Thursday, November 30, 2006

Violence and schizophrenia

The forthcoming edition of Schizophrenia Research includes an article by TAC board president Dr. E. Fuller Torrey on "Violence and Schizophrenia." Dr. Torrey writes in part, as noted by Swanson and Holzer: “No one is served by ignoring the evidence that mental illness is associated with some increased risk for assaultive behavior.”

The violence issue among individuals with schizophrenia is a treatment issue, nothing more nor less. In virtually every case it has been found that the individuals responsible for such homicides, like the young man who killed Dr. Fenton, were not taking medication.

The problem is that approximately half of all individuals afflicted with schizophrenia have moderate or severe anosognosia; they are neurologically impaired and thus unable to perceive their own illness or need for medication. Laws governing the treatment of mentally ill individuals in the United States ignore this fact and make involuntary treatment exceedingly difficult to carry out.

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Wednesday, November 29, 2006

Overbuilt prisons, underfunded mh systems

Mary Beth Pfeiffer weighs in on the terrible situation in Florida in today's Miami Herald.

Pfeiffer is author of the forthcoming book Crazy in America: The Hidden Tragedy of the Criminalized Mentally Ill.

Pfeiffer, a well-respected author, notes that the small number of inmates who are drawing all the attention are just the tip of the iceberg. We would like to add that Florida has one tool that could help - a reformed Baker Act allows people to get court-ordered community treatment. Counties just need to start using it and may then be able to help some of these people who end up instead behind bars.

These inmates are a vivid reminder of the price to be paid when a society overbuilds ts prisons and underfunds its mental-health system, a demonstration of how long erm care of the mentally ill has shifted to the place where there is always a bed. Since 1997, Florida's prison population has swelled by 44 percent, to 89,000 inmates. Meantime, in a state that had 56 state psychiatric beds per 100,000 people in 1990, there are now eight. Squeezed by flagging reimbursements, 36 private psychiatric hospitals have closed in Florida since 1992 -- taking an additional 4,400 beds ....

Just 5 percent [of those inmates] were known to the mental-health system before they were jailed. Had they received care, they likely would not have gotten so sick -- and their prospects for recovery would not be so dim. They also might not have committed crimes that put them behind bars.

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Tuesday, November 28, 2006

A family's struggle

"We're not a Norman Rockwell family ..." this grandmother of seven says.

Then she goes on to describe a Thanksgiving that ended with her grandson being involuntarily committed. This family, like so many others, is struggling to find real help for a person they love who is not able to help themselves. Their struggle is made harder still because they live in Connecticut, one of only 8 states without AOT.

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Monday, November 27, 2006

England: Many say new law needed now

Letters to the editor in reaction to Tim Salmon's oped about his son have been fierce. A few examples ...

In all The Observer coverage last week of the new Mental Health Bill, the insightful portrayal by Tim Salmon of his son's schizophrenia best explained why we must reform the law to help patients and their carers ensure that the small number of who need it receive the treatment and protection they need. The proposals in the Mental Health Bill are essential to reflect how care is now delivered. Eight years of consultation have shown how difficult it is to find a consensus, but there is broad agreement that we must update the 1983 Act, and it is urgent that we make these changes.

- Rosie Winterton Minister of State for Health, London SW1

As doctors, we, too, have noted the linguistic shifts where people are called 'service users' when they may only be 'using' the services after legally being forced to do so. The aim, apparently, is to empower patients. In fact, health providers use this language to withdraw care. To talk of 'choices' makes it easy to present them as no longer in need. One of us has suffered a mental illness for the past 25 years. The 'care' was perfunctory and punitive. It is almost now non-existent. We were told to 'take responsibility', often by people unable to do so themselves.

- Sally Baker and BJ Brown Llanrug, Caernarfon

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Friday, November 24, 2006

England: "They're getting away with murder"

There has been much public outcry in the aftermath of the headline-grabbing tragedy of John Barrett, a man with schizophrenia who killed a stranger in England.

A distraight father, Tim Salmon, talks poignantly in the Observer about stigma and the system and the impossibility of getting real help for his son in a cuture that values language and empowerment above all else - including medical intervenation. He writes that one mental health worker noted his son was "having issues" - a euphamism for his schizophrenia, and then discuses:

... the intractable and messy nature of an illness whose distinguishing feature is loss of reason. Not that you are allowed to say that, because it runs counter to the 'ethos of optimistic realism', probably promotes stigma and generally interferes with our modern desire to pretend that there are no inequalities or other unpalatable differences between people.

