A cop speaks: "I know if he gets that gun, I'm dead."

Sometimes, no amount of police training can change the course of a terrible event that happens in a split second.

It is last summer. Mike is stopped at 9th and Market. He looks up and sees a naked man outside his patrol car. The next thing Mike knows, the guy has his hands on Mike's gun and is pulling it from its holster.

"I'm thinking, 'Oh, s---!' " Mike recalled the other day. "I know if he gets that gun, I'm dead."

Mike survived. The naked man did not.

Police officers like Mike who end up confronting someone in a psychotic state face terrible decisions. These situations are dangerous for all involved.

Training for officers is vital. But so is making certain that people with mental illnesses get help before they end up naked and grabbing an officer’s weapon.

Attacks on big pharma

There are many good reasons for the Treatment Advocacy Center’s policy of not accepting funding from pharmaceutical companies. There is also no doubt that the pharmaceutical companies have peddled their influence when it comes to psychiatric prescribing practices and research.

The most recent “expose” is that “[e]very psychiatric expert involved in writing the standard diagnostic criteria for disorders such as depression and schizophrenia has had financial ties to drug companies that sell medications for those illnesses.”

Believe us, TAC is not an apologist for the psychiatric community or the pharmaceutical industry.

But, the implication that schizophrenia is not a real diagnosis is factually wrong, not to mention dangerous. Schizophrenia was a diagnosis long before the first edition of the DSM in 1980. In fact, with respect to schizophrenia, the DSM didn’t broaden the diagnosis, it actually narrowed it. The term “schizophrenia” was used much more loosely and broadly in the United States until 1980 when the DSM established official diagnostic criteria for the illness (see Surviving Schizophrenia, pg. 63).

Schizophrenia is real – just ask someone who has been psychotic and remembers the experience. Or look at the science and judge for yourself.

Are mental health drugs overprescribed? This blogger takes the debate a step further …

Wash Post: Mentally ill people and their families can't get help

Last week, the U.S. Supreme Court heard a case questioning the constitutionality of Arizona’s insanity defense. The case involves Eric Clark, a young man with untreated schizophrenia who was delusional and thought that aliens had invaded Flagstaff. Eric’s family tried desperately to get help, but could not because he was not yet dangerous. Clark was convicted for shooting and killing a police officer.

On Saturday, April 24, 2006, a Washington Post editorial, writing about the insanity case noted that:

[t]his legal question, however important, comes into play only after the system has failed. The real question should be why people like Mr. Clark's parents so often cannot get help before it's too late. The answer, unfortunately, is as glaring as it is intractable. Politicians don't like paying for care for the critically mentally ill. And the courts, in their zeal to protect the rights of the mentally ill, often neglect their welfare; the courts will generally not allow authorities to hold anyone for treatment in the absence of evidence that he poses a threat, evidence not always available before somebody gets hurt. Instead of taking responsibility for sick people -- some of whose very illnesses prevent them from making informed choices -- our system "frees" them to homelessness or delusions until they do something for which it can exact revenge.

Surviving Schizophrenia

JUST RELEASED!

Surviving Schizophrenia: A Manual for Families, Patients, and Providers (5th Edition)
Since its first publication in 1983, Surviving Schizophrenia has helped thousands understand this complex and often stigmatized illness. In clear, sympathetic language, this definitive book describes the nature, causes, symptoms, and history of schizophrenia, taking readers inside the minds of those living with the disease.

This completely updated fifth edition includes the latest research findings, information about the newest treatments, and answers to the questions most often asked by families, patients, and providers.

"A comprehensive, realistic, and compassionate approach... Should be of tremendous value to anyone who must confront these questions." - Psychology Times

"E. Fuller Torrey is a brilliant writer. There is no one writing on psychology today whom I would rather read." - Los Angeles Times

TAC to SCOTUS: Crime, anosognosia, weak laws

The Treatment Advocacy Center filed a “friend of the court” brief filed in the Clark v. Arizona case, that said in part:

[A]nosognosia increases the likelihood that victims of severe mental illness will reject or fail to seek treatment. This problem is exacerbated by antiquated state civil commitment laws that forbid treatment interventions until individuals pose an immediate physical danger to themselves or others. Because untreated severe mental illnesses are closely correlated to an increased risk of violence, anosognosia and these commitment laws operate together to ensure that mental illness will cause some of those it afflicts to engage in criminal behavior.

