Deadly Similarities

On opposite sides of the country this week, two different families felt the same harrowing impact of untreated mental illness.

In Celina, TX, 21-year-old Preston Boan struck his grandparents repeatedly with a wooden dowel until they were lying bloody on the floor.

In Raleigh, NC, 37-year-old John Patrick Violette is charged with decapitating his 4-year-old daughter.

Both men were diagnosed with severe mental illness- one with bipolar disorder, one with schizophrenia. Both had been in and out of hospitals and had a history of going off their prescribed medications. As one of Boan's family members noted:

“You'll find ... that he has had problems for quite a while. I think that we, as a family, have tried to do everything in the world that we can to help him and support him and get treatment for him."

Law enforcement and corrections officers as mental health advocates

Why should corrections executives care about mental health policy?

Because America’s jails and prisons have become the nation’s de facto psychiatric hospitals.

[And ] unlike Dorothea Dix, modern mental health advocates … tend to focus very little on what the mental health system should be doing to abate this tragedy and instead shift the burden to law enforcement and corrections officials.

The criminal justice system is called upon to divert the mentally ill from the criminal justice system through specialized police programs, mental health courts, and jail-based treatment. Mental health advocates push law enforcement to improve crisis intervention training, ignoring the fact that it is their role to stop crises before they get to that point. They want more mental health courts, seemingly forgetting that those useful tools still require someone with a severe mental illness to be arrested before that “diversion” tool can be implemented.

Read more from TAC Executive Director Mary Zdanowicz in this month’s Sheriff Magazine, published by the National Sheriffs Association.

Warped priorities

In Pennsylvania, still more hospital beds are being phased out – leaving precious few for anyone other than those accused of crimes.

Under a settlement of a lawsuit reached last year, the hospital agreed to phase out 210 of 304 patients, most diagnosed with schizophrenia, in the civil section over four years. The forensic section, for people accused of crimes, will be unaffected.

And in California, mental health workers, physicians, and pharmacists are rapidly shifting from hospital jobs to prison jobs, where pay is a remarkable 40% more. The result is significant staff shortages at the hospitals.

Although several of the state hospitals still accept patients committed through the civil courts, the vast majority of mental hospital patients statewide now are channeled through the criminal justice system … Abysmal medical and mental-health care in the state's prisons prompted federal overseers in two separate lawsuits to order the soaring pay increases as a way of luring competent clinicians to the California Department of Corrections and Rehabilitation.

The California debacle leaves Atascadero State Hospital with only 30% of its allotted psychiatrists. (And now the prisoners who are supremely ill and require inpatient psychiatric care cannot get transferred into Atascadero – and are being sent straight back to prisons, where hopefully all those newly hired medical professionals will find a way to treat them …)

It would be nice if the recent surge in concern over improving prison mental health care was paralleled by a concern for improving care in inpatient psychiatric hospitals. Alas, it seems that the search for quality inpatient beds is being totally abandoned in lieu of improving prison and other forensic beds.

As today’s Washington Post notes:

Patient advocates say the long-term solution to the problem is simple: Make
more beds available. ... [As one expert says] "There is no more expensive way to access the mental health system than through the court system.”

Averting Jail in Texas

In Tarrant County, Texas, compassionate police officers, trained in assisting the mentally ill, are working to keep the mentally ill out of jail. Thanks to those like Officer Spakes, people like this older man were able to get help instead of getting arrested.

Instincts and training kicked in when Fort Worth police officer W.E. Spakes
answered a call on his north-side beat and encountered an older man. Spakes knew that there was something wrong with the man, who had a habit of walking the streets carrying his money in a plastic grocery bag. He said the man talked about "hearing voices that were telling him to do things" -- to himself and others. Spakes didn't consider the man an imminent threat to anyone else, so he made a call and described the situation. As a result of the call, Spakes said, he got the man "the help he needed" without putting him into the criminal justice system.

Tarrant County and officers like this one are working to “get mentally ill people the help they need rather than filling the jails with them.” Another story that makes it clear that it is the right combination of people who care and laws that work – and are implemented – that will truly help the mentally ill get treatment.

