Tuesday, October 31, 2006


Here is something REALLY frightening.

Law enforcement officers, forced for too many years to be de facto front-line mental health workers, are being charged with managing people with mental illnesses … by the mental health community.

It is spooky to hear mental health providers so fully divest themselves of responsibility for the sickest citizens, expecting law enforcement to pick up the slack. After James Chasse died in a terrible tragedy, the reaction of the mental health community hasn’t been to look inward at their role in averting the deadly encounter, but to gather in force to demand action from law enforcement.

Beckie Child of the Mental Health Association of Oregon said delegates to a mental health conference held in Portland last week signed a petition pressing the mayor to commit to training all cops in crisis intervention, and to do so within six months.
James Chasse did not deserve to die in an encounter with police, and it is important that everyone keep the pressure on law enforcement to examine actions, policies, and procedures that may have contributed to his death.

The difference is, the police seem to KNOW they have to step up. They are working on increasing CIT training and assessing their behavior. They are actually acting to make things better, even as they remind us that the problem begins … and should be handled … long before someone ends up in an encounter with an officer.

Robert King, president of the Portland Police Association, said Monday that while the union supports any increased training, "it would of course not changed the encounter with Mr. Chasse. Until our community gets serious about helping the mentally ill, it won't matter how much training we have."
The issue in Oregon is twofold – the deadly encounter and the years of neglect that led up to it. The more the mental health community can keep the focus on the encounter that cost Mr. Chasse his life, the less they have to face the very scary truth – it is the long-term failure of the mental health system that led to this tragedy in the first place.

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Monday, October 30, 2006

The ethics of psychosis

I feel that it is the responsibility of everyone else to try to keep me from being irresponsible. I believe that telling someone else that he or she appears to be psychotic and in need of treatment is very important.

If that person refuses treatment, the only responsible thing to do is have them forcibly treated.

This is exactly equivalent to taking the car keys away from someone who has had too much to drink. More ...


Friday, October 27, 2006

"48 Hours": Jeremy Perkins tragedy

Tomorrow night, 48 Hours will investigate the case of Jeremy Perkins, a young man with untreated paranoid schizophrenia who stabbed his mother to death.

In his statement to police, Jeremy said “She was screaming no, don't, Jeremy no don't. I stabbed her about 4-5 times before she fell down...”

He then stabbed her more than 70 additional times.

Jeremy was being “treated” with vitamins, not antipsychotic medication – 48 Hours will investigate the role in her death of the family’s strong belief in Scientology, thus disbelief in psychiatry and mental illnesses.

As you watch this case study, remember that the problem is far greater. Scientologists are not the only group that is trying to displace psychiatry in the treatment of severe mental illnesses such as schizophrenia. Every day, people across the country like Jeremy are kept from getting the real treatment they need by weak and outdated federal and state laws and policies. We are all to blame for many similar horrible deaths – whatever the reason – every time someone with a severe mental illness can’t get treatment.


Thursday, October 26, 2006

Honestly questioning the road to "recovery"

Harriet P. Lefley, Ph.D. will never be accused of advocating coerced care as a first-line treatment for severe mental illness. But, she makes a cogent and compelling argument about the dangers of a mental illness treatment system in which involuntary treatment is no longer an option. Her remarks are incredibly brave because she dares to question (in a very polite way) the ideologues who advocate a mental health system based entirely on consumer choice.
It seems to me that sometimes a mystifying dishonesty pervades this discussion [about recovery]. A noble ideological principle too often is coupled with an unconscionable indifference even to acknowledging the conditions that typically generate forced treatment. Psychotic and self-destructive behaviors can lead to terrible social consequences and may affect many people other than those who are ill. Children, siblings, spouses, and aging parents are among those deeply affected and psychologically harmed by untreated psychosis—not to mention the damaging effects to the persons themselves.
Questioning the “transformation” to a recovery based system is like challenging motherhood and apple pie. It takes guts. So we applaud Dr. Lefley and hope that her honest opinions encourage others to speak up. For some people with mental illnesses, leveraged care may be a necessary side trip on the road to recovery.


Wednesday, October 25, 2006

PA: Robert Flor's insight

In the past, Robert Flor refused psychological evaluation and would not argue against getting the death penalty. After a week on new medication, that has all changed.
The Bucks County man who admitted this week to killing a Newtown police officer now says he doesn't want to be put to death and would prefer to spend the rest of his life in prison, contrary to previous testimony in the case, according to his defense team.

The defense says a new medication Robert Flor, 39, formerly of Bedminster, is taking for bipolar disorder, has dramatically changed his thinking and willingness to cooperate with his attorneys, prompting the change of heart.