Some states are reacting to the tragic ramifications of untreated mental illnesses, and consequently anosognosia, by adopting more comprehensive commitment schemes with less restrictive, more flexible standards. New York’s improved law, known as Kendra’s Law, has resulted in dramatic reductions in incarceration, arrests, homelessness and hospitalizations of the severely mentally ill. [1]

Extensive clinical research has found analogous outcomes for reformed commitment laws in numerous states. [2]

TAC respectfully submits that reforms such as these, as opposed to unduly limiting—if not completely obliterating—the insanity defense, are the proper method to balance safety concerns of States with the due process rights of the mentally ill.

The staff and board of directors of TAC thank the attorneys from the Dechert law firm who provided invaluable pro bono services on TAC’s brief:

David A. Kotler
Megan Elizabeth Zavieh
William Gibson, and
Elliot M. Gardner
Princeton, NJ 08543-5218

[1] See N.Y. Mental Hyg. Law § 9.60 (Consol. 2005). Individuals in the first five years of New York’s assisted outpatient treatment (“AOT”) program experienced fewer hospitalizations (77%), episodes of homelessness (74%), arrests (83%), and incarceration (87%), and had improved medication compliance (fifty percent) and participation in substance abuse treatment (65%). Fifty-five percent fewer recipients engaged in suicide attempts or physical harm to themselves. Three out of every four of the program participants reported that Kendra’s Law had helped them regain control of their lives; four out of five said that AOT helped them to get and stay well. See New York State Office of Mental Health, Kendra’s Law: Final Report on the Status of Assisted Outpatient Treatment (2005).

[2] See, e.g., Marvin S. Swartz et al., Can Involuntary Outpatient Commitment Reduce Hospital Recidivism?, 156 Am. J. Psychiatry 1968, 1973 (1999) (hospital admissions reduced by 57% when used for at least six months and combined with routine mental health services); Jeffrey Swanson et al., Involuntary Out-Patient Commitment and Reduction of Violent Behaviour in Persons With Severe Mental Illness, 176 Brit. J. Psychiatry 224 (2000) (assisted outpatient treatment of six months or more combined with routine outpatient services reduced the incidence of violence in half (24% versus 48%)); Jeffrey Swanson et al., Can Involuntary Outpatient Commitment Reduce Arrests Among Persons with Severe Mental Illness?, 28 Crim. Just. & Behav. 156, 182–83 (2001) (same); Virginia A. Hiday et al., Impact of Outpatient Commitment on Victimization of People with Severe Mental Illness, 159 Am. J. Psychiatry 1403 (2002); Gustavo A. Fernandez & Sylvia Nygard, Impact of Involuntary Outpatient Commitment on the Revolving-Door Syndrome in North Carolina, 41 Hosp. and Community Psychiatry 1001, 1003 (1990) (median readmissions decrease from 3.7 to 0.7 per 1,000 days); Virginia A. Hiday & Teresa L. Scheid-Cook, The North Carolina Experience with Outpatient Commitment: A Critical Appraisal, 10 Int’l J. Law & Psychiatry 215, 229 (1987) (over six months, 30% medication refusal versus 60% absent orders); Robert A. Van Putten et al., Involuntary Outpatient Commitment in Arizona: A Retrospective Study, 39 Hosp. & Community Psychiatry 953, 957 (1988) (“almost no patients” without orders voluntarily maintain treatment in mental health system versus 71% who do in group with orders); Guido Zanni & Leslie deVeau, Inpatient Stays Before and After Outpatient Commitment, 37 Hosp. & Community Psychiatry 941, 942 (1986) (hospital readmissions decrease from 1.81 to 0.95 per year).

Time suck ...

The New York City Police Department responds to a call dispatched as involving a person with mental illness every six minutes.

