Too late for Seidel, NJ could still save others

Joel Seidel, a frail 65-year-old retired stockbroker with schizophrenia, was stomped to death in 2004 in a Camden County, New Jersey, jail.

His cellmate, accused of the murder, was so violent he had been sent to jail from a psychiatric hospital after he raped another patient. Jail procedures in New Jersey have since been reformed to prevent vulnerable inmates from being housed with violent ones. Seidel’s family hopes those procedures will be made permanent in a settlement of a lawsuit against the county.

But what has been done to prevent people like Seidel ending up in jail in the first place?

Seidel “repeatedly refused to take medication for schizophrenia and had failed to complete outpatient treatment programs.” His family did not bail him out of jail because they believed that he “could only get help if he was involuntarily committed to a county psychiatric hospital” from the jail.

If his family had had some other way to ensure he would participate in treatment in the community rather than getting treatment via jail, he might be alive today. But the family’s hands were tied because New Jersey is one of only 8 states whose archaic law prevents court-ordered community treatment. Community treatment programs were available for Mr. Seidel – he was just too sick to realize he needed treatment. A court order might have saved his life.

A bill (S1093) that will help prevent other New Jersey families from facing the Seidel family’s dilemma and tragic loss passed the New Jersey Senate unanimously nearly a year ago. But it is still not law because the Assembly Human Services Committee has not even scheduled a hearing for the bill (A2304).

New Jersey must act now to make community services available to people like Joel Seidel who are too sick to participate voluntarily.

Cops in Crisis

Anyone who doubts that law enforcement are increasingly the ones responding to people with mental illnesses who are in crisis needs only to look in the newspaper.

Just in the past two days, we’ve seen these examples of how the safety of both law enforcement and citizens is compromised when the mental health community abdicates their responsibility to care for people with the severest mental illnesses.

• In El Paso, TX, a man with schizophrenia was fatally shot by a police officer after he threatened paramedics with a gun and threw bleach at officers during a psychotic break.
• A middle-aged man in Ohio was shot and wounded by police officers after the man beat a police officer with a lead pipe and threatened to shoot him. The man is described as having bipolar disorder.
• A grand jury has decided three officers in Texas were acting in self-defense when they shot a woman with schizophrenia in January. The police were called to the woman’s home and she charged at them with a 14-foot knife.
• Chicago police are involved in a lawsuit for fatally shooting a young man who had a mental illness. The officers were called to “diffuse the situation” while the young man was having a psychotic break. He threatened the officers with a knife.

Plea for intervention

In Oklahoma, a woman diagnosed with paranoid schizophrenia stabbed her younger sister. The woman had been hospitalized multiple times, but was unable to be admitted to a mental health center because she didn’t meet the criteria. In a letter to the editor, her family explains:

We know what the criteria is, that’s why my daughter called. Her sister has had an ongoing mental issue for at least 12 years. She has been diagnosed as paranoid schizophrenic. She does OK sometimes, but then there are times when she is not OK. The voices she hears wreak havoc with her and she has had to be hospitalized numerous times.

If this sick young woman had been hospitalized three weeks ago a young woman would probably not have been stabbed and a young woman would not be facing criminal charges that she cannot even understand. She was trying to “save” her nephew from what the voices were telling her had happened to him.

I am merely asking that everyone be a bit more understanding, cooperative, more empathetic — and pro-active — to stop this type of tragedy before it occurs again.

Seeking a proactive approach

Officers in Yakima County, Washington appear to have grown tired of taking people with mental illness to jail, and acting as mental health workers. According to Rick Weaver, chief executive officer for Central Washington Comprehensive Mental Health:

"There's a whole layer of people out there who commit a nuisance offense or are panhandling. They are mentally ill. Everyone knows it but the legal wraps around involuntary treatment don't qualify them."

Yakima police chief echoed the sentiments and said when his patrol officers encounter a person with mental instability, they have no choice but to take the person to jail.

"If we had a program that gives us an option other than jail and help reduce the
jail population, that is a big draw," he said.

Washington State law allows for assisted outpatient treatment (called a “less restrictive alternative” or an “LRA”). It also has a good mental health treatment standard. Why does the state fail to use them to help people before they fall into the criminal justice system?

Simple logic

Prison = bad.
Prison + mental illness = very very bad.

Get it?

