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 doesn't always mean good i'm 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. he's 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 i'm a very old and dear friend of elizabeth ford and the second is i'm 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 wouldn't 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. it's 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 don't 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 you'll 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 shouldn't have been so worried i can say without exaggeration that i don't 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 it's 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 hard-won 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 wasn't just that she was a very smart and well-trained 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. that's elizabeth. [laughter] [applause] now when you read the book you'll 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 doesn't 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 what's 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. it's 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 that's 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 you're 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 don't 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

person's 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 it's 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 it's 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 here's 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 it's 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 didn't 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 didn't 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 shouldn't have too shuffled down in front of a judge wearing hospital pajamas and he'll also reading the book about how that was accomplished. now i want to close with a quotation and since it is the strand it's a quotation from herman melville.

the reason i'm 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 solomon's 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 i'm 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. it's 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 don't 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 there's 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 it's 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 i'm going to be part of a story to introduce a couple of characters in here and you won't hear the

descriptions but for reference a composite of medical students and there's 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 he's 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 i'm back in here again but this is the last time i promise. i don't 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. it's 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. let's 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. it's not working. okay we will talk about that separately when the group is over. arthur, campbell. i'm doctor ford, also a psychiatrist. what is your name, i ask the patient that has his head hung low and i'm not sure if he knows i'm 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 don't 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 it's 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 you've got to man up there is no way to avoid fighting you've got to figure out what's worse, what you can do or what you can have done to you. he's young compared to the others in the group.

there's other ways he says i just stay out of everyone's business and that is the only way to get through the. he may still be a psychotic hence the admission to the hospital but he's holding it together for the group. i used to fight all the time about anything. no one disrespected me but i'm tired from all that fighting it just keeps getting me back in the box. i am so sorry, he'd fumbled. i am so sorry. >> it's not a big deal, he chuckles. that's so kind of you. i'm sorry to interrupt. please continue, i will be quiet. they are puzzled by his comments. does anyone else have any experience you would like to share? he asks about his medication

again. conversations turned to drugs and alcohol when he talks about getting arrested for smoking a blunt. everyone has something to say about drugs. need i say something minor, he asks in the pause and discussi discussion. i don't mean to take up everyone's valuable time in the group i know i don't deserve it. thanks for letting me speak. he sighed in frustration. i struggled with alcohol for so long and i've been sober since getting locked up and i hope i can stay clean once i get out. he seems to be a little more comfortable now. he tells us of being whipped against the wall as a 7-year-old. one morning he drank one of the glasses of leftover orange juice

not realizing it was mixed with vodka and when his father found out he with ten until blood seeped through his shirt but it didn't hurt that much this time because he was tipsy from the alcohol so he drank as much as he could get his hands on. thank you for letting me share. i know i'm not worth your time. i wrote these words and i'm still getting a little tearful. he said you are worth it, you have courage. just hang on and keep going one day at a time. that's all you've got to do wi with. think about all those days that he survived already.

i glanced at cynthia to see if she is appreciating what's going on in front of us. her eyes are wide with amazement and we see a pivotal moment for the group itself. a collective responsibility to care for someone else but no one wants it to end. so, i chose that because first of all it's short enough and also i hope that it shows the potential and to my mind the amazing things that can happen. this is a group of people off of whom had been incarcerated with the exception of drug crimes and mental illness and they came together in this setting and collectively helped this 40-year-old man that didn't feel about significant things in history. and at that moment to talk about the trajectory hasn't been back in the system that i'm aware of.

he was engaged in treatment when he was released from custody and that may not seem like a huge deal but in this world any of those things are pretty phenomenal. thank you very much. i would like to hear some questions and have a discussion. thanks for being interested in the topic. [applause] if you have a question or discussion please raise your hand do you have a wish list of anything society can do to help psychiatric patients and what would be on the top three of your list? >> i started to question and have like 25 different kinds of top three. my perspective one of my first

wishes would be for the psychiatric and mental health provider community to practice what we are all taught which is to listen to our patience and approach them with as much empathy as we can drum up and i work with patients for whom sometimes it is very hard to feel that way with public systems outside of the jail as well where it isn't public perception that can be problematic but also it can be a psychiatrist or providers biases and assumptions and misconceptions about a patient's behavior and noted that can be destructive and i want to reflect on that and i would love to see decisions made about systems chang changes coming fre bottom up, so feedback from patients and consumers and staff

rather than some of the top-down policy approaches that have been and i think in my mind sometime we miss what can be very tiny but critical details in a plan or program that works. what would be my third. >> which patients ended up in the correctional view and how that worked.

it's really kind of seeps into the care of all patients one is a relatively easy question to will tell you what i remember about how people get in their. the forensics units treat to a different kind of patience. the first are those that are requested by the police and have not yet seen a judge. so they've been picked up on the street and they are somewhere between the actual arrest and at the time with the judge and the police sometimes it is the defense lawyer.

