"No parent should reach the point we did ..."

Reaction to the Wall Street Journal article continues to pour in, including this passionate letter from Minnesota Rep. Mindy Greiling …

TO THE EDITORS:

Assisted treatment laws are vital for people so ill with diseases like schizophrenia and bipolar disorder that they cannot make informed treatment decisions. Minnesota passed a strong law in 2001 not because of a tragic headline ("A Doctor's Fight," Feb 2.), but because many families were seeking earlier intervention for loved ones who did not recognize their illness.

Our law was not a reaction to tragedy, but a reaction to research. Experts from the University of Minnesota and others showed us that without early intervention and treatment, patients do much worse over time. The Treatment Advocacy Center's expertise helped us ensure that our law could both help the people who needed it most and include judicial and procedural safeguards to prevent abuse. That year we also passed the Mental Health Act, which greatly improved our mental health system to lessen the need for deterioration in the first place.

I speak as a legislator and a mother. No parent should reach the point we did, almost wishing for the crisis that would allow our son to get the treatment he so obviously needed, but was too sick to appreciate that he did. Our family's painful experience gave us firsthand knowledge of the peril of weak laws that require someone to be dangerous before society can intervene.

Minnesota State Representative Mindy Greiling

Homeless on the tracks

Charles, homeless, spent one of the 20 biggest snowstorms in Maryland history under a railroad bridge. Can anyone be certain the reason is untreated schizophrenia? It seems a likely contributor …

Root of the problem

Jonathan Rodriguez may go back to prison against the wishes of his mother and his wife, the person he is accused of harming. Both recognize that the root of his actions is illness and not intent.

APA, NAMI defend AOT in WSJ

The Wall Street Journal [subscription required] today ran three strong letters to the editor in support of assisted outpatient treatment and TAC.

As one family member said so eloquently: “I can safely say to the civil libertarians that this isn't the life [my brother] would have chosen for himself; it was chosen for him by his untreated illness.

Steven S. Sharfstein, M.D., President of the American Psychiatric Association:

One of the great tragedies of modern psychiatry is the large number of incarcerated individuals who are mentally ill or drug addicted ("A Doctor's Fight: More Forced Care for the Mentally Ill," page one, Feb. 1). This is the inevitable consequence of our reluctance to use caring, coercive approaches, such as assisted outpatient treatment. A person suffering from paranoid schizophrenia with a history of multiple hospitalizations for being dangerous and a reluctance to abide by outpatient treatment is a perfect example of someone who would benefit from these approaches. We must balance individual rights and freedom with policies aimed at caring coercion. Our responsibility to each other and our respect for personal rights lie at the center of our social and moral choices as Americans.

The Treatment Advocacy Center is to be commended for its sustained advocacy on behalf of the most vulnerable mentally ill patients who lack the insight to seek and continue effective care and benefit from assisted outpatient treatment.

Shari L. Steinberg, New York:

My 41-year-old brother has suffered from serious mental illness since he was 15. At times, his behavior has become sufficiently threatening or dangerous to require involuntary hospitalization. Like many others with this disease, he doesn't believe that he is ill (a neurological deficit known as anosognosia) and therefore refuses to voluntarily comply with treatment or to take medication, even though it has proven remarkably effective. As a result, my smart, funny and talented brother has spent much of the past 25 years homeless, jobless and delusional. I can safely say to the civil libertarians that this isn't the life he would have chosen for himself; it was chosen for him by his untreated illness.

Before Kendra's Law, there was nothing my family could do to force him to obtain treatment. Although the law isn't a panacea and the mental health system is a disgrace, being forced to stay in treatment is the only chance he has of resurrecting his life.

Michael Fitzpatrick, Executive Director, National Alliance on Mental Illness:

Using the term "force" to describe state laws authorizing court-ordered treatment overlooks the point about what these laws are intended to accomplish. Most people with serious mental illnesses are able to make informed decisions about treatment. In a minority of cases, mental illness negatively affects insight and ability to recognize the need for treatment. The greatest risk is to the individuals themselves.

A New York State Office of Mental Health report shows that the impact of Kendra's Law has been positive in reducing hospitalizations, arrests, homelessness and other consequences from lack of treatment. And most people treated under Kendra's Law say it has helped them.

When narrowly crafted and sufficiently protective of civil liberties, laws authorizing court-ordered outpatient treatment can be both humane and beneficial.

Canadian advocates

Issues surrounding lack of treatment are prevalent around the world.

If you are from Canada, visit the CFACT website. The Coalition for Appropriate Care and Treatment is a nonprofit organization working to ensure appropriate treatment for the seriously mentally ill.

And visitors from any country will find some of CFACT’s resources extraordinarily helpful. Take, for instance, their piece on the “Seven Deadly Sins of Mental Health Reform …”

Decline in hospital beds

"From 1972 to 1990, available beds decreased by more than 70 percent because of hospital closures, according to the National Association of State Mental Health Program Directors Research Institute...."

