Submit a nomination for the Torrey Advocacy Commendation Award

The Treatment Advocacy Center is now accepting nominations for its 2007 Torrey Advocacy Commendation (TAC) Award.

The TAC Award rewards the courage and tenacity of those who selflessly advocate - despite criticism and opposition - for the right to treatment for those who are so severely disabled by mental illnesses that they do not recognize that they need treatment.

The title of the award fittingly honors the man who inspired the Treatment Advocacy Center - the most fearless and dedicated advocate for the most severely ill - Dr. E. Fuller Torrey.

Nominees should have a continued and long-term focus on advocacy. They are strong advocates whose work supports securing humane and timely treatment for individuals suffering from the most severe mental illnesses and assisted treatment for those who do not recognize that they are ill.

Those interested in submitting a nomination must do so by September 17, 2007. More information on the award and how to submit a nomination is available here.

Previous winners have included:

2006: Three community psychiatrists: Dr. Jeffrey Geller, Dr. Richard Lamb, and Dr. Darold Treffert.
2005: Sheriff Donald Eslinger, Linda Gregory, Alice Petree.
2004: Charles "Chuck" Sosebee;
2002: Dr. Morton Birnbaum

Few options left

An op-ed in The Day in New London, Connecticut had the following to say about deinstitutionalization:

At the threshold of the 21st century, a disturbing trend has become evident. As the number of hospitalized adults decreased during the second half of the 20th century, the number of prison inmates with serious mental illness was on the rise. In fact, the federal Bureau of Justice Statistics (BJS) reports that the number of inmates in jails and prisons with mental illness quadrupled in just six years — from 283,000 in 1998 to 1.25 million in 2006. This surge coincided with the closure of the last of the hospitals.

The magnitude of the problem is evident upon examination of prison statistics in Connecticut, where the adult population of people incarcerated with moderate to severe mental illness has increased from 2,200 in 2000 to 3,700 in 2005, or from 12 percent to 20 percent.

With few inpatient beds and no law that allows for assisted outpatient treatment, the citizens of Connecticut with severe mental illnesses aren’t left with many options.

Goodbye Mary Z

The Treatment Advocacy Center has launched a nationwide search for an executive director following the resignation of its current executive director, announced board president Dr. E. Fuller Torrey today.

TAC’s president Dr. E. Fuller Torrey:

“The Treatment Advocacy Center has been very fortunate to have MaryZdanowicz’s strong leadership for the past nine years. Today TAC is a well-respected advocacy organization that has played a major role in influencing positive changes in mental illness treatment laws, policies and attitudes. I am supremely confident in our staff and board and look forward to continuing the fight for treatment.”

Read more from our press release

If you would like to send a message to Mary, please send an email to: info@treatmentadvocacycenter.org with the subject “message for Mary”.

Valuable online resources

Do you know what to do if someone in your community is in need of emergency psychiatric treatment for a severe mental illness? If not, check online where many communities are making life-saving information available. Here are just a few examples:

NAMI Maryland offers a brochure on “What to do in a Psychiatric Crisis in Maryland.”

The Superior Court of DC created an FAQs to explain how to help someone who needs it.

NAMI Greater Chicago created A Guide to Voluntary & Involuntary Treatment, Someone I Care About Needs Help: What Should I Do?

The State of Florida offers their entire Baker Act Handbook, including petitions for emergency psychiatric evaluations, a summary of the mental health treatment law.

If your community does not provide this information online, consider joining your state mental health department and/or your state NAMI in an effort to make this information available. Lives in crisis depend on easy access to these types of resources.

The first responders

Family members said Steven Guillory, 39, had been in and out of treatment for paranoid schizophrenia his whole life.

On July 21, Guillory pummeled the windshield of a patrol car and threw a piece of three-foot pipe at officers. The officers at the scene said they attempted to taser Guillory, but it had no effect. Shortly after, Guillory charged at the officers and was fatally shot.

The response by many in the Texas community where this tragic incident happened has been to blame law enforcement. Whether or not the police handled the situation properly is open to investigation, but there is no question that law enforcement officers are increasingly the ones responding to people with mental illnesses who are in crisis. The safety of both law enforcement officers and citizens is compromised when the mental health community abdicates their responsibility to care for people with the more severe mental illnesses.

A "roller coaster ride" that you hope never makes the news

Families of the most severely mentally ill individuals share some unique experiences.

“Advocates refer to it as the family roller coaster - a terrifying, heart- wrenching ride that leaves people frustrated and exhausted.”

When you love someone who suffers periodic relapses of a severe mental illness, it can sometimes feel like you are on a roller coaster. When your loved one is doing well and things are on the upswing, you have to keep your emotions in check because you never know when things might head downhill again.

And then there is this experience that many TAC families will recognize:

"Families who have members with mental illness read the paper differently than other people. We're always scanning between the lines - here's a family suffering as we did, caught unawares, doing what they thought was right. And it wasn't enough."