"States can institute policies to keep mentally ill inmates out of segregation or wait for litigation to force them to do so. They can improve the quantity and quality of mental health services they provide. But even those necessary steps fail to confront the larger question - should prisons be de facto mental institutions? If not, then the country must reduce the number of mentally ill people who are incarcerated. "

Who is left to do the right thing?

William Demegall got 25 to life for the stabbing, bludgeoning and burning of 56-year-old George Mancini. His severe mental illness, though acknowleged by the court, was not seen as a factor in sentencing.

Despite pleas by members of the local NAMI, the judge gave Demegall the maximum sentence possible.

Once again, we turn to the prison system as the last hope for treatment. As the editors of the local paper noted in an editorial today:

"It is now up to the New York State Department of Corrections to be the institution, at last, to do the right thing in this case and assign Mr. Demagall to a facility that can properly treat mental illness." [Berkshire Eagle, March 23, 2007]

So much for reform

Reporter and columnist Ruth Sheehan continues to follow the story of Phil Wiggins, a man suffering from the symptoms of schizophrenia. Wiggins' journey through the North Carolina mental health system has lasted more than 43 years and has become increasingly tumultuous since Wiggins was released from his group home and the state began its mental health reform. In her most recent column, Sheehan says:

The team of mental-health workers who have handled his case for the past year is disbanding as the county is forced to get out of the business of providing direct care to severely mentally ill patients.

With adequate care, Wiggins has shown how much he can improve in a community-based setting -- engaging in lucid conversation rather than mumbling, making wisecracks from time to time.

But in Wiggins' case, "adequate" care means nearly round-the-clock, one-on-one care.

If the community can't provide that, Wiggins is destined for a psych ward again.

So much for reform.

No beds in Oregon

In a recent article, Joseph D. Bloom, M.D. correlates the significant drop in civil commitments in Oregon over the past 20 years to the virtual disappearance of psychiatric inpatient beds. While the number of investigations for civil commitment have more than doubled over the last 20 years (from 3996 to 8315), the number of actual commitments has dropped by a third (1165 to 785). The other dramatic change in Oregon is the number of civil psychiatric beds. The state psychiatric hospital system has a total of 741 beds, of which 307 (41%) are civil beds and 434 (59%) are designated for the forensic system. Dr. Bloom concludes that it is primarily the decrease in available beds that has resulted in reduced inpatient commitments rather than a reduced need for commitment. Based on his analysis, he warns that:

The use of civil commitment as a method of diverting individuals from the criminal justice system to the mental health system has been replaced by diversion from one part of the criminal justice system to another, from jails to mental health courts. Reversing this trend toward criminal justice sanctions will take a concerted effort to restore civil commitment to a meaningful place in the mental health system.

Criminal justice professionals should heed Dr. Bloom’s warning if they don’t want to see their jobs permanently transformed into being mental health professionals. Law enforcement and corrections officials should be advocating the restoration of a meaningful civil commitment system, both inpatient and outpatient.

The right to choose?

James DiCioccio, a 43-year-old man who has been described as schizophrenic, is sitting in jail for punching and choking a man to death because he was “tired of the man bothering him.”

DiCioccio had a history of violence, and, on multiple occasions, police had been called to the group home where he lived because of DiCioccio’s violent outbursts.

According to Detective Sgt. John Kelty who is investigating:

“James R. DiCioccio, known as Dusty, had not been taking medications that would have allowed him to function. Caregivers at the facility for mentally ill men are not permitted to force residents to take their medications.”

A city health department nurse who inspects group homes said:

“Residents have a right to refuse medication. It's not desirable because most of the medicines are psychotropics that help with psychological disorders.”

Maybe now that DiCioccio is in jail on a murder charge, he will get the treatment he wasn’t able to ask for, but obviously needed.

Gov. Richardson: Demand NM legislators get it right

Statement from TAC Executive Director Mary Zdanowicz:

New Mexico is again on the verge of denying critical treatment to the sickest people with severe mental illnesses, discriminating against them because they are too ill to ask for help.

Gov. Bill Richardson has publicly supported mandated community treatment legislation since Rep. Joni Marie Gutierrez first introduced it in 2006. Despite passing the House this year, the bill stalled in a Senate committee, a victim of political infighting and the work of one of Gov. Richardson’s own cabinet members, Secretary of Human Services Pam Hyde, who refused to rise in support of the measure despite her Governor’s position.

We urge Gov. Richardson to right this wrong, following up his supportive words with real action. He should add to his list of expectations for legislators that they exhibit true concern for people with debilitating brain diseases and the inability to choose treatment. Other bills to be addressed in a special session purport to protect the rights of New Mexico families and prevent them from violent harm – these criteria are also the case with the mandated community treatment legislation.

