Reform is long overdue

Virginia’s mental health system is in dire need of reform. An overly restrictive commitment standard, combined with a weak AOT law and a severe shortage of inpatient hospital beds has resulted in a statewide mental health crisis.

But the move toward real change has begun. The Virginia Senate Health & Education Subcommittee will be holding hearings this Thursday, August 3rd on SB18 and SB309, two AOT bills before the Virginia Legislature. We encourage all Virginia advocates to voice their opinion and let the Virginia legislature know that the time for reform is long overdue.

The status quo is unacceptable

It took five terrible years for a jury to decide that Andrea Yates was insane when she murdered her children, despite overwhelming evidence regarding the severity of her illness. She will likely spend the rest of her days in a maximum-security forensic hospital. Eric Clark will spend at least the next 25 years in an Arizona prison, where his family still struggles to ensure he receives adequate treatment. And a story from Pensacola, Florida is the latest in a mind-numbingly long list detailing the terrible conditions the mentally ill face when incarcerated.

The theme running through each of these tragedies is simple: the criminal justice system is a meager substitute for mental health care. Mental health departments across the country are failing in their missions, and are far too willing to abandon the most difficult individuals to jail cells and prisons.

So the next time you read an article about the horrendous conditions in a local jail, or an incident where a family couldn’t get treatment for their son because he wasn’t “dangerous enough yet,” ask yourself, is my mental health department doing all it can to help the most severely ill? Have they implemented AOT? Are they still relying on outdated dangerousness standards for determining who needs care? Are they advocating for change, or simply enforcing the status quo?

We’ve seen the results of the status quo, and they are unacceptable.

Was it worth it?

Andrea Yates has been found not guilty by reason of insanity in the drowning deaths of her five young children. No doubt many pundits, like Andy Cohen of the Washington Post, will find this verdict a victory for both compassion and common sense.

We agree but also ask an additional question – why was this trial necessary at all? The possibility of a capitol sentence was eliminated in the first trial. Hundreds of thousands – if not millions – of public dollars were expended determining whether Andrea Yates would spend her next guilt-ridden years in a jail or a locked psychiatric facility.

Who cares for the most severely ill?

Anyone who still questions whether law enforcement personnel are the chief community caretakers of those most incapacitated by severe mental illnesses should read “Fresh tack helps hard problems” in the July 23 edition of the Modesto Bee:

[Modesto Police Officer Joey] Mercado is a downtown bicycle patrol officer who says calls involving the mentally ill take up nearly all his time. He sees the same group of repeat offenders — alcoholics, drug addicts and mentally ill — three to four times a day.

"A lot of people [with mental illness] out there have had contact with us hundreds of times," [Modesto Police Sgt. Kathleen] Blom said.

Why AOT is necessary

We often hear the argument that if you just have enough voluntary services, the need for AOT will disappear. Of course that isn’t the case, as anyone who works with the most severely mentally ill will tell you. Some individuals simply cannot understand that they are sick and will never accept voluntary services. That is why AOT is necessary, no matter how comprehensive the voluntary system is.

One telling example is California’s AB 2034 program. AB 2034 is comprehensive statewide homeless outreach program, offering premium wrap-around-services with a special emphasis on housing. And it has achieved very good overall results for participants, including decreases in homelessness, incarceration and hospitalization. But the AB 2034 programs have a major limitation; they are voluntary in nature and cannot help those individuals whose illness causes them to refuse needed care.

In a 2003 report to the State Legislature regarding the program, the California Department of Mental Health reported that, “1958 consumers, 22.7% of all the consumers ever enrolled, have simply disappeared or dropped out in most cases, without explanation.” And this number fails to capture the individuals who refused to ever enroll in the program, despite the promise of housing and comprehensive services.

