145 00:08:21,840 --> 00:08:25,760 Speaker 1: that responded to it handled it with compassion, no handcuffs, 146 00:08:26,000 --> 00:08:28,960 Speaker 1: They kept him calm, even played his favorite music on 147 00:08:29,000 --> 00:08:31,400 Speaker 1: the way to the hospital. But when they got there, 148 00:08:31,760 --> 00:08:35,040 Speaker 1: the hospital initially refused to admit him because he wasn't 149 00:08:35,080 --> 00:08:40,480 Speaker 1: considered in immediate danger to himself or others. Oh my goodness, 150 00:08:40,720 --> 00:08:44,679 Speaker 1: because he had a good first responder, everything did ultimately 151 00:08:44,720 --> 00:08:47,800 Speaker 1: work out. They did help him. So how do we 152 00:08:47,840 --> 00:08:51,760 Speaker 1: begin to shift this perception so that people in obvious 153 00:08:51,840 --> 00:08:55,360 Speaker 1: crisis aren't turned away simply because they don't meet a 154 00:08:55,440 --> 00:09:00,559 Speaker 1: strict immediate threshold. And what changes, whether in policy, training, 155 00:09:00,640 --> 00:09:05,120 Speaker 1: or awareness, need to happen so getting help actually leads 156 00:09:05,280 --> 00:09:06,320 Speaker 1: to meaningful care. 157 00:09:06,720 --> 00:09:10,840 Speaker 5: That's because our culture doesn't look at these illnesses as treatable, 158 00:09:11,240 --> 00:09:15,040 Speaker 5: no fault brain diseases. They're just like any other organ 159 00:09:15,080 --> 00:09:19,520 Speaker 5: based disease in our body. Yet they are discriminated against. 160 00:09:19,840 --> 00:09:24,319 Speaker 5: And most of that discrimination comes from old, ancient legislation 161 00:09:24,800 --> 00:09:27,760 Speaker 5: that was drawn back like sixty years ago in our state, 162 00:09:27,960 --> 00:09:32,679 Speaker 5: that did not recognize these conditions as medical because at 163 00:09:32,679 --> 00:09:36,400 Speaker 5: that time they didn't have the scientific evidence we do now, 164 00:09:36,520 --> 00:09:41,640 Speaker 5: there's no excuse. Yet they are still being block. Barriers 165 00:09:41,640 --> 00:09:44,640 Speaker 5: to care are so high to get somebody into care, 166 00:09:44,880 --> 00:09:48,200 Speaker 5: and it's just it's not right. And the only thing 167 00:09:48,679 --> 00:09:50,760 Speaker 5: I can see that we can do is we can 168 00:09:50,800 --> 00:09:55,200 Speaker 5: get doctors involved, because family advocates are not listened to 169 00:09:55,440 --> 00:09:58,600 Speaker 5: a lot of the time, believe me. But doctors have 170 00:09:58,640 --> 00:10:01,240 Speaker 5: an MD by their name and they are listened to. 171 00:10:01,600 --> 00:10:04,640 Speaker 5: And that's one thing that I don't understand is why 172 00:10:04,720 --> 00:10:08,000 Speaker 5: doctors have not come out and fought for their own 173 00:10:08,120 --> 00:10:13,440 Speaker 5: patients to in this arena that you're talking about, Because 174 00:10:13,559 --> 00:10:18,400 Speaker 5: I don't see anything really happening of consequence until we 175 00:10:18,440 --> 00:10:20,920 Speaker 5: get it through our heads in our culture that these 176 00:10:21,000 --> 00:10:25,280 Speaker 5: are treatable diseases that are being discriminated against. No other 177 00:10:25,400 --> 00:10:28,800 Speaker 5: disease is discriminated against like this. In our society. We 178 00:10:28,880 --> 00:10:32,559 Speaker 5: would never say, oh, you're having a stroke, you can't talk, 179 00:10:32,800 --> 00:10:34,920 Speaker 5: the doctor will not treat you till we get a 180 00:10:35,000 --> 00:10:38,600 Speaker 5: lawyer here. No, but if you have a brain attack, 181 00:10:39,600 --> 00:10:40,480 Speaker 5: forget it. Well. 182 00:10:40,480 --> 00:10:42,679 Speaker 3: The Michigan Metal Health Commission back in two thousand and 183 00:10:42,679 --> 00:10:45,720 Speaker 3: four came the conclusion of metal unless as streatable recovery 184 00:10:45,760 --> 00:10:49,360 Speaker 3: as possible provides you intervened early, and early intervention was 185 00:10:49,400 --> 00:10:52,600 Speaker 3: the key and now whitty for crisis. So Michigan has 186 00:10:52,640 --> 00:10:55,120 Speaker 3: rewritten the Metal