This extreme aversion on the part of the caring professions to calling things by their proper names is one of the most vexatious 'issues' I have encountered. The sick are no longer patients, but clients or service users and, by implication, considered capable of evaluating their own needs, entering into contractual relations with doctors and other agencies whose function is to deliver the chosen service or care package. If this seems a surprising way of approaching people who, when ill, are almost by definition 'not in their right minds', what are we to make of the recent 'best value' review of mental health services by Camden council in north London in which it proposes to give patients/clients direct payments from social services with which 'to organise and buy the services you need for yourself'? And this, when one of the most notorious symptoms of schizophrenia is an inability to understand your own situation.

Camilla Cavendish in today's Times is also up in arms about the culture of what we way seeming to matter more than the importance of what we actually do to help people.

[The] determination [of the mental health lobby] to stamp out stigma can lead them to rewrite reality. Illness has become health. Patients have become clients. Savage attacks on other people have become "untoward incidents".

Now last week’s devastating inquiry into the death of 50-year-old Denis Finnegan, murdered while cycling through Richmond Park by a paranoid schizophrenic, John Barrett, is being twisted by powerful groups who put patient "rights" above public protection.

A respected consultant psychiatrist neatly summed up his profession’s hostility to inquiries. "Being retrospective," he said, "they foster a simplistic notion of the preventability of homicides". Really? What last week’s inquiry showed was that Finnegan’s death was wholly preventable, caused by gross incompetence and arrogance — from the tribunal that discharged Barrett in the absence of his doctor, to the psychiatrist who gave him an hour's leave from hospital, to the nurses who
failed to warn the right people that he had not returned ....

The whole reaction has been surreal. On Friday the Royal College of Psychiatrists insisted that "all the professionals involved in this inquiry [must] be supported" and
announced that it is planning — a seminar. Shouldn’t someone be sacked? ...

The Mental Health Alliance, a group of 80 charities, is concerned only to emphasise that Finnegan’s death was "extremely rare". This is a familiar refrain from those who fear the public will shun schizophrenics. But it borders on falsehood. When I called the Department of Health this week, I discovered that between 55 and 63 people are killed every year by people who have recently been in contact with mental health services. At about 10 per cent of the total murder count, dare I say this is quite a lot? The charity SANE believes that at least one in three of those murders is preventable. Its analysis of 69 such inquiries finds that in half the cases, professionals had ignored warnings from family and friends. Some psychiatric patients refuse treatment. What is less well known is how many others are denied it, even when they or their relatives are crying out for it ....

There was a preference for "engaging" with patients, over "intervening". There is an understandable reluctance to act in loco parentis for adults who may at times be perfectly capable. But the jargon of "empowerment" creates nonsenses. It means a manic depressive choosing not to "engage" with social services, which then walk away. It means a schizophrenic choosing whether or not to take medication, even if he has a violent history. It means setting Barrett free to buy a packet of knives
and take a taxi to Richmond Park. In most cases, treating people who have lost
their reason as though they were rational beings leads to misery and neglect. In
a few cases it leads to death.

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Wednesday, November 22, 2006

Not a happy Thanksgiving in Mass.

Thanksgiving is looking more grim than ever if you live in Massachusetts.

The Department of Mental Health appeared poised last night to go ahead with its plan to freeze admissions to state psychiatric hospitals today in response to recent budget cuts, despite intensive meetings with Romney administration officials who want the agency to find less painful ways to reduce spending.

The department has notified private hospitals that "admissions are shut down starting tomorrow until further notice, and we haven't gotten any further notice," David Matteodo , executive director of the Massachusetts Association of Behavioral Health Systems, said yesterday.

...Mental Health Commissioner Elizabeth Childs is planning to reduce spending on hospital staffing by $1.9 million, meaning some of the 850 or so beds in the hospitals would have to be left empty. The agency also plans to cut services to the mentally ill in the community. Advocates for the mentally ill on Monday circulated an analysis estimating 170 agency jobs would have to be cut.

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Tuesday, November 21, 2006

Making sense of the senseless

“Man dies after drinking gas, setting self on fire, police say

That headline from a short Dallas Morning News article raises eyebrows and disconcerting questions. Even if he decided to kill himself, why would Derek Hobaugh choose to end his life in such an incomprehensibly painful manner? And why even bother to drink the gas?

