Stop. Read. Think.

Liz Spikol gets respect around our offices because she seems to think about and weigh the issues surrounding mental illness treatment carefully. (Even telling visitors to "please do read the entire text of the bill before making any judgments, pro or con. I think people don't do that enough." Amen.)

For instance, on SB 226, a bill under consideration in Pennsylvania to change that state's treatment law, she writes:

As I've said before, I have concerns about this type of legislation, but on the whole, am in sympathy with its intent, which is to get severely ill people treatment when they desperately need it -- providing enough safeguards so people's rights will not be trampled. I know it's a tall order. Is Senate Bill 226 the answer? I can't say.

Of course, a kind word from us will probably make some distrust her. (Sorry Liz.) But we wish more people would stop the knee-jerk reactions and read ... and think ... a little more.

Building a “safe house” in an unsafe system

New Mexico is still one of only 8 states without AOT, and even as a handful of advocates continue to pat themselves on the back for fighting to stop the state from actually passing a compassionate treatment law, we see gems like this one.

"A lot of problems happen when families call 911 when a family member is in a mental health crisis," said Julie Medina, an advocate for Parents for Behaviorally Different Children. "More often than not, he ends up in jail. He's committed what's considered an act of domestic violence or is in a paranoid delusional state." [Valencia County News Bulletin, NM, Sep 26, 2007]

One solution being proposed now is to establish “safe houses.” This, and the suggestion about implementing “quick response teams,” both acknowledge the fact that some people with untreated severe mental illnesses need more than standard community services.

Yet proponents are quick to point out that the safe houses (which would cost the state upwards of $3 million) would be voluntary, noting that they would be places “where people can choose to go ... and take a few days to get out of crisis.”

That will be a nice additional service for those who understand they are ill and know they need help. But they won’t do a thing for those who steadfastly refuse help because they don’t think they need it.

Perhaps they should ask some family members what happens when their loved ones descend into psychosis that leads the families to call police.

If the person were capable of choosing to “get out of crisis,” you wouldn’t need safe houses.

Without the option for assisted outpatient treatment, the people who really need the safe houses are the family members, who are unable to get real help for the people they love until they become dangerous, and then must call police.

"I had to press charges against my son..."

“I am unable to do anything for my son now because as an 18-year-old, he is considered legally responsible for himself. I see him often wandering my neighborhood, wearing bedroom slippers, walking around wide-eyed and confused. Hopeless.

I had to press criminal charges against my son in hopes of getting treatment.”


- op-ed in the Atlanta Journal Constitution in which a mother describes her struggle to get treatment for her son who has a severe mental illness

CIT: It shouldn't be the only tool

Crisis Intervention Training (CIT) is an excellent tool for law enforcement officers who will inevitably encounter a person with a mental illness who is in crisis. The training helps officers to de-escalate situations that may otherwise turn deadly.

CIT is a very important tool, but it shouldn’t be the only one.

Law enforcement officers in Buchanan County, Missouri will be receiving CIT “in light of dwindling funding for mental health programs and increased demand for such programs”

Police Sergeant Matt Rock, a CIT supervisor in Buchanan County said:

“The response for CIT officers will range from a call of a mentally-ill person caught shoplifting to an emotionally-distressed subject threatening to jump off a bridge. The officers will facilitate emergency mental health assessments at the scene of a crisis."

Is it too much to ask to have police officers enforce the law and mental health professionals provide mental health evaluations?

Oprah on bipolar and violence

Andrea Petrosky killed her child. On The Oprah Show today, she talks about it, and about her bipolar disorder.

Petrosky is one in a long line of mothers whose untreated or wrongly treated severe mental illness had such a sickening result. In fact, of children killed by a parent, 15.8 percent of defendants had a history of untreated mental illness.

What she has to say about it sounds very familiar.

Andrea says the person who killed her son "wasn't me. It wasn't the real me. It was a very sick me, because I would never hurt him. Never," she says.

Her voice is an eerie echo of many who have been through similar circumstances. Like Naomi Gaines, who killed her 14-month old twins.

"I know how I was feeling that day. I know I was not the same Naomi who got up with my kids a million times before and fed them and bathed them and walked them and breast-fed them and cared for them," she says. "I wasn't that same person. So I know that I would never hurt them if I had had my sanity."

It isn’t the disease that leads to violence, it is the lack of timely and effective treatment for that disease.

People with severe psychiatric disorders are not more dangerous than the general population - if they are being treated. But without treatment, some commit acts of violence because of their delusions and hallucinations. Many of the cases in the news eventually uncover the fact that the person who killed their child was not taking medication. And research shows that the most common reason that people with severe mental illness refuse treatment is because they are too sick to realize they need treatment.