The need for reform is irrefutable

Today’s title is a quote from Richard Bonnie, discussing the state of Virginia’s mental health system before the Virginia Tech Review Panel. Professor Bonnie, chair of a parallel Virginia commission focusing on the mental health system, also addressed the utilization of outpatient commitment in Virginia. Bonnie suggested that increased use of outpatient commitment systems would be more effective and ultimately less costly than the current arrangement. We couldn’t agree more.

No single answer to severe mental illness

The reform of restrictive treatment laws is the focus of the Treatment Advocacy Center. While success in that effort would bring needed psychiatric care to tens of thousands of people now abandoned to the most acute symptoms of severe psychiatric disorders, improved commitment laws are not the sole, or even chief, solution for people with these illnesses. When it comes to a myriad of illnesses that impact people in a variety of ways, degrees and manners at different times – there is no one answer.

What is needed are effective systems and laws that can offer treatment targeted to the specificities of each illness, condition, situation and person. An admirable attempt to advance our woeful mental system towards that full and reactive system of care is the push for insurance parity. That what are now almost uniformly accepted as types of physical illnesses should be treated as other conditions seems self-evident, but is distinctly not the practice in most cases.

Congress is now considering national legislation that would require mental illness to be treated in insurance policies like any other. It has done so in a string of past years, but this session’s effort looks to have a chance. Among parity’s backers are former First Ladies Betty Ford and Rosalynn Carter, who pointed out in a recent op-ed that patients affected by mental illnesses “should be treated with the same urgency and diligence as patients with any other disease.”

The campaign for parity is rightfully one of the primary advocacy goals of many mental health advocacy groups. If attained, a national parity law would mean more treatment resources for people with severe psychiatric disorders. But is parity THE answer? No more, by itself, than commitment law reform is. For instance, parity would be irrelevant to the many people without insurance and mean little – absent the use of interventions – for those who are so sick that they don’t know it.

Increased risk for family members

Family members are the primary caregivers for people with severe mental illnesses who live in the community. If their loved one has an untreated severe mental illness, they face a very real risk of violence. A 1997 study focusing on the prevalence of abuse faced by families of individuals with a mental illness found that 32 percent of relatives had been struck on at least one or two occasions. Verbal abuse, threats, and temper outbursts were reported by more than 50 percent of the relatives. The American Psychiatric Association notes that

"Family members are most at risk of a violent act committed by a mentally ill person … [Another study] found that among those who had attacked people prior to their admission [to a psychiatric hospital], 65 percent ... had attacked a family member."

Two stories that made the news this week emphasize the danger families can face if a loved one with untreated mental illness becomes violent:

In Palo Alto, California this week a middle-aged man with paranoid schizophrenia stabbed his brother to death in their mother’s home where both men were living. The middle aged man had a long history of mental illness and criminal activity.

In Indiana, a younger sibling is alleged to have shot his older brother in self-defense after the older brother, who had bipolar disorder attacked his younger sibling.

Of course, individuals with severe psychiatric disorders are no more dangerous than the general population - IF they are being treated. Click here for tips on what to do if someone with severe mental illness does become assaultive.

Strain on jails and prisons continues

It’s likely not a coincidence that the jails and prisons are experiencing strain and overcrowding as inpatient psychiatric beds close. According to the Chronicle Telegram in Ohio:

Ohio had a 16 percent decrease in the number of private hospital psychiatric beds from 1997 to 2002, as well as a 21 percent decrease in state hospital beds over the same period. Thirteen private psychiatric units were also closed during those years.

These are not statistics the forensic community is not excited about in Ohio.

Jail administrator Ken Kochevar:

“If we had intensive treatment services in the community, then we wouldn’t be forced to operate a mental hospital here. We’re a jail. … Don’t ask us to do all these specialized services.”

Debbie Nixon- Hughes, chief of mental health services for Ohio prisons:

“Unfortunately, we’re probably one of the larger mental health providers in the state.” And that isn’t exactly what our mission was intended to be.”

Researcher: Mother’s flu could lead to mental illnesses

We have long known that bipolar disorder and schizophrenia are diseases of the brain. Scientists have also documented some things that are wrong with the brain in severe mental illnesses like schizophrenia.

This week, researchers discussed new findings about the possible cause of severe mental illness:

Professor Patterson, speaking from an international neuroscience conference in Melbourne, said schizophrenia and autism resulted from a combination of environmental factors such as the mother's health and genetic predisposition. Professor Patterson, from the California Institute of Technology, said that when a pregnant woman contracted respiratory infections such as influenza during pregnancy, there was a greater risk the foetus's brain would be permanently altered, leaving it prone to the possibility of mental illness later in life.

This is just the latest in a growing body of research about the role that viruses might play in the development of severe mental illnesses.

Mental health and the Virginia Tech review panel

The Virginia Tech Review Panel will hold its fourth public meeting on Wednesday, July 18th, at the University of Virginia in Charlottesville. The meeting, which is scheduled to begin at 9AM, will focus heavily on mental health issues with presentations on civil commitment law reform and mental health issues. The agenda for the meeting can be found here. Directions and a campus map are available here.