The main body of the article adds details, some of them puzzling, but little clarification. Before he died, Hobaugh explained that “they” had taken him from his apartment and “poured gas on him, made him drink gas and set him on fire.” And “they” told him that he deserved it. The reporter, however, clearly believes he is describing a suicide.

A logical context, if not understanding, only comes with the concluding sentence: Hobaugh “had been prescribed medicine for schizophrenia but had not been taking it.” Every year approximately 5,000 people with either schizophrenia or bipolar disorder die by their own hands.


Monday, November 20, 2006

Upcoming hearing on AOT

Tuesday, November 28th marks the culmination of months of hard work by advocates throughout Virginia. Following three separate hearings and hours of testimony, the Virginia Senate Education and Health Committee will hear the recommendation of its subcommittee on two AOT bills – Senate Bills 18 & 309.

This marks a real opportunity for Virginia to update its laws to help those most in need and we encourage everyone to attend. A strong showing by advocates will signal to the Legislature just how important AOT is to the people of Virginia.

The hearing will take place in Senate Room B in the General Assembly Building at 10:00AM, Tuesday, November 28th. Directions and information on visiting the Capitol are available here.


Friday, November 17, 2006


  • One Florida judge gives the state 60 days to figure out how it will move mentally ill inmates out of Orange and Osceola jails and get them the treatment they need, saying “"I wanted to have something done today, but years of neglect of the mental health system is nothing something that's going to be fixed overnight."
  • A Maine advocate applauds Robert Bruce’s lawsuit against the state claiming state negligence played a role in his wife's death at the hands of their son. The letter-writer noted “What a shame when the difference between life and death are a few pills a day, and you can't make your loved one take them. His fight isn't just for him, but for all of us who have been there.”
  • A Virginia paper comes out in support of Virginia State Supreme Court Chief Justice Leroy Hassell’s Commission on Mental Health Law Reform.
  • Kaiser Permanente is charged in skid-row dumping in Los Angeles, California.

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Thursday, November 16, 2006

"Housing First" leaves sickest in the cold

When we can more clearly separate “severe mental illness” from “mental health,” it will be easier to also treat those two populations appropriately.

Take homelessness.

Housing First” is all the rage, and for those who are not severely mentally ill and symptomatic, that plan has great merit. Many are homeless because of poverty, life circumstances that turned against them, substance abuse, or mental health problems. Getting them first into an apartment and then into the care they need may be just the ticket.

But for the homeless who are also severely mentally ill, delusional, psychotic, and lacking insight into their own situation, giving them the keys to their own place isn't the answer. Some already have their own place. Some have family members eager to bring them back to their homes. The problem isn’t a place to sleep at night, it is a brain disease that convinces them that those places are inhabited by monsters or operate as fronts for the CIA.

These people actually need treatment first, often involuntary treatment, to bring their brain diseases into check. Then and only then will they be able to accept proffered offers of housing.

This group, as we have said before, is a small percentage of the total homeless population, but they drain an inordinate amount of resources from the system.

“In the early [1990s], [Dennis] Culhane’s database suggested that New York City had a quarter of a million people who were homeless at some point in the previous half decade. … But only about 2,500 were chronically homeless,” [Malcolm] Gladwell wrote.

Culhane estimated that at least $62 million was being spent each year to shelter those 2,500 hardcore homeless people in New York.
Providing housing first may be just the thing for many homeless. But it won't help the most severely mentally ill. Yes, they are the hardest to help in many ways, but they also deserve our consideration. Someone should launch a “Treatment First” plan to address that very different population.


Wednesday, November 15, 2006

Heroic judges

As you know, Florida judges are threatening to jail a Florida mental health official for failing to transfer more than 300 jail inmates to state psychiatric hospitals for treatment. But it should not surprise anyone considering that the state closed a 382-bed state psychiatric hospital in 2002.

If judges with contempt powers can’t get the state to hospitalize mentally ill inmates, imagine the obstacles that Florida families now must face in trying to get hospital care for a loved one.

TAC applauds the Florida judges for holding the mental health administrators accountable for the neglect of the states severely mentally ill citizens. It’s about time somebody did.

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Tuesday, November 14, 2006

Texas two-step

After 2 years of treatment, Dena Schlosser, who killed her infant daughter by cutting off her arms, has been ordered to remain in a forensic psychiatric facility for at least another year. But Lisa Ann Diaz, who drowned her two daughters, has been released on the condition she undergo outpatient treatment.

