Sunday, December 30, 2007

Yes, Virginia, Kendra's Law works ...

From the Washington Post December 30, 2007:

Susan Wezel had been committed to the city's hospital wards more than a dozen times in 10 years. Her psychosis was so deep and debilitating that she lost her career and her relationship with her son, as she refused to take her medication or follow treatment.

But because of a New York state law, Wezel hasn't been hospitalized in more than a year. She doesn't wander the streets alone at night anymore. She takes her medication willingly. She even has plans to follow her dream of singing at a neighborhood nightspot, something that was unthinkable 18 months ago.

Wezel and her caseworker agree that the transformation occurred because of the law, which allowed officials to force Wezel into an outpatient treatment program after she was discharged from a hospital.

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Saturday, December 22, 2007

Wall Street Journal: "Free to Die in Iowa"

In today's Wall Street Journal, Michael Judge has a powerful piece about the Sonny Iovino case in Iowa:

After Iovino's death, a spokesman for the VA Medical Center told the Cedar Rapids Gazette, "If somebody doesn't want to be treated, you can't treat them." This is simply not the case. Given his debilitated state, the VA psychiatrist on duty could have forced Iovino to receive the treatment that might have saved his life ...

In fact, Iowa's commitment standard is better than many states', which demand that a person be an "imminent" danger to himself or others. In Iowa, however, to be eligible for AOT a person must lack sufficient judgment to make responsible decisions concerning treatment; and be either (1) a danger to self/others or (2) unable to satisfy the need for "nourishment, clothing, essential medical care, or shelter so that it is likely that the person will suffer physical injury, physical debilitation, or death."

When Iovino was picked up by police just two days prior to his death, he was digging up the earth with his bare hands, talking to himself, barefoot in frigid weather, and huddling near a building's exhaust vent to stay warm. He was at the very least a danger to himself ...

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Friday, December 21, 2007

The only place that can't refuse to take you

“Prior to 2000, the Alabama Department of Corrections didn’t consider mental-health treatment part of our mission,” [said Corrections Commissioner Richard] Allen

Yet now that is a primary responsibility. The results have been pretty horrible.

Allen noted something stunning in his presentation to a legislative committee. Of the 25,000 people in Alabama's state prisons, 20% (5,000 people) need treatment. Yet

"4,400 of those people would be considered outpatients were they not also
convicted of crimes."

So if Alabama were using outpatient treatment to intervene BEFORE these people committed crimes, the number of people needing treatment behind bars would be reduced dramatically … to less than 3% of the prison population instead of 20%.

That would save not only lives, but money.

Allen said the state prison system budget will fall short by $31 million this
year, and the cost of treating mental illness has contributed to that.

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Thursday, December 20, 2007

Reading is fundamental

Opponents of AOT will often rely on hyperbole to argue against providing necessary assisted care for individuals with a severe mental illness. You’ll commonly hear that programs like Kendra’s Law will run roughshod over all consumers, or that it’s “social control” targeting those who may just act differently.

Of course, we know the reality is quite different. AOT programs like Kendra’s Law focus care toward the most mentally severely ill, reducing the crushing consequences of nontreatment – arrests, incarcerations, homelessness, and victimization. Unfortunately, most opponents of AOT simply haven’t even bothered to read the eligibility criteria associated with an AOT program, preferring to rely instead on overheated rhetoric.

So today, we’re providing you with an example of what eligibility criteria for an AOT program typically look like. The below example comes from New York, but could just have easily have been taken from any number of states around the country: In order to be eligible for New York’s AOT program, a court must find, by clear and convincing evidence and after a full hearing, that all of the following have been met.