''What has happened in one week, we have literally moved heaven and earth,'' Bradley Bastedo, one of Flor's three attorneys, said in court Tuesday. Flor, who hadn't been cooperating with his defense team in the weeks leading up to his guilty plea, has also agreed to get a psychological evaluation, something he's refused to do in the past.

''We continue to believe that [Flor's past] refusal to comply to testing was an outgrowth of mental illness,'' said Peter Hall, who along with Bastedo is defending Flor.

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Tuesday, October 24, 2006

LAPD launch investigation

Now the LAPD are launching a criminal investigation into the dumping of people with mental illnesses onto "skid row."
Los Angeles Police Department officials, who photographed and videotaped the five alleged dumping cases, called it a major break in their yearlong effort to reduce the number of people left on skid row by hospitals, police departments and other institutions.

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Monday, October 23, 2006

No room on skid row

In Los Angeles, police are focusing on cleaning up "skid row" - moving homeless people out of their encampments, at least during daylight hours.

Wonder if anyone is focusing on how people end up on skid row. (You'll recall that many people with mental illnesses are dumped there upon release from a hospital ... some instances were even caught on cameras ...)

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Friday, October 20, 2006

"How am I to understand medication is relevant?"

Pam Wagner and her sister, authors of “Divided Minds,” are sought after speakers. In this excerpt of Pam’s speech at a recent NAMI meeting, you can see why.
I could be your daughter or your son, your sister or brother, your mother or father, your friend or your neighbor. I suffer from schizophrenia.
She goes on to talk very compellingly about compliance and side effects, as well as lack of insight. In her words …
The right medications can help, though, and when the side effects are tolerable, they make the difference between chronic illness and recovery. I wouldn’t be standing here today without them.

But if, as I believed in the mid-1980s, the CIA and FBI control me through a microchip implanted in my tooth, how do I know pills could resolve that? If I hear invisible voices that sound real, and think bizarre thoughts that feel true, how am I to understand medication is relevant? The solution is obviously to get rid of the radio in the wall or go to the Middle East, find 22 linguists, and translate Gray Crinkled Paper?

I asked the dentist about my tooth. For a moment, he looked taken aback, but he regained his composure and answered, “I understand you believe there’s a microchip in your tooth. I don’t think that’s possible. I think it’s a symptom of your illness. But I’ll take a look if it will make you feel better.”
Read more from the always-gripping blog of Pam Wagner.

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Thursday, October 19, 2006

Stop the madness: A call to arms

This is a call to arms!

The mental health system today is not being “transformed” it is being deformed. What first evolved as a hopeful message of recovery has devolved into a political agenda.

We are all in big trouble if nobody challenges a “mental health counselor specializing in recovery-focused psychosocial methods” who tells the public that:

  • Schizophrenia is not a brain disease, it is caused by trauma
  • Delusions and hallucinations are not symptoms, but are caused by life experiences
  • Trusting relationships, not medication, lead to recovery
  • Nazis take away choices – so those who take away patient's choices are Nazis

These are not the rantings of a lone wolf. Mental health professionals do a great disservice when they post on the internet a definition of recovery that seems to preclude people with schizophrenia who rely on mediation to control symptoms, such as the one using these four criteria:

  • Having a social life similar to others in the wider community
  • Holding a paying job or volunteering
  • Being symptom free
  • Being off of psychiatric medications

If recovery means we are headed to a mental health system without medication … we’re all in trouble.

We need to save the mental health system. Don’t let the self-righteous recovery zealots intimidate you. Dare to ask questions and stop the madness.

UPDATE: Read a reaction to this post from Psychlinks Blog.

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Wednesday, October 18, 2006

Acting when nobody else will ...

What choices do they have?

  • A Florida jail has installed 4 padded cells with cameras (at the cost of $131,00) in the wake of the deaths of two inmates with mentall illnesses.
  • A Virginia Supreme Court justice has launched a mental heath commission – as one legislator notes: "They [the judiciary] have been put in the situation where at every level and at every court, the people with mental illness are confronting the judges. And they don't have the tools for confronting these people. I think [the judges] are acting responsibly and reacting to our actions and lack of actions."

Corrections officers, judges, law enforcement officers … all of them are filling the gap left by the mental health community. People are left untreated, land in the criminal justice system and … surprise … we expect the criminal justice system to make everything OK.

We’ve said it before … where are the grand juries to investigate the mental health system?

The criminal justice system has no other choice but to build in safety nets for the many people who have fallen through the cracks.

But instead of fixing the cracks, the mental health community seems intent on criticizing the quality of the nets.