READ MORE ...

Right to be psychotic

Dr. David Fennell, the outgoing Atascadero medical director, in today's LA Times:

A lot of times, a family will say: 'Please treat our son. He's ill.'"And I say: 'I'm sorry. I can't.' I know it's the best thing for him medically. But as a society we have decided you have the constitutional right to be very psychotic and medically ill — and miserable."

Deinstitutionalization knows no borders

“Canada is not alone in jailing the mentally ill. The United States, too, deinstitutionalized a large number of psychiatric patients. There, too, law-enforcement agencies increasingly are left to pick up the pieces.

In New York City, according to statistics compiled by the Treatment Advocacy Centre, the number of police responses to complaints about "emotionally disturbed persons" climbed from 20,843 in 1980 to 64,424 in 1998. In Florida, mentally ill people in crisis must be assessed under the state's mental-health treatment law. In 2000, there were 80,869 mental-health assessments, a figure that handily surpassed the 60,337 drunk driving arrests that year.”

More from the Montreal Gazette …

For more information on ensuring appropriate treatment for people with severe mental illnesses in Canada, visit: http://www.cfact.ca/

Research update: Genetic approaches to new tx

TAC relies on its supporting organization, the Stanley Medical Research Institute (SMRI), to carry out research to ascertain the causes of and develop better treatments for schizophrenia and bipolar disorder. A recent update from SMRI follows.

On March 8, 2007, the Broad Institute in Cambridge, Massachusetts, announced that SMRI had awarded the institute $10 million a year for ten years to use genetic approaches to find new medications for treating schizophrenia and bipolar disorder. This is the largest single award ever given to a U.S. institution for psychiatric research.

The Broad Institute is a joint venture of Harvard University and the Massachusetts Institute of Technology. The SMRI-funded program will be headed by Dr. Edward Scolnick, a highly experienced psychiatric researcher who was previously in charge of drug development at Merck Pharmaceuticals. The program will utilize the latest in rapidly advancing technology to identify which proteins are affected in these diseases and to then devise new medications to target these abnormal proteins. This new program is part of SMRI’s reallocation of resources to spend three-quarters of its funds to find new medications and the remaining one-quarter on research to find the causes of these diseases.

Support for AOT in New Jersey

TAC executive director Mary Zdanowicz’s recent op-ed in the Star Ledger has prompted a flurry of responses from families and advocates across New Jersey, echoing Mary’s calls for passage of AOT legislation in New Jersey. If you'd like to help advocate for change in New Jersey, write a letter to the Star-Ledger today!

Recent letters to the editor in the Star-Ledger:

Three cheers for Mary Zdanowicz for stating clearly one major problem with our mental health system. New Jersey lags far behind other states in dealing with one of the most stubborn problems facing families and mental health professionals. Our system waits until a person is a danger to himself or others before he can receive involuntary treatment in a psychiatric hospital. There is no mechanism for allowing assisted outpatient treatment before that point is reached. More from Elaine Goodman...

Expanding the availability of court-ordered community care can achieve this by avoiding unnecessary hospitalizations and treating the illness before it spirals out of control. Whether you call it outpatient commitment or assisted outpatient treatment, it has been effective in New York and elsewhere. More from Raymond Deeney...

We support passage of greatly needed legislation to provide for involuntary outpatient treatment in New Jersey. Passage of this bill is vital to treating the severely mentally ill. We are the parents of someone who suffers from a serious mental illness and know firsthand the difficulty in getting help when a patient goes off his medication. Most often, patients require crisis team intervention and consequent hospitalization. More from Warrren and Irene Cook...

When politics corrupts science

We expect reputable institutions to conduct honest scientific inquiry. However, a recently published British "review" of the literature on assisted outpatient treatment demonstrates how science can be so easily corrupted by politics. The report evidences a clear bias against AOT and serves up a full menu of platitudes that can be used by individuals and organizations that oppose AOT. But, before opponents use this report to try to discredit AOT, they should be prepared to apply the same analysis standards to the alternative treatments they propose.