Health Code as it relates to when 187 00:10:55,120 --> 00:10:58,240 Speaker 3: you can hospitalize someone, it's no longer danger to selve 188 00:10:58,240 --> 00:11:00,920 Speaker 3: for others. You won't find that in our What you'll 189 00:11:00,920 --> 00:11:04,280 Speaker 3: find is risk of harm. That's the question. So for 190 00:11:04,400 --> 00:11:07,600 Speaker 3: recent case in Michigan, this individual had a law history 191 00:11:07,600 --> 00:11:10,920 Speaker 3: of mental illness. He'd be treated, be hospitalized to get out, 192 00:11:11,040 --> 00:11:13,920 Speaker 3: wouldn't take his medicine. He comes into court and the 193 00:11:13,960 --> 00:11:17,840 Speaker 3: doctor who is testifying on behalf of the county says, well, 194 00:11:17,960 --> 00:11:21,800 Speaker 3: he is currently not at risk of harm. However, within 195 00:11:21,840 --> 00:11:24,280 Speaker 3: three to six months we can expect he'll stop taking 196 00:11:24,280 --> 00:11:26,240 Speaker 3: his medicine again, and then he'll be at risk of 197 00:11:26,280 --> 00:11:30,240 Speaker 3: harm due to possible suicide, drug abuse, increased risk of 198 00:11:30,240 --> 00:11:34,160 Speaker 3: dementia and other things. Court of Appeal said that works. 199 00:11:34,440 --> 00:11:38,040 Speaker 3: So by intervening earlier, that helps. But then the second 200 00:11:38,040 --> 00:11:40,360 Speaker 3: part is when the court inners in order for treatment. 201 00:11:40,559 --> 00:11:43,680 Speaker 3: If you've been hospitalized for mental illness, you've got to 202 00:11:43,840 --> 00:11:47,480 Speaker 3: even temporarily. That's pretty serious. Does anybody really believe you 203 00:11:47,480 --> 00:11:50,080 Speaker 3: can be discharged the next day with nothing. I don't 204 00:11:50,080 --> 00:11:52,720 Speaker 3: think so. So what we do in Michigan, the standard 205 00:11:52,840 --> 00:11:55,360 Speaker 3: order is, if we come to court on a petition 206 00:11:55,559 --> 00:11:57,800 Speaker 3: and you're in the hospital, we will enter a combined 207 00:11:57,840 --> 00:12:00,240 Speaker 3: treatment order of one hundred and eighty days of assistant 208 00:12:00,280 --> 00:12:03,640 Speaker 3: pacing treatment and up to sixty days of hospitalization to 209 00:12:03,679 --> 00:12:06,559 Speaker 3: be used during that period of time. And just kind 210 00:12:06,600 --> 00:12:09,920 Speaker 3: of evidence of why this works. I saw I studied 211 00:12:09,960 --> 00:12:13,360 Speaker 3: recently regarding those persons who are found not gut through 212 00:12:13,400 --> 00:12:16,760 Speaker 3: reasonable sanity, and they measured with the likelihood of them 213 00:12:16,800 --> 00:12:20,400 Speaker 3: being arrested again over the next five years. For those 214 00:12:20,440 --> 00:12:24,120 Speaker 3: people who were treated at the forensic center and discharged 215 00:12:24,160 --> 00:12:27,040 Speaker 3: without community treatment, they were arrested forty four percent of 216 00:12:27,080 --> 00:12:30,120 Speaker 3: the time. For those who were discharged on the supervision 217 00:12:30,320 --> 00:12:32,880 Speaker 3: of a treatment plan, they were arrested eight percent. 218 00:12:33,360 --> 00:12:37,720 Speaker 4: Yeah, I just want to say states are so very 219 00:12:37,920 --> 00:12:43,000 Speaker 4: different in their criteria for involuntary treatment. So the problem 220 00:12:43,040 --> 00:12:46,080 Speaker 4: that Linda just described, we don't really have it. In 221 00:12:46,160 --> 00:12:51,280 Speaker 4: the Arizona. We have persistent and acutely disabled statutes, not 222 00:12:51,640 --> 00:12:54,600 Speaker 4: just gravely disabled or danger to sell for others. And 223 00:12:54,640 --> 00:12:58,760 Speaker 4: so for example, that description of someone walking out naked 224 00:12:58,800 --> 00:13:02,960 Speaker 4: in the street as not being considered harmful. In Arizona, 225 00:13:03,200 --> 00:13:06,280 Speaker 4: I'm legal guardian of a woman who ended up easily 226 00:13:06,320 --> 00:13:10,559 Speaker 4: getting hospitalized for exactly that she was disrobing walking outside 227 00:13:10,559 --> 00:13:14,240 Speaker 4: of her group home, and she