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Tuesday, October 17, 2006

Leverage vs. coercion

A recent entry on schizophrenia.com points to this fascinating blog entry by a psychiatrist ...
"Some of the best research on mandated treatment is being done by the MacArthur Foundation. The interesting thing about this work is that it showed that leveraged treatment is not necessarily perceived as coercive by the patient if the patient is given a chance to participate in the process -- ie. to participate in a mental health status conference with a judge or to discuss how money will be spent with a payee. While outcomes studies are still being done, there is evidence that use of leverage reduces likelihood of rehospitalization and reduces length of stay."

Monday, October 16, 2006

Death sentence

In Ohio, a young man with mental illness died in prison after a struggle with guards. The terrible death of a young man in a prison in Michigan has led to a broader investigation of prison care for people with mental illnesses. More evidence that prison is not a good place for people with severe mental illnesses.

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Friday, October 13, 2006

When the media are the targets

'The voices told me to do it,'" said Sean Michael Campbell, 30, who witnesses say "shattered 10 first-floor windows at The Modesto Bee with grapefruit-sized rocks as frightened employees sat in their offices Thursday afternoon." Luckily nobody was hurt.

Members of the media often report on such incidences, but it is not uncommon for them to also be targets. When TAC did a survey on threats by people with mental illnesses to radio and television stations in 1999, several responding stations commented on the volume of such communications:

"Phone calls from these clearly suffering from mental illness are routine—averaging perhaps 10 a week." - Television station in Texas

"I am in HR and this is a daily part of my job—dealing with people who hear voices and suffer from various mental illnesses." - Television station in Oregon


Thursday, October 12, 2006

Is Kendra’s Law constitutional?

AOT opponents in Albuquerque said in a New Mexico court that the answer is “no.” But experiences from every other state with an AOT law prove otherwise.

In fact, 42 states have assisted outpatient treatment laws, some for over 20 years, and NONE have been ruled impermissible.* Most relevant, since the New Mexico bill is based on New York's Kendra's Law, the law in that state was unanimously ruled constitutional by the state's highest court (In the Matter of K.L.).

No challenge to an AOT law or its standard has succeeded.

Interestingly, in her comments in court about the Kendra's Law case, Judge Huling indicated that she was concerned not about whether the law itself was constitutional, but whether the city council overstepped its powers by legislating in an arena pre-empted by state legislation. It appears that the case will turn on an issue of home rule.

It would be unfortunate for the city to be prevented from using the ordinance immediately when it becomes effective. It is a beneficent law with numerous patient protections and great potential to reduce hospitalizations, arrests, incarceration, homelessness (outcomes proven in other states).

But if the court finds that a state technicality will keep Albuquerque from helping its citizens immediately, it is just more pressure on the state to get the law passed so everyone has access to this proven treatment mechanism.

* See In re Detention of LaBelle, 728 P.2d 138 (Washington Supreme Court 1986); State of Wisconsin v. Dennis H., 647 N.W.2d 851 (Wisconsin Supreme Court 2002); In re K. L., 806 N.E.2d 480 (New York Court Of Appeals 2004)

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Wednesday, October 11, 2006

The Commission's real mission ... action

We commend Virginia Supreme Court Chief Justice Leroy R. Hassell Sr. for launching a new Commission tomorrow that will look at Virginia's laws for mental health treatment.

He has the right vision and the right mission - to actually see change take place.

However, as TAC executive director Mary Zdanowicz said in today's Washington Post, there have been many commissions and reports in the past. "Something needs to be done now," she said, and we think the power of this Commission is that the Chief Justice agrees.

Finding real ways to help people lost to symptoms of untreated mental illness is a commendable goal. Acting on those answers is where too many commissions and blue-ribbon panels fall down on the job. We believe this one will be different. We hope we are right.

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Tuesday, October 10, 2006

A real look at Kendra's Law

I invite ... you to spend a night in a house with my brother - an untreated, paranoid schizophrenic.

Try not to cry as you listen to him pound on walls, scream, swear and make threats at some unseen person.

Watch as my mother, who should be enjoying her senior years, has to call the police when it becomes too much for her to take.

Be there when the staff at the psychiatric hospital tells her that, true, her son is psychotic, but he is refusing medication and that's his right - since he doesn't appear to be imminently violent.

Take him home; see how comfortable you feel with the determination that he is not imminently violent.

Watch him sink into complete insanity, tormented by demons that don't exist.

More ...

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Monday, October 09, 2006

More from Oregon ...

"I was so hopeful that this time I could get him some help," [Glenda Linville] said of making the 911 call. "When I tried in the past they said he had to hurt himself or someone else, and he had never hurt anybody."
Glenda Linville's son Devon Shane Linville, was shot and killed by police. A grand jury has found the officers were justified in using deadly force.

