Sad story from Minnesota

Shortly after Stephen R. Miles was arrested for the slaying of his stepmother last December, attention focused on the family's unsuccessful attempts to hospitalize him just hours before the grisly killing in Burnsville. But parents Roland and Carol Miles struggled for years to get help for their 23-year old son, especially in the days and months before Maris Jo Miles died, recently filed court documents show. As the parents, social workers and doctors became concerned about Miles' worsening condition last year, each of them was powerless by themselves to force treatment on an adult who refused to take anti-psychotic medications. "The system is designed so that you have to fail first," said Sue Hanson, a mental health advocate and mother of a schizophrenic son. " And then you have to continue to be ill in order to receive help."

Miles is accused of decapitating his stepmother. Read the chilling transcript of his emergency room visit before the murder ...

Consequences

She couldn’t ask for help, but they saved her anyway. They didn’t debate for hours while she drowned. They acted – as heroes – to save someone incapable of saving themselves.

In real life, as Washington Post reporter Tom Jackman points out, there are real consequences.

Memorial Day

Kendra.
Laura.
Kevin.
Gregory.
Alan and Gene.
Ian.
Vicky, Michael, and Michael.
Jeff.
Pamela.
Ben, Garrett, David, Michael, Richard.
And thousands more.

Those who took their own lives. Those who are missing in action in a different way – homeless on our streets or lost in their own homes. Those who are a different kind of prisoner of war – a war in their minds, imprisoned in our jails. – a war in their minds, imprisoned in our jails. And those who were caught in the crossfire – law enforcement officers, family members, mental health professionals, friends.

Today we remember. And as others work to unlock the science behind these terrible diseases, we vow anew to break down the legal barriers to people getting the treatment they need.

Raising the bar means many will fall

When resources for inpatient psychiatric treatment are scarce, restrictive civil commitment laws raise the bar for everyone. The criteria for hospitalization, voluntary or not, becomes imminent danger. Managed care dictates that for purposes of "cost-effectiveness," immediate psychiatric consultation is only indicated for a "patient who are a danger to him/herself or to others." (more …).

The dearth of inpatient hospital beds around the county has reached crisis proportions. For example, "74% of the states (35) report experiencing shortages in psychiatric beds as a result of hospital downsizing and the closure of general hospital psychiatric beds and private psychiatric hospitals."

Rather than advocacting to improve inpatient care, most mental health "advocates" have tried to make it harder to hospitalize people (through restrictive commitment laws) and to close them down (through litigation). Enough is enough. It is time for a new paradigm of advocacy - one that promotes treatment rather than denial of mental illnesses.

Why would the Antichrist need medication?

Does it sound like Fred Engel could have made an informed treatment decision?

He says his delusions ruled his decisions. Today he is in treatment and delusion-free ... oh, and in jail …

“This guy was a walking time bomb.”

Andrew Goldstein will get a new trial in the murder of Kendra Webdale. Goldstein, off his medication, pushed Kendra in front of a New York subway train in 1999.

“If this case has a silver lining,” says the New York Post in an editorial today …

… it's that it produced the groundbreaking Kendra's Law, which lets interested parties get a court order to force outpatients to comply with medical treatment - including taking their medicine.

The real tragedy here is that Andrew Goldstein was free to kill because of a policy that shut down state mental hospitals and dumped thousands of mentally ill people, many potentially dangerous to themselves and others, onto the streets.

Kendra’s Law, a program of assisted outpatient treatment, was designed to help someone like Goldstein. Before the murder, he received 199 days of inpatient and emergency room services, on 15 different occasions, in six different hospitals from 1997 to 1999 (the year Kendra was killed). In 1998 alone, New York spent $95,000 for his mental health and residential care. But because New York did not have AOT, little could be done to ensure Goldstein maintained treatment.

Consequently, Goldstein spent the two years prior to Kendra’s death in repeated emergency room visits, medication noncompliance after release from the hospital, and at least eight incidents of unprovoked violence against others. Whenever Goldstein requested services, he changed his mind or failed to follow through. At no point did he appear to regularly take medication.

As the prosecutor noted in the New York Times, "He was striking out at nurses and psychiatrists. This guy was a walking time bomb."

As everyone is forced to relive the pain and horror of Kendra’s murder, the Treatment Advocacy Center wants to take a moment to remind everyone of the incredible good that Kendra’s Law is doing. The amazing results, the lives saved – the Webdale family can take pride in knowing that their advocacy is what made the difference.

The danger in averting suicide

In a Maryland county, law enforcement doesn’t allow the crisis team to put their own lives at risk. That means if they are called to a standoff, there isn’t much they can do.

