Annual Report 2010
Message From Elmer L. Cerano, Executive Director
The Year 2010 in Review
As predicted at the close of last year, 2010 brought unprecedented challenges. The fiscal crisis in Michigan continued to have far- reaching negative impact on the people that MPAS represents. Successfully advocating for services and supports for people with disabilities was challenged, and it became necessary for MPAS to redesign and reinvent itself to respond to increased demands for advocacy support and legal representation with decreased resources. We did this in several ways.
MPAS has taken aggressive steps to:
¨ Streamline operations to be more customer focused,
¨ Strategically redesign areas of service,
¨ Implement electronic communications strategies to reduce costs and use technology to better serve clients,
¨ Begin the process of agency web site modernization.
Based on input from the people of Michigan who use disability services, MPAS has become more priority driven. Although our goal has always been to protect the rights of all people with disabilities, we have had to be more diligent in our systemic advocacy efforts to best use our limited resources to do the greatest amount of good for people with disabilities.
Our priorities are simple and straightforward. As you review this report, you will see what issues matter most to MPAS and the people we serve. What’s more, you will clearly see the direct impact the agency has had on the many lives we have touched – that is the real measure of our success.
Again, another year draws to a close and MPAS has successfully managed its limited resources to advocate and protect the legal rights of people with disabilities in Michigan. In addition, as a part of a national network of Protection and Advocacy agencies, we have done our part to improve the lives of people with disabilities throughout the nation.
Elmer L. Cerano
Executive Director
The mission of Michigan Protection and Advocacy Service, Inc. (MPAS) is to advocate and protect the rights of people with disabilities.
MPAS Selects Cases Based on a Priority Setting Process
Michigan Protection and Advocacy Service seeks input on a regular basis regarding issues that affect the lives of people with disabilities in Michigan. Priorities are reevaluated and adjusted based on client input and general need within the community. This information is used to set priority areas where the agency will concentrate its efforts. Information used to set priorities is gathered from surveys, analysis of trends in the field, and calls coming into the agency.
The 2010-2011 agency priorities are:
¨ Eliminate abuse and neglect,
¨ Improve rights protection systems,
¨ Eliminate employment barriers and protect rights,
¨ Improve access to necessary services, and
¨ Ensure the right to a high quality education.
Priority: Eliminate Abuse and Neglect
The protection and advocacy system was originally designed to protect the rights of people with developmental disabilities who lived in state-run institutions. While all of those institutions in Michigan have now been closed, problems with abuse and neglect still remain for people with physical, emotional, developmental, and mental disabilities. Abuse and neglect continues in places where people with disabilities reside as well as in public schools across the state. Many facilities and group homes where individuals with disabilities reside are monitored by MPAS on a consistent basis.
MPAS has invested a great amount of effort to eliminate the use of seclusion and restraint in education settings as well as in mental health facilities, jails, and prisons. The results of investigating restraint and seclusion at a large child caring institution were sent to the facility demanding improvement. MPAS staff secured an agreement from the facility to take steps to eliminate restraint and seclusion and to report data regularly to MPAS.
MPAS provided information, referral, short-term assistance or direct representation related to abuse and neglect to over 174 individuals and handled 354 calls for information and referral. Advocates conducted 118 monitoring visits to facilities and institutions where individuals with disabilities reside. As a result, cases of abuse and neglect were investigated resulting in numerous corrective actions.
Highlight
A Recipient Rights Officer contacted MPAS to report that a man had arrived at a psychiatric facility wearing a blood stained gown and with injuries. The client, who had come to the facility from a medical hospital’s psychiatric emergency room via an ambulance, reported he had been restrained unnecessarily and assaulted by both hospital and ambulance workers. MPAS investigated and filed complaints with the Office of Recipient Rights which resulted in a substantiated violation of Neglect Class III.
Besides this case, MPAS was involved with five other investigations involving this same emergency room regarding abuse and inappropriate use of restraints. MPAS initiated a systemic project to investigate and address these issues and is seeking a permanent, systemic correction.
