TAC's statement on SCOTUS ruling

Statement by TAC on the ruling: "We as a nation need to finally stop counting on the insanity defense to keep mentally ill people out of prison and start counting on treatment to keep people from committing crimes in the first place ..."

SCOTUS ruling

The Court ruled Arizona's law on the insanity defense does not violate constitutional due process and upheld Arizona's definition of the insanity defense. Resources for reporters on U.S. Supreme Court: Clark v. Arizona.

Negative symptoms

The general public rarely hears about people who have “negative symptoms” of schizophrenia, such as apathy, social withdrawal, poverty of thoughts, blunting of emotions, slowness of movement, and lack of drive.

That’s probably because, according to a recent study, people with negative symptoms are 9 times less likely to have a serious violent episode than people with the “positive symptoms” normally associated with schizophrenia (paranoid delusions or hallucinations).

The same study revealed that people who had mostly positive symptoms were 3 times more likely to have serious violent behavior than those who had both negative and positive symptoms.

That doesn’t mean that negative symptoms are good. They are the most difficult symptoms to treat. And they significantly impact quality of life by impairing social networking and the ability to work.

Violent episodes grab media headlines – people living isolated in a back bedroom do not. Theirs are not stories about recovery and hope, but neglect and despair, which is why the consumer elite never acknowledge their pain. So who will tell their story? Here is a good start.

Fighting generalizations with science and truth

There is a big difference between someone who has schizophrenia, is in treatment, and is doing well vs. someone like William Bruce.

For too long, it seems the only choice in public discourse about the role of violence in schizophrenia has been to demonize EVERYONE with schizophrenia as being potentially violent, or to preach that NOBODY with schizophrenia has a greater risk of violence than anyone else. Neither is reasonable or logical.

Implying that all people are violent is simply not true and is hurtful to the majority of people with schizophrenia who are taking medication and not violent. Failing to acknowledge that under some circumstances some people with schizophrenia have an increased risk of violence is not only misleading, it can lead to dangerous situations when caregivers, police, or the mentally ill do not recognize the warning signs such as paranoid delusions.

We are grateful that the editors at the Kennebec Journal and Morning Sentinel chose a third option – clarifying who of that larger group really needs humane intervention and helping them. Educating the general public to not paint everyone with either the broad brush of violence or the broad brush of nonviolence is the best way to not only remove stigma from the majority of people with mental illnesses, but also to avert tragedies.

Waiting for danger? Here it is.

“What do we have to wait for? Do we have to wait for him to hurt somebody or
kill somebody before they do something?”

Seems like far too often, the answer is yes.

Wait until he escalates. Until you can prove he is a danger. Until danger is imminent.

The latest result of such twisted and irrational policies is making headlines in Maine this week.

Robert and Amy Bruce spent years trying to help their son deal with his mental illness, even letting him live at home despite their fears. But on Tuesday, the illness won out and authorities say William Bruce, 24, bludgeoned his mother to death. Efforts to help William Bruce through the years were stymied, first by the hope that he would grow out of it and later by confidentiality laws and civil liberties intended to protect his freedom, but at the expense of the treatment he badly needed but refused to accept.

The Bruce family, barred from having a say in many of their son's treatment decisions, were left to either turn their back on him or accommodate his illness and accept the risks.

NJ bill passes Senate

SB 1093 passes the New Jersey Senate unanimously, 38-0.

NJ Senate votes today

The full New Jersey Senate will vote on SB 1093 TODAY at 2:00 pm. It is supported by grops like NAMI New Jersey, The New Jersey State Association of Chiefs of Police, and The New Jersey Psychiatric Association.

It was also recommended by The New Jersey Governor's Task Force on Mental Health. "The Task Force concluded that any comprehensive reform of a mental health system requires that the needs of the people with the most severe and persistent mental illnesses be addressed," said Task Force Chair Bob Davison."Our careful deliberations and extensive research led us to conclude that for those who are too ill to access mental health services, IOC strikes the appropriate balance of individual's well being and their constitutional liberties."

“I don’t want Gregory’s death to have been in vain …”

The Katsnelson family continues to show unfathomable strength in fighting for better treatment laws in New Jersey.

Why?

They don’t want other families to go through what they went through – and they don’t want other families to so through what the Pituch family has gone through. Ronald Pituch killed his own mother before stabbing 11-year-old Gregory Katsnelson to death four years ago.

Cathy Katsnelson poignantly notes that getting legislation passed won’t heal her wound – that makes this family and others like them all the more heroic. They have chosen to turn their energies toward helping people who are very ill, when everyone might have expected them to focus on vengeance. And when the result still won’t erase their pain.

As Kendra Webdale’s mom noted: “It does not boost the ego of a grieving family to have a law named after the deceased. It honors the life of our beloved Kendra to dignify and restore some quality of life to those who suffer from an abhorrent disease not of their choosing.”