This is focusing many in Texas on the issue of what constitutes appropriate punishment for someone like these two mothers.

"There needs to be a change in the law, something that would allow a person to receive treatment for illness but not escape punishment," said Greg Davis, a Collin County prosecutor. Davis and others are pushing for a new sentencing option in the state, guilty but mentally ill.

Apparently it isn’t punishment enough to have a debilitating brain disease, deteriorate into psychoses, and brutally murder your own child. Once you are restored to sanity, you then must spend the rest of your life behind bars plagued by what you did when you were lost to the symptoms of an untreated mental illness. Others in similar situations tell horrible stories of their torment once medication brings their symptoms under control.

As the editorial board of the Dallas Morning News noted: “The public can temper its revulsion by considering the very condition of mental illness. The afflicted do not cause or invite their torment. They suffer from it. Mental illness doesn't boil up from some malevolent core. Rather, it commonly stems from chemical or structural abnormalities in the brain.”

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Monday, November 13, 2006

"There ought to be a sense of outrage ..."

Texas has a good law ... but it is rarely used.


Thursday, November 09, 2006

Beds in Florida ...

In Florida, DCF officials may soon be in cells next to the hundreds with severe mental illnesses waiting for hospital placement, committed to what DCF claims are nonexistent inpatient beds.
Long waits for placement in state psychiatric hospitals are nothing new in Florida. One man, ordered into care on Oct. 18, 2005, waited 176 days to be transported to a hospital. Two other men, found incompetent in June, waited 82 and 86 days.
Brevard County is acting to create more psychiatric beds - too bad the 288 beds being added aren't in a new psychiatric hospital, but in a new wing of the prison.

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Wednesday, November 08, 2006

Abuse of commitment laws

The Treatment Advocacy Center advocates for strong treatment laws – and protections. Our Model Law includes numerous overlapping protections to safeguard those under court-ordered treatment and to ensure that only those for whom it is appropriate are placed or remain in assisted treatment.

It should be extremely difficult to abuse such laws, and we are pleased when people trying to do so are caught and punished.


Tuesday, November 07, 2006

"You're only God for awhile"

In a state with no AOT, a creative judge finds a way to keep a young man out of jail and on his meds.

Travis Williams said he was embarrassed by his behavior now that he's thinking clearly and he is happy to have medication administered intravenously once a month.

"I'm lucky that no one got killed. I remember being mad but I don't remember why I was mad," he said. "You're only God for a while."

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Monday, November 06, 2006

Rosie's Journey

If this whole series in the Dallas Morning News, "Rosie's Journey," is as gripping as the first two days, you won't want to miss a single installment.


Friday, November 03, 2006

Goldstein gets 23 years

“When I took a train today and I waited for the train and I looked down the platform for the train to come, I was just sick, thinking, you know, of my daughter waiting for that train,” said Webdale’s mother Patricia Webdale. “And the only other emotion I could share with you is I felt great sadness when I looked at Andrew Goldstein. Just really sad. Not hatred, like, ‘I really hate you,’ but ‘I really am sorry that you didn’t get treatment before you killed my daughter.’

“I don’t think we really hate Andrew Goldstein,” said Ralph T. Webdale. “We really hate what he did; maybe the system that didn’t take care of him well enough to have this not happen.”

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Thursday, November 02, 2006

Goldstein sentencing

Andrew Goldstein’s sentencing is today.

Goldstein pushed Kendra Webdale – for whom Kendra’s Law is named – to her death in front of a subway train.

MORE ON GOLDSTEIN: Recycling an old debate - A walking time bomb - No freedom from his illness - NY spent $95K for his treatment (hardly the profile of someone refused services)


Wednesday, November 01, 2006

The task force blues

It is always a question ... actually act to change the system or spend time meeting about acting? Many in Oregon are pushing for the former ...
Doris Cameron-Minard, a past president of the National Alliance for the Mentally Ill in Oregon, whose son suffers from mental illness, said she has served on two governors' mental health task forces. She said she's been frustrated that many of the ideas that came out of those reports are still gathering dust. Steps that need to be taken, she said, include expanding access for the mentally ill to community treatment, and providing diversion treatment programs so people suffering from mental illness don't end up in jail. - The Oregonian, Nov. 1, 2006
We commend Oregon advocates like Cameron-Minard and state Sen. Avel Gordly for realizing that meeting alone won't solve anything.

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