pretty quickly was qualified 228 00:13:14,240 --> 00:13:18,120 Speaker 4: for a partition for involuntary hospitalization. She actually was in 229 00:13:18,160 --> 00:13:21,080 Speaker 4: an er for a while. They even had to use 230 00:13:21,120 --> 00:13:25,240 Speaker 4: restraints to keep her from continuing that behavior walking out naked, 231 00:13:25,400 --> 00:13:29,119 Speaker 4: and we were able to get her into a hospital 232 00:13:29,280 --> 00:13:34,000 Speaker 4: under court ordered treatment and a safe discharge plan, which 233 00:13:34,200 --> 00:13:38,000 Speaker 4: I was required to authorize the discharge plan as her guardian, 234 00:13:38,320 --> 00:13:40,240 Speaker 4: and so I was able to make sure she got 235 00:13:40,280 --> 00:13:45,040 Speaker 4: into safe placement once her treatment was right. And you know, 236 00:13:45,080 --> 00:13:49,680 Speaker 4: it was a successful pathway towards compassionate if you will, 237 00:13:49,800 --> 00:13:53,400 Speaker 4: involuntary or I like to say, life saving medical orders, 238 00:13:53,600 --> 00:13:56,080 Speaker 4: and so we have good laws in Arizona. I actually 239 00:13:56,080 --> 00:14:00,760 Speaker 4: think they're probably model for the country. Were able to 240 00:14:00,840 --> 00:14:03,920 Speaker 4: get someone a court ordered evaluation and treatment if they 241 00:14:04,120 --> 00:14:07,360 Speaker 4: have even just signs of psychosis and they're refusing treatment. 242 00:14:07,520 --> 00:14:10,160 Speaker 4: The problem we have in Arizona is that we don't 243 00:14:10,160 --> 00:14:13,600 Speaker 4: have enough hospital beds and we haven't funded the system 244 00:14:13,640 --> 00:14:17,120 Speaker 4: at all. So the average we have the fewest state 245 00:14:17,160 --> 00:14:21,120 Speaker 4: hospital beds per capita of any state in the country, 246 00:14:21,480 --> 00:14:25,560 Speaker 4: and Maricopa County has almost none. So we don't have 247 00:14:25,640 --> 00:14:29,280 Speaker 4: the ability to hospitalize people for more than about twenty 248 00:14:29,320 --> 00:14:32,560 Speaker 4: two days. That is the average if you're lucky, if 249 00:14:32,600 --> 00:14:37,120 Speaker 4: you get into an involuntary court ordered civil hospital. So 250 00:14:37,840 --> 00:14:42,040 Speaker 4: we're releasing people on court ordered outpatient treatment, but they're 251 00:14:42,080 --> 00:14:44,920 Speaker 4: not stable. They have nowhere to go. They're going home 252 00:14:44,920 --> 00:14:48,560 Speaker 4: to families. Family parents are getting killed. There was a 253 00:14:48,680 --> 00:14:54,480 Speaker 4: very you know, nationally visible case last Monday, two parents 254 00:14:54,560 --> 00:14:58,440 Speaker 4: died after their son killed them because of poor treatment 255 00:14:58,560 --> 00:15:01,640 Speaker 4: after discharging from a hospitpital. So we have to have 256 00:15:01,720 --> 00:15:05,000 Speaker 4: a funded system. It's like the opposite of California. You 257 00:15:05,040 --> 00:15:08,120 Speaker 4: guys have money, but you don't have laws. In Arizona, 258 00:15:08,200 --> 00:15:10,680 Speaker 4: we have laws, but we don't have the money. And 259 00:15:10,840 --> 00:15:14,240 Speaker 4: I'm fighting legislation right now, and I'm having to beg 260 00:15:14,520 --> 00:15:18,560 Speaker 4: for five million dollars or a program, and I'm probably 261 00:15:18,600 --> 00:15:21,200 Speaker 4: not going to get it because our state budgets. Our 262 00:15:21,280 --> 00:15:24,040 Speaker 4: state legislature doesn't like funding things. 263 00:15:24,280 --> 00:15:28,280 Speaker 1: So we've been talking about funding and clearly resources matter. 264 00:15:28,680 --> 00:15:32,760 Speaker 1: They shape what services are available, how long someone can stay, 265 00:15:33,160 --> 00:15:36,320 Speaker 1: and what kind of follow up care even exists. Now, 266 00:15:36,400 --> 00:15:39,080 Speaker 1: I'd like to shift this for a moment, because even 267 00:15:39,160 --> 00:15:42,240 Speaker 1: beyond the dollars, there's something deeper going on in how 268 00:15:42,280 --> 00:15:46,280 Speaker 1: the system itself actually works. David, you've had a unique 269 00:15:46,400 --> 00:15:50,760 Speaker 1: vantage point on this. You've spent decades working in jails, prisons, 270 00:15:50,880 --> 00:15:55,320 Speaker 1: and psychiatric hospitals. So from your experience, how would you 271 00:15:55,360 --> 00:15:59,520 Speaker 1: describe the difference between how the criminal justice system handles 272 00:15:59,520 --> 00:16:03,920 Speaker 1: serious mental illness versus how the civil system handles it today? 