Sad anniversary

A mother on her son:

Jevon was diagnosed with bipolar manic depressive disorder on June 18, 2005. I was told it was an incurable mental illness. The diagnosis was unbelievable and overwhelming to discover. He had been healthy his entire life and did not believe he was ill. I sought help from the doctors at the hospital but was told he did not meet the commitment standard of dangerousness to self or others, so there was nothing they could do. I begged for help, insisting that something was terribly wrong. He did not believe what the doctors were saying. Every mother knows when something is wrong with their child. I could see it in his eyes; the emptiness, confusion and fear. He promised me he would be alright; it was a promise he couldn't keep. Thirty-one days later, [he] was dead.

Jevon Lampkins was 23 when he died. His case is not unusual, though we wish it were. His mother couldn’t get him help because of a weak treatment law. And like too many others, he died in an encounter with a law enforcement officer.

Our thoughts are with Jevon's family today. And with all the other families who are still trying to get help. Keep making noise.

How to get into an inpatient psychiatric facility ...

Is the only way to access inpatient treatment for someone who is extremely ill an act of unfathomable violence?

William Bruce will be moved from prison to a psychiatric facilty at least long enough for evaluation - the local sheriff is relieved, noting the prison isn't a good place for inmates with serious mental health conditions. Bruce killed his mother, his family had been trying desperately to help him.

Too often such horrible events spur a call for punishment instead of compassion. Andrea Yates' fate is being decided in the deaths of her 5 children for a second time, but recall that the first time, she ended up in jail. That is where Brenda Drayton is headed as well - for the next 20-30 years, for killing her daughter.

Most often weak state laws make us wait until a crime is committed to help someone ... and then the focus is on punishment, not treatment. People with severe mental illnesses deserve to get real help from the civil treatment system before situations occur that lead them to be punished by the criminal one.

William Bruce, Andrea Yates, Brenda Drayton - if they could have been on an outpatient commitment order long before they committed murder, they might not have gotten so sick to need a hospital bed ... or land in a jail cell.

Crimes and misdemeanors

The vast majority of jail inmates with serious brain disorders who do have charges against them have been arrested for misdemeanors such as trespassing.

Some have been arrested for misdemeanors many times over. Like Gloria Rodgers of Memphis, who in 1998 was reported to have had 258 previous arrests and to have been jailed 114 times in the previous four years.

One study found the four most common offenses perpetrated by the mentally ill were assault/battery, theft, disorderly conduct, and drug- and alcohol-related crimes.[1] One young man smashed a store window “because he saw a dinosaur jumping out at him,” and a young woman refused to pay for her meal in a restaurant because she claimed to be “the reincarnation of Jesus Christ.”[2]

Sometimes, a misdemeanor arrest can quickly land someone in jail on a far more serious charge ... all because of lack of treatment.

[1] National Alliance for the Mentally Ill, Criminalizing the seriously mentally ill: The abuse of jails as mental hospitals (1992).
[2] Gary E. Whitmer, From Hospitals to Jails: The Fate of California’s Deinstutionalized Mentally Ill, 50 Amer. J. Orthopsychiatry 65, 66 (1980), and Edwin V. Valdiserri et al., A Study of Offenses Committed by Psychotic Inmates in a County Jail, 37 Hosp. Community Psychiatry 163, 165 (1986).

Ever-growing DSM met with skepticism

Under the proposed changes in the DSM, "everyone who's had any kind of mood swings in their life becomes bipolar," [Dr. Fuller] Torrey said. "And because of that, the concept loses meaning."

Dr. Torrey has long advocated a research focus on the most severe mental illnesses.

Pad the cells or stop arrests?

Some jails and prisons have responded to the ever-increasing population of incarcerated people with severe mental illnesses by creating special mental health units or adding padding to cells.

It is so bad in some places that courts are ordering prisons to do a better job for inmates with severe mental illnesses.

Yet too often you hear people say that someone will finally get help now that they have been arrested.

Where is the disconnect?

Diversion programs and tools like mental health courts can save lives - but still don't come into play until after someone is arrested. Assisted outpatient treatment keeps people in the civil court system and doesn't require them to first commit a crime.

Las Vegas officials seeking hospitalization

Las Vegas city officials have just announced a plan to round up homeless people and evaluate them for their need for hospitalization. The plan, known as Legal 2000, is being touted as a means to make Las Vegas’ parks safer.