Which is more restrictive - assisted treatment or prison?

Brian E. Cliff was sentenced to 25 years in prison for murdering his mother’s boyfriend.

The judge heard testimony Wednesday from Cliff's relatives and a counselor for the Heritage Behavior Health Center that Cliff did not always take his medicine for schizophrenia when not incarcerated and, during those times, easily could become agitated. "We have somebody with serious mental health issues who doesn't always take his medication and who drinks," [the judge] said. "He has a long history of violence. We've reached the point where he will be dangerous if he gets out of prison a year from now or 10 years from now."

"We're still warehousing them. We're just hiding them better ..."

"We might have closed down those state asylum warehouses but we haven’t solved their patients’ problems. We’re still warehousing them. We’re just hiding them better so we don’t have to deal with them." - Pete Earley

When former Washington Post author Pete Earley was doing research for his new book Crazy: A Father's Search Through America's Mental Health Madness, he turned to Miami as an example of the problems the country is facing because of criminalization of those with mental illnesses.

Some statistics from his book ...

• Number of mentally-ill prisoners booked into Miami jails accused of felonies: 3,000 (they often spend months waiting for their cases to be resolved)
• Amount of time it took for the chief psychiatrist at the Miami Dade jail to complete his rounds of the 92 most dangerous and unpredictable mentally ill inmates in the jail’s “primary psychiatric unit”: 19½ minutes (an average of 12.7 seconds per inmate)

Why did he focus on Miami? In his own words ...

"Miami has a higher percentage of mentally ill residents than any other city in the country .... It has a jail system—the fourth largest in the U.S.—that is generally outdated and dangerous to begin with. The 9th floor of the county jail is just about as barbaric as any facility around today. Miami also served as the perfect example of the nationwide tragedy that ensued when state mental institutions were shut down and their patients forced out into the community. When that happened we all acted like the problem was solved. After all, these asylums were horrid places straight out of One Flew Over the Cuckoo’s Nest. In Miami these patients were splintered into 647 boarding homes—with perhaps 20 to 30 mentally ill people per home. Approximately 400 of these have failed to pass the state’s minimum safety and health standards. Two thirds of them are in abysmal shape. But the state continues to let them operate because there’s nowhere else to put the mentally ill. We might have closed down those state asylum warehouses but we haven’t solved their patients’ problems. We’re still warehousing them. We’re just hiding them better so we don’t have to deal with them."

The Treatment Advocacy Center highly recommends this well-researched, thoughtful book, both as a chronicle of one father's struggle to get help for his son from a system seemingly built to bar it, and as an investigative look at what happens in our jails and prisons to people so lost to symptoms of mental illnesses. Earley's passion for reform and compassion for people like his son who desperately need and deserve treatment is a refreshing perspective on one of America's biggest failures - the abysmal way we treat people who are too ill to help themselves.

Wrapup on Supreme Court case

SCOTUS blog on the arguments in today’s insanity defense case Clark v. Arizona …

More: NPR story TAC’s brief to the Court AP story on the Clark case

NPR on Supreme Court case

On NPR’s “Morning Edition” this morning ...

Legal Affairs: High Court Takes on Case Questioning Insanity Defense
by Nina Totenberg

Morning Edition, April 19, 2006 · The Supreme Court is reviewing a challenge to the insanity defense. A young Arizona man killed a police officer and his parents want him declared guilty but insane. But the state does not want the defendant's mental state considered in court. The case of Clark v. Arizona could end up making it more difficult for criminal defendants to prove insanity.

LISTEN NOW ...

Supreme Court hears insanity defense

Tomorrow the US Supreme Court will hear a direct challenge to the insanity defense for the first time in more than 25 years, since the John Hinckley case prompted so many states to change their laws.

At issue? Eric Clark, a young man with untreated schizophrenia who killed a police officer because he thought he was an alien. He didn’t know he was ill, like about half of those with schizophrenia.

His parents just want to get him treatment – the same thing they wanted before he shot Officer Jeff Moritz.