273 00:16:04,280 --> 00:16:07,440 Speaker 6: Well, I'm a psychiatrist who's been doing this for over 274 00:16:07,480 --> 00:16:12,280 Speaker 6: three decades, worked in jails and prisons, currently working again 275 00:16:12,400 --> 00:16:16,560 Speaker 6: at a forensic psychospital, this time on the maximum security unit. 276 00:16:16,880 --> 00:16:21,400 Speaker 6: And you know, it's so sad that at this point 277 00:16:21,600 --> 00:16:25,800 Speaker 6: the criminal justice system has the laws and policies that 278 00:16:26,800 --> 00:16:31,600 Speaker 6: they have sufficient accountability, the ability to follow through, the 279 00:16:31,720 --> 00:16:35,600 Speaker 6: ability to actually do things better than the civil system does. 280 00:16:35,680 --> 00:16:38,640 Speaker 6: Because the laws and the civil side had been anemic 281 00:16:38,800 --> 00:16:42,240 Speaker 6: and they just let people go. They don't realize, they 282 00:16:42,240 --> 00:16:48,000 Speaker 6: don't recognize the reality, the neurological reality of the illnesses themselves, 283 00:16:48,480 --> 00:16:50,880 Speaker 6: and so the criminal justice system picks up the slat 284 00:16:51,000 --> 00:16:53,400 Speaker 6: And you know, I don't think a lot of people 285 00:16:53,440 --> 00:16:56,200 Speaker 6: are aware of that because you know, nobody goes to 286 00:16:56,280 --> 00:16:59,920 Speaker 6: visit a prison to see all the mentally ill people there, 287 00:17:00,160 --> 00:17:03,560 Speaker 6: and nobody goes to the forensic psyche hospital up here 288 00:17:03,600 --> 00:17:07,560 Speaker 6: on the hill to know what that is like or 289 00:17:07,640 --> 00:17:10,920 Speaker 6: what kinds of people lined up there. Now there's in Texas, 290 00:17:11,119 --> 00:17:14,760 Speaker 6: we're building a whole slew of new hospital beds because 291 00:17:15,160 --> 00:17:19,560 Speaker 6: the balloon phenomenon, you you close down the civil hospital beds, 292 00:17:19,560 --> 00:17:21,240 Speaker 6: and of course it doesn't do way with a need. 293 00:17:21,680 --> 00:17:24,919 Speaker 6: And then what we owned up with was this enormous 294 00:17:24,960 --> 00:17:29,160 Speaker 6: backlog of people who were incompedent stand trial, and that 295 00:17:29,240 --> 00:17:31,399 Speaker 6: put the pressure on to do something. And part of 296 00:17:31,440 --> 00:17:34,879 Speaker 6: the doing something is building the state hospital beds, a 297 00:17:34,920 --> 00:17:37,280 Speaker 6: lot of them all over the state, and overall, when 298 00:17:37,320 --> 00:17:39,520 Speaker 6: all is said and done, about sixty percent of those 299 00:17:39,520 --> 00:17:41,760 Speaker 6: are going to be forensic beds. And that's just how 300 00:17:41,840 --> 00:17:44,480 Speaker 6: the rules are written, how the structure is and until 301 00:17:44,520 --> 00:17:48,320 Speaker 6: the civil side can do something different, something more realistic, 302 00:17:49,200 --> 00:17:51,080 Speaker 6: it's just it's going to have to be that way. 303 00:17:51,280 --> 00:17:51,480 Speaker 1: You know. 304 00:17:52,000 --> 00:17:56,480 Speaker 6: My experience is that the two major factors that result 305 00:17:56,560 --> 00:18:00,600 Speaker 6: in people being rehospitalized or medication on it here and 306 00:18:00,640 --> 00:18:05,160 Speaker 6: that with the neurological illness of schizophrenia is directly attributable 307 00:18:05,320 --> 00:18:09,640 Speaker 6: to the anazagnosia. You know, I keep talking about neurological illness. 308 00:18:10,040 --> 00:18:13,640 Speaker 6: I consider her schizophrenia to be a neurological illness. As 309 00:18:13,640 --> 00:18:20,879 Speaker 6: neurological symptoms, anasygnosia is one of them, delusions, hallucinations, neuropsychological decline, thought, disorganization. 