Prisons as warehouses ...

Too true ...

The mentally ill desperately need advocates to demand changes and improvements in the ways that they are apprehended, locked up and all too often mistreated. Can we depend on elected officials to pass new laws and regulations? Can we rely on our law enforcement and mental health officials to devise plans and procedures to deal with the growing problem?

Safer in prison?

Talk about stories that speak for themselves ...

Maggie has reached a painful realization: Both the public and her paranoid schizophrenic son may be safer if he goes to prison. Only there, will he receive the 24-hour-a-day supervision he needs … "Would you say that an Alzheimer's patient should hit rock bottom? My son has a brain disease. It's not about behavior," she said. "If Brian understood consequences, would he be where he is today?"

Indeed.

"How, I wondered, could as vulnerable and ill a person as this woman be left so completely out of our mental health system?"

Killed by the only remaining safety net ...

Too often, when someone with a severe mental illness is arrested, the family is quoted in the papers saying something along the lines of “at least now he can get some help.”

The mental health treatment situation is actually so bad that some people are relieved when the person they love is arrested. But the reality is that jails and prisons weren’t set up to provide effective mental health care, and arrest often only exacerbates an already terrible situation.

Joel Seidel’s family was faced with an horrendous choice; allow him to remain in a dangerous jail where he might finally receive care, or release him back to the community where he would again refuse treatment. In the end, Joel’s family decided not to pay $150 in bail to get him released. Because they live in New Jersey, there was no other way to help him. That state's outdated mental illness treatment law makes it nearly impossible to help severely mentally ill people who refuse treatment. Hopefully that will soon change.

But it will be too late for Joel Seidel. He died in jail, kicked and punched more than 100 times by his cellmate.

Your tax dollars and hospital closures ...

"Deinstitutionalization is a thing of the past" – at least that is what most people think.

But, in fact, psychiatric hospital closures have proceeded at a furious pace over the last 15 years. There were so few beds when this new assault started that the people who remain in institutions are those who really need intensive care. Some can be “integrated” with sufficient support, but for others, life becomes a living hell once they are “freed.”

There are many factors driving the closures, but the most egregious is that the very groups that are paid by the federal government to “protect” the mentally ill, Protection and Advocacy (P&As) are the ones forcing many of the closures.

And when the doors are closed, the displaced residents are on their own.

In his book Crazy, Pete Earley investigates the tragic life and death of Deidra Sanbourne, the named plaintiff in the Florida P&A 1988 suit to close a hospitals (pg. 108 – 207).

The Bazelon Center, another group heavily funded by the federal government, joins many of these suits … and they aren’t satisfied with closing hospitals. In New York, Bazelon brought a suit to close boarding homes. In Connecticut, Bazelon brought a suit to get the mentally ill out of nursing homes. Where do they expect seriously ill people to live?

One need only read about M., who was placed in his own apartment when Harrisburg State Hospital closed. The P&A was nowhere to be found when M. ended up lying on a sidewalk – he was scared of his apartment.

For years, these federally funded “advocates” have imposed their own values on people who don’t have the resources to live independently. Rather than advocating to improve conditions in hospitals, boarding homes, and nursing facilities – they try to close them down.

Violent crimes up

The FBI national crime figures for 2005 are out - and violent crimes are up for the first time in 5 years.

Bad week all around ...

Law enforcement and people with mental illnesses had a particularly bad week.

• June 3. A man trying to commit suicide in Barrett Township, Pennsylvania, threatened to attack police with a knife during a standoff. His mother said he needs psychiatric help.
• June 5. Jury selection began for a man in Rhode Island accused of killing a police officer. “His family and girlfriend have said he was mentally ill and experiencing hallucinations,” notes the story. “They said they had tried to get him psychiatric help before his arrest.”
• June 6. A man in Seattle, Washington, is shot and killed by police during a routine traffic stop. Diagnosed with schizophrenia and bipolar disorder, he had been committed in the past for threatening to kill his parents.
• June 8. A man in Portland, Maine, is sentenced to 11 years in prison. He attacked two homeless men, knocked out one police officer and choked another officer to the point of unconsciousness. He had four assault convictions since 1996, most occurring in a period when he was hospitalized three times for mental illness.
• June 8. A paranoid and delusional man in West Chester, Pennsylvania is sentenced to 18 to 36 years in prison for attempting to kill two sheriffs.

Prison conditions

Anyone reading this blog knows that jails and prisons usually exacerbate psychiatric symptoms, both because individuals with serious brain disorders are frequently placed in solitary confinement and because they often are not given the necessary medication to control their symptoms.

Today a private national commission issued a major report on prison conditions for all inmates, which contains some interesting information. The report was the subject of a congressional hearing this afternoon. Both may draw more attention to the plight of people with mental illnesses behind bars.

