Personal encounters with untreated mental illness, stigma & YouTube

A key and understandable focus of many mental health organizations is fighting stigma. Educating, and sometimes chastising, journalists who propagate derogatory stereotypes is a common way to try and prevent the most severe manifestations of mental illnesses from being associated with all who have them.

Yet would stigma be eliminated if advocates were given the final say on every article, movie and TV Show? Hardly. Opinion is forged through personal experience.

People who have overcome mental illnesses don’t wear tags marked “I have Bipolar Disorder” or “successfully dealing with Schizophrenia.” Many of those in the grips of the untreated symptoms of such illnesses make their conditions distinctly apparent. An encounter with someone in the midst of a psychotic episode can shape an individual’s opinion about mental illness for life. E-mails, phone calls, and media education can’t prevent such encounters – only treatment can.

Nafiza Ziyad is “an ambitious, bright and happy person.” She also has bipolar disorder, but “thinks she can do without the medicine.” A manic episode recently led to Ziyad angrily, confusingly confronting an elderly woman on an Atlanta train and to becoming the face of mental illness for most of the other passengers.

As it happens, Ziyad’s behavior also provided an “education” for many others. It was recorded and posted on YouTube. The video is entitled “Crazy Girl on Train.”

Currently, 847,638 people have viewed the sad incident and 10,274 have posted written comments concerning it. Should you wish to watch the video of this sad episode, please be aware that it contains a great deal of profanity.

And does this create stigma?...below are a sample of comments from the YouTube posters (profanity has been excised).


“Oh my God...what a horrible person.”

“That was scary”

“what a nutcase.”

“She needed to be popped in the mouth.”

“some forgot to take her meds..”

“i'd hit her in the middle of the face with a baseball bat if i was just sitting there in the train going home or anything. i'm pretty sure i would have support”

“Yall can't see that this girl is mentally insane.”

“shes disturbeddd”

“If i had been on the train i would have ------ kicked her in the face.”

“that chick needs to be medicated.”

“THIZ FEMALE CRAZY”

“Somebody call the doctor. This girl is obviously not healthy in the head”

“Definitely psychotic”

“Schizophrenia is a terrible illness of the mind. She needs meds STAT! Or she needs to up her dosage.”

“This girl is having a psychotic episode. Somebody should have called the doctors in white coats to take her to the nearest state mental hospital.”

“...wow...get this b---- a straight jacket...”

“nuuuuuuuuuuuuuuuttssssssssss”

Protection?

“I’m sorry, we are not allowed to share that information with you.” Is a phrase that family members seeking information about their loved one hear frequently. HIPAA (Health Insurance Portability and Accountability Act of 1996) is a long and complicated statute that most people, including many mental health professionals, do not understand. The Treatment Advocacy Center routinely receives phone calls from family members who are frustrated by the privacy laws concerning patient medical records.

Although many times it makes sense for patient medical records to be protected, countless situations challenge whether absolute confidentiality is the best option for patients and the public. What many families seeking information may not know (and mental health professionals for that matter) is that a covered entity (i.e., health care provider) can provide family members with information if the entity obtains informal permission from the patient by either asking the person outright or by circumstances that clearly give the person the opportunity to agree or object to the disclosure. This “protection” of information many times functions as an impairment to individuals with severe mental illness.

At What Cost?

Serious mental illness cost the U.S. at least $193 billion a year in lost earnings, estimates a new study by the National Institute of Mental Health. This staggering figure just begins the scratch the surface of the financial toll schizophrenia and other serious illnesses cause.

In fact, we know this study included very few people with schizophrenia. Nor did it access people in hospitals or prisons. The number is undoubtedly much, much higher. This leads to some obvious question:

Why did a NIMH study leave these patients out?
How much higher could the real figure be? Twenty percent? Fifty percent? Double?

And, most importantly: At what cost do we as a nation get serious in providing access to treatment?

Oops, Wrong Patients

A new study published online by the Journal of Clinical Psychiatry concludes that there may be a serious problem with the over diagnosis of bipolar disorder. Mark Zimmerman who oversaw the study at the Rhode Island Hospital stated:

“We hypothesize that the increased availability of medications that have been approved for the treatment of bipolar disorder might be influencing clinicians who are unsure whether or not a patient has bipolar disorder or borderline personality disorder to err on the side of diagnosing the disorder that is medication responsive.”

If this study is correct, it means that many psychiatrists may be subjecting patients who do not even meet the clinical criteria for a bipolar disorder diagnosis to unnecessary treatments and medications. The great irony is that while many such patients may be receiving improper diagnoses and treatments they don’t need, literally hundreds of thousands of other people who are most severely ill and who are imprisoned by their psychosis are receiving no treatment at all.

We desperately need a mental health system that prioritizes helping the sickest of the sick.

A Quest For Answers

Everyday people contact us in a quest to navigate their state’s commitment laws and fractured mental health systems. Many times they are seeking help to get treatment for family members and friends who have stopped taking their medication and who no longer recognize that they are ill. For anyone that has a loved one who may need involuntary treatment at some point, it is imperative to become acquainted with the commitment process now, rather than waiting for a crisis to occur. The illogical and confusing process of commitment is difficult to understand at anytime, let alone during a crisis. One important step is to look up your state’s commitment laws. The more you know about the law in your state the more effectively you will be able to act in a crisis situation.

Learn what forms you will need to fill out and who you will need to contact if a crisis arises. A good place to start is the courthouse in the county where your loved one lives. Many times, the clerk of the court is a great resource for finding out the procedures for filing an involuntary commitment petition in your county. Another resource is your state/local mental health departments. They may have helpful materials that they can provide. Also, the local NAMI chapter in your family member’s area is a great resource. Most of the NAMI members have been in similar situations and can give you the benefit of their experience.

More tips and strategies, including information on preparing for a crisis and creating a CARE kit, are available on our website.

Increasingly Popular Skid Row

Employees of an Orange County hospital are accused of driving a psychiatric patient 42 miles, past multiple homeless facilities, in order to dump the man in L.A.’s Skid Row. If the allegation is correct, it would not be the first such reprehensible shirking of responsibility by a hospital.

A chief reason to not just dump a patient but to do so far away is to ensure that, when the almost inevitable next crisis occurs, the inadequately treated and discharged patients end up at someone else’s door, i.e., another hospital or a jail. Skid Row dumping in L.A. is emblematic of our mental health system’s failure, sometimes even blatant refusal, to take responsibility for the most problematic patients in the post-deinstitutionalization treatment framework.

For those with acute mental illnesses that psychiatric treatment providers do abandon to skid row, there remains the hope of getting help from L.A. County Sheriff's Deputy Craig McClelland – a fitting symbol of our mental health system’s growing abdication of its responsibilities to criminal justice facilities, programs and personnel.

Where is the mental health community?

The mission statements of local departments of mental health frequently declare a goal to, “[ensure] … the availability and accessibility of effective, efficient, culturally competent services.”

Unfortunately, everyday tragedies prove that the current laws do not provide access to those individuals most in need. How can someone who doesn’t even realize they are ill access mental health services?

Everyday we are faced with countless tragedies where a family was unable to get treatment for their son/brother/mother because the law would not allow it. Weak treatment laws often require a person to be a danger to themselves or others before they can get help. Where is the mental health community when those individuals most in need of help are unable to access treatment?