310 00:18:21,640 --> 00:18:24,240 Speaker 6: Calling it a mental illness makes it too fuzzy and 311 00:18:24,320 --> 00:18:29,160 Speaker 6: it conflates it with all of the diagnoses in DSM 312 00:18:29,240 --> 00:18:32,280 Speaker 6: that are a dubious validity. There's a lot of debate 313 00:18:32,359 --> 00:18:36,480 Speaker 6: around the validity of that body, that billing code book 314 00:18:36,520 --> 00:18:41,320 Speaker 6: that we call DSM in any event, So anazygnosia is 315 00:18:41,400 --> 00:18:46,120 Speaker 6: one of the major drivers or hospital admission or readmission 316 00:18:46,440 --> 00:18:48,520 Speaker 6: or getting picked up on the street by the police. 317 00:18:48,560 --> 00:18:51,879 Speaker 6: And nowadays unfortunately we think, oh, if they're lucky, a 318 00:18:51,960 --> 00:18:55,879 Speaker 6: felony filed and something will actually happen. The other is 319 00:18:55,960 --> 00:18:59,360 Speaker 6: substance use. So the two major factors are substance use 320 00:18:59,480 --> 00:19:03,040 Speaker 6: and as ignosia. I look at how the system flows, 321 00:19:03,160 --> 00:19:06,399 Speaker 6: how the system flows, and you know, if a person 322 00:19:06,600 --> 00:19:11,320 Speaker 6: can't see that he has a mental illness. Now sometimes 323 00:19:11,320 --> 00:19:14,359 Speaker 6: it gets better with treatment, not consistently, and it tends 324 00:19:14,400 --> 00:19:17,760 Speaker 6: to be a pretty persistent symptom in people of schizophrenia. 325 00:19:17,920 --> 00:19:20,800 Speaker 6: You know, the anazagnosia doesn't go away because you discharge 326 00:19:20,840 --> 00:19:25,560 Speaker 6: them to an outpatient setting, and the general strong tendency 327 00:19:26,160 --> 00:19:29,760 Speaker 6: unless there are pretty robust services in places for the 328 00:19:29,800 --> 00:19:32,439 Speaker 6: medication to be stopped or substances to be used. And 329 00:19:32,480 --> 00:19:34,920 Speaker 6: then the wheels fall back off the bus and again 330 00:19:35,320 --> 00:19:39,160 Speaker 6: find ourselves are wondering or hoping that the police get 331 00:19:39,160 --> 00:19:41,800 Speaker 6: involved in charge of felony so the person is safe 332 00:19:41,800 --> 00:19:44,840 Speaker 6: and the family is safe. But I notice there is 333 00:19:44,960 --> 00:19:50,359 Speaker 6: this terrible reluctance to consider compelled medication in an outpatient setting. 334 00:19:50,600 --> 00:19:51,600 Speaker 3: And if that was an. 335 00:19:51,480 --> 00:19:57,480 Speaker 6: Option, that would materially impact the need for psychiatric hospitalizations 336 00:19:57,760 --> 00:20:00,360 Speaker 6: if people have to stay on their medication. Of course, 337 00:20:00,400 --> 00:20:03,080 Speaker 6: it'd be careful review process, you know, there'd be a 338 00:20:03,119 --> 00:20:07,439 Speaker 6: lot of a lot of process and with representation, so 339 00:20:07,520 --> 00:20:10,240 Speaker 6: for then the ability at some point to get out 340 00:20:10,240 --> 00:20:12,720 Speaker 6: of that kind of an order. But you know, right now, 341 00:20:12,760 --> 00:20:15,560 Speaker 6: the only place medication can be compelled is in the hospital, 342 00:20:15,600 --> 00:20:17,080 Speaker 6: and then they walk out the door and it's no 343 00:20:17,119 --> 00:20:20,479 Speaker 6: longer compelled. Even with AOT. AOT is a nice model 344 00:20:20,640 --> 00:20:23,959 Speaker 6: but nobody compels medication in AOT. It's just not written 345 00:20:23,960 --> 00:20:26,280 Speaker 6: that way right now, So it's just it's one of 346 00:20:26,280 --> 00:20:31,880 Speaker 6: my frustrations. It's also interesting the variability and how the 347 00:20:31,920 --> 00:20:35,480 Speaker 6: involuntary detention laws are written on the civil side. And 348 00:20:35,560 --> 00:20:39,920 Speaker 6: I was thinking of the original Lessarde v. Schmidt in 349 00:20:40,280 --> 00:20:45,760 Speaker 6: out of Wisconsin, where the imminent dangerousness verbiage originated, and 350 00:20:46,359 --> 00:20:50,680 Speaker 6: it's ironic that Wisconsin actually wound up blocking