all men by the way ages 16 and older and male patients from the jail system have already been charged with a crime. you have to have both of them, the mental illness and significantly dangerous to yourself and other people. because of this criteria it is hard to get on that unit. this is a tiny represented family of elements in the syst

system. that's how people get in the emergency system like any other hospital and whether they meet the criteria which can lead to the second question about the admission of the decisions or not. the new york state law is very doctor friendly i would say so there's a lot of discussion in terms of how you can define mental illness so they hopefully our objective but sometimes can be colored by how afraid the psychiatrist is whether they have an experience in the past where there is a threat or physical interaction that happens. choose your pointo your point at

is to do this work. it is extraordinarily noble work and very challenging taking care of patients. it's provided for or given or taken what they need to be healthy and it can be hard for someone to be sitting in front of someone asking you to essentially fix everything in that moment. i start to get angry at the person in front of me for being so.

collectively if the psychiatric training staff are not talking about this as a person and being mentor to these real phenomena that happen when you run the risk feeling ashamed about it. i think everybody probably has an individual sort of thing that would work for them but i don't know that there is a human being alive but thinks everybody is wonderful and doesn't have feelings about them when they needed them.

>> i have a question about how you feel about being a woman in this career and job how do you think this works and how do you think that affects the results? there were not so many in the field, so there are thankfully more now. i think that anybody, regardless their gender, orientation can be a phenomenal doctor.

i do think particularly in the jail setting there is a. i think sometimes i'm deluding myself that i'm safer but there is that because i work with men and there's a sort of respect for the mother figure into the women that have brought children into the world alternatively sometimes they are deep-seated angry feelings that get us. whether i'm automatically a mother or not unlike a woman figure just beating a woman andi find that helpful because it can bring up a lot of things to talk about with the patient if they have conflicted relationships with some of them have a wonderful relationship but that unfortunately it's not as common as i would like to.

they were always asking me what i needed even if they couldn't get me anything. but there were some patients that worked there and were scared of me leaving and abandoning them and once you deliver a child can't predict how things will shift to. but i get asked sometimes

because i think it continues to be such a male-dominated field whether i feel like there are barriers to care for me. [inaudible] >> i'm the mother of a diplomat and -- the daughter of a diplomat and a psychologist and that has allowed me to feel i can do whatever i want although i know i can't. [laughter] >> how do you feel mental health care will be affected by the political climate?

i think anything political on who is running the country and push his tolerance more to the back burner and leads to shifts in healthcare and less coverage rather than more and at least what appears to be leaning to criminal justice policies like mandatory sentencing and any leadership will be highly problematic. i will stop there. >> i am a child adolescent and grown-up psychologist the last 35 years or so from oklahoma and i had a comment first of all of that being a woman in this field. oklahoma has more places than

any in the world. we have the largest incarceration of women being anywhere in the world. right now what i do for work is see people on federal probation and i've done this a number of so what i see his family trauma and drugs and alcohol and affordable problem to me is isolation. i've been in isolation for so long and we talk about being out of the so one to three hours a day i saw a man not that long ago which to me is torture a.

if you are in the county jail community setting its because we were violent and always invites or because you've been involved in gangs or in some situation you're going to be killed if you are in community. if. i think you are referring to solitary confinement. so, anything that restricts people to that degree is not healthy. there's no question. there are some ways to address that.

the restrictions on the solitary confinement are the site of regulation and it has become so much more. it is very important because two years ago people were serving 800 sentences in solitary. it can be done. so the trick is to make sure you are replacing that with something to the officers will buy into because this is a system that isn't a health care system, it's a criminal justice system and whatever my personal feelings are, they exist as they are right at this moment. it's the bod body and aggression staff and if they have to feel safe so for many of them it's

much safer now for the patients but for the staff. i think it is naïve people are not considerin considering thein these kinds of issues. so the critical piece is to make sure there's something in place they can understand and appreciate. it switched the dynamics from one of punishment to positive rewards. there is no isolation. you go to patients that are serving long sentences. the things i think might be helpful arch writing small issues and then trying to group it into the system.

but it's very complicated and people feel very strongly. i don't think we are going to find a solution if we stay on either end of the spectrum so thank you is there an official partnership? >> that is an excellent question. i don't know. >> they talk about integrating everything you're talking about and we appreciate the. >> [inaudible] >> anyone else? i wondered if you can see some thing about what it's like working with the cards on the un and how that impacts the first

thing i learned is not to call them guard and i'm going to go off on a tangent. language is important and the words you choose show how much respect you have for the people that you are around and so that was an early thing for me to learn. but the offices are the ones around the patient more than anybody else. it's different than the hospitals and jails system because there are more hospital and nursing staff are bound and it is much more than just officers but i went into the work thinking this is embarrassing to say that it's

all self revelation i suppose. people became correction officers because they wanted to beat people up. i thought those that chose this kind o of work sort of had it in for the inmates and this is some way to act out aggression. i haven't talked to anybody for whom this isn't true. they go into this work because they want to help people some of them feel like they are helping the community at large because they are keeping these dangerous criminals out of the streets.

there are some officers for wh whom. it's the paramilitary organization. some of them are very proud of that. it's very troubling to me and i feel that this has to be the next step somewhere. when they are not paid enough or they don't have health michael easton they shift the way that you behave.

i found i wasn't always a compromise or by the way, and my husband would disagree with you. we share a lot of things, the officers and health staff. we want people to be safe. they are so sweet, the same with the health staff so we have to find that shared ground