Doctors angel cano wrote about her experiences in his new memoir, sometimes Amazing Things happen. This is a place where problems and our society are incarcerated and the mentally ill come together and his doctor for pointed out on the daily show amazing doesnt always mean good im delighted this important book as are the number one on some biography bestseller lists. [applause] so here to introduce the therefore it is dr. Howard owen who worked alongside dr. Ford in the department of psychiatry at nyu school of medicine and sits on the jars. Hes going to tell us about fountain house and a couple of minutes. I want to say how much i deeply admire both of your works working in one of the most challenging careers possible, caring for those in our country that our country often abandons. Please join me in welcoming dr. Owen to the strand. [applause] i want to thank you and the strand for being here for this event. There are two reasons why i am here. First is because im a very old and dear friend of Elizabeth Ford and the second is im also an old friend of fountain house. Fountain house is an organization that is not quite as old as the strand. It was first established in 1948 by it are the people who had been patience at the Rockland State hospital and they came back to new york city and wanted to create a place for themselves where they wouldnt be shunned and stigmatized, where they would have their own place. One of the main problems that people suffer from serious mental ominous as they often feel lost and that they have no place at all in Everyday Society fountain house on 47th street provides a place for people with serious Mental Illness. Its a place to form strong relationships a place to pursue meaningful work, place to pursue your education and a place where you are valued for what you can do and where the focus is on health and wellness and not on symptoms. The ultimate aim of fountain house is to help people pursue their goals to be able to thrive in society. If you are not familiar with this we have a table over here and literature that can tell you more about fountain house. Unfortunately many people with serious Mental Illness dont thrive in society. As we all know many end up in homeless on the streets and ultimately many end up in jail, the only place we have left to. The book were talking about tonight takes us into this place where Mental Health confessional struggle to help people with serious Mental Illness under very difficult and very stressful circumstances. The union jail is an extraordinary stressful experience for anyone and to be mentally ill adds to the impossible conditions. I am going to be introducing you tonight to a person who is a truer form or as anyone youll ever meet someone who is devoting her career to working to improve the Mental Health care for people in our correctional system. It was a bit ford is the chief of psychiatry for correctional Mental Health services for new york city for new York City Health and hospital corporation. She is also a clinical professor of psychiatry at nyu school of medicine. After the events that are described in the book at the very end of the book elizabeth describes how she goes to a new job which is her current position where she is the chief of psychiatry for the jails than when she first told me that she was taking this job, i was worried. I thought of Rikers Island as being a place that reince people down and burns them out and i never had the ambition to actually go and work their, so i was concerned. If it turns out perhaps i shouldnt have been so worried i can say without exaggeration that i dont know anyone who could be better suited for the kind of job that she has. She has only been at Rikers Island for a relatively short time but she has already accomplished some quite Amazing Things they are to improve the quality of care for the mentally ill people who are in jail. Now the book tells the story that leads up to this point in her career and its about the development of a young psychiatrist working first in the Bellevue Hospital emergency room and then in the psychiatric prison ward on the 19th floor of bellevue it takes you to the trials and hardwon battles that we early stages of her career in psychiatry. I want to go back first to the first time i ever met elizabeth. I was at that time as i am now part of the faculty of the Forensic Division of dull view at and White Bellevue at nyu. This is the point in the book where she has finished her specialty framing in psychiatry and was starting, and was starting her forensic psychiatry fellowship. The first time i met elizabeth i was impressed and it wasnt just that she was a very smart and welltrained and very energetic young psychiatrist. There was another quality which struck me very early on and that was she was fierce. What i mean by that is she was fiercely determined whenever she saw someone getting a raw deal for particularly when she saw mentally ill people or were not getting proper treatment. She had the fierce determination that something should be done to correct the situation. Think of the wonderful scene in the second alien movie. [laughter] the alien is about to grab the little girl and Sigourney Weaver gets inside of this mechanical robot machine with the two arms and she is going to take out the alien. Thats elizabeth. [laughter] [applause] now when you read the book youll learn about many different battles that she has fought along the way in order to improve patient care or for just simply basic human rights for people who were in jail in the hospital but this brings us, brings me to the second characteristic which is maybe even more important than the first and that is the fact that when elizabeth decides to fight for something she doesnt go into the mode of us against them , the unfortunate usual approach that people have to fighting where you caricatured the opponent so that you can be the mop. Instead she looks at whats wrong with the system and comes up with ideas about how the system might be