Increased training or treatment?

In November, police officers fatally shot 19 year-old Ryan Salisbury when he ran toward them with a knife. Salisbury’s mother had warned police officers that he suffered from bi-polar disorder and was having a psychotic break, and they took precautions, like turning off their lights and sirens upon arrival, and initially shooting him with non lethal beanbags.

But the beanbags didn’t phase him, and he kept advancing on officers. Salisbury’s mother watched from a bedroom window as her son was struck by four bullets.

Just one week before the shooting, the officer who shot Salisbury had participated in a training session about how to handle encounters with people with mental illness.

The officer was trained to handle people with mental illness, they first used non lethal methods, and they were responsive to the family in their approach. Yet Salisbury still died.

Increase officer training? Or stop people from deteriorating into psychosis in the first place?

Good Judge-ment

A powerful letter to the editor by Judge Tom Rickhoff, a probate judge from Bexar County, Texas, highlights many of the unfortunate realities of our nation’s mental health system. Judge Rickhoff rightly points out the important role lack of treatment must play in any discussion of stigma, explaining that “we must recognize and treat the dangerously mentally ill, not just fight the stigma.”

We couldn’t agree more.

Kendra's Law saves lives

James Masse struggled with severe mental illness for years. Eventually, he was placed in Adult Protective Services, but even that wasn’t enough to help him. When Masse was found walking into oncoming traffic, Kendra’s Law- New York’s version of assisted outpatient treatment (AOT) - was enacted for him. According to Megan Johnson, deputy clinical director at the Office of Community Services for Warren and Washington Counties:

It's a "last resort," Johnson said, but can help people avoid ending up in jail
or an emergency room.

"It is the most restrictive measure available to us, and taking away an individual's freedom of choice is not something we take lightly," she said. "But it allows us to intervene earlier, before they become an imminent danger to themselves or others.

Thanks to AOT Masse’s life has turned around. Masse says:

"I'm not ashamed of having a chemical imbalance. It's something that happened by accident; it's not like I'm being struck down for doing something bad," he said.

"If other people can help and not be the way I was, that's good."

Behind bars in Texas

Philadelphia Weekly managing editor Liz Spikol points on her blog to an amazing editorial in Texas' Navasota Examiner, that says in part:

Aaron George sits in the Grimes County Jail, deteriorating every day, becoming less and less functional, less and less himself, less and less "human" as a human being, all while leaving the sheriff and jail staff frustrated and helpless ....

It's criminal, when [District Attorney Tuck] McLain says the state could use at least four times as many mental health beds, to continue to cut funding for state mental health services ....

This isn't a "conservative" or a "liberal" issue; it's a humanity issue, as any religious or philosophical beliefs you hold will tell you. Period.

SWAT team or hospital?

Marty Dale Rogers was killed by a police SWAT team, dispatched to his house by mental health providers who said Rogers may have threatened mental health officials earlier that day.

When faced with someone who has severely deteriorated, even mental health providers seem to turn to law enforcement for help.

Watch now for the outcry of the mental health community that law enforcement officers need more training, despite the fact that those same providers are already theoretically fully trained to deal with people in psychosis.

North Carolina has a good law that should have allowed Rogers to get help before he dressed in camouflage and hid in a field with an automatic rifle. Officials said he could have taken out four or five officers if he hadn't himself been shot. It is a tragedy all around, and appropriately enough, the involved officers have been put on leave while there is an investigation.

Would that we could say the same for those charged with treating Mr. Rogers.

Parricides in California

In the past four months, three young men have been accused of killing their parents in Contra Costa County, California, two in the last five days. All three young men suffer from mental illness and were living at home.

[Angelito Ares, who stabbed his father to death] had a long history of mental disorder. The father had been attempting to help him with those issues, and had actually taken him in the past two years.

A local pastor said [Lymus] Howard [who beat his mother to death,] has suffered emotional problems since age 6 when he saw his father shot dead. Friends said his mother battled with Howard to get him to take his medication.

[Andrew Matas’] father said the boy hears voices, and admitted he had stopped taking his anti-psychotic medication, Risperdal. [Matas bludgeoned his mother to death with a baseball bat.]

And yet some are having trouble seeing a link in the crimes.

"Forgive us for not coming to her rescue..."

