Transcript for the Piece Audio version of Fred Friendly Seminars: Minds on the Edge *Modules*

Module 1 The ER (Tape alone: 4:01)

Local Ax: From the Fred Friendly Seminar, a highlight from “Minds on the Edge”--- an exploration of mental illness in America. The emergency room is often the first place patients and families go in a mental health crisis. But, as we’ll hears not always equipped to respond.

We’ve created a hypothetical scenario and invited experts to weigh in. Our patient is Olivia, a college student, and she’s experiencing a breakdown. Reporter Pete Earley plays her dad; former State Senator Avel Gorldy, her mom. In real life, they both have children struggling with mental illness. Psychologist Fred Frese will be Olivia----he has battled schizophrenia for 30 years. Together, they will see Dr. Thomas Simpatico in the ER. But first, journalist Frank Sesno addresses the “parents”-----

(Tape starts here) FRANK SESNO:
And you come across Olivia in a park. And she's walking in circles. And she's muttering to herself. And she's talking about states of consciousness. And you go up to your daughter. This is not the Olivia you know. And you say what?

PETE EARLEY:
Tell me what you're thinking. We've heard you're not in class. You didn't answer our calls. What's goin' on? Why-- are you unhappy? Are you sad? Why are you in this park, walking around in circles?
AVEL GORDLY:
I throw my arms around her, and I hug her. I pull her close. I tell her-- that I love her. I'm concerned. I'm fearful for her. She needs help. And I want to help her get that help

PETE EARLEY:
Okay, Olivia, We're in the car, we're on our way.
FRANK SESNO:
But you go to--
PETE EARLEY:
To the emergency room.

FRANK SESNO:
To the emergency room. And-- and Olivia reluctantly goes in the emergency room with you. And Dr. Simpatico is there. What do you want him to do?


PETE EARLEY:
Doctor, our daughter is acting bizarrely. She is apparently manic. She wants to go to this spa-- We literally have forced her to come in to see you. Help us.

FRANK SESNO:
Dr. Simpatico, you’re a professor of psychiatry at the University of Vermont College of Medicine.
THOMAS SIMPATICO:
My first reaction is that I share their concern. And those concerns are supported by what-- Olivia appears to look like at first blush. So, my reaction would be to-- tell them that I think they've made the right choice to bring her for an evaluation. And my next step would be to-- talk with Olivia and get a better sense of what's going on.
FRANK SESNO:
Okay, well, since Fred Frese, you've become Olivia here. It would appear. (LAUGH) And we thank you for that. You pull yourself together. What do you say?
FREDERICK FRESE:
Doc, my folks are gettin' older here. I don't know why they brought me in here. (LAUGH) I think they've had some trouble in the past. And we're on our way to Washington. Because they've promised to take me to this spa, but they said I had to stop by here. Isn’t that silly? There is no purpose in that.
THOMAS SIMPATICO:
And what do you hope to accomplish once you get to Washington?
FREDERICK FRESE:
The spa. Well, I've been working on this project. And-- Washington is-- is the center of a lot of activities. Very important people in Washington. I know if I can get in with those waters it'll help me with this project I'm working on.
FRANK SESNO:
But Olivia has something else in-- in her mind, too. She does not want to be here or treated. What can you do?
THOMAS SIMPATICO:
I would not feel comfortable having Olivia simply leave the emergency department. I'd want to get more information.

PETE EARLEY:
God bless you. That's not what happens. (LAUGH)
What happens is the doctor asks a series of quick questions. What does crying over spilled milk mean? Who's President? Do you know what day it is? And then comes to the parent and says, "The law is very specific. Unless this person poses a danger to themselves or others, I may not require them to stay in this hospital. So, you know, good luck and good bye."

FRANK SESNO:
Estelle Richman, you are Pennsylvania’s Secretary of Public Welfare… So what do you think?
ESTELLE RICHMAN:
One of the other factors is that Olivia probably, if she gets agitated, is gonna run out the door.
FEMALE VOICE:
Yeah, right.
ESTELLE RICHMAN:
And no one's going to stop her.
FRANK SESNO:
And the emergency room doc, as a point of reality, he's got patients-- stacked up. Is he gonna go running after her?
ESTELLE RICHMAN:
He is not-- not only is he gonna go running after her, every emergency room has police on duty. They aren't gonna run after her, either. And she's gonna be lost in the streets before anyone realizes, sometimes, that she's even gone.
(Tape ends here)

Local Ax: And Olivia goes out the door. Can emergency rooms do a better job helping families secure the treatment they desperately seek? Are there other ways the community can provide more effective, initial services? The Fred Friendly Seminars seek answers to these questions and more--- in “Minds on the Edge,” airing (time and date of broadcast).