"The one alternative they can always count on is jail."

One reason for this? Money.

Read more …

Kendra's Law coming to Albuquerque

In New Mexico, Kendra’s Law was passed unanimously by the House – but the constitutionally mandated end of the session came before it could be called for a vote on the Senate floor. The law was widely supported – the science and data clearly registered with legislators more than the emotions and fear tactics of opponents.

And proponents like Mayor Chavez, Rep. Gutierrez, and Senator Domenici are clear about their intentions. Next week, Albuquerque Mayor Chavez will introduce Kendra’s Law for the city – and Rep. Gutierrez has promised to reintroduce the bill statewide the first day of the next session.

Stay tuned.

News roundup

In the news this week ...

• A man who was off medication for bipolar disorder beat and stabbed 4 members of his family, including his 18-month-old nephew – when police arrived, they shot and killed him. The child is in critical condition, the other family members all survived.
• A woman who killed her infant daughter is in court, pleading not guilty by reason of insanity. She was off medication for bipolar disorder when she cut off the 10-month-old girls’ arms to “give her to god.”
• A family worries that a son with schizophrenia who killed his father will soon be released and continue his cycle of going off medication and becoming violent. "He finally got the help he needed after years and years of us going to court and trying to get him hospitalized," his mother said. But he has a history of going off medication soon after being released from care.

Consumers and testimony

Consumers who are able to testify at legislative hearings and speak cogently to reporters are unlikely to meet the strict criteria for Kendra’s Law – but ironically, passage would help them anyway.

Because these laws go beyond helping the small group of desperately ill people who need them, by improving the system as a whole and making existing services more effective. That will benefit voluntary users as well as the 75-100 people who will likely be in the program in New Mexico (based on the number in New York).]

Families in NM support Kendra's Law

There have been many letters to the editor in support of bringing AOT to New Mexico. NAMI New Mexico supports this bill because too many families have had an experience like this one.

I APPLAUD MAYOR Martin Chávez for his support of assisted outpatient treatment for the mentally ill. I am a Democrat who strongly supports civil liberties and the rights of the disabled. As an attorney, I have worked to protect both. But I am also a sister to an untreated, paranoid schizophrenic.

Because the illness, by its nature, makes [my brother] paranoid and untrusting, he refuses treatment. He hallucinates constantly. He is tormented by the voices he hears, which are violent enemies in pursuit. He cannot care for himself.

Despite his condition, we are repeatedly told that we can do nothing to help him until he hurts himself or someone else. Imagine your loved one being terribly sick and your government actually preventing you from getting them the medication they need. My family's only choice is to wait for a horrific crisis. It's an ongoing nightmare that takes its toll on my entire family. We worry every day that he will hurt someone or that a well-meaning police officer will hurt him.

- Excerpt of letter from Susan Warren, Albuquerque Journal, January 10, 2006

Consequences are too great to wait

As U.S. Senator Pete Domenici said in announcing his support for bringing an assisted outpatient treatment law to New Mexico:

"Some argue that it is wrong to force individuals to undergo treatment against their will. We argue that the tragic consequences are simply too monumental not to require help under certain circumstances. The success rate of the AOT program in other states has been well documented in both research and in practice."

We couldn’t agree more.

Bottom Line: Kendra's Law Will Save Lives in New Mexico

The New York Times covers the battle for reform in New Mexico today:

Across the country, proponents have pushed the laws as a pragmatic approach to the mentally ill who fall through the cracks of the mental health system, particularly those who have committed no crime but could harm themselves or others as their sickness worsens. These mentally ill people often do not need to be in a hospital, but do need to stick to treatment, which could include medication, therapy or both.

And you have to ask yourself - who knows better if Kendra's Law is working in New York than the New York Office of Mental Health?

“… the success of Kendra’s Law in New York has been undeniable and well-documented by statewide data …”

TAC executive director Mary Zdanowicz wants to make sure that New Mexicans know that Kendra's Law will save lives :

Kendra’s Law will improve the quality of life for a small group of New Mexicans with the most severe mental illnesses. Don’t ignore the research and science in favor of emotion. These laws save lives. Let’s work together to ensure there is no discrimination against those who are the sickest – and that they have the true civil right to be free of psychosis.

Top Policymakers Support AOT for New Mexico

New Mexico is one of only 8 states without an assisted outpatient treatment (AOT) law. That means someone who is too ill to make an informed treatment decision must be left untreated until they are in a crisis, posing a “likelihood of serious harm to themselves or others.”

Who supports bringing AOT to New Mexico? Republicans and Democrats alike have rallied behind the effort to update New Mexico's mental illness treatment laws.