"Lock him up for his crime," Terry Clark says, "but treat him for his mental illness, please. Eric didn't choose to be mentally ill. It chose him." – CNN (Associated Press), April 18, 2005

NPR: Fighting for treatment

"The only thing we were good at was emptying the hospitals, everything after that has been a disgrace."

Listen to Pete Earley and Dr. Fuller Torrey on NPR’s Fresh Air – on the struggle to get mental illness treatment for someone you love. Earley’s book, Crazy: A Father’s Search Through America's Mental Health Madness, will be released April 20.

Previously: Riveting new book on fight for treatment
More: Get information to help a family member in crisis Read Chapter one Preorder the book (on sale April 20)

Albuquerque Mayor Chavez: "We're not waiting"

When the New Mexico Senate failed to act to pass Kendra’s Law in January, despite overwhelming support from the Governor, Senator Domenici, and a unanimous vote in the House, Albuquerque Mayor Martin Chavez decided that he would not let inaction on the part of the state harm the people he was elected to protect.

"We're not waiting. The consequences are too severe," Chávez told the Albuquerque Journal on Sunday. "When the state fails to act, I am still charged with protecting the public in Albuquerque."

The Albuquerque Journal agrees. To the argument that you need more services before you can implement an assisted outpatient treatment law, the paper’s editorial board had this to say:

That's a pointless chicken-and-egg argument for families of the mentally ill, who say they can't wait for a new program or building. Their loved one is in crisis now. Perhaps once judges start ordering treatment, the state and the health-care community will finally find the wherewithal to assure its availability.

Unwilling to join in the hand-wringing as another Albuquerquean commits suicide by cop or kills a police officer on a mental-health pickup, and unwilling to join in the whining that there aren't enough treatment facilities so it's best to do nothing, Chávez has stepped up to help those who aren't able to help themselves.

Four appointed to TAC board of directors

Treatment Advocacy Center President E. Fuller Torrey announced the appointment of four new members to TAC’s board of directors. The newest board members bring extensive experience in law enforcement, mental health advocacy, community psychiatry, and business development, as well as personal and family experience with mental illnesses:

* Donald F. Eslinger, Sheriff of Seminole County, Florida.
* Valerie Fox, advocate and writer, New Jersey.
* Jeffrey Geller, M.D., director of public sector psychiatry and professor of psychiatry at the University of Massachusetts Medical School.
* Stephen Segal, president of Family Partners, Inc., Pennsylvania.

"We are pleased to welcome people of such caliber to be stewards for this unique advocacy organization," said TAC president E. Fuller Torrey, MD. "Each has shone not only in his or her chosen field, but also as an advocate for people with severe mental illnesses too ill to fight for themselves. Their collective wisdom, expertise, and passion are an important addition to our board of directors, and will strengthen our ability both to defeat laws and policies that are barriers to treatment and to campaign for practices that ensure timely and sustained treatment."

Read full bios of new and current TAC board members.

Snapshot: Lack of insight

Chiropractor James C. Burda insists that he can realign people’s bones telepathically.

According to the Cleveland Plain Dealer, the Ohio State Chiropractic Board has determined that Burda can no longer practice because of "mental illness, specifically delusional disorder, grandiose type."

Burda’s response? "I don't think I'm delusional, and I don't think I'm mentally ill," he said. "A person who is delusional is saying something he can't really do and I can do what I say I do."

Scott Finn: Profiling struggle led to reform

It is rare to find a reporter willing to move past sensational headlines and take on the complicated issues surrounding providing care for the most severely mentally ill.

Fortunately for West Virginians, Scott Finn is one of those rare reporters. His “Brother’s Keeper” series in the Charleston Gazette (January and February 2005) profiled West Virginia’s urgent need for reform, and the struggle that families all too often face in seeking treatment for their loved ones.

Last week, the Investigative Reporters and Editors organization judged “Brother’s Keeper” the best investigative reporting in America by any newspaper of less than 100,000 circulation. Judges noted:

Finn’s storytelling acumen made this compelling reading, and undoubtedly was a factor in the impressive results: The state passed reform laws and restored funding for mental health services.