that back. 351 00:20:50,720 --> 00:20:53,160 Speaker 6: They found it didn't work too well, so they came 352 00:20:53,240 --> 00:20:56,119 Speaker 6: up with a fifth standard in the mid nineteen nineties 353 00:20:56,240 --> 00:20:59,480 Speaker 6: as a way out of that overly restrictive language. And 354 00:20:59,520 --> 00:21:02,360 Speaker 6: I think or states are figuring out ways of doing 355 00:21:02,359 --> 00:21:04,880 Speaker 6: that as well. It sounds like Arizona. It's an example 356 00:21:04,880 --> 00:21:05,159 Speaker 6: of that. 357 00:21:05,840 --> 00:21:08,879 Speaker 1: A big part of this comes down to perception. People 358 00:21:08,920 --> 00:21:13,199 Speaker 1: don't truly understand this unless they've lived it. Yet. We 359 00:21:13,400 --> 00:21:17,119 Speaker 1: also just heard that even when the need is recognized, 360 00:21:17,520 --> 00:21:21,760 Speaker 1: the system is understaffed. So let's address that. How do 361 00:21:21,840 --> 00:21:25,880 Speaker 1: we change it? How do we attract, train, and retain 362 00:21:25,960 --> 00:21:29,760 Speaker 1: the kind of people who are willing and prepared to 363 00:21:29,800 --> 00:21:33,920 Speaker 1: do this work and actually help those who need help 364 00:21:34,080 --> 00:21:34,720 Speaker 1: the most. 365 00:21:34,920 --> 00:21:39,480 Speaker 4: I attended a conference recently and I had the opportunity 366 00:21:39,520 --> 00:21:43,439 Speaker 4: to sit with a number of psychiatry residents and I 367 00:21:43,600 --> 00:21:47,879 Speaker 4: asked this whole table, why did you choose psychiatry? And 368 00:21:48,000 --> 00:21:51,959 Speaker 4: everyone said exactly the same thing. They said they didn't 369 00:21:52,040 --> 00:21:55,680 Speaker 4: they had planned to do something else entirely, but they 370 00:21:55,760 --> 00:21:59,439 Speaker 4: went into their psychiatry rotation. They fell in love with 371 00:21:59,480 --> 00:22:04,080 Speaker 4: psychiat and when they told their parents that was their choice, 372 00:22:04,400 --> 00:22:07,200 Speaker 4: one even said it was worse than coming out as gay. 373 00:22:07,720 --> 00:22:08,520 Speaker 1: We don't have. 374 00:22:08,680 --> 00:22:12,840 Speaker 4: Any kids saying I want to be a psychiatrist when 375 00:22:12,880 --> 00:22:16,639 Speaker 4: I grow up. We need to build esteem back to 376 00:22:16,720 --> 00:22:21,120 Speaker 4: that profession, and we need to build up the value 377 00:22:21,119 --> 00:22:24,399 Speaker 4: and the importance of our good psychiatrists that are treating 378 00:22:24,440 --> 00:22:26,800 Speaker 4: the most serious mental illnesses. I want to be a 379 00:22:26,800 --> 00:22:30,159 Speaker 4: psychiatrist when I grow up. We have to start attracting 380 00:22:30,200 --> 00:22:31,320 Speaker 4: people into the field. 381 00:22:31,480 --> 00:22:31,760 Speaker 1: Yeah. 382 00:22:32,400 --> 00:22:35,040 Speaker 5: Yes, And I think that a big part of that 383 00:22:35,400 --> 00:22:38,280 Speaker 5: is because I have talked to a lot of psychiatrists 384 00:22:38,320 --> 00:22:42,359 Speaker 5: in our county and one thing I will say is 385 00:22:42,520 --> 00:22:46,120 Speaker 5: many do not want to take the hardest cases. Many 386 00:22:46,400 --> 00:22:50,280 Speaker 5: of the psychiatrists and clinicians in our county don't even 387 00:22:50,440 --> 00:22:54,240 Speaker 5: understand and asygnosia that these are the people that are 388 00:22:54,280 --> 00:22:57,080 Speaker 5: taking care of our loved ones who are ill. That 389 00:22:57,280 --> 00:23:01,760 Speaker 5: is really a terrible thing. I mean, the education is 390 00:23:01,960 --> 00:23:05,639 Speaker 5: lacking and it has not caught up to the scientific 391 00:23:05,720 --> 00:23:10,040 Speaker 5: and medical protocols, and we don't have a standard of 392 00:23:10,119 --> 00:23:13,560 Speaker 5: care protocol for across our nation, which would be so 393 00:23:13,880 --> 00:23:17,560 Speaker 5: helpful if we had. You know, Okay, this person needs 394 00:23:17,560 --> 00:23:20,640 Speaker 5: to be evaluated. Here's what we're looking for, here's what 395 00:23:20,680 --> 00:23:23,000 Speaker 5: we need to do to evaluate them. I know at 396 00:23:23,040 --> 00:23:28,159 Speaker 5: Meneger Clinic in Texas they always test for other diseases 397 00:23:28,400 --> 00:23:31,720 Speaker 5: that could cause psychosis. Well, that's the logical thing to 398 00:23:31,760 --> 00:23:36,080 Speaker 5: do first before you diagnose somebody with a serious brain 399 00:23:36,200 --> 00:23:40,679 Speaker 5: disease or neurological disease. And that's pretty scary right there. 