25 years since Hinkley ...

Today is the 25th anniversary of John Hinckley’s shooting of President Ronald Reagan. This case’s impact on the insanity defense has been phenomenal.

On April 19, the U.S. Supreme Court will hear an insanity defense case for the first time since the Hinckley case led to the change in so many state laws. The case centers around Eric Clark, a young man with schizophrenia. Clark killed a Flagstaff, Arizona, police officer during a traffic stop and was sentenced to 25 years in prison.

As with about 50 percent of those with schizophrenia, Clark lacked insight into his illness - he didn't know he was sick, and in fact thought that Flagstaff was being invaded by aliens.

Fatal encounter with the sheriff

A Palm Beach County sheriff's deputy fatally shot an unstable woman Monday after she attacked him and another deputy with a 13-inch knife in an attempt to kill them, a sheriff's spokesman said Tuesday.

They were at the house at the request of her husband.

People with severe mental illnesses are killed by police in justifiable homicides at a rate nearly four times greater than the general public.

Penalty for illness - continued nontreatment?

"What illness in the United States is left untreated for nine months when the treatment is known?"

Dumping the homeless

A number of our readers sent in this story today.

It is the latest in a series of stories from around the country about people being dumped out of hospitals into shelters or onto skid row.

This one has extra attention because surveillance cameras show a woman in a hospital gown wandering the streets after a taxi dropped her off on skid row.

Whether this poor woman also had a severe mental illness isn’t included in the story – but considering past similar events in California, we wouldn’t be surprised.

Schizophrenia: Early treatment important

How important is early care for schizophrenia?

Schizophrenia.com’s excellent news blog highlights the new Harvard Mental Health Letter article reporting that “research is beginning to show that early treatment of schizophrenia is very important.”

Past studies have documented some of the adverse effects of delaying treatments such as: increased treatment resistance; worsening severity of symptoms; increased hospitalizations; and delayed remission of symptoms. Such studies support the contention that early intervention is important for clinical reasons.

Must read series

This week, the Milwaukee Journal Sentinel ran a compelling series that is likely to win some awards.

SUNDAY: Preyed upon by opportunists and neglected by the people we pay to care for them, hundreds of Milwaukee's mentally ill people are fending for themselves. It's killing them - literally.

MONDAY: How did filthy homes with questionable landlords and long lists of building code violations become acceptable housing for people with mental illness?

TUESDAY: A host of steps can be taken to make sure people with mental illness live in safe places. One of the first: Local bureaucrats need to stop ignoring the problem and blaming each other.

EDITORIAL: A test for a just society: Thirty years ago, it looked like it was going to be a watershed moment in the treatment of the mentally ill. But what seemed good and just in theory then has turned out to be something quite different in practice.

FOLLOWUP: County calls emergency session on housing

Waiting for competency - for 23 years?

Almost 10 months after he allegedly killed his brother, Eryk Drej has been declared competent to stand trial in Utah.

It took almost 10 years for Joseph Guendulain, accused of killing his roommate, to be found competent to stand trial in Washington state.

Carolyn McDonald spent 23 years in an Indiana psychiatric facility waiting to be found competent to stand trial for the murder of her sister – she pled guilty and was finally sentenced this week.

Which is the greater burden on civil liberties and society?

#1. Society does nothing until someone who is psychotic commits a crime, then we lock them in a hospital - or a jail cell - until they are deemed competent to stand trial. Sometimes that takes years, sometimes decades. It is all on the taxpayers’ dime, and all contingent on the person first deteriorating enough to commit a crime to trigger the whole process.

#2. Society court-orders someone with a severe mental illness who meets very specific criteria to receive treatment in the community, before a crime is committed. They stay out of an institution. They get the treatment they need. They can be restored to the point of again making informed treatment decisions. They get their life back.

Riveting new book on fight for treatment

Pete Earley had been a journalist for over 30 years and the author of many award-winning books. Yet he'd always been on the outside looking in.

Then his son Mike was declared mentally ill, and Earley was thrown headlong into the maze of contradictions, disparities, and catch-22s that is America's mental health system.

His new book, to be released April 20, is an intense look at what he found.

My son was so out-of-control that a nurse called hospital security. I was glad. Maybe now they will medicate him, I thought. But before the security guard arrived, Mike dashed outside, cursing loudly. I went after him. Meanwhile, the doctor told my ex-wife that it was not illegal for someone to be mentally ill in Virginia. But it was illegal for him to treat them unless they consented. There was nothing he could do.

"Even if he's psychotic?" she asked.

"Yes."

Mike couldn't forcibly be treated, the doctor elaborated, until he hurt himself or someone else. [Chapter 1]

Crazy is getting intense praise from people like Patty Duke, who calls the book a “godsend,” Bebe Moore Campbell, who says “CRAZY is both a clarion call for change and justice and an enthralling portrait of a father who refused to surrender,” and Senator Pete and Nancy Domenici, who said, “A book as riveting to read as it is important it be read …. Many of the tragic situations he uncovers were preventable. Maybe, with this book, they can be.”