Module 2 – Public policy (Tape alone: 1:57)

Local Ax: From a Fred Friendly Seminar, a segment from “Minds on the Edge”--- an exploration of mental illness in America.
As we face the problems in mental health care as a society, we inevitably have to figure out where the money is going to come from for their care. Will the government provide? And will the judicial system offer help in making sure unwilling patients are treated?

We’ve created a scenario and invited experts to weigh in. Our patient is Olivia, a college student, in a breakdown. To discuss these issues, are: Supreme Court Justice Stephen Breyer, Judge Steven Leifman and bioethicist Art Caplan who will play the mayor in our scenario. He’s challenged by reporter Pete Earley who is father to our patient, Olivia, but who in real life has a son also struggling with mental illness-
(Tape starts here) PETE EARLEY:
We know how to help most people with mental illnesses. We just don't do it because of the money. Now, you want to worry about cost effective? Forget it. I'm gonna tell you it's gonna cost more. But I want you to do something. You go under that bridge. And that's your son. That's your son. How much do you want to spend, to help him?"

ART CAPLAN:
I've had mental illness in my own family. And I know what that means. But you have to understand something. I hear stories about who's under the bridge. Who's unemployed. Every single day. I-- I have empathy. But this city, as you know, is undergoing severe budget cuts. You tell me to spend more, I'm telling you, it isn't gonna happen.

PETE EARLEY:
I'm gonna come to the mayor. And I'm gonna say, "Okay, I've heard you." And you know what I'm gonna do now? "I want to sue these people, because the court is the only way that I can (LAUGH) (UNINTEL) to force them to do the right thing.

JUSTICE STEPHEN BREYER:
Now, I would beware of the courts. I mean-- (LAUGH) if this person doesn't know much about the problem, so let's go to a group of people who know still less. (LAUGH)

FRANK SESNO: (spare parts)
Judge Leifman, she's not apparently a threat to anybody, or to herself. What does the law provide?


STEVEN LEIFMAN:
Very little.
STEVEN LEIFMAN:
She's gonna be released. She's not an imminent threat to herself or anyone else.
FRANK SESNO:
Doesn't matter that she's been walking around for two days?
STEVEN LEIFMAN:
Not at all.
FRANK SESNO:
Doesn't matter that she's--
STEVEN LEIFMAN:
The tragedy--is just beginning.
(Tape ends here)

Local Ax: ”The tragedy is just beginning…” from the judges, family members and government officials---all ensnared in our country’s mental health care crisis. Listen as our distinguished panelists continue to debate these issues in a Fred Friendly seminar, “Minds on the Edge: Facing Mental Illness,” airing (time and date of broadcast).

Module 3 Public policy (Tape alone: 2:11)

Local Ax: From the Fred Friendly Seminars, this is a segment of “Minds on the Edge,” an exploration of mental illness in America. Experts in health care, the courts and the legislature agree that the treatment system is broken. Public policy and the courts need to be overhauled to face a history of neglect and failure to treat people suffering from mental illness.

On this panel, bioethicist Art Caplan, Pennsylvania’s Secretary Of Public Welfare Estelle Richman, Judge Steven Leifman, and psychologist Fred Frese search for answers in a hypothetical scenario. Journalist Frank Sesno assigns a role for Art Caplan to play----

(Tape starts here) FRANK SESNO:
Mr. Mayor, not only is your budget being cut, but your constituents and your taxpayers, oh and your donors, are calling you. What are they saying?
ART CAPLAN:
They're probably saying that-- James doesn't vote, so you better listen to what I have to say. But-- (LAUGH)


ESTELLE RICHMAN:
No, but that's very true. (UNINTEL) They're saying, you already put money in that system. Look, look at the homeless population. I'm not gonna give you more money. I don't think this is a nuisance. I think these people are dangerous.

ART CAPLAN:
: Estelle, I know you've given me a lot of money. I value your support. (LAUGH) But the reality is, this city is not gonna be able to tolerate a bunch of people out on the street. It's gonna give us a bad reputation for business. We can't have that. You remember what it was like here 12 years ago. We had reams of people wandering around the street. We couldn't get anybody to come downtown, and no one would live downtown. I gotta spend something here.
STEVEN LEIFMAN:
But Mr. Mayor, you're spending $100,000, a day, keeping these people in your jails.
FRANK SESNO:
Fred Frese, what's happening to James, while all of this is going on?