Expansion of Background Check Legislation
In Michigan, individuals applying for work in hospitals, nursing homes, group homes, and private residences must undergo a criminal background check prior to working with people with disabilities. While this law has proven effective, it doesn’t go far enough. MPAS has discovered that many caregivers continue to keep their jobs or get similar employment elsewhere even after allegations of serious abuse or neglect have been investigated and substantiated. After educating legislators on this issue, legislation to tighten existing laws had been drafted in 2010 but failed to be enacted. Efforts to move this legislation forward will continue in 2011.
MPAS Report is Catalyst for Seclusion and Restraint Legislation at State Level
In November 2009, MPAS released a report based on investigations and survey accounts from families whose children have suffered physical and emotional harm from being restrained and/or secluded in school. The report, “Safe and Protected? Restraint and Seclusion Remain Unregulated and Underreported in Michigan Schools,” was provided to Michigan policymakers and others in an effort to drive home the urgency of passing legislation to eliminate these abusive practices.
Prompted by information found in the report showing widespread use of restraint and seclusion on students with disabilities in schools throughout Michigan, State Rep. Deb Kennedy (D-Brownstown) introduced legislation (HB5639) which sought to restrict the use of restraint and seclusion in Michigan schools. The bill was introduced at a press conference at the State Capitol, and two parents of children with disabilities spoke to reporters and detailed personal accounts of how these dangerous techniques took a physical and psychological toll on their children.
Rep. Kennedy referenced the MPAS report and stated how schools must change the dangerous practice of using restraint and seclusion on schoolchildren.
“There were children as young as six or eight years old who were put in a room with windows blacked out and the door closed. They would then be left for long periods of time sometimes without being checked,” Kennedy said.
Federal law restricts the use of seclusion and restraint to emergency circumstances for children in hospitals, community-based residential treatment facilities, and other facilities supported by federal dollars. These rules, however, do not currently apply to public or private schools.
It has become apparent to MPAS that restraint and seclusion in schools is symptomatic of a more extensive underlying problem – a lack of mental health services and positive behavior supports in schools. The remedy to this problem lies in first identifying which children are experiencing behavioral problems due to disabilities. Once identified, it is crucial they be evaluated and provided the supports and services mandated under special education law which will allow them to be successful in school without the use of seclusion and restraint.
Highlights of MPAS Report on Restraint and Seclusion
The MPAS report “Safe and Protected? Restraint and Seclusion Remain Unregulated and Underreported in Michigan Schools” made several recommendations, many of which were included in legislation introduced by Rep. Kennedy.
¨ Elimination of chemical, physical, and life-threatening restraint,
¨ Elimination of aversive treatment,
¨ Elimination of the use of seclusion,
¨ Limiting the use of force to unforeseeable emergencies involving significant risk of substantial harm to self or others,
¨ Elimination of restraint and seclusion as treatment or behavior support,
¨ Required public reporting of aggregate use of restraint and seclusion.
Michigan Family Joins Disability Advocates in Push for Federal Legislation to Protect Students from Restraint and Seclusion
Nicole and Alan Holden spoke in favor of more stringent federal laws restricting the use of restraint and seclusion in schools. At a Washington, D.C. press conference in December 2009, the couple from Fruitport, Michigan, joined U.S. Reps George Miller (D-CA) and Cathy McMorris Rodgers (R-WA) as they announced the introduction of bi-partisan legislation that would, for the first time, protect all children in schools from the harmful practice of restraint and seclusion.
The Holdens spoke from experience. Their son, Ethan, was restrained as a three-year-old attending an Early On preschool. Nicole told reporters from the national press of how she attended her child’s holiday party and found her son strapped in a high chair. She later discovered he had been restrained all day, every day he was at the school. In an attempt to join the other children, Ethan would tip over his high chair and drag it behind him, causing pain and bruising on his body. School personnel had previously told Ms. Holden the bruising had occurred on the playground.
“He just wanted to participate with all the other kids in the class and he didn’t understand why he couldn’t be with the other children,” Holden said of Ethan, who has autism and does not speak.