Natashay Ward has been sentenced to three consecutive life terms for killing her three young children in 2005. Both the prosecution and defense in Ward’s sentencing agree she suffers from a mental illness – yet prison is her “treatment”.

According to Ward’s pastor:

"You and I would agree, I think, that a mother would not allow her children to starve to death while she reads the Bible and be normal at the same time. She was not thinking of her own reality, she's living in someone else's reality, which may not even be real…

On the level of forgiveness, she may need to forgive us. She may need to forgive us for not coming to her rescue in time.”

Painting the town red

In Seattle, Todd Michael Wagner painted the town red, or at least a home he was supposed to be remodeling. Unlike the turn-of-phrase, Wagner’s painting was literal and psychotic.

Wagner now sits in the King County jail, charged with a $200,000 vandalism tab. According to a family member:

“Michael suffers from paranoid schizophrenia, and he refuses to acknowledge it, even now, in jail."

"Michael is so adamant that he's not mentally ill, and he wants me to bail him out. I just can't. I feel really bad for the people he did this to. He's truly a wonderful human being, but he's sick and needs help. I hope the judicial system figures that out."

"She belongs in jail where she can't hurt somebody else"

Tiffany Sutton is under arrest for stabbing a man and attempting to drink his blood.

Her mother - like many others - is actually feeling a measure of relief that her daughter is now in an Arizona jail - because perhaps now, she will get help, or treatment, or at least be kept safe.

"I knew it was coming," [Lorrie] Hanneman said. "I told the police officer I talked to on the last time that she's become a danger to herself and others. She's not afraid to die right now. I honestly believe she wants to die, so I just keep waiting for that phone call that she's dead."

"If I can't help her, then she belongs in jail where she can't hurt somebody else. What else can I do?"

Hurricane Katrina and the treatment crisis

In New Orleans, Hurricane Katrina decimated the city’s psychiatric services.

In the 16 months since the storm hit, the number of hospital beds has plummeted. Remaining facilities have limited space and people in crisis often end up being treated by – or held in – the city’s emergency rooms until a bed opens up somewhere else. And as for police, “two officers always escort psychiatric patients to emergency rooms, where they often must wait for hours until the hospital can accept them. The wait prevents officers from patrolling.”

Some small measure of relief may be coming in the form of a new psychiatric facility.

"That would be tremendous," [Dr. Joseph ] Guarisco [chairman of emergency medicine at Ochsner Medical Center] said. "Psych is our No. 1 crisis right now in the emergency department. The city's outpatient and inpatient psych capacity was plundered by the storm. We have been inundated with chronic mental illness without any available resources for these patients."

The country overall is facing very similar problems. Just because it took 40 years to reach this crisis nationwide doesn’t mean it isn’t worth addressing just as aggressively.

Our national system was plundered by a different kind of storm, waged not by nature, but by well-meaning advocates who saw all hospitals as negative and all commitment laws as paternalistic.

Suicidal … but not deemed a danger to self?

Police said he was suicidal, the family saw him deteriorating – but then mental health professionals evaluated him and decided there were no problems.

They let him go because, as a representative of the facility later noted, a patient “can refuse service if they’re thought to be okay.”

Then Topeka resident Stuart Williams, a man with schizophrenia, jumped in front of a semi-truck.

Not guilty by reason of insanity

For years Bill and Tena Neely struggled to get appropriate and consistent treatment for their daughter Tracy, diagnosed with schizoaffective disorder. Even after Tracy shot her mother at the family’s home, the Neelys still had to fight to get treatment for Tracy. As one advocate noted, in South Carolina,

“… mentally ill people usually go to prison, where they may get little or no treatment.”

Tracy Neely’s family fought hard for her to get a rare “not guilty by reason of insanity” verdict – one of only 7 such decisions statewide last year. Now she is receiving treatment in a mental health center instead of serving time in prison. Her dad offers advice to other family members in similar situations:

"There's no rulebook. You've just gotta hit it as hard as you can and as fast as you can to save your daughter."

Good advice for families. But what about all of those with severe mental illness who don’t have someone to fight the system to get them treatment?

The importance of treatment

Two stories today illustrated the importance of consistent treatment for severe mental illness.