changed or how we might try to do something differently and then brings other people in who can be persuaded to giving it a try and to collaborate and actually improve things. You will see an example of this also in the book. There is no doubt that there are some bad actors in this book and not all of them are jail inmates. There are some people in the system who actually be rim need to be removed but the other thing you will see in the book is the respect and appreciation that elizabeth shows toward people in the Corrections Department and individual correction officers who are good people and who are actually trying their best to do the right thing and people that you can collaborate with. Now this brings me to the last characteristic which is really by far the most important which i think is the main parts of this book and that is elizabeth tremendous empathy for people, for many of us were many people in society, people who considered the lowest of the low who are the dregs of society, that is people with serious Mental Illness who are also criminals. Its also important that we not whitewash this and look at the patience as if they are really nice people. In fact many of the patients are people who have done quite horrific and awful things whose behavior may be quite up noxious and thats the reality that we are dealing with. So this is the problem for psychiatrist. Early in your career when you are being framed as a psychiatrist one of the first things you are taught is youre supposed to approach the patient with an attitude of neutrality, which means among other things, what that means is your job is to help the person with their problems, not to impose your small views or your values on them. And of course in most of the practice of psychiatry, maintaining this kind of neutrality is not that difficult because after all most people dont do horrific things. However when you come into the criminal Justice System you have to deal with that problem. Think for example of a person who drives a car up on the sidewalk of Seventh Avenue and runs over and kills a young woman and sends 20 other people to the hospital. What would it be like to be that persons doctor or if he went back 1981 when Mark David Chapman killed john lennon and was sent to Bellevue Hospital. This was before dr. For its time but he was sent to Bellevue Hospital to the prison ward is a patient they think about the difficulty of being a psychiatrist who is supposed to manage this patient. Now its one thing to be able this to say to yourself as a psychiatrist, i will try to maintain my anonymity here. I can do a careful of violation, i can prescribe the most appropriate medication if its necessary and i will try to restrain my feelings and not show the contempt or rage or hatred that i might feel for this person. But heres the question. This is the question that is at the heart of this book. How do you manage to bring yourself to actually care about that person . I think again if you read the book you will see dr. Ford has answered that question and made it clear how its possible care in spite of some of the awful things that you have to deal with. There are stories in this book that are heroic. There are other stories that are just mundane. The heroic stories are things like the time that the psychiatric staff in the prison ward had to manage and take care of the patients who walked to the 19th floor during hurricane sandy. The hospital was flooded. The main electrical power went out. The elevators didnt work. The phone service went out. There was no regular food service and the inmates who were psychiatric patients were locked in the 19th floor. The staff had to walk up 19 floors just to get to where the patients were. There were a few days they were really very harrowing and extremely difficult both for the patients and the staff. Dr. Ford at one point was ringing boxes of pizzas to the hospital that had to be carried up to the 19th floor so there would be something to be. You probably all know the outcome of this story which is that the staff succeeded in getting all those patients out safely and to other hospitals and didnt lose a single patient the more mundane kind of story, the one i really like is the time that the ford decided that the patients deserved to have decent clothing to wear when they had to go downtown to the criminal court court to appear in front of the judge. In other words, and this to me represents a sort of basic Human Dignity issue. The concern was the patients shouldnt have too shuffled down in front of a judge wearing hospital pajamas and hell also reading the book about how that was accomplished. Now i want to close with a quotation and since it is the strand its a quotation from herman melville. The reason im doing this is because i want to make the point that this is a true book. Melville said that the truest of all books with solomons book of ecclesiastes because it was made out of the fine hammered steel of wool. He went on to say that if a person dodges hospitals and jails and has to walk fast to get past graveyards, that person is unfit to sit down with solomon. And then he says this. There is a catskill evil and some souls that can dive down into the blackest origins and sewer out of him again and become invisible in the sunni stages. I would submit to you that this book certainly does not hesitate to take you right into the hospital and the jail and the author is certainly a person who has gone down into the blackest gorges and again is still able to soar up into the sunny spaces in fact you can even see this depicted on the cover of the book. So for all these reasons i am suggesting to you, read this book. [applause] thank you howard and nancy thank you very much. I am very humbled at this and very thankful to be here and was also told reading from my book might be too boring but im going to try it anyway. If it gets too much just raise your hand. I very much enjoyed the writing experience. It was very cathartic for me and a way to metabolize