The individual must:

1. be eighteen years of age or older; AND

2. suffer from a mental illness; AND

3. be unlikely to survive safely in the community without supervision, based on a clinical determination; AND

4. have a history of non-adherence with treatment that has:
a. been a significant factor in his or her being in a hospital, prison or jail at least twice within the last 36 months; or
b. resulted in one or more acts, attempts or threats of serious violent behavior toward self or others within the last 48 months; AND

5. be unlikely to voluntarily participate in treatment; AND

6. be, in view of his or her treatment history and current behavior, in need of AOT in order to prevent a relapse or deterioration which would be likely to result in:
a. a substantial risk of physical harm to the individual as manifested by threats of or attempts at suicide or serious bodily harm or conduct demonstrating that the
individual is dangerous to himself or herself; or
b. a substantial risk of physical harm to other persons as manifested by homicidal or other violent behavior by which others are placed in reasonable fear of serious physical harm; AND

7. be likely to benefit from AOT; AND

8. if the consumer has a health care proxy, any directions in it will be taken into account by the court in determining the written treatment plan. However, nothing precludes a person with a health care proxy from being eligible for AOT.

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Wednesday, December 19, 2007

Top 10 stories you didn’t hear in 2007

In 2007, media coverage concerning people with severe mental illnesses was understandably dominated by the Virginia Tech tragedy.

But for every Seung Hui Cho, there are thousands not receiving treatment for schizophrenia or bipolar disorder languishing in back bedrooms, living on the streets, or sitting in jail cells. Those stories don’t lead the evening news.

The Treatment Advocacy Center is the only national organization fighting to get needed treatment for people who are most seriously mentally ill – long before the untreated symptoms of their illnesses make their lives the stuff of headlines. Many of these individuals are unable to make informed decisions about their need for treatment because of brain changes caused by their diseases.

Here is the top 10 list, for 2007, of the most under-reported trends and issues brought about by our nation’s continued neglect of those who are the most severely mentally ill.

Tuesday, December 18, 2007

Unlucky 7

Justin Quintana claimed he was God. He called police officers to saying he should be treated like the President and wanted 24-hour protection. He threatened his mother, and police had been called to Quintana’s house six times in a little more than a year. His mother – Susan Kuchma- was a state police officer, but there was nothing she could do to get treatment for her son’s paranoid schizophrenia. He didn’t chose treatment and wasn’t deemed dangerous.

One of Kuchma's family members said Friday that the officer loved her son and took great pains to document his behavior with the goal of getting him help. But her efforts were often frustrated.

"It's a lot of red tape," said Kuchma's niece and Quintana's cousin, Tenika Susana Sosa-Quintana, 28, of Mesquite. "...we all have civil liberties and Justin is an adult and Justin has not been deemed incompetent by any court.

"The whole thing comes down to whether or not a person is construed to be dangerous to themselves and/or others," said Ron Gurley, a local advocate for the mentally ill. "Well, that is in the eyes of the beholder. But locally here there seems to be a strict adherence to dangerousness being something where you have to almost present the fact that you are going to hurt somebody or hurt yourself."

Last Thursday, the seventh time police were called to Quintana’s home, officers found Kuchma dead from a gun shot wound. Maybe now that Quintana is charged with murdering his mother he’ll get treatment.

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Monday, December 17, 2007

TAC honors grassroots advocates

The board of directors of the Treatment Advocacy Center today announced that Karen Gherardini from Illinois, Janice DeLoof from California, and Jeanette Castello from Pennsylvania are the winners of its annual Torrey Advocacy Commendation.

“Individuals are the heart of the effort to reform and improve our nation’s mental illness treatment system,” said president Dr. E. Fuller Torrey. “The system will not change without the untiring fortitude of individuals like Karen, Janice, and Jeanette. Fighting the entrenched establishment, especially on an issue like real treatment for people with severe mental illnesses, is far from easy. But legislators cannot look impassioned family members in the face and deny the need for real reform. That is why their work is so critical, and why I am so proud TAC is recognizing these three tireless advocates. They are tenacious in their personal dedication and commitment to helping a group of people with few real champions.”

The TAC award recognizes 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 severe mental illnesses that they do not recognize that they need treatment.

The board of directors of the Treatment Advocacy Center voted unanimously to recognize these three outstanding advocates. More about the recipients...

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Friday, December 14, 2007

More money always helps ... but isn't tied to commitment laws

An expert from Utah told the Washington Post that improving their involuntary commitment standard did NOT result in skyrocketing costs.