400 00:23:41,119 --> 00:23:44,520 Speaker 5: So I'd say I agree with you, Rachel, but I 401 00:23:44,640 --> 00:23:47,679 Speaker 5: also really don't like what I'm seeing in my little, 402 00:23:47,760 --> 00:23:50,400 Speaker 5: well not so little state of the people that are 403 00:23:50,520 --> 00:23:54,600 Speaker 5: treating our folks and their lack of knowledge and their 404 00:23:54,680 --> 00:23:58,720 Speaker 5: lack of respect for the families. You know, the majority 405 00:23:58,960 --> 00:24:03,879 Speaker 5: of care givers for people with schizophrenia and other really 406 00:24:03,960 --> 00:24:08,320 Speaker 5: serious illness are the families. And like you like to say, 407 00:24:08,359 --> 00:24:11,600 Speaker 5: the families are the new asylums. Yet we get no 408 00:24:12,000 --> 00:24:15,320 Speaker 5: help from disabilities, We get no money to have an 409 00:24:15,440 --> 00:24:20,439 Speaker 5: in home caregiver like autism and other spectrum illnesses, and 410 00:24:20,760 --> 00:24:23,480 Speaker 5: that isn't fair. Many of us have had to give 411 00:24:23,560 --> 00:24:26,359 Speaker 5: up our jobs. It's a full time job to take 412 00:24:26,400 --> 00:24:30,080 Speaker 5: care of somebody who is ill and in psychosis, and 413 00:24:30,119 --> 00:24:32,520 Speaker 5: we have no training for that. We learn on the 414 00:24:32,640 --> 00:24:33,600 Speaker 5: job the hard way. 415 00:24:34,080 --> 00:24:38,480 Speaker 1: Yeah, and that's a very difficult position to be put into. So, David, 416 00:24:38,640 --> 00:24:42,760 Speaker 1: from a clinical standpoint, are their key factors, maybe even 417 00:24:42,800 --> 00:24:46,959 Speaker 1: neurological ones that you feel. The feel still isn't fully 418 00:24:47,040 --> 00:24:51,840 Speaker 1: recognizing or incorporating into how we diagnose and treat serious 419 00:24:51,880 --> 00:24:52,560 Speaker 1: mental illness. 420 00:24:52,840 --> 00:24:58,399 Speaker 6: Right, just briefly following up on what Linda is saying, 421 00:24:58,640 --> 00:25:06,320 Speaker 6: and that is my feshion has its own anazygnosia. About anasygnosia, 422 00:25:07,160 --> 00:25:11,399 Speaker 6: it's not even one of the criteria for schizophrenia. I 423 00:25:11,440 --> 00:25:15,440 Speaker 6: know doctor Ammador has tried it. I mean he used 424 00:25:15,440 --> 00:25:19,040 Speaker 6: to be involved in it with the researchers who developed 425 00:25:19,880 --> 00:25:23,919 Speaker 6: DSM three and DSM three are and he's spoken with 426 00:25:24,040 --> 00:25:29,439 Speaker 6: people about anazygnosia being a diagnostic criterion for schizophrenia, and 427 00:25:29,520 --> 00:25:32,520 Speaker 6: for some reason, it's just not there. Our profession doesn't 428 00:25:32,560 --> 00:25:36,880 Speaker 6: even consider it, and yet it's the major reason for rehospitalization. 429 00:25:37,520 --> 00:25:41,240 Speaker 1: So taking that into account, families that are listening across 430 00:25:41,240 --> 00:25:45,040 Speaker 1: the country right now, the system can feel completely different 431 00:25:45,280 --> 00:25:48,600 Speaker 1: depending on where you live. So in essence, we're dealing 432 00:25:48,640 --> 00:25:52,720 Speaker 1: with a nationwide problem with fifty different systems trying to 433 00:25:52,760 --> 00:25:55,440 Speaker 1: solve it. So how do we move beyond the patchwork 434 00:25:55,560 --> 00:25:59,920 Speaker 1: of state by state approaches and start building something more coordinated, 435 00:26:00,119 --> 00:26:04,439 Speaker 1: something that makes access to care more consistent and effective 436 00:26:04,480 --> 00:26:05,560 Speaker 1: across the country. 