Truly impressive: Because of Scott’s series and strong advocacy by families throughout the state, the West Virginia Legislature passed a number of important mental health measures, including SB 191, which created an AOT program to provide care for individuals whose illness causes them to repeatedly cycle in and out of the system.

The Treatment Advocacy Center congratulates Scott Finn and all of the tireless advocates in West Virginia working to provide care to the most severely mentally ill.

Untreated mental illnesses compromise ALL emergency room patients

The general public has a vested interest in supporting psychiatric treatment mechanisms that stop the revolving door for people with severe mental illnesses.

A recent survey in Maryland confirms earlier reports that untreated mental illnesses compromise care for all patients needing emergency room care.

Maryland hospitals said these numbers are increasing, and 63 percent report increasing wait times for psychiatric patients — nearly double the wait time for other patients. The two major reasons for the long waits are a lack of available state mental health beds and outpatient/community resources for uninsured psychiatric patients.

According to a survey reported in 2004, more than 60 percent of emergency department physicians reported seeing an increase in patients presenting with psychiatric emergencies in the past 6-12 months. Emergency physicians attributed the rise in psychiatric patients to increasing state health care budget cutbacks and the decreasing number of psychiatric beds.

These increases have negative effects for all patients seeking emergency room care: reducing the availability of beds in the emergency department (96%), reducing the availability of emergency staff for other patients (91%), resulting in patient frustration (89%), resulting in longer waits for patients in the waiting room (85%) and increasing the amount of time the hospital diverts ambulances to other hospitals (31%).

Untreated mental illnesses affect everyone.

CATIE - Phase 2

The National Institute of Mental Health has released further findings from its large-scale examination of treatments for schizophrenia in its Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE).

The initial results were presented last September, and were chiefly a comparison of various anti-psychotics when used as initial or first-line treatments for the symptoms of schizophrenia. The outcomes from the first stage of this large-scale study were widely reported in the national media, principally because an older and far cheaper antipsychotic of the previous generation had results analogous to "atypical" antipsychotic medications that are many times more expensive.

Results from CATIE’s second phase are reported in the April issue of the American Journal of Psychiatry and evaluate how various antipsychotics perform as second-line medications, i.e., ones that are tried after another is discontinued. The clear winner for performance in CATIE’s second round is clozapine, which was not tested in the first phase. 44% of patients who took clozapine (brand name: Clozaril) after trying another anti-psychotic stayed on it for the rest of the 18-month study, versus only 18% who switched to the other medications tested.

We caution, however, that determining what medication should and can be used for a particular person entails far more considerations than the results of a single study (no matter how large or well-constructed). Different things work for different people.

WI prison suicides 2x national number

Suicides in Wisconsin prisons average nearly twice the national number, and more than half of prison suicides in the state happen in single cells where inmates are kept apart from others, according to a recent report. … More suicides probably occur in solitary confinement and other single-cell "segregated settings" because officials place mentally ill people there at twice the rate of other inmates, [Department of Corrections mental health director Kevin] Kallas said.

Mental health recovery

Recently, SAMHSA released a National Consensus Statement on Mental Health Recovery that identifies 10 fundamental components necessary to achieve mental health recovery. While the statement is filled with hope, it neglects an important, but often neglected group of people with severe mental illnesses. According to the explanation for the first component, self-direction means that:

By definition, the recovery process must be self-directed by the individual, who defines his or her own life goals and designs a unique path towards those goals.

Yet, research shows that competence to make decisions about treatment may be problematic among people with serious mental illnesses. If decision making is so compromised that an individual is incapable of making safe choices about treatment, is it right to encourage self-direction? Can the principles of recovery be reconciled with the need to use leveraged or mandatory care in some circumstances?

Some very thoughtful authors have tried to address this apparent inconsistency and proposed to “broaden the concept of patient-centeredness to include mandated care under certain circumstances. … [U]sing incentives and disincentives to facilitate and promote adherence to treatment is patient-centered care to the extent that these interventions are experienced by patients as being grounded in a caring therapeutic relationship.” See Mandated Treatment in the Community for People with Mental Disorders.

Read more on the Ethics of Mandatory Community Treatment.