MPAS stepped in and convinced school personnel to stop restraining Ethan. He now attends another school where he is adjusting well to his new environment. The bill introduced that day was passed by the U.S. House Education and Labor Committee as well as the full United States House of Representatives. At the end of fiscal year 2010, companion legislation introduced in the Senate by U.S. Senator Chris Dodd (D-CT) and Richard Burr (R-NC) was awaiting a vote.
MPAS is working to eliminate segregation of prisoners with mental illness and assure proper assessment and treatment
Following the death of an inmate with a history of psychiatric disabilities in 2006, the Michigan Department of Corrections (MDOC) was mandated to conduct an independent study to assess how many prisoners had a mental illness and, of those diagnosed, how many received treatment within the correctional system. The University of Michigan study showed about two-thirds of prisoners with severe mental illness go without treatment behind bars.
MPAS filed a lawsuit against the MDOC on behalf of prisoners with mental illness, and positive changes have resulted. Through visits and interviews with inmates, MPAS is now monitoring to make certain MDOC has complied with an interim agreement to provide appropriate mental health screenings and services, and incidents of administrative segregation have declined.
Priority: Improve Rights-Protection Systems
The purpose of the Office of Recipient Rights (ORR) is to protect and promote the constitutional and statutory rights of recipients of public mental health services and to empower recipients to fully exercise these rights. Unfortunately the internal structure and lack of enforcement within the Michigan ORR makes the system flawed and often ineffective for those who depend on it. Many individuals who need the system elect not to use it due to fear of retaliation and its inability to remedy rights violations.
MPAS continues to seek data from the Office of Recipient Rights regarding the number of complaints filed, investigated or intervened, substantiated, and appealed.
MPAS staff continue to monitor facilities where individuals with disabilities reside or receive services. MPAS staff investigates all suspected or reported violations on individuals’ rights.
Recipient Rights Bill to Correct Mental Health Rights System is Introduced in the Michigan House
MPAS provided sample language to legislators, and witnessed the introduction of recipient rights legislation by Rep. Kate Segal (D-62, Battle Creek). The bill (HB 6456) if passed, would consolidate local recipient rights offices into the state office of recipient rights and give the state office sanction authority when a rights violation has been substantiated.
The need for this legislation was based, in part, on a 2007 Michigan Protection and Advocacy Service report entitled, “Navigating the Mental Health Maze in Michigan: Why the Recipient Rights System is Broken and How We Can Fix It.” The report documented how the failure to provide mental health services contributed to the death of an inmate in a Michigan county jail. Subsequent attempts to address that failure through the recipient rights system provided a case study which revealed the system’s major flaws. The report clearly illustrated the system designed to protect the rights of mental health consumers is defective and in need of major legislative corrections.
MPAS supports legislation to reform Michigan’s entire rights system. Proposed changes would improve accountability, reduce conflicts of interest, improve outcomes for consumers, streamline processes, potentially cut costs, and place greater focus on the needs of the consumers of community mental health agencies, hospitals, or facilities.
Statewide advocacy groups have advocated for changes to the recipient rights system for years. In fact, many of the requirements spelled out in the proposed legislation have been endorsed by over 20 statewide disability organizations that participate within the Common Disability Agenda. The legislation did not pass the Michigan House of Representatives during the 95th legislative session, but will be re-introduced in 2011-2012.
Rights of Individuals with Guardians
MPAS believes individuals deserve the freedom to choose whether or not to receive mental health treatment and should not be forced into treatment by a guardian. Due in part to MPAS’ participation with other like-minded groups, a collective voice opposing legislation that promotes involuntary mental health treatment was heard and efforts to expand the ability of guardians to force consumers to receive treatment were stopped.
MPAS also continued to work with the State Bar of Michigan’s equal Access Initiative, which consists of lawyers, judges, and court personnel from throughout Michigan. MPAS serves on the Disabilities Workgroup which focuses on specific groups that are underrepresented in the judicial system or who may be poorly served by the courts.