Where is the grand jury to assess Oregon's system, which put everyone in this terrible position?
After a manic episode six weeks before his death, Glenda Linville convinced her son to let her check him into St. Charles Medical Center-Bend to get help for his illness. She said he had been ranting and raving, pacing the floors and talking to God. He rarely slept and sometimes fasted for days at a time.

At the hospital, Devon Linville was diagnosed as delusional and manic, according to hospital records. He told doctors that he believed he was the Messiah and that he had frequent communications with God.

Two physicians recommended putting a psychiatric hold on Linville on July 30, records show, but he was released from the hospital the following day.

"He wouldn't take their medications so they let him out," Glenda Linville said.

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Friday, October 06, 2006

Suing for justice

When factoring in the costs to society of not treating people, don’t forget to include that of lawsuits.

Grieving families whose loved ones were abandoned by the mental health system are too often left with no choice but to call law enforcement when the person they love stops medication and deteriorates. Many of those encounters – again, sometimes in spite of rigorous police training – end up in tragedy. Some family members turn to lawsuits.

In California, police had responded twice before to take Jesse Hernandez into custody for mental health reasons – he had schizophrenia and was off his medication. The first two times they took him in without incident. The third time, after a 2-hour standoff with the SWAT team, he was killed.

In Ohio, the sheriff is facing a $250,000 lawsuit from the grieving family of Nasir Abdi. Abdi was killed “when four deputies came to take him to a treatment center for his paranoid schizophrenia after his family called for help because he refused to take his medication and was hearing voices. The deputies said that Abdi lunged at them with a kitchen knife before he was shot.”

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Thursday, October 05, 2006

Doing a disservice

Albuquerque, New Mexico recently passed a city-wide ordinance providing for AOT for their most severely mentally ill citizens. Unfortunately, opponents of the measure have resorted to scare tactics in hopes of preventing its implementation. The federally funded Protection and Advocacy Systems has repeatedly claimed that, "Under this law, a person can be picked up if there is simply the belief they might be a danger at some point in the future.”

In reality, the ordinance specifies that individuals are only eligible for AOT if they meet eight specific criteria; criteria that have been carefully crafted to focus only on the most severely mentally ill. But you won’t hear that from AOT’s opponents. Instead of discussing the realities of AOT, you only hear exaggerations and fear mongering. And that does a disservice to everyone involved in the process.

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Wednesday, October 04, 2006

Finger pointing in Oregon

“We all need to take some of the responsibility for society's problems.”
So says the chief executive officer of Cascadia Behavioral Healthcare in Oregon, in an oped piece today. You’d think the piece would go on to talk about how the community of providers can better help people in crisis. Instead, it spouts the latest provider party line:
“Police need to be able to recognize mental illness and work more effectively with someone who is experiencing a different reality.”
Who is to blame for a tragedy like the recent one in this community?

The writer notes that Project Respond, the crisis intervention group that works with police in crisis situations, was not contacted in the Chasse case.

We hear it all the time. It isn’t our fault because we weren’t called, it isn’t our fault because we don’t have enough resources, it isn’t our fault because the police need to be mental health professionals.

What happened after James P. Chasse was brought into custody was horrible, and answers need to be sought. As law enforcement assesses their policies, their mistakes, and their actions, we think the mental health community – so eager to speak up now – should do the same. Chasse had schizophrenia, and according to one family member, "He was in and out of half-way houses and acute care settings with various medical/psychiatric diagnoses and treatments prescribed."

His death came at the end of a violent struggle. His entire life was a similar battle. The mental health community should step up and assess their role, not in his brutal end, but in his brutal day-to-day life that preceded it.

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Tuesday, October 03, 2006

Laura's Law extended - now lets get it implemented

California's Laura's Law was extended to 2013 with a stroke of the Governor's pen on Friday. The bill (AB 2357) was overwhelmingly supported by California legislators (30-4 in the Senate and 65-5 in the Assembly).

California legislators sent a clear message about the county-determined program: California counties must help people with severe mental illnesses who are too sick to help themselves, and counties will be given more time to use a nationally proven program to do just that.

Nick and Amanda Wilcox - Laura's parents - are to be commended for their advocacy, as are the determined advocates at California Psychiatric Association, NAMI California, the California Medical Association, and a variety of supporters, from police chiefs to judges to editorial boards from the Los Angeles Times to the San Francisco Chronicle.

The California Treatment Advocacy Coalition and The Treatment Advocacy Center together produced "A Guide to Laura's Law" to help counties with implementation. We hope now that there is more time, people will get moving to bring this important treatment tool to those who need it most.

* * *

MORE: Statement by TAC Executive Director Mary Zdanowicz: LAURA’S LAW EXTENDED TO 2013: California legislators overwhelmingly support mandating treatment to the sickest – counties have green light to help those with the most severe mental illnesses

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