But the question that springs to mind is how did the situation in Las Vegas, one of the fastest growing cities in the nation, spiral so far out of control?

One major problem: Nevada is one of only eight states without AOT.

Professional storyteller tells her story of bipolar

Check out a very brave, very personal 5-part series by Orange County Register reporter Valeria Godines. The paper says: This series isn’t just about bipolar disorder. It’s about the human spirit, how we survive the unimaginable. It’s the true story of a woman who falls apart and is gingerly put back together.

Read the first story in the series, "On December 5, I Killed My Daughter"

Ending stigma ...

The vice president of the Heritage Foundation wants to end the stigma of mental illness - through, among other things, parity and outpatient commitment. "America has abandoned those who suffer with brain disorders for far too long," she says. "We can, and must, do better."

The myth of harm

Some mental health professionals assume it is harmful to mandate someone to accept treatment.

This is a myth.

In one study, individuals in court-mandated community treatment had low levels of perceived coercion, similar to individuals who had never experienced any form of leverage -- they didn't feel "forced," in other words. But those same people reported significantly higher treatment satisfaction than those whose treatment had been voluntary, probably because they didn't get to choose whether to take medication or not. [More in Sunday's Kennebec Journal ...]

Short bits …

• Pete Earley testified before a congressional hearing, saying that “he was appalled that the government refused to help his son's disorder but would punish him for it.” Earley’s book CRAZY is still a hot seller – get a copy for your vacation reading stack or get your book group to read and discuss.
• Rockthepsychiatryvote on Dr. Torrey’s call to divorce mental illness from mental health …
• Alaska’s state supreme court in Myers corrected an oversight in state law, clarifying that a person’s "best interests" be taken into account when the state exercises its duty to protect an individual from themselves. (Most other state laws and the Treatment Advocacy Center’s Model Law for Assisted Treatment include similar determinations.) Myers is one of many cases decided each year in the state courts that has no real impact nationally, but can hopefully make a difference for some people in Alaska.
• “The mental health consumer needs to recognize that liberty is precious, but not everyone in our cohort can "handle" liberty …”
• Pam Wagner’s (coauthor of “Divided Minds”) recent blog entries on outpatient commitment are compelling reading, as she weighs honestly how she feels about it and hears from blog visitors what they think.

Refusing treatment ...

A young man, diagnosed with schizophrenia, held his grandmother hostage in Chicago. A police dog subdued him, biting the man in the scrotum in the process. From the news story:

[Kane County Sheriff Ken] Ramsey is looking into whether authorities can take any legal steps to force Colborn, who is being held in the Kane County Jail, to accept medical treatment.

"Right now, my biggest concern is getting him health care," Ramsey said.

We should clarify – the medical treatment they referring to is for the dog bite, not the brain disease.

Normalizing, glorifying, stigmatizing …

Big Pharma’s latest campaign will probably send everyone in New York City running to their doctor to see if they have bipolar disorder.

Their goal is to sell more pills. But the result is just as bad as that of well-meaning advocates who use the normalizing approach to try to reduce stigma. Their advocacy leave the general public wondering “if people with severe mental illnesses are just like everyone else, why can’t they work to support themselves? Why should we use tax dollars to pay for their treatment programs?” These are severe and debilitating illnesses – trivializing their impact on people is not helpful.

Nor is it always useful to illuminate the accomplishments of historical figures who suffered severe mental illnesses. Public figures like Patrick Kennedy, who entered a treatment program after crashing his car through a gate at the Capitol, can draw needed attention to the symptoms of these illnesses can be and how critical it is to get treatment. But sometimes that lends a false impression – that symptoms are desirable, like with Van Gogh, or quickly overcome.

Normalizing and glorifying severe mental illnesses don’t eliminate stigma – it just confuses the issue for everyone. Stigma is a huge problem for people with severe mental illnesses – one that can be fixed with straight talk, not feel-good platitudes.

What is it like to hear voices?

Imagine living minute by minute as does Rod.