Not sick enough to get a hospital bed, too sick to get help from the crisis team – once again, it is law enforcement officers who are forced to fill this bizarre void, stepping in to deal with people in acute psychiatric crisis because the situation is too dangerous for those who are actually trained to handle it.

Sure, police get training on dealing with people in mental health crises. And it is a good day when police are able to stop a suicide. But an estimated 5,000 suicides a year are completed by people with bipolar disorder or schizophrenia, many of them untreated. Some people die in standoffs or shootouts – including some law enforcement officers.

Expecting police to be there in time to avert suicide isn’t really good public policy. Helping people before a standoff or suicide is far better for everyone.

Treatment Advocacy Center honors three of psychiatry's heroes

The board of directors of the Treatment Advocacy Center today announced that Dr. Jeffrey Geller from Massachusetts, Dr. H. Richard Lamb from California, and Dr. Darold Treffert from Wisconsin are the winners of its annual Torrey Advocacy Commendation.

“TAC can change laws and encourage treatment, but ultimately it is the mental health professionals who have to make it happen,” said psychiatrist and board president Dr. E. Fuller Torrey, for whom the award is named. “Psychiatrists such as Drs. Geller, Lamb, and Treffert, and psychologists, social workers, and psychiatric nurses who have a special interest in the severely mentally ill are the bedrock of the system. The battle for treatment is one that they wage every day in ways large and small. It is an effort and sacrifice that should not be ignored.”

More …

Read essays by the three winners and more on community psychiatry in a special issue of TAC's newsletter dedicated to community psychiatry.

MD and VA offer little defense ...

"What do I have to do, have him kill someone to get him treatment?"

That is the prophetic question a Reston (Virginia) mother asked mental health professionals shortly before her son beat her to death with a baseball bat in her home nearly eight years ago. History repeated itself this month when Pamela Jones was killed in her Fairfax City home by her mentally ill 24-year-old son …

In the years between these two tragedies, Virginia has kept the same outdated law that requires the mentally ill to be "imminently dangerous" before their objections to treatment can be overridden, even though they may be too sick to realize that they are ill. Incredibly, Virginia families are often told that nothing can be done to get their loved ones into treatment unless they become homicidal or suicidal.

Maryland law is similarly restrictive …Read more from the Washington Post …

“It's like you almost have to do a major crime to get help.”

Although it seems that most news agencies have unfortunately decided to take Monica Randolph’s story as humorous, if you look past the sensation surrounding her husband’s injuries, you find a woman continually failed by Pennsylvania’s treatment system. Ms. Randolph’s brother told reporters that his sister would repeatedly stop her medications when she felt better, turning her into a “monster.”

We at TAC wonder how many tragic stories it will take for Pennsylvania to finally revisit their ridiculously outdated treatment standard so that families like the Randolph’s can finally get the help they so desperately need.

Bloggers on Kennedy shooting ...

Bloggers are talking about the tragic Michael Kennedy case in Virginia … and its national implications. Some examples …

Have a friend who's suddenly talking about conspiracies and aliens? Want to get them temporarily committed for their own good? Good luck with that. Gotta wait until they hurt somebody, I'm afraid. – Musement Park

Kennedy may have pulled the trigger, but the real root cause of this tragedy is this society's failure to address the problems of the mentally ill in this country. - Confined
Space

Something needs to snap, we need something to form critical mass. Because this is a situation that will be repeated and repeated, all across the country, until we reform our mental health-care system. – Live from Silver City

Another needless death

The Washington Post’s editorial board today is up in arms about the recent tragedies in Virginia attributed to people who are psychotic – the murder of two police officers and the beating death of a woman by her own son. They say in part …

The concern for their rights, in practice, represents a cruel kind of joke: a right to exist in a delusional state and then get prosecuted severely for the damage. The cost savings are mythical, too. Society pays in so many ways for failing to take the problem of mental illness seriously. One of those ways is tragic killings, like those of Detective Armel and Officer Garbarino.

Geraldo and the mentally ill

Geraldo Rivera has demonstrated that he understands and sympathizes with the plight of the mentally ill in America. In 1999, he exposed the tragic “transinstitutionalization” of the mentally ill to jails and prisons after so many psychiatric hospitals closed. In the award-winning documentary "Back To Bedlam" he showed “[e]specially painful … accounts of parents who find that the only way they can get some sort of medical attention for their children is to have them convicted of a felony.”

So we don’t think he really meant it when he said on Geraldo At Large last night - in a story about the tragic police shootings in Virginia - that mentally ill people who are dangerous should be incarcerated.