Hospitals are victims as much as villians

A series from the Atlanta Journal Constitution earlier this month focused on at least 115 suspicious deaths of patients in Georgia’s seven psychiatric hospitals and more than 190 cases of physical or sexual abuse. The series also documents violence against hospital employees and ties much of the horrors back to gross understaffing and underfunding of these institutions.

There are calls for a legislative commission – and NAMI wants the U.S. Justice Department to launch an investigation.

For decades there has been a widespread and concerted effort to close down hospitals and move patients into community treatment. Community providers take the money that comes with such a shift with ease, but then balk at performing some of the more critical hospital functions, including involuntary treatment. At the same time, there is little realization that some people need intensive inpatient care – and for those people, the cry should be not to kick them out of the hospitals, but to make the hospitals better. The result is that some of the sickest people are left behind, because neither the much-touted community services or the outdated and underfunded hospitals can address their very real and immediate treatment needs.

Horrors like those listed in the AJC stories are eye-opening and terrifying – but the hospitals did not end up underfunded and understaffed by their own choosing. As Dr. Jeffrey Geller says in the series:

"Ultimately, do the taxpayers want to do what's needed to be done in their state hospitals, or not?" says Dr. Jeffrey Geller, director of public sector psychiatry at the University of Massachusetts Medical School.

"It's too simplistic to make the state hospital the isolated villain," he says. "The state hospital is as much a victim as a villain — a victim of inadequate funding, a victim of the general population of the state not caring enough about its most unfortunate and disenfranchised, a victim of ineffective utilization of resources that do exist."

State of the Union: Mental Illness

From National Journal - mental illness is one of the issues you will NOT hear addressed in tomorrow's State of the Union ...

After 40 years of blue-ribbon panels, myriad reports, and poorly aligned public policies, severe mental illness remains an intractable and deepening problem in America. For proof, look no further than the homeless lady muttering on the corner outside your office building.

"Mental illness is the No. 1 public health crisis in the U.S. today," declared Ron Honberg, legal director for the National Alliance for the Mentally Ill, an advocacy group based in Arlington, Va. ...

In 2001, the most recent year for which official figures are available, the U.S. spent $85 billion on mental health treatment. Experts estimate that figure is closer to $130 billion today, with federal prescription coverage included. The costliest subset by far is the severely and persistently mentally ill -- about 12 million adults with schizophrenia, bipolar disorder, and major depression -- who account for 58 percent of the spending, according to researcher and activist E. Fuller Torrey ....

It doesn't help that the federal government continues a long-standing ban on the use of Medicaid money to fund state mental hospitals, said Mary Zdanowicz, executive director of the Treatment Advocacy Center. The policy led to a wholesale emptying of state psychiatric hospitals in the mid-1960s and another wave of discharges in the early 1990s. "In Virginia, we've closed 50 percent of state hospital beds in the last 20 years," Zdanowicz said. "That's a critical -- and often overlooked -- loss for people who need intensive treatment for a severe mental illness."

Dateline producer: "This is not tilting at windmills stuff"

From the blog entry of Dateline producer Lee Kamlet - Dateline will be airing a show on the Kendra Webdale story today, SATURDAY, JANUARY 20 at 8:00 pm EST:

On a damp, dreary day in January 1999, Kendra crossed paths with another New Yorker, a stranger named Andrew Goldstein. Kendra had made a last-minute decision to defy the rain, and take the subway to meet some friends. Andrew was going to take the same train home. Witnesses say Andrew stepped up to Kendra and asked the time. Then, just as the train pulled into the station, he stood behind Kendra, and with what one person called impeccable timing, shoved Kendra in front of the train. She died on the tracks.

The horrific story stunned not only New Yorkers, but the entire nation. What could have prompted someone to push a total stranger in front of the fast-moving train? To find the answer, Dateline spent 10 months investigating the story. We learned that Andrew Goldstein had quite a history ... [Read more ...]

Missing persons

The story about the two missing boys who were found alive in Michigan has made the nation painfully aware of the suffering that families must experience when a beloved child disappears. On any given day, there are scores of families around the country wondering about a missing loved one whom they know is vulnerable to a severe mental illness. Three separate newspaper stories yesterday exposed the commonality of this problem:

A Michigan man’s 56-year old brother who has schizophrenia walked away from a group home without his medication and has been missing for 2 weeks.