Don’t believe the hype you will hear today from some in the mental health community – that these cases are extremely rare. In Texas just last week, Alysha Green doused her three-, five-, and seven-year old daughters with gasoline and lit them on fire. The three-year-old has since died. Alysha’s husband says his wife had a history of mental illness with a past diagnosis of bipolar disorder. She was prescribed medication. She stopped taking her medication and, her husband reported, her behavior deteriorated in the three weeks prior to the tragedy. That same week, Helen Kirk was found insane in her murder trial in Massachusetts – she told police she believed her son Justin was “the devil” after she strangled him.

Oprah also talks to General Hospital star Maurice Benard and actress Jenifer Lewis from their perspectives as people with bipolar disorder. Benard returns to the issue of violence when he recounts what happened one evening when he was off medication.

“I started yelling. And I told [my wife] if she didn't stop [crying], that I was going to kill her—in my mind I didn't believe I would."

As much as we don’t want it to be true, violent behavior is one of the consequences of failing to treat. Even NIMH gets that now.

Oprah doesn’t delve into the concept of assisted outpatient treatment, which is too bad. The obvious question after a show like this is “how can we help people before they get so sick?” Maybe in a future show, they will include the perspectives of so many who can attest to the importance and value of earlier intervention.

Until then, we call this a good beginning.

Staggering stat

A 40 percent increase in the numbers of homeless people isn't drawing much attention - perhaps because the temperature in St. Paul, Minnesota, is a lovely 76 degrees today. Of course, in January that drops to an average of 21 degrees.

For the 40 percent of that group with a diagnosed mental illness, the impending cold weather is just one of the many dangers they face.

A research group says it found 587 homeless people in the [St. Paul] area last fall, a 49 percent increase since 2003. The study found more than 40 percent of the homeless were told within the last two years that they have a serious mental illness such as major depression, schizophrenia or post traumatic stress disorder.

Relief because he committed a crime

It’s hard to believe a mother would ever feel relief that her son committed a crime.

But that’s exactly what Joyce Blevins feels. Her son Glenn will finally be getting the treatment he needs for his schizophrenia now that he has been sent to a state institution for beating a man into unconsciousness.

As she told the Monterey County Herald, Joyce is sad for her son and his victim, but relieved the system will finally do what she's been asking for more than a decade.

We just wait for the call," Blevins said of parents of the mentally ill. "I always worried (Glenn would) kill a lot of people and himself."

The law had tied the hands of Joyce and mental health professionals.

"I did notify (authorities)," she said. "They did nothing. I'm glad (mental health officials) have been there ... but wasn't there more they could do?"

A mother feels relief because committing a crime means getting treatment. What kind of system requires criminal activity to get treatment for a severe mental illness?

Victims of untreated mental illness

Two recent stories at opposite ends of the criminal justice system mirrored those of Andrea Yates, LaShaun Harris, Sherry Sims, Christine Wilhelm, and so many others.

In Massachusetts yesterday Helen Kirk was found not guilty by reason of insanity for fatally strangling her 3- year-old son. Kirk had a long history of mental illness and believed her son was the devil when she strangled him. She will finally be getting treatment in the state hospital where she is committed.

A young mother in Texas faces a capital murder charge. On Saturday, Alysha Green doused her three girls and herself with gasoline and lit them on fire. One of the girls died; two remain in the hospital.

Alysha’s husband says his wife had a history of mental illness with a past diagnosis of bipolar disorder. She was prescribed medication. She stopped taking her medication and, her husband reported, her behavior deteriorated in the last three weeks.

Will Alysha Green someday be committed to treatment as Helen Kirk was? Maybe.
For now four children are victims of untreated mental illness. The mothers are victims too; once they're brought back to reality they must live with something unfathomable.

Guest Blog: Mental Illness and the Law

Guest Blog:
Written by Robert Gerard

The specific issue in the Virginia Tech shooting has to do with the criteria for having someone like Cho Seung-Hui hospitalized involuntarily. Ask any mental health professional about the criteria for involuntary hospitalization. It’s a joke! To be hospitalized involuntarily, the person must demonstrate behavior that demonstrates “immediate danger to self or others.” In our current zealous pursuit of civil rights, this means that the troubled person must be in the process of cutting her wrist or putting a noose around her head or explicitly threatening someone. “Ideation” (the psycho-babble label for expressing thoughts or ideas about harming self or others) doesn’t qualify.

Does anyone remember New York Mayor Koch’s heroic attempts to find shelters for homeless people during the bitter winter of 1987? In the wake of sub-zero temperatures, the Mayor insisted that the homeless, who were curled up on city streets, be taken to shelters for their own safety. One mentally ill person refused assistance, and the Mayor received a firestorm of criticism from civil rights advocates who rushed to protect those who had no insight into the danger they faced.