Some experts believe changing the imminent-danger standard could be costly if it results in more people being hospitalized and treated. But states that have abandoned the standard have not seen a substantial rise in costs, officials said ... Utah changed its law in 2003 to remove the "immediate" criterion and allow judges to consider a person's mental history. There was an initial increase in people being ordered to treatment, said Jed Erickson, an associate director of Valley Mental Health in Salt Lake City, but that dropped off. Erickson said the publicity concerning the law's change increased awareness of the issue but didn't affect the mental health system itself.

Thursday, December 13, 2007

Help those who need treatment

We need you on our team to help fight for better treatment laws and policies for people with severe untreated mental illnesses. Let me give you six good reasons why the Treatment Advocacy Center is worthy of your support.

1. Because we are helping people.

A mother whose son had schizophrenia sent me an email. Her son was unwilling to take medication and had misdemeanor charges pending. I recommended she research her state’s commitment laws on our website. Two days later, very pleased, she wrote back. She was from Michigan and had discovered Michigan’s Kevin’s Law, allowing assisted outpatient treatment. Armed with her new knowledge, she was going to accompany her son to court and insist on his getting treatment under her state’s law.

2. Because we will use your money better than other charities will.

Charity Navigator awarded TAC four stars, its highest possible rating, saying TAC “outperforms the majority of nonprofits in America with respect to fiscal responsibility.”

3. Because we are making a real difference.

The Treatment Advocacy Center has been involved in reform of 18 laws in nine years and has continued to be a loud voice on the national stage, actually changing the shape of the message about the need for treatment for those who are the most ill.

4. Because we change commitment laws in states when change is needed.

For five years, TAC worked with Illinois advocates, legislators, and stakeholder organizations to shepherd a better law through the legislature. The result, passed this year, is the greatest improvement to Illinois’ treatment law in decades, permitting court-ordered treatment before someone presents a demonstrable threat of immediate physical harm. The law will make mandated treatment a priority over mandated psychosis, and help hundreds of people each year. “This means so much to so many families,” said Linda Virgil, chair of NAMI Illinois’ public policy committee.

5. Because we don’t only change laws, we follow up to get them used.

After successfully changing Florida’s commitment law in 2004, TAC worked with the Seminole County Mental Health Center and the Seminole County Sheriff’s Office to create a model program in that county. In the first 18 months, the new assisted outpatient treatment program resulted in a 43 percent decrease in hospital days and a 72 percent decrease in jail days for those severely mentally ill individuals in the program. The savings totaled more than $15,000 per patient.

6. Because we educate the public about what is wrong and how to change it.

During 2007, an average of 15 million newspaper readers, radio listeners, and television viewers had a chance to see or hear our message each month. Our staff also made presentations in states like Delaware, California, Idaho, Pennsylvania, Texas, and Virginia, and our website and blog have substantially increased in traffic.

We are the only organization that focuses exclusively on the most severely mentally ill individuals. TAC’s work is making a real difference – and support from people like you is what makes it all possible.

Please make a gift today.

With appreciation, E. Fuller Torrey, MD President

P.S. – Because we still take no money from pharmaceutical companies, support from individuals like you allowed TAC’s quick response to the Virginia Tech tragedy. Our message about treatment was heard on Anderson Cooper 360, NPR, CBS Evening News, and CNN, and in papers like the Wall Street Journal and the Washington Post. Your gift ensures that TAC can continue to do whatever it takes to get the message out.

P.P.S. – You can donate right now on our website

Wednesday, December 12, 2007

Remember Million-Dollar Murray?

Remember Million-Dollar Murray? So does Washoe County, Nevada. After cycling in and out of the county jail for 10 years, Murray, a homeless man with a mental illness, cost the county an estimated $1 million. He’s also the inspiration for a study completed by the University of Nevada that outlines the cost of homelessness in Washoe County.

According to the Reno Gazette Journal in its report on the study:

The Washoe County Jail is one of the largest providers of mental health services to the homeless, who are further burdening an already-crowded facility. But the jail and court system are the only places for many homeless to receive mental health treatment.