There's a section supporting more media access to prisons (interesting, and may bring more stories) – the report also says …

“Finally, along with committing more funds to care for mentally ill prisoners, states and counties need to expand treatment in the community. Our jails and prisons should not function as mental institutions.”

For reporters ...

TAC's press room is being revamped ... please take a minute to check it out and give us your feedback. It is a work in progress and all thoughts are welcomed!

In VA, care must wait until it's too late

Suppose when you awoke this morning you weren't feeling well. You've been dragging for some weeks now, but this morning you have a coughing jag; blood comes up.

Worried that something is terribly wrong, maybe lung cancer, you scold yourself for not heeding the surgeon general's warning as you toss a pack of cigarettes in the trash and reach for the phone. Maybe you can catch this in time.

You call the health clinic. They ask some questions. How long have you felt this poorly? Is this the first sign of blood? Any family members to make you soup?

Then, incredibly, the clinic tells you, sorry we can't help you unless you are in imminent danger of dying today. Call us back when you can no longer breathe.

Of course this won't really happen if your illness is physical. But mental illness is a different story, especially in Virginia and especially for those who lack insurance or have run out of coverage.

Virginia operates in crisis mode. Unless you are in "imminent" danger of harming yourself or someone else, take a number.

More from this Roanoke Times editorial ...

"Bring him back after he tries to hurt you ..."

"Bring him back after he tries to hurt you or someone else."

Award-winning author Pete Earley tells his story on the syndicated radio show Criminal Justice Forum.

Earley's new book, “Crazy: A Father’s Search Through America’s Mental Health Madness,” is a compelling recount both of the story of his own struggle to keep his own son in treatment for a severe mental illness and of his encounters with the people he met on the Miami Jail’s 9th floor, where the most severely ill prisoners are held.

From Florida and want to hear more about the Baker Act? Listen to CJF's piece on Baker Act reform.

Big Pharma and advocacy groups

The Philadelphia Inquirer published a news story last week that revealed the dangers of mental health advocacy groups accepting funding from pharmaceutical companies. (“Donations tie drug firms and nonprofits: Many patient groups reveal few, if any, details on relationships with pharmaceutical donors,” May 28, 2006).

Although patients seldom know it, many patient groups and drug companies maintain close, multimillion-dollar relationships while disclosing limited or no details about the ties.

At a time when people are making more of their own health-care decisions, such coziness raises questions about the impartiality of groups that patients trust for unbiased information. It also poses a challenge for groups trying to hold patients' trust and still raise money to serve them.

An Inquirer examination of six groups, each a leading advocate for patients in a disease area, found that the groups rarely disclose such ties when commenting or lobbying about donors' drugs. They also tend to be slower to publicize treatment problems than breakthroughs. And few openly questioned drug prices.

The Inquirer singled out NAMI in the field of mental health. But pharmaceutical company funding is also flowing into the National Mental Health Association (see page 12 of their annual report) and Bazelon Center for Mental Health (see page 18 of their annual report).

TAC is sometimes wrongly accused of accepting money from pharmaceutical companies, but we have had a policy since we first opened our doors that we will not accept such funding. That certainly makes fundraising more difficult, but it is our policy. TAC operates on a modest budget for a national organization, but our lean and mean approach has resulted in many successes.

We agree that additional regulation is not necessary – whether or not to accept pharmaceutical funding is a decision that individual organizations should make. But, the pitfalls are great when there is not adequate transparency or independence.

And many patients expressed surprise at the ties [between big Pharma and advocacy groups]. "I don't think that would make a difference as far as taking a drug," said Gloria Antonucci, 65, leader of a Montgomery County pain-support group that relies on Arthritis Foundation advice. "But I think it would make me, maybe, 250 percent more skeptical about what the group is saying."

Family tried, law failed them

"Unless he posed a threat, it was the family's responsibility ..."

Recovery and coercion

The American Association of Community Psychiatrists (AACP) Guidelines for Recovery Oriented Services note that "recovery has been variably defined" and that "[t]he use of coercive measures for treatment is not compatible with recovery principles."

SAMHSA (Substance Abuse and Mental Health Services Administration) defines “recovery” in its Consensus Statement in a way that appears to foreclose the possible compatibility of recovery and the use of leveraged treatment. The first of its ten ten fundamental components of recovery is self-direction: "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."

This perspective on recovery dashes all hope of rescuing those who are refusing treatment – it erects one more barrier to treatment for clinicians who are already facing too many obstacles. The most discouraging aspect of the SAMHSA formulation of recovery is that an organization that purportedly promotes an "evidence-based approach" has apparently ignored research demonstrating that the use of leverage is both necessary and beneficial for a small group of individuals with the most severe mental illnesses.

The debate about leveraged care, which promises to continue to rage, should be an informed rather than an emotional one. An informed review of relevant data shows that the practice of rescuing people with leveraged treatment can be entirely compatible with, and sometimes necessary for, recovery.

More …