While video cameras, campus police, and other sources of security are important, the solution to avoiding another tragedy like the one at Virginia Tech lies in promoting and passing legislation that broadens the criteria for involuntary hospitalization of mentally ill persons who demonstrate a “potential” danger to self or to other members of the community.

Just think about what might not have happened if Professor Lucinda Roy’s appeal for intervention for Cho had been supported by the law and the mental health system.

Robert Gerard is a Professor Emeritus at Mount Saint Mary’s University in Emmitsburg Maryland, and has worked as a volunteer in a community mental health center. He is a member of the National Alliance for the mentally Ill (NAMI) and the parent of a child who is mentally ill.

The opinions expressed by guest bloggers are their own and not necessarily that of the Treatment Advocacy Center.Want to be a guest blogger? Tell us why at info@treatmentadvocacycenter.org.

"Imminent Danger" in the Washington Post

Two opinion pieces in yesterday’s Washington Post addressed the “imminent danger” standard in Virginia.

An editorial from the Washington Post:

Virginia currently requires that authorities determine that an individual poses an "imminent danger" to self or others, or be unable to care for himself, before they can order involuntary detention. That high hurdle, once embraced by a majority of states, has kept many unstable and dangerous people from receiving the care they need.

An op-ed from Pete Earley describing his experience in getting treatment for his son who has a severe mental illness:

When I rushed my college-age son -- in the throes of a psychotic breakdown -- to a Fairfax hospital, I was told he wasn't "sick enough." He could not be treated involuntarily until he posed an "imminent danger" to himself or someone else, doctors said. His mental illness had been diagnosed two years earlier, he had been hospitalized twice and he had done well on medication. But still doctors couldn't legally intervene.

Sen Righter: new law will help avert crisis

Illinois Senator Dale Righter, major bill sponsor, on the passage of SB 234:

The passage of SB 234 is a monumental victory for the mental health system in the State of Illinois. The legislation was brought to me by Karen Gherardini, who has struggled for years to help a loved one receive appropriate help and treatment. Karen’s perseverance, persistence and dedication to this issue, in addition to the support of so many other families who have loved ones that suffer from a mental illness have finally paid off.

All too often, the criteria currently in law makes it very difficult and sometimes impossible for individuals suffering from mental illness to get the help they need. In many instances, the individuals have stopped taking necessary medications, and as a result, fail to realize that they need those medications, or even that they suffer from an illness. In these situations, a brief involuntary commitment is the only way to ensure that someone with a mental illness returns to their medications and ceases to become a danger to themselves or others.

SB 234 will allow those who have made the care for and concern over individuals suffering from mental illnesses to do more to help avert a crisis.

The worst mistake of his life

A recent article from the Pittsburgh Post-Gazette led to a powerful letter from Bill Shane, a former Pennsylvania legislator who called his work in passing the clear and present danger standard, “the worst mistake of his life.”

Pennsylvania’s treatment standard is one of the most restrictive in the nation, requiring an individual to first pose a clear and present danger before receiving necessary care. The result is countless tragedies, and a system that is unresponsive to many of the most severely ill, despite being one of the best funded in the nation. We stand in awe of Mr. Shane’s honesty, and hope his words will help spur needed reform.

A monumental victory in Illinois

Yesterday, Illinois Governor Rod Blagojevich signed Senate Bill 234 into law. The measure – the culmination of a five-year effort – is a dramatic change to the Illinois commitment standard for both inpatient and outpatient assisted treatment.

When SB 234 takes effect next June, the short and simple-appearing legislation will be the greatest reform to Illinois commitment law in decades.

We cannot more commend the capability and compassion of Senator and chief bill sponsor Dale Righter, who doggedly pursued the measure over five years and three legislative sessions, and Representative David Leitch, who successfully guided SB 234 through the Illinois House.

NAMI–Illinois stood steadfastly behind this monumental reform each and every step along its path to becoming law.

But most of all – this monumental victory is a tribute to those who wrote, called, testified, and fought for SB 234 and treatment. A group of determined advocates decided to change a law that mandated non-treatment for many of those in their state lost to severe mental illnesses – and they did.

Jon Stanley's interview with Schizophrenia Connection

Robin Cunningham interviewed TAC’s acting executive director, Jonathan Stanley at the 2007 NAMI conference. The following is an excerpt of the interview posted at SchizophreniaConnection.com

We're talking 200,000 people with [untreated] mental illness who are homeless [or one-third of the estimated 600,000 homeless population] and 300,000 in jails and prisons [about 16% of the total jail and prison inmate population]. In the general population, about 1 in 100 has schizophrenia and 1 in 100 has bipolar disorder.] That's partially because we don't have perfect medications yet. But I think just as important, a lot of people that need medications don't get them. And that's partly what we [at the Treatment Advocacy Center] try to address, whether it's doing court ordered out-patient commitment or getting to those people in crisis, but it's all for a lack of systems that are reaching out and getting them care.