The review discounts all evidence except randomized control trials and does not even consider secondary analysis for such trials, at the same time acknowledging the practical and legal challenges to conducting such studies of AOT. The Cochrane Reviews use a similar approach to declare the following treatments/practices for schizophrenia to be unsupported by the data, some of which are specifically designated "evidence based practices" by the Center for Mental Health Services:

· case management
· cognitive rehabilitation therapy
· compliance therapy
· family intervention
· psychodynamic psychotherapy techniques
· life skills training
· integrated substance abuse treatment
· supported housing

Those who dare to use the British review to oppose AOT had better be prepared to abandon these services as well as the current "transformation to recovery" for which not a single randomized control study proving its efficacy can be found.

Psychiatric illnesses are extremely complex. A more thoughtful consideration of evidence of benefit for a variety of options, including AOT is a morally and intellectually sound approach. Simplistic, knee jerk analyses based on political pandering do a disservice to those who are suffering.

She suffocated her parents so they would live...

Harvard educated doctor, Kathleen Hagen, has struggled with bipolar disorder her entire life. Seven years ago she spiraled into psychosis and heard a voice that told her she could transport herself and her parents to a better place by suffocating them.

"I was thinking about Resurrection with a capital 'R,'" said Hagen. "I thought they were going to arise and I was going to hear Mommy in the kitchen making breakfast."

Feds address Medicaid discrimination?

Congress is finally taking a look at the discriminatory Medicaid IMD exclusion.

When initially enacting Medicaid, the federal government specifically excluded payments for patients in state psychiatric hospitals and other "institutions for mental diseases," or IMDs, to accomplish two goals: fostering deinstitutionalization; and shifting the costs back to the states, which were viewed by the federal government as traditionally responsible for such care.

States proceeded to transfer massive numbers of patients from state hospitals to nursing homes and the community where Medicaid reimbursement was available. This resulted in a massive transinstitutionalization of people who needed inpatient care to facilities ill-equipped to fully help them.

TAC has long advocated for repeal of this discriminatory provision. We urge you to contact your representatives and call for passage of HR 1155.

From a NAMI email alert:

Congresswoman Eddie Bernice Johnson (D - Texas) has introduced a bill, HR 1155, to repeal the current prohibition on the use of Federal Medicaid dollars to pay for services for individuals between the ages of 22 and 64 in private and public inpatient psychiatric treatment facilities. If enacted, HR 1155 would be extremely helpful both in addressing the ongoing crisis in inpatient services for people with severe mental illness and potentially expanding the availability of community-based services for these individuals. HR 1155 has been referred to the House Energy and Commerce Committee for consideration. Your Representative sits on this Committee. We urge you to write to your Representative and urge his/her support by co-sponsoring HR 1155.

Bed shortage? Try outpatient.

In a recent Baltimore Sun editorial, the newspaper lamented the shortage of inpatient beds to treat people with severe mental illness.

While it is frustrating that there aren’t enough beds available, it is even more frustrating that the state doesn’t have the option of AOT.

AOT is legal in Texas

From a Texas news article :

"Another uneducated reaction from some is to insist that people with mental illness be forced into treatment. That’s illegal. As long as people are well enough to make decisions, they can dictate what treatments they receive and who is involved in those treatments."

In Texas, it is far from “illegal” to get a court order to help someone who is severely ill get the treatment they need.

Texas’ assisted outpatient treatment law allows families to get a civil court order for outpatient treatment, providing their loved one meets a specific set of criteria.

For those whose illness leaves them too sick to make rational treatment choices, Texas should be using their humane outpatient commitment law.

Too much expected of hospitals

"If you overwhelm a system beyond its point of capacity, it can't do everything it needs to do."

- Dr. Jeffrey Geller, a psychiatrist from the University of Massachusetts medical school who is monitoring the hospitals for the federal government.

Hospitals as scapegoats

Across the country, the few state psychiatric hospitals left are taking the blame for failures in the mental health community. TAC executive director Mary Zdanowicz outlines the problem in an opinion piece in New Jersey's Star Ledger.

“New Jersey already closed one hospital and "reinvested" the money in the community. Yet the psychiatric hospitals are overcrowded because community mental health providers can't -- or won't -- do what is necessary to keep patients out of the hospital. Thus, tragedies among this very vulnerable population are inevitable both in and out of hospitals.

Blaming the hospitals is the easy way out, and allows the mental health community to again dodge blame for the crisis we are now facing. The community providers aren't doing their part, and it is far past time to hold them accountable.

There are now more patients in fewer hospitals than 10 years ago. Community mental health must step up and do more for hospital patients than just take their money.”

Read more from Zdanowicz’s editorial published in the New Jeresy Star-Ledger.