TAC certainly does not advocate that position. We advocate treatment before a person becomes dangerous using proven means such as assisted outpatient treatment.

We appreciate that Geraldo once again exposed the consequences of nontreatment by telling the story of Michael Kennedy, a man suffering from psychotic symptoms who was killed after he took the lives of 2 Fairfax County police officers.

We suspect Geraldo would agree that treatment works and that the focus should be on early and sustained treatment that allows the mentally ill to live safely and productively in the community.

Out of the Shadow - Film to watch!

Susan Smiley’s very personal, award-winning film about her mother is being broadcast nationwide on PBS beginning this month.

Susan intimately and compassionately depicts her mother Millie’s lifelong struggle with paranoid schizophrenia and its effect on her family. In an interview for Schizophrenia Digest, Susan said:

"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."

Filmed over five years, Out of the Shadow uncovers one family’s struggle, but reveals a national plight. More than 2.5 million Americans and 1 to 2 percent of the world’s population have schizophrenia.

Visit the documentary's website to find out when it will air in your community.

NJ hospital admissions and AOT

“Admissions and census levels at the state hospitals have remained at higher levels than would be preferred.”

That quote comes from the New Jersey Department of Human Services, responding to a question regarding the continually high census rates at state hospitals despite significant investments in community resources. Unfortunately, these investments havn't resulted in the sort of reductions the state anticipated. In fact, the total hospital census for FY 2006 is over 125 individuals higher than it was in FY 2001.

One factor that directly contributes to these numbers is New Jersey’s lack of an assisted outpatient treatment law. Without an effective means for ensuring that the most severely mentally ill maintain their treatment in the community, New Jersey’s most ill are allowed to cycle in and out of hospitals, jails, and the streets.

Data from the state shows just how drastic a problem New Jersey is facing. The Division of Mental Health Services reported that almost 10% of individuals between the ages of 18-64 admitted to a state hospital are readmitted within 30 days of discharge. The readmission rate jumps to 22% in the 6-month period following discharge. According to the New Jersey Office of Mgmt. & Budget, readmission rates are estimated to be as high as 35% at one of the state hospitals.

Fortunately, hope is on the horizon. Senator Richard Codey, with the support of groups like NAMI NJ, the NJ Psychiatric Association and the Governor’s Task Force on Mental Health, introduced SB 1093, a bill that would finally provide for an AOT law in New Jersey – and give hope to the most severely ill.

Vicky Armel took up for my son when the system wouldn't

Thank You, Detective
Vicky Armel Took Up for My Son When the System Wouldn't
By Pete Earley (Washington Post, May 12, 2006)

Fairfax County Police Detective Vicky O. Armel, who was murdered Monday during a shooting rampage by a troubled teenager, had helped people with severe mental illnesses. I know because she helped my son.

Four years ago, I rushed my college-age son to a Fairfax Hospital emergency room only to be turned away. Although Mike was delusional and had been hospitalized twice before for treatment of bipolar disorder, a doctor said he was not sick enough -- yet. Mike thought pills were poison, and Virginia's restrictive commitment statutes prohibit doctors from treating a person with a mental illness against his will unless he poses an "imminent danger" to himself or others. I was told to bring my son back after he hurt himself or me. Forty-eight hours later, Mike broke into a stranger's house to take a bubble bath. The homeowners, who were away for the weekend, pressed charges, and Detective Armel was assigned to the case …

MORE: Painful irony in murder of police officer * Pete Earley’s book, Crazy

Schizophrenia and violence

A comprehensive new study confirms violence is not an anomaly for some patients with schizophrenia. Researchers, using data from the National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project, found that 19.1% of participants had a violent incident in a six-month period.

“This study joins a large body of scientific research confirming what we can too easily see each day in the newspaper,” said Treatment Advocacy Center President Dr. E. Fuller Torrey. “Although most individuals with mental illnesses are not violent, violence by a subgroup of individuals with schizophrenia is far from rare. And the violent behavior is almost always associated with the person not having received treatment for their illness. The only solution is treatment.”

The study also found that the symptoms most predictive of violent behavior are positive symptoms, like hallucinations, paranoid delusions, and grandiosity. “Positive symptoms of schizophrenia are not only the ones most predictive of violence, but also the ones most responsive to medication,” noted Dr. Torrey.

Painful irony in murder of VA police officer

Michael Kennedy’s delusions that the town was full of aliens may be what led him to kill Officer Vicky Armel and seriously wound two other officers on Tuesday in Fairfax, Virginia.

Ironically, Officer Armel understood that untreated mental illness is a medical problem, not a crime. A few years ago, she personally walked another similarly ill young man through the system with the goal of getting him treatment instead of jail time.