In Virginia, a young man tied up and assaulted family friends shortly after he was released from a state mental hospital. The victims, who have publicly forgiven their attacker, explained,

“When [he] takes his medication, he’s a nice caring person. But when he doesn’t, he’s dangerous.”

In Texas, the brother and sister of a man who fatally shot his parents before killing himself told sheriff's deputies their brother had a mental illness and had stopped taking his medication. Aransas County Sheriff Mark Gilliam explained:

"The family said the mother and father were dealing with trying to get him to take his medication and he wouldn't," Gilliam said. "When he didn't, he would go off the deep end."

DCF settles feud over treatment of jailed mentally ill

Back in December, we wrote about the battle between DCF and local jails in Florida. While the state Department of Children & Families argued that they had too few hospital beds, people with severe mental illnesses were languishing and dying in county jails. The problem had gone on for years (as noted in this 2002 Florida Sheriffs Association resolution.) DCF maintained they did not have the bed space for the inmates even though they were required by statute to provide them hospitalization AND even after district court judges ordered the department to follow the law.

With new leadership at DCF and an increase in funding from the state legislature, the department is now trying to make good on its responsibilities to some of the states most vulnerable citizens.

More than the lack of a home

According to a recent report from the National Alliance to End Homelessness, almost three-quarter of a million were homeless in a single month of 2005. Included were 3,415 people who were homeless in Minneapolis. Given the high concentration of those suffering from mental illness among those living in the streets and shelters, it is not surprising that Minneapolis is seeking to alleviate homelessness among that beleaguered population.

The city is offering attractive and purposefully affordable housing with no strings attached. It’s the logical approach – solve homelessness with homes, but that’s not working in Minneapolis because there have been few takers. Fifty vouchers for highly-subsidized housing where given to the Assertive Community Treatment team dedicated to serving the municipality’s homeless population. Since then, only five people with mental illness have taken the chance to move from the streets into a place of their own. The rest remain homeless, braving a Minnesota winter either by choice or – perhaps more likely – by illness.

Do state laws place mental health professionals in danger?

Washington State trains county designated mental health professionals to assess whether a person with severe mental illness who is in crisis is also a danger to self or others. If so, the person might qualify for a 72-hour hold and evaluation to determine if hospitalization is needed.

Marty Smith responded to one such crisis and lost his life to a dangerous patient. Now state legislators are considering the “Marty Smith” bill to recognize him and to help improve safety for mental health professionals. While elected officials debate this bill, we also need to ask them some hard questions:

Why do mental health professionals have to wait until a patient deteriorates to a point of dangerousness before they can help?

Why do county designated mental health professionals and judges not use the state treatment law and intervene for people who are “gravely disabled” ?

Why does the state fail to make use of its “less restrictive alternative” provision to provide mandated treatment in the community instead of hospitals?

41 other states let families directly petition a court to get treatment for a loved one in crisis. Why does Washington State require county designated mental health professionals to be the “middle man” in their process?

The Shock, Grief, Panic and Guilt from the Other Side of a Tragedy

Severe mental illnesses can agonize in so many ways. The most direct manner is the impact on those who have them, but the scope can range far wider – to the families, others, and numerous critical components of our society.

Among the most heart-wrenching of anguish is that of families whose loved ones fall victim to the acute psychiatric disorder of another. We have painfully watched as families, such as those of Kendra Webdale, Laura Wilcox, and Gregory Katsnelson, bravely withstand the devastation of needless and unexpected loss. We have also been awed as members of these families have nobly turned their grief, not into revenge, but to bringing treatment to people incapacitated by illnesses like the one that ripped away their child, sibling or parent.

There is a flip side of these tragedies that rarely gets attention – the grievous turmoil of the families of the person who caused the harm, and did so only because of the symptoms of an illness that were neither asked for nor susceptible to self-control.

Imagine the turbulent mixture of shock, grief, panic and guilt experienced by the parents of Anthony Capozzi when their son, who has schizophrenia, was charged with two rapes in 1985 and later convicted of them. Was it the illness? Could his parents have prevented his actions? Something else? According to Albert Copozzi, Anthony’s father, "It is with you every moment …We don't go to bed at night without thinking about our son."

To put a twist on the Capozzis' distress that is hopeful yet also utterly confounding, imagine that – after 23 years of weekly eight-hour roundtrips to visit him in prison – Anthony Capozzi might not have done anything after all.