AOT eases caregiver burden

The burden on caregivers is tremendous. A new study showed that spouses died at a greater rate following hospitalization or death of an ill partner, and that people whose spouses have mental disease are more likely to die - both immediately after their spouses are first hospitalized and in the long term.

The good news is that assisted outpatient treatment significantly improves caregiver strain.

PETA fights for animals – who fights for the veterinarian?

New Jersey is still considering outpatient commitment – in the meantime, people are slipping through the cracks.

This veterinarian now has a criminal record and a contempt of court charge – which will likely impede his ability to practice if he gets well again. And imagine how mortified he will be, if he finally gets treatment, when he realizes what he has done.

Missing persons

These stories are everywhere. A young man in Oregon was missing – and was safely found. This missing man in Washington wasn’t as lucky. And this mother in Arkansas is still hoping. What is a family to do?

Strong privacy law, weak treatment law

Very strong privacy laws and very weak mental health treatment laws are keeping Lindsey Rice from saving her mother.

Lindsey Rice said she couldn't get her mother committed to the state hospital or get foster care, and meanwhile voices were telling her mother to pull her own teeth. Amid all that grief, the daughter said, it didn't help that her mother would be in and out of hospitals in Southern Oregon, and the family couldn't keep track of her because medical personnel were trying to follow HIPAA, the Health Insurance Portability and Accountability Act of 1996. Once, Rice said, her mother walked out of a hospital without getting a proper discharge, but, because of the privacy law, the hospital didn't call Lindsey. Later, she said, the police found Rachel and brought her home. ''She was just being released into a world of paranoia, and it wasn't good,'' Rice said.

Services can fail when treatment law is weak

An intensive outpatient program that is being discontinued, "changed my life" according to an Albuquerque woman who had been hospitalized for mental illness and suicidal thoughts.

All outpatient programs in New Mexico are voluntary because the state is one of eight that does not have assisted outpatient treatment. So it should not be a complete surprise "that many patients weren't showing up for the nine required hours per week,” according to Dr. John Lauriello, executive medical director at the UNM Psychiatric Center.

If they didn't show up for a full nine hours, insurers wouldn't reimburse UNM for the service.

Opponents said "mandated treatment wouldn't work in New Mexico, due to a lack of services." But, this is a case where services didn't work, in part, because New Mexico does not have AOT.

It is important to have as many options as possible to increase treatment compliance, including AOT, particularly in communities that have a dearth of services. Nonadherence to treatment has significant fiscal (and clinical) implications.

For example, medication nonadherence is a significant factor in hospital readmissions. A study of Medicaid recipients with schizophrenia in California revealed that “individuals who were [medication] nonadherent were two and one-half times more likely to be hospitalized than those who were adherent.” The same study found that those who are non-adherent incur 43 percent more in service costs than those who adhere to medication.

AOT can help reduce such costs by improving medication compliance. Under AOT in New York the number of individuals exhibiting good adherence to medication increased by 103 percent and good service engagement increased by 51 percent.

Last week NAMI gave a D+ grade to the state that spends the most per capita on services – this could be because Pennsylvania is a state that has an overly restrictive AOT law that is rarely used, making services ineffective and inefficient – like New Mexico.

"She doesn't understand ..."

Schizophrenia Digest profiles Susan Smiley’s powerful documentary “Out of the Shadow” …

"One of the most confounding aspects of Mom’s illness is that she has no insight about it. No awareness that she has it. She doesn’t understand why over the past 20 years she’s been in and out of 17 psych wards, 8 apartments, 3 boarding houses, and countless motels. She has not been able to hold a job in 30 years. She’s alienated her family and lost touch with every friend she’s ever had."

"He won't even talk to the psychiatrist"

''How will we force him to take his medications? He won't even talk to the psychiatrist.''

This quote comes from a Pennsylvania father faced with the task of ensuring care for his son in a state whose laws make that an often insurmountable obstacle. The reality in Pennsylvania for far too many families is that very little can be done to help their loved ones until they become so sick that they pose a danger to themselves or someone else.

Unfortunately, we know that wait can have tragic consequences.

Impossible situations

This father "approached [a police officer] at a Valero [Texas] convenience store … and asked him for help because he couldn't handle his son's mental problems." When his son pulled a knife on the officer, the officer killed him.

Online resource, Kendra's Law

A new online databank from New York includes many more details and breakdowns on the successes of Kendra’s Law.

Grading the States: New Mexico, C-

NAMI today released a state-by-state report card called “Grading the States.” It shows that most states are dramatically failing those with mental illnesses.

Initial reaction from U.S. Senator Pete Domenici on New Mexico’s dismal C minus:

"While our efforts so far have raised public awareness about mental health issues, it's clear that more needs to be done."

Domenici said the [New Mexico] Legislature should have passed Kendra's Law to allow a patient's family or doctors to obtain a court order requiring the patient to get treatment. The law is named for Kendra Webdale, a New Yorker killed by a schizophrenic.

Read Domenici's earlier statement on Kendra's Law.