This case reminds us of both the importance of treatment for severe mental illnesses and the fact that untreated mental illness can, in fact, lead to violence.

Law enforcement officers know too well the dangers of lack of treatment. Officers like Vicky Armel also know the importance of getting people help. It is ironic and sad that she never had that chance with Michael Kennedy.

"Mental illness in Michigan is a lifestyle choice"

That quote comes from Paula Kolonich, whose ex-husband, Gil, recently died of a heart attack. But to the residents of Holt, Michigan, Gil Kolonich was known simply as the bird man, a man who spent his days collecting cans and feeding the birds.

Gil had paranoid schizophrenia; and like so many others with this insidious disease, he was unable to understand that he needed care. That meant that under Michigan law, he could not be provided care until he posed a danger to himself or someone else. So he was allowed to deteriorate on the streets, removed from a family that desperately sought to get him care.

His son Josh explained, "We knew he was there somewhere, but there was nothing that could be done to get him back.”

In Michigan, there is hope for people overcome by severe mental illness. Kevin’s Law provides for outpatient treatment for people whose severe mental illnesses cause them to refuse needed care. Effective since March 2005, families in Michigan can use Kevin's Law to obtain effective, consistent care for their loved ones with the most severe mental illnesses.

The case for outpatient commitment

In this week’s Psychiatric News, the thoughts of two distinguished physicians on outpatient commitment.

One may sympathize with the sensitivity of individuals with mental illness regarding AOT. But substance abuse disorder "recovereds," as part of their recovery process, have always recognized the usefulness of external coercion when necessary in the acute phase of their disorders. This acceptance that they are powerless and need help to recover often provides the "bottom" that counters denial and begins the recovery process. Andrew Goldstein had his freedom from involuntary care, but not freedom from his illness. If this had been reversed Goldstein would not have caused the death of Kendra Webdale.

Swing the pendulum back to center

From blogger Dan Morgan …

The pendulum has swung way too far in the direction of just letting deranged people roam the streets in a pathetic state. It is not right to let people, in the name of freedom, be utterly neglected. And it is not fair to burden families with this by taking away channels to force treatment if a family member refuses it because they have gone insane.

And it is not healthy for society to have mentally ill citizens neglected, filthy, vulnerable to crime, and living on the streets eating out of garbage cans.

The bottom line is that we need to start committing people again and forcing them to get treatment. Between a judge, a panel of experts, and family members – the courts should be able to have a mechanism to quickly get an outpatient commitment for
someone in a delusional state.

"He deserves to have a better life than being crazy"

Today's Wall Street Journal has an excellent article called “No Way Out: Trapped by Rules, The Mentally Ill Languish in Prison.” The reporter notes that …

Once imprisoned, mentally ill inmates are rarely paroled. Some "max out" their sentence, serving at least 85% of their term, and are released. With nowhere to go, and with a recidivism rate higher than that of the general prison population, they often end up back where they started …

And when they are discharged, as readers of this blog know too well, too many will slip through the cracks.

The prison will discharge Mr. Smith with two weeks of medication that Mr. Smith says he won't take, because a "genie in my rectum" told him he doesn't need it. He says he has heard the genie for as long as he can remember. Throughout his life, he says, he has used drugs and alcohol to quiet the voice.

The prison doctor interviewed in the same article says: "He deserves to have a better life than being crazy." We couldn't agree more.

USA Today: “Stuck in a vicious revolving door …”

"Dad, how would you feel if someone you loved killed himself?"

My college-age son, Mike, has stopped taking medication for the mental illness that was diagnosed a year ago, and he is having a relapse. He and I are speeding to an emergency room. Hang on son, I think. The doctors will help you.

But after waiting four hours, a doctor appears and tells me it's illegal to treat Mike. He is not sick enough. He is not in "imminent danger," and because Mike now thinks "pills are poison," the doctor cannot forcibly medicate him under Virginia law. I'm told to bring him back if he tries to kill himself or someone else.

MORE: Riveting new book on fighting for treatment - NPR: Fighting for treatment

APA president commends TAC’s “extraordinary advocacy”

TAC will be honored later this month with the American Psychiatric Association’s Presidential Commendation. APA President Steve Sharfstein, M.D. said about TAC:

“One of the great tragedies of modern psychiatry is the large number of individuals with mental illnesses who are incarcerated or homeless. This is the inevitable consequence of our reluctance to use caring, coercive approaches, such as assisted outpatient treatment. The Treatment Advocacy Center has been the catalyst for many positive changes in our laws and a shift in our perception of the importance of intervention. Their unique advocacy is restoring the important balance between individual freedom and caring coercion.”