437 00:26:05,800 --> 00:26:08,480 Speaker 3: You know it might be helpful is in Michigan, the 438 00:26:08,560 --> 00:26:12,800 Speaker 3: governor appointed a Mental Health Diversion Council about fourteen years ago, 439 00:26:13,080 --> 00:26:16,360 Speaker 3: and that council has takeholders across the system and we've 440 00:26:16,400 --> 00:26:20,119 Speaker 3: recently added to the Michigan Hospital Association to it. And 441 00:26:20,200 --> 00:26:23,000 Speaker 3: so this group has been able to craft the legislation 442 00:26:23,240 --> 00:26:26,359 Speaker 3: to get it through the legislature because they represent all sides. 443 00:26:26,640 --> 00:26:29,959 Speaker 3: We have disability rights online, we've got prosecutors, We've got 444 00:26:30,000 --> 00:26:32,760 Speaker 3: the hospitals. We tell them what their interests are. Their 445 00:26:32,880 --> 00:26:36,840 Speaker 3: emergency rooms are crammed, they they can't handle the population, 446 00:26:37,160 --> 00:26:39,160 Speaker 3: and they know that there's a better way to treat 447 00:26:39,160 --> 00:26:42,000 Speaker 3: them instead of in the hospital. So the batch of 448 00:26:42,080 --> 00:26:45,359 Speaker 3: legislation that we're working hand now has passed the House 449 00:26:45,400 --> 00:26:48,479 Speaker 3: and the Senate and will really make the intigment changees 450 00:26:48,520 --> 00:26:51,679 Speaker 3: in how we handle mental health cases in Michigan. And 451 00:26:51,720 --> 00:26:54,560 Speaker 3: we had a unanimous vote in the Senate. Kind of 452 00:26:54,600 --> 00:26:57,000 Speaker 3: a weird yes vote in the House, but that's an 453 00:26:57,160 --> 00:27:01,000 Speaker 3: internal plorical problem. But there's an are you saying? And 454 00:27:01,000 --> 00:27:04,760 Speaker 3: we're seeing more local politicians talk about this, So it's 455 00:27:04,840 --> 00:27:06,520 Speaker 3: just a matter of finding way to spread the word. 456 00:27:06,560 --> 00:27:10,320 Speaker 1: I guess yes, that makes perfect sense. Hopefully we can 457 00:27:10,400 --> 00:27:13,520 Speaker 1: keep spreading that message to everyone. This has been a 458 00:27:13,520 --> 00:27:17,760 Speaker 1: powerful conversation and honestly, we're just getting into some of 459 00:27:17,760 --> 00:27:20,840 Speaker 1: the most important parts of it. I'm going to pause 460 00:27:20,920 --> 00:27:24,040 Speaker 1: things right here for today, but this is not the 461 00:27:24,160 --> 00:27:27,320 Speaker 1: end of the conversation, not even close. We'll be back 462 00:27:27,359 --> 00:27:29,960 Speaker 1: in just two days with Part two, where we go 463 00:27:30,119 --> 00:27:34,600 Speaker 1: deeper into solutions, real world challenges and what this all 464 00:27:34,640 --> 00:27:39,119 Speaker 1: means for families and communities. And then we're not stopping there. 465 00:27:39,440 --> 00:27:42,520 Speaker 1: We've got a Part three coming as well, where we 466 00:27:42,560 --> 00:27:45,080 Speaker 1: bring it all together and talk about where we go 467 00:27:45,160 --> 00:27:49,479 Speaker 1: from here. So stay with us. This conversation matters, and 468 00:27:49,560 --> 00:27:53,600 Speaker 1: we're just getting started. If today's conversation helped you see 469 00:27:53,600 --> 00:27:56,800 Speaker 1: the world a little differently. Then we're doing exactly what 470 00:27:56,840 --> 00:28:01,439 Speaker 1: we hope to do. Until next time, Keep believe, keep learning, 471 00:28:01,920 --> 00:28:13,240 Speaker 1: and most importantly, keep asking yourself why not Me? Thanks 472 00:28:13,280 --> 00:28:16,040 Speaker 1: for taking time out of your busy schedule to listen 473 00:28:16,040 --> 00:28:19,720 Speaker 1: to our show today. We hope you enjoyed it as 474 00:28:19,760 --> 00:28:23,240 Speaker 1: much as we enjoyed bringing it to you. If you 475 00:28:23,400 --> 00:28:26,760 Speaker 1: know someone who has a story to share, tell them 476 00:28:26,880 --> 00:28:32,000 Speaker 1: to contact us at why NOTM World. One last thing, 477 00:28:32,440 --> 00:28:37,280 Speaker 1: spread the word about why Not Me, our conversations, our 478 00:28:37,359 --> 00:28:42,719 Speaker 1: inspiring guests, the show. You are not alone in this world.