Happy 70th Birthday Dr. Torrey!

An article in Psychiatric News:

"Fuller gets as much credit as anyone for moving American psychiatry from a psychoanalytic foundation to a biological one," said APA Trustee Roger Peele, M.D., who was chair of the department of psychiatry at St. Elizabeths Hospital in Washington, D.C., and hired Torrey as a staff psychiatrist in 1977.

"His provocative books and his plausible, although yet to be proven, concept as to the cause of schizophrenia contributed to a focus on the biological. His call for change was markedly enhanced by not remaining academic. He is combative—when public agency chiefs heard he was due to be on national TV, they ran to their bunkers—and he has used pithy public pronouncements to hammer home the need for public research monies to be devoted to a biological understanding of people with the most disabling of psychiatric illnesses."

Read more of "Search for schizophrenia's roots started at home"

Bipartisan call for new VA commitment law

Recent calls for reform echo that of the Virginia Tech reform panel, which recommended the criteria for involuntary commitment be modified to “promote more consistent application of the standard and to allow involuntary treatment in a broader range of cases involving severe mental illness.”

The Roanoke Times noted Virginia's GOP support:

Republican leaders also called for legislation to modify the standard for involuntary commitments to allow more easily the detention of individuals who present a danger to themselves. The change would eliminate the current standard of "imminent danger to self and others" and address a broader range of severe mental illnesses."We want to better clarify the individuals that need the additional mental health services," [Del. Phil] Hamilton said.

A later article from the Associated Press highlighted Democrat support:

Later, Del. Brian J. Moran, leader of the House Democratic Caucus, found no fault with the Republicans' generalized recommendations.

"Reforming the state's mental health system is not a partisan issue," Moran said. "It's incumbent on the legislature to make sure something like the Virginia Tech tragedy never occurs again."

In Virginia: Upcoming hearing on AOT

This Monday, SEPTEMBER 10, the Virginia House Courts of Justice Committee will be focusing on outpatient commitment and addressing some of the failures of the system.

Delegate Dave Albo, the chair of the committee, has been a strong supporter of improving Virginia’s archaic mental health treatment law and has introduced bills in the past. A strong show of support from family members and advocates would be a good way to show him – and his fellow committee members – how broad the support is to finally pass a better state law. If you can’t attend, take a moment to fax or email a letter of support to him.

The hearing will take place in House Room C in the General Assembly Building at 2:00 pm Monday, September 10.

Directions and information on visiting the Capitol

Neglecting an important solution

A recent letter to the editor in the Philadelphia Inquirer:

Treating mentally ill

Re: "Colleges cram for campus security," Aug. 26:

The emphasis on what to do after an incident such as the tragedy at Virginia Tech is neglecting an even more important solution.

The final report from the Virginia Tech Review Panel recommended that "the involuntary treatment criteria be improved to allow involuntary treatment in a broader range of cases involving severe mental illness."

Legislation has been introduced to change Pennsylvania law to allow for assisted outpatient treatment (AOT). Similar to New York's Kendra's Law, the goal is to enable more consistent adherence to treatment for the small minority whose severe mental illnesses impair their ability to voluntarily comply through a prescribed community treatment plan.

The Senate Public Health and Welfare Committee will be holding public hearings on Oct. 2. People interested in preventive strategies should attend and ask our senators to vote for SB 226 now.

Jeanette Castello

SMRI research - an interview with Dr. Torrey

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. In the following interview with Robin Cunningham Dr. E. Fuller Torrey - TAC’s president and director of laboratory research at SMRI- talks about possible causes of and treatments for schizophrenia and bipolar disorder.

Dr. Torrey and his colleagues have been looking very intently at infectious agents as possible causes of both schizophrenia and bipolar disorder.

"Probably there are four [infectious agents] that have really come to the front of it," he continued. "My first choice is Toxoplasma gondii, which is a parasite that is carried by cats... This is an area of great interest. The other infectious [agents] are viruses...cytomegalovirus, which is a herpes virus; herpes simplex viruses (HSV1 and HSV2); and endogenous retroviruses."

Dr. Torrey has published a number of papers on the evidence linking infectious agents to schizophrenia and bipolar disorder. Most recently, he and Dr. Robert Yolken co-edited six papers on Toxoplasma gondii as a possible cause of schizophrenia that were published in the June 2007 issue of Schizophrenia Bulletin. These presented work from both their laboratories and from other researchers.

I asked him to elaborate on the potential connection between cats and schizophrenia…

More of Dr. Torrey’s interview with Robin Cunningham can be found on Schizophrenia Connection.