It costs just under $84 a day to house an inmate at the Washoe County Jail. Homeless inmates comprise about 7 percent of the population. In 2004, there were 443 homeless inmates compared with 746 in 2005. Comparatively, 96 of the inmates in 2004 were housed in mental health units while 169 of the homeless inmates in 2005 were housed in the mental health unit. In 2006, it was estimated that homeless inmates cost the county more than $890,000.

Researchers concluded that local officials could save money if they addressed the reasons why people become homeless rather than primarily responding to them during crisis, which leads to costly trips to jail or the emergency room.

"Homelessness is not a problem, it's a symptom," Bartholet said. "If someone is a chronic inebriate and you only provide them with a meal and a place to sleep, you may save their life by keeping them from freezing to death, but you're not doing anything to address the chronic condition they're in.

Yet that’s what the entire state continues to do. Without access to programs like assisted outpatient treatment (AOT), housing will remain nothing more than a band-aid for many of Nevada’s severely mentally ill citizens. The cycle from street to jail will continue. Remember million-dollar Murray?

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Tuesday, December 11, 2007

Homeless shelters are the new mental health facilities

Roughly 150,000 to 200,000 individuals with schizophrenia or bipolar disorder are homeless. In the absence of psychiatric hospitals, homeless shelters are yet another example - along with jails and prisons- of today’s “mental hospitals”.
Out on the streets, people with mental illness and addiction problems are guaranteed neither a home, food, health nor safety.

As [Dennis] Marble [executive director of the Bangor Area Homeless Shelter] and many others see it, the morphing of the homeless shelter into what Marble calls an "underfunded mental health facility" is one of the unintended consequences of the "downsizing" of the state’s mental health institutions, including Bangor Mental Health Institute, now known as the Dorothea Dix Psychiatric Center.

A major complaint of the critics of deinstitutionalization was that adequate community resources were not put into place to support patients after their release. As a result, many did and still do wind up in homeless shelters or jails, which are increasingly hard-pressed to house them adequately.

"I look at some of the folks who come here and it’s pure and simple — they can’t [fend for themselves]," Marble said. "And for me to say the right thing for them is to live their lives in this shelter and that’s their choice? That ends up ringing hollow really fast."

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Monday, December 10, 2007

Do you subscribe to e-news?

Do you subscribe to e-news? Readers tell us they greatly appreciate this weekly email newsletter that includes commentary and news stories from around the country on the consequences of nontreatment and some of the solutions.

Just complete the contact form on our website to to be added to the mailing list for this popular weekly electronic newsletter, our periodic hardcopy newsletter, Catalyst, and all other important mailings.

Don't miss anything!

Friday, December 07, 2007

How can my loved one get inpatient care?

The above question is commonly raised by families seeking treatment for someone they love. Unfortunately, the reality of treatment in the United States is that care too often only comes once they’ve committed a crime.

A recent study in the journal of Psychiatric Services looked at the psychiatric and criminal histories of individuals in a large urban county jail and what psychiatric services they received while incarcerated. Their conclusion? One that is not at all surprising – a large percentage of persons with a severe mental illness receive their acute inpatient treatment in the criminal justice system rather than in the mental health system.

The study’s specifics are sadly familiar: 75% of the random sample were diagnosed as having a severe mental illness; 92% had a history of nonadherence to medications before their arrest; 95% had prior arrests.

These terrible statistics bring to mind the comments of the Bazelon Center’s Michael Allen, who recently pondered whether it was worse for a person with a severe mental illness to be in a psychiatric hospital or in prison.

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Thursday, December 06, 2007

Getting messages from the TV

Jeffrey Arenburg is in the news again; this time facing charges for punching an officer in the face.

Twelve years ago, Arenburg killed Ottawa sports broadcaster and former hockey pro, Brian Smith after he finished his 6 p.m. sports show. Police said Arenburg, who had worked as a fisherman, had made complaints in the past that TV stations were broadcasting messages into his head.

According to Canadian media reports, Arenburg was later diagnosed as a paranoid schizophrenic and was found by a judge to be “not criminally responsible” for the death of Smith.

In a terrible irony, after Arenburg killed Brian Smith, Ontario passed “Brian