a lots of the stories that i heard from patients and the personal experiences. I do want to read a little bit about it and hopefully field whatever questions you have, any of them are fine for they may not answer them all to your satisfaction but i will try and also to start, just to let you know the characters in this book with the exception of me are all identified. Not only the names have been changed but many times i have changed the ethnicity and some of the diagnoses. Its extraordinarily important to me to protect the confidentiality of my patients and it was probably the biggest barrier about my idea of even publishing Something Like this. It became. Clear to me after a decade of this work that the pieces that were published in academic journals and the policy discussions that were happening and the headlines and on the tv shows, i dont think we are getting to the root of some of the challenges and we are leaving behind the people, not just the patients but those who work in this environment. I do fight sometimes fiercely and it seems that theres anything i can do to further the humanity of the discussion that i need to do it and this book is that result. It is also a book that is a narrative. I wanted to initially just right pieces about the patient but then my very wise editor and publisher informed me that i really was the narrator. It did turn into a memoir and the patients are very much part of my life and the staff who i worked with who were absolutely incredible have been very key to that. It does mean the stories come its hard to excerpt them out because they are part of the narrative so i will try to introduce a little bit of what i wrote and give you a bit from the authors note to try to set the stage. For most doctors working behind bars but patients who mother see as criminals, inmates even bodies is not. Peeling but there is relieving suffering and the award can seem few and far between. At come to see my success as a doctor not by how well i treatment alone is but how well i respect and honor my patients humanity no matter where they are our what they have done. The world described in this book the hospital and the jail it serves her heartbreaking at times come infuriating at others and always compelling. These can deeply shaped the lives of patients staff for officers and the hardened angry and traumatized versions of themselves. So the book is a lot of stories about that and then im going to be part of a story to introduce a couple of characters in here and you wont hear the descriptions but for reference a composite of medical students and theres some offices here and a few patients that have been introduced. The room is on the Northeast Corner of the unit overlooking the east river and the expansive views make it seem larger than it is in the still functioning stereo into one quarter with locked closets along the one balled. There were broken hearts and hopeful messages about getting out of jail. Some of the pieces are from a coloring book while the others are originals that in different circumstances could be hanging in the gallery. One second i say of the medical student and i shoved them next to each other with ten plastic chairs around the edges and i do a quick scan, take up a paper and a loose staple from the floor and walk over to let the patients in a. Of the patients literally trying to get out of his own skin and whom after he was released to attend one of the nursing text and they ran into each other on the street. Seeing his face brings back his history in an instant into my mind. I say in response of m with my l just as big hes put on the week and has taken a shower in his skin is perfectly in tact. He is this beautiful black man and was convinced he was white and was repeatedly peeled off his skin in an attempt to prove that he was white and so here i am seeing him years later in aj also not wonderful but certainly looking healthier. He laughs except im back in here again but this is the last time i promise. I dont tell them how often they heard that before. Some patients are up close to the table and others pressed against the wall as far away from the conversation as possible. Its very calm and orderly. She begins to speak first. Good morning gentlemen, welcome to the group this is called dealing with jail and we talk about anything you would like to share or think is useful to talk about surviving a Mental Illness. Lets go through the rules and introductions and then we will get started. A couple recite the rules not different from those in the meetings and then we begin introductions. I need to talk about my medicine. Its not working. Okay we will talk about that separately when the group is over. Arthur, campbell. Im doctor ford, also a psychiatrist. What is your name, i ask the patient that has his head hung low and im not sure if he knows im talking with them. He reaches out to the patient and taps him on the shoulder. The patient looks up briefly and then walks back down again. You dont have to say your name again. I see him Walking Around in the conversation. So, the floor is open. Anyone have anything you would like to share, it is in a unit that is always so noisy. It can be about anything, they say hoping someone will break the awkward silence but still nothing. I know its hard to talk about stuff in a group like this especially when you are in jail. Do you know people stayed twice as long without Mental Illness or they end up in the box of solitary confinement more frequently and stay in the box longer or they get beat up more often how do you make it through a place like that youve got to man up there is no way to avoid fighting youve got to figure out whats worse, what you can do or what you can have done to you. Hes young compared to the others in the group. Theres other ways he says i just stay out of everyones business and that is the only way to get through the. He may still be a psychotic hence the admission to the hospital but hes holding it together for the group. I used to fight all t