• Rep. Joni Gutierrez (D-Las Cruces), who introduced the bill in the House, said that "existing New Mexico law essentially forces people who lack insight into their illness to hit rock bottom before they can be helped ... Forced deterioration is cruel and inhumane."
• U.S. Senator Pete Domenici has strongly endorsed the legislation, pointing out "Some argue that it is wrong to force individuals to undergo treatment against their will. We argue that the tragic consequences are simply too monumental not to require help under certain circumstances. The success rate of the AOT program in other states has been well documented in both research and in practice.”
• Governor Bill Richardson held a news conference to endorse the measure, saying "We need this law to prevent events like the tragic murders in Albuquerque last summer. We have to do everything we can to prevent this from happening to another family, another police officer, or another community, ever again.” [Read more about the news conference.]
• Albuquerque Mayor Martin Chávez is a strong supporter, noting that 20 percent of the 55 homicides in Albuquerque in 2005 were related to mental illness.
• The bill is supported by the state and local chapters of the National Alliance for the Mentally Ill (NAMI).

GET THE FACTS

What is assisted outpatient treatment?
Why does New Mexico need AOT?
How is it working in other states that are using it?
Why do some people refuse treatment for severe mental illnesses?

Among other things, assisted outpatient treatment:

• Reduces homelessness, psychiatric hospitalizations, arrests, incarceration, and harmful behavior, and improves treatment compliance
• Reduces caregiver strain
• Is retroactively endorsed by participants

Some individuals and organizations have raised concerns about assisted outpatient treatment. Most of these fears are based on misinformation or misunderstanding. Educate yourself about the myths surrounding assisted outpatient treatment.

Research: No Insight, Major Problem

New data on lack of insight: A recent study found that:

... patients who lacked awareness [of their mental illness] had significantly longer episodes of antipsychotic nonadherence, were more likely to completely cease taking the antipsychotic medication, were more likely to have severe positive symptoms, and were more likely to be psychiatrically hospitalized after nonadherence than those who were aware of their illness. Psychological interventions and several types of family interventions were significantly less effective among patients who lacked awareness.

Awareness of Illness and Nonadherence to Antipsychotic Medications Among Persons With Schizophrenia, by Mark Olfson, M.D., M.P.H., Steven C. Marcus, Ph.D., Joshua Wilk, Ph.D. and Joyce C. West, Ph.D., M.P.P.

TAC's Battle for Better Treatment Laws

The Treatment Advocacy Center's battle for better treatment laws is highlighted on the front page of the February 1 edition of the Wall Street Journal.

This is an especially impressive placement on such a heavy news day, following the State of the Union and the confirmation of a new Supreme Court justice, and shows that the Treatment Advocacy Center has indeed achieved the status of being a major player in the field. And that the issue of assisted treatment warrants this level of coverage.

The article talks about the hard work of Dr. E. Fuller Torrey and TAC to improve treatment laws to help those who are the most ill - those lost to the symptoms of schizophrenia and bipolar disorder. It highlights TAC's work to change the laws and the successes we’ve had around the nation.

But it omits many key points – that people with untreated mental illnesses fill our jails and prisons, live homeless and vulnerable on our streets, and are far more often the victims of violent crimes than the perpetrators. That many lack insight into their illness and thus cannot make informed treatment decisions.

It is easy to cast TAC as a villain for being unafraid to include the risk of violence in the list of consequences of lack of treatment. Maybe they wouldn’t have sold as many newspapers if they had actually focused on the research that support these assertions – or read a newspaper.

Many newspapers that same day included the front page story about the woman in California who sprayed bullets through the post office, killing eight people (including herself).

The article also overlooks the real statistics that prove the value of strong assisted treatment laws. Did you know that for those under New York’s Kendra’s Law, 74% fewer experienced homelessness, 77% fewer experienced psychiatric hospitalization, 83% fewer experienced arrest, and 87% fewer experienced incarceration. Individuals in Kendra's Law were also more likely to regularly participate in services and take prescribed medication.

And after receiving treatment, 75% of those interviewed reported that AOT helped them gain control over their lives, 81% said AOT helped them get and stay well, and 90% said AOT made them more likely to keep appointments and take medication.

Those statistics come from the New York Office of Mental Health.

Yates leaves prison

Andrea Yates will get treatment in a psychiatric facility instead of prison ...

READ MORE: A mother speaks from jail about killing her child (not Andrea Yates) Words from Yates’ mother Better off in a hospital?

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A mentally ill Carlsbad man who claims to be a 2,000-year-old alien has been sentenced to 16 years to life in prison for murdering his father and badly injuring his mother and another relative. … Nine months before the attack, Johnson stopped taking his anti-psychotic medication because he planned to take back control of his life, in particular his finances, according to court records.

“Mentally ill man who killed his father gets minimum sentence,” San Diego Union Tribune, Feb. 1