Recovering from Force & Coercion Fund Survey

About You

The Wildflower Alliance has a small fund available to support people who've been subjected to force or coercion in the psychiatric system that has led to direct or indirect expenses.

The Wildflower Alliance believes that force and coercion are fundamentally problematic, harmful, and counterproductive. We acknowledge that numerous studies now indicate that force/coercion can lead to higher suicide risk, and many other negative consequences. We also acknowledge that those negative impacts are cumulative, and for someone who's already experienced force/coercion, additional force and coercion can become harder and harder to navigate. The power of loss of power can be profound.

The sorts of expenses that this fund is designed to assist people with include (but are not necessarily limited to):

Ambulance fees that result from forced psychiatric hospitalizations
Lost wages at work during a forced/coerced stay in a psychiatric facility
Penalty fees for late bills that could not be paid because someone was in a forced/coerced stay in a psychiatric facility
Pet and/or child care expenses while someone is in a forced/coerced stay in a psychiatric facility

Please be aware that these funds are limited, and we won't be able to approve every request, or necessarily approve the entire amount someone has requested, but we will be doing our best, and will continue to seek to raise funds.

PLEASE NOTE: As we raise funds, it will also be useful to collect data and stories that we can share about people's experiences with the costs of force/coercion in people's lives. At the end of this application, we will ask you if you would like any of your story shared. Sharing your story is entirely voluntary and will not influence whether or not your request for funding is approved.

This is a new fund with limited resources. We are just learning about how much demand there will be, and other challenges we may face. We apologize for any messiness or bumps we hit along the way to figuring this out! /'

1.Your Name:

2.Your Location & Contact Information:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

3.The date(s) that you experienced force/coercion (Please note: We will prioritize people whose experience was within the last 6 months):

4.The location of the facility where you experienced force/coercion:

Facility

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

5.Please share as much detail as you are willing about what happened (how you ended up experiencing force/coercion, how it negatively impacted you, etc.)

6.If not already explained above, how was force/coercion involved? (Did someone call 911 or do a 'wellness check' on you, did the police approach you on the street, did your family or clinician ask for you to be forced to a hospital for evaluation, etc.)? (Again, please only share what you're comfortable sharing)

7.The specific costs you incurred as a result of the force/coercion:

Ambulance or other "treatment" related fees:

Lost wages at work:

Penalty fees for late bills:

Pet and/or child care expenses:

Other:

8.Please tell us some about your current financial situation?

Do you currently have a job? If yes, are you working part or full-time?

Do you have other debt you're also managing?

Are you on a fixed income (ie., Your main source of income is SSI, SSDI, or similar)

Do you have family or other people in your life who could help you with these expenses?

Do you usually have enough money to meet all your expenses comfortably or are you living paycheck to paycheck?

Anything else?

9.What is the total amount you are requesting from this fund? (Please be sure you've given enough information in questions 7 and 8 so that we can understand your ask)

10.Anything else you want us to know?

11.Do we have permission to share your story when reporting or asking for donations/grants for this fund?

Yes, but only without any identifying information.

Yes, and I'd like my name/identifying information included.

Maybe, Please contact me to discuss this further.

No, I do not want my information shared, and I do not want to discuss this further.

Other (please specify)