A Maryland family is hoping that their mentally ill brother, who has been missing for a month, will return safely. Before he left, he told his sister that he wanted to go to the airport, but he left without his medication.

While those families are hoping for a safe return, others are not so fortunate.

An Arlington, VA woman learned that her brother who suffered bipolar disorder was found dead in the woods neighboring the George Washington Parkway. The discovery ended nearly 2 months wondering where her brother was.

Our hearts go out to these families and so many others who are still wondering and waiting for a mentally ill loved one to return.

Kendra's Law on Dateline this Saturday

Tune in to Dateline this Saturday, January 2o, for a piece by Edie Magnus on the death of Kendra Webdale 8 years ago in New York. New York's widely successful "Kendra's Law" was named for her and is in place and helping people today because of the compassionate advocacy of the Webdale family.

Find your local channel and airtime on Dateline's website.

A SAMPLE OF THE RESULTS OF KENDRA'S LAW ...

During assisted outpatient treatment (AOT):

• 74% fewer participants experienced homelessness
• 77% fewer experienced psychiatric hospitalization
• 83% fewer experienced arrest, and
• 87% fewer experienced incarceration.

Individuals in Kendra's Law were also more likely to regularly participate in services and take prescribed medication.

And AOT recipients endorsed the effect of the program on their lives. After receiving treatment, 75% reported that AOT helped them gain control over their lives, 81% said AOT helped them get and stay well, and 90% said AOT made them more likely to keep appointments and take medication.

VA hearing moved to 8:00 am

Thursday's hearing time has been moved up to 8:00 am ...

http://psychlaws.blogspot.com/2007/01/in-virginia-upcoming-hearing-on-aot.html

Twisted justice in Kentucky

No question Jacob K. Robling needed help. He was keeping the severed head of the family cat under his bed.

And no question his family was not setting out to have him arrested on animal cruelty charges.

Yet that is what happened.

Robling's stepfather said in an interview on Thursday that he and his wife never intended for Robling to end up in jail when they called police to report they'd found Clarabelle's remains. Gene Willis said he just wanted police to take their son to a hospital.

Execution watch ... Indiana

Normal Timberlake is set to be executed January 19 in Indiana for killing a state trooper. His attorney wants the execution delayed until the U.S. Supreme Court rules on a parallel case of Texas inmate Scott Panetti.

"Norman is paranoid schizophrenic. He is delusional. He is experiencing auditory hallucinations and he irrationally believes the government operates a machine that tortures him and is trying to kill him," [his attorney, Brent] Westerfeld said. "As is true with most people with that kind of mental illness, Norman believes he is completely sane and firmly believes this machine exists."

[Norman] Timberlake talked about the machine during his clemency hearing before the state Parole Board on Monday, saying the federal government should look into the use of the machine.Westerfeld said that during the appeals process Timberlake wanted his attorneys to prove the machine exists.

In Virginia: Upcoming hearing on AOT

Following three separate hearings and hours of testimony, the Virginia Senate Education and Health Committee will finally hear the recommendations of its subcommittee on AOT and Senate Bill 808.

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 8:00 am [NOTE: This was originally set for 9:00 am], Thursday, January 18th. Directions and information on visiting the Capitol are available here.

A consumer on compliance

A riveting new blog by Robin Cunningham offers a compelling look at the issue of compliance ...

In all the incidents of non-compliance cited above, both voluntary and involuntary, the consequences were devastating. Within three or four days my symptoms returned with a vengeance, especially thought insertions, hallucinations, paranoia and delusions of grandeur. Within seven to ten days, I lost all insight, i.e., I no longer realized I was ill.

"I'm the face of a thousand people behind me just crying for help"

One mother in Utah has tried to help three of her adult children get the treatment they need. But what does it take to get them that treatment?

For these three siblings, the answer was murder, a suicide attempt, and an arrest. Two of the three are now receiving treatment in prison.

In 2005, nearly 1,300 people deemed "seriously and persistently mentally ill" were booked into Salt Lake County Metro jail. To incarcerate, assess and treat this population would cost the county more than $7.3 million.

That's just one jail system, and doesn't account for the human costs, said [Sherri] Wittwer [of NAMI Utah].

"What a difference it would make, for the individual, the family and the community, if we intervened earlier."