FREDERICK FRESE:
James has been locked out by the establishment that is totally controlled by chronically normal people, (LAUGH)
FREDERICK FRESE:
No insult intended. (LAUGH) We have these disabilities. We want roles in society. And we want to be acknowledged as fellow citizens in your community, Mr. Mayor.
MALE VOICE:
But I-- if you want--
FREDERICK FRESE:
Not just avoiding us, and say put us in jail.
ART CAPLAN:
I don't want to avoid you, but I've gotta build those jobs. You tell me how these programs are gonna contribute--
FREDERICK FRESE:
You start us off at minimum wage, three hours a week. That's all you have to pay for these poor folks who are totally lost out there, and give them a little bit of hope.
ART CAPLAN:
Well, I might accept that, if that really is gonna be cost effective. I can start you down the road. (Tape ends here)

Local Ax: A start down the road for new solutions to treat mental illness. But this opens up more questions – Not just where will the money come from----but who will supervise these folks? What will they do? And who will be the person or agency to get the call when someone does break the law or doesn’t take their meds? (cont)

Local Ax: (cont.) Community treatment offers reasons to hope, but raises many questions too: Listen to our distinguished panel confront them in the Fred Friendly Seminar, “Minds on the Edge,” airing (time and date of broadcast).

Module 4 Justice System (Tape alone: 2:01)

Local Ax: From the Fred Friendly Seminars, this is a highlight from “Minds on the Edge,” an examination of serious mental illness in America. Our panel of experts in health care, the judicial system and the state explore a broken system in a search for solutions. We’ve constructed a hypothetical scenario and asked experts in the justice system to respond.

Our composite patient, James, is in crisis. He always heard voices, but they’ve been getting louder. He’s recently lost his mother who took care of him. He’s rational enough to seek help from the local hospital’s emergency room, where he’s seen and given an appointment for a session with a counseler – in three weeks. Journalist Frank Sesno sets the scene for Florida Judge Steven Leifman, former Washington State Senator Avel Gordley and Pennsylvania’s Secretary Of Public Welfare Estelle Richman.

(Tape starts here) FRANK SESNO:
So, James walks out with his appointment three weeks from now.
ESTELLE RICHMAN:
And maybe a prescription. Maybe.

FRANK SESNO:
And maybe a prescription. And is disoriented. He is now about to have something else happen. He is arrested for public urination. He now goes not to the hospital, Judge Leifman, but to--
JUDGE LEIFMAN:
Jail.
FRANK SESNO:
Surprised?
JUDGE LEIFMAN:
Not at all. Judges are much more likely to see consumers with mental illness than psychiatrists.
FRANK SESNO:
Judges are more likely than psychiatrists to see--
JUDGE LEIFMAN:
By far.
FRANK SESNO:
You see more--
MALE VOICE:
Probably with mental illness.
JUDGE LEIFMAN:
I probably--

FRANK SESNO:
Than Dr. Skale here.
JUDGE LEIFMAN:
Probably ten times more a day than-- than she does.
FRANK SESNO:
What is going on here?

JUDGE LEIFMAN:
Well, he's committed a crime. And-- law enforcement officers are there to enforce the law. And the public's outraged. This guy is exposing himself. He's urinating in this beautiful-- rose bush. And-- and the woman who owns the rose bush is outraged. And she calls the police. And they come and they do their job.
FRANK SESNO
Senator Avel Gordly.
AVEL GORDLY:
We assume that the police --encounter-- has that outcome. The police are poorly trained. The police-- tackle James-- on the street.
JUDGE LEIFMAN:
James runs from them. So it’s going to be resisting a police officer. Now it’s a felony so that it's unlikely that it ends up as a urination case.

JUDGE LEIFMAN:
Don't you understand that the mental health system is a definition of insanity at this point. You keep doing the same thing again and again, and we expect a different outcome. It will not change until the system changes.
(Tape ends here)

Local Ax: “It will not change until the system changes”-----Judge Steven Leifman, one of Florida’s leading advocates for mental health reform. But in this time of recession, mental health care may not be on the priority list for most state and municipal governments. What kinds of programs can make a difference – save tax dollars; protect those with mental illness and those who must live with them?

For ideas that are working in communities across the country, listen to “Minds on the Edge,” a Fred Friendly Seminar, airing (time and date of broadcast).

Key to Pronunciations of Names

Stephen Breyer BRY - er
Art Caplan KAP - lin
Pete Earley ER - lee
Fred Frese FREESE
Avel Gordley A – vuhl GORD - lee
Steven Leifman LIFE - man
Estelle Richman RICH - man
Frank Sesno SEHS - no
Tom Simpatico sim – PAH – tih - koh

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