Advocates should note that extra time has been allotted at this meeting for public comment, so we encourage everyone with an interest in seeing effective mental health care for Virginia to attend the meeting and make your voices heard.

Canadian police praise treatment act

Police officers in Nova Scotia praise the passage of the Involuntary Treatment Act in Canada:

Halifax police Supt. Bill Moore said the new law is useful, particularly since his officers come in contact with people with mental health problems on almost every shift.

"We have to understand a lot of people with mental illness are not going to voluntarily come to the system, so this is the system going back out to them," he said. "So from that point of view, I think it is a step in the right direction."

Treatment to prevent suicide

Did you know that suicide accounts for approximately 29,000 deaths each year in the United States? Two different methods of analysis both suggest that at least 5,000 of the individuals who commit suicide have schizophrenia or bipolar disorder at the time of their suicide. Other studies indicate that most of these individuals were not receiving adequate psychiatric treatment at the time of their death. Adequate psychiatric treatment could save up to 5,000 lives per year. These numbers, and the personal tragedies behind them should prompt serious discussion about the role that treatment can play in suicide prevention. The following Treatment Advocacy Center briefing paper has more information.

Hear about TAC on PBS this weekend?

Read more about the Virginia Tech tragedy on our blog: http://psychlaws.blogspot.com/search?q=Virginia+Tech

In case you missed it, the PBS show Religion and Ethics aired a program about involuntary commitment on Sunday, July 8. Follow this link to watch the show or read the transcript.

Policing mental illness

A local TV station in Houston, TX recently followed police officers as they encountered people with mental illnesses. The TV station- KPRC – found that officers were well- trained in working with people with mental illnesses.

Perhaps what is most interesting and startling about the investigation, however, is that the officers used this training so often throughout the day. According to the report:

Officers encounter mentally ill people more often that you might think on the job.

Robert [KPRC reporter] tells us the department believes that at least 10 percent of all the calls an officer handles every day involves a person who is mentally ill.

That is 10 percent of each officer’s day that he or she spends as a mental healthcare provider. Perhaps its time to start providing meaningful treatment before encounters with law enforcement.

More insight into the link between violence & schizophrenia

The more we understand about the link between violence and schizophrenia, the better chance there is to prevent violent episodes from happening. A recent report from the CATIE studies informs us that:

there may be two pathways in which adults with schizophrenia may become violent — one in which pre-existing conditions like that of antisocial conduct in childhood, regardless of the presence of psychotic symptoms, may link to violence, and one in which psychotic symptoms of schizophrenia themselves may link to violence.

How families feel about AOT

The Otago community treatment order study has provided us with valuable information on how AOT has been working in New Zealand. There, researchers examining the views of participants concluded that, “the usefulness of community treatment orders is accepted by most patients under them in New Zealand, as well as by most physicians.” Their most recent study, “Family perspective on community treatment orders: a New Zealand study” carries this research over to consumers’ families, a group whose experiences and views of their family members have been little studied.

Psychiatric treatment in Canada

Nova Scotia’s new Involuntary Psychiatric Treatment Act went into effect on Tuesday. The Halifax police department welcomed the new law stating, “in the past officers were powerless as they watched someone's condition slowly deteriorate over a day or week. If that person committed a crime, police would take him to an emergency room to try to have him forced into treatment.” Now police are able to intervene, without waiting for a crime to occur, if a person: (i) is threatening or attempting to cause serious harm to himself or herself or has recently done so, has recently caused serious harm to himself or herself, is seriously harming or is threatening serious harm towards another person or has recently done so, or (ii) as the result of the mental disorder, the person is likely to suffer serious physical impairment or serious mental deterioration; AND is likely to benefit from treatment.

Mental health treatment in prison

On May 22 in the LA County Jail a man strangled his roommate to death. Kurt Karcher has bipolar disorder and was being held in the LA County jail because he was facing trial for a similar slaying that had occurred in the state prison.

In a report regarding this case, released on June 29, the grand jury recommended, in part:

“…developing a program to better train mental health professionals who provide jail services.”

As reports continue to call for increased mental health staff and services for the criminal justice system, there is little doubt jails and prisions are acting as our country's de facto mental health system. Is it really prudent to wait until someone has committed a crime to provide treatment, and is prison really the best place to be getting it?

When Dr. Torrey speaks, people listen

Dr. Torrey made a major presentation to a crowd of about 700 people at the NAMI Convention in San Diego last month. His talk, entitled The Causes And Consequences Of Our Failure To Treat Individuals With Severe Psychiatric Disorders was received enthusiastically. Advocates were motivated to return to their home states and advocate early and sustained treatment for the most severely ill in their families and communities. One advocate wrote:

I attended the NAMI National Conference in San Diego and was fortunate to hear Dr. Fuller Torrey speak. I agreed with everything he had to say. What a wonderful dedicated soul. We need more like him and you!!!

To view Dr. Torrey’s powerful Powerpoint presentation go to the TAC website.