Misunderstanding the law

Too often, even in states that have the option of assisted outpatient treatment, the prevailing belief is that the only option is inpatient commitment - and even then only after someone becomes dangerous.

That just is not true in many places. Make sure you know where your state stands, so if you hear this from a mental health provider, law enforcement officer, or other professional, or even read it in the paper, you can correct it.

To the jury

The LaShaun Harris case will go to jurors today.

During the trial, a cadre of psychologists and psychiatrists called by both the prosecution and defense testified that Harris is schizophrenic and prone to hallucinations. “She had been suffering from it before, during and after” the incident, said court-appointed psychologist Paul Good, whose statement that the schizophrenia caused Harris to kill her children was stricken from the record as conjecture.

What killed Trevor New?

Police bullets? Lack of treatment?

“None of us feel the police did anything other than what they had to do in that situation,” [New's fiance] said. “We totally support the police and their actions.”

What concerns her, however, are the years and months that led up to Thanksgiving. “The system failed,” she said.

A message from E. Fuller Torrey, MD

We need your help.

This past year, with the support of those like you, the Treatment Advocacy Center provided direction, answers, and hope to desperate families, compassionate legislators, and frustrated providers, all of whom want to improve treatment policies and laws.

We made great progress. And received a big honor: A 2006 Presidential Commendation from the American Psychiatric Association for “extraordinary advocacy on behalf of the most vulnerable mentally ill patients who lack the insight to seek and continue effective care and benefit from assisted outpatient treatment.”

We have been extremely successful, but there is much work yet to do.

We need your support. Our opposition has deep pockets, and many of them receive federal dollars. We refuse to accept funding from pharmaceutical companies, which means more than ever that our successes depend on supporters like you.

Please take a moment right now to donate online to TAC.

Until we find the causes and definitive treatments for schizophrenia and bipolar disorder, we have an obligation to those who are suffering to try to improve their lives.

TAC is the only organization willing to take on this fight, and I am very proud to be part of it.

E. Fuller Torrey, MD, president of the board of directors

A long descent

The sad story of Donald Voorhis mirrors what many families are going through ...

"For seven or eight years, it's been going on long enough the system should have picked up on it by now," said [one relative]. A string of convictions in Anchorage and in Palmer courts trails Donald Voorhis, mostly misdemeanor offenses: driving on a suspended license, disorderly conduct, criminal mischief, criminal trespass, assault on a police officer. He was fined, sentenced to short jail terms and placed on probation. It was a long descent to his September arrest on more serious charges ...

"We let them run amok in life until they get to the point where we can incarcerate them. If that's the only choice we have in life, so be it," [another relative] said. "Hopefully this will get him some help."

Legal fallacies of antipsychotic drugs

A fascinating paper was profiled yesterday on Dr. Helen's blog.

An excerpt:

The safeguarding of individual liberties is an important function of the courts. Indeed, antipsychotic medications are associated with numerous side effects ... But the implication that such medicines are mind-controlling and have the propensity to sabatoge intentionality of free thinking fundamentally misunderstands the effects that these life-saving medications have for millions of people. More crucially, the notion that antipsychotic drugs impair cognition for people suffering from psychosis is in direct opposition to the wealth of scientific studies that have demonstrated just the opposite: that these medicines improve cognition.

The lead author is Steven K. Erickson. You can read the whole study here: "Legal Fallacies of Antipsychotic Drugs"

Navigating federal privacy laws to help a loved one

Both family members and mental health care providers conservatively interpret confidentiality laws like HIPAA.

This means mental health providers often do not share information with relatives because they think sharing violates confidentiality laws. And family members often do not ask for information, because they do not think they have the right to be informed.

Knowing the law may help family members convince providers to share vital information about their relatives. Read our overview of HIPAA , which includes some creative legal ways to share needed information.

Florida DCF told: Treat inmates now

A Florida appellate court has ruled inmates must get treatment.

Notice that once again, it is law enforcement/corrections stepping up to fill the gap where the mental health system has failed ... .

''I can commiserate with them somewhat because we've had to deal with overcrowded jails, but they're going to have to operate overcrowded forensic hospitals until the Legislature steps up to the plate,'' he said. 'We never thought we could go into court and say, `We know how to solve that problem; we're not going to accept any new arrestees.' ''

- Assistant Miami-Dade County Attorney Randy Duvall

NJ Law Journal: AOT is "a good first step"

New Jersey is currently one of only eight states without AOT. But there is hope - a bill sponsored by Senator Richard Codey passed the Senate unanimously in June and awaits action in the Assembly.

The push for reform in New Jersey has received widespread support from groups like law enforcement, hospitals, medical professionals, families, and now from the legal community.

The New Jersey Law Journal, America’s second oldest legal newspaper and one of the leading voices on legal issues in New Jersey, recently voiced its support for AOT in an editorial. Calling the program, “a good first step,” the Journal lamented the fact that treatment in New Jersey is currently limited solely to inpatient care, and only for individuals who’ve already evidenced danger to themselves or others.

"Societal priority": Intervening? Incarcerating?

Tom Davis, columnist for New Jersey's Bergen County Record, weighs in on Andrew Goldstein's sentencing.

Many people with mental illness can't get treatment unless they show they're a threat to themselves and to others, said Debra Wentz, who heads the New Jersey
Association of Mental Health Agencies.

And, even then, the treatment is questionable, she said."It really goes back to a societal priority -- what if that person was bleeding to death on the street? Would they help him then?" Wentz said. "To fail to treat a man who was delusional and paranoid and clearly ill -- it's a clear failure in the system."

- "Prison is no place for the ill," December 5, 2006

UK: 1 person a week killed by someone with SMI

The Department of Health for England & Wales has released a report analyzing homicides and suicides by and “unexplained deaths” among people in those countries. The study looks at 27% of all suicides and 9% of all homicides in the countries over multi-year periods.

An average of one person a week dies at the hands of a mentally ill patient, according to an official report.

And almost a third of the killings are carried out by people who had been judged not to be a risk to the public. [The Guardian, December 4, 2006]

The report is The National Confidential Inquiry (NCI) into Suicide and Homicide by People with Mental Illness.

Dr. Torrey's latest piece on violence and schizophrenia is in the latest edition of Schizophrenia Research ...

Australian researchers on AOT's value

A new study of AOT in Victoria, Australia looked at almost 1,200 individuals over nine years. The results, recently published in the journal Social Work in Health Care, echo other published studies of AOT.

Individuals in the Australian study receiving extended outpatient commitment experienced significant decreases in hospitalization (from an average 56.3 days per year before extended AOT to only 19.6 days per year after) and a third more service utilization than in the period before AOT.

Researchers also found that neither AOT nor community services alone accounted for the reduction in inpatient bed use – in fact, either service alone was actually associated with increased inpatient utilization. Their analysis demonstrated that “it is the combination of community services enabled by outpatient commitment that facilitates the reduction in hospital utilization…” This further shatters the myth that enhanced services alone are enough for this population.

The researchers explain that “outpatient commitment is perhaps best conceived as a delivery mechanism rather than a treatment in and of itself” that serves as a “way of delivering services to a population that cannot or will not accept such services voluntarily.” AOT’s role is “to raise the level of outpatient commitment to that provided to the treatment compliant comparison sample.”

In other words, the goal of AOT is to allow individuals whose illnesses cause them to refuse care the opportunity to access the same services as other individuals with mental illnesses. AOT is simply a means of ensuring that everyone has the same opportunity to recover from their illness.