Development or treatment?

If nothing else, we hope that Kenneth Smith instilled in readers of the News & Observer a measure of perspective, a tad of guilt for their own preoccupations, and a spark of desire to improve the care of people like those no longer in Dorothea Dix Hospital. In his excellent letter to the editor, he says, in part:

Years ago the decision was made to close Dorothea Dix ... Collectively discussed was whether this priceless piece of real estate should be park land, condos, offices or
other forms and combinations of the ubiquitous development that crawls like
kudzu over Raleigh.

Conspicuously absent from the discussion is the asking of a simple question: Are mental patients better off as a result of closing Dix?

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Overhyping a coercion controversy?

Two international studies recently examined consumers and other stakeholders’ experiences with AOT in long-standing programs in Canada and New Zealand.

Their findings echo what we hear over and over from families and consumers who’ve actually participated – AOT works and the controversy surrounding its use is much more attenuated than those who oppose it would have you believe.

As the Canadian researchers explain, “[O]ur findings were similar to those of researchers in New Zealand who noted that the actual experience of coercion by the majority of patients was much less than the strident policy debates… sometimes suggest.”

Remembering Kendra Webdale, her family and so many others

Eight years ago today, Kendra Webdale a vibrant, beautiful young woman was pushed to her death from a subway platform in New York City by a man with schizophrenia who had a documented history of assaults and failing to follow prescribed medication regimens.

At the time, advocates like DJ Jaffe had been working for at least 10 years in New York toward a statewide assisted outpatient treatment law. Kendra family’s commitment to prevent the tragedy of untreated mental illness coupled with Governor (then-Attorney General) Elliot Spitzer’s political will finally succeeded in achieving the reality of Kendra’s Law for assisted outpatient treatment in New York. All those who are being helped by Kendra's Law in New York today are indebted to the Webdales, particularly Kendra’s mother Pat, who continues to advocate and Chairs the AOT Quality Improvement Panel sponsored by New York’s OMH.
In addition to mourning Kendra, today is a day to remember some other random victims of the violence that is sometimes a result of untreated mental illness ... and the families who have, like the Webdales, opened their hearts to try to help others.

Edgar Rivera, who lost his legs after being pushed from a NY subway platform in April 1999, epitomized grace and understanding when he lamented that although he lost his legs, at least he had his mind, unlike his assailant. Linda Gregory partnered with Alice Petrie, the sister of the man who shot her husband in the line of duty as a sheriff’s deputy. Their successful advocacy lead to Florida’s adoption of AOT and they continue to advocate for more humane treatment. Amanda and Nick Wilcox’s daughter was killed at a mental health center in California by a man with untreated mental illness. They are fighting to get their county to adopt Laura’s law.

There are so many others, too many to mention here, but we particularly want to remember 11-year-old Gregory Katsnelson who was killed, while riding his bike, by a young man whose family was told he was not “dangerous” enough to be helped. Before he killed Gregory that day, he also killed his own mother. Gregory would be 15 years old now - the Katnselsons have spent the last 4 years trying to persuade New Jersey legislators to become the 43rd state to adopt an AOT law. The Senate, under the leadership of Governor Codey, passed the bill last year.

Our hope for the New Year is that the Katsnelsons will succeed as other families have in making a terrible tragedy into a legacy of hope for others ... and that better laws and better usage of and understanding of the laws that exist will mean fewer sad anniversaries like today.

Posted by TAC executive director Mary Zdanowicz.

Required reading for psychiatrists ...

In Crazy, Earley provides a remarkable and fresh look at the US mental health system. He does so in a balanced, honest, self-reflective, and informed way. Crazy offers a unique and sensitive perspective on questions America is reluctant to address. It should be required reading for psychiatry residents, forensic fellows, and any psychiatrist interested in public sector psychiatry ...

Placing his argument in historical context, he describes deinstitutionalization as a well-intentioned but poorly reasoned outgrowth of the antipsychiatry movement, which began in the 1960s ... Earley describes deinstitutionalization as an "unplanned social disaster," which ... has created an environment as abusive to the mentally ill as the dreaded state hospitals of the past ... Earley poignantly reflects on a society that accepts homelessness as a civil right ...

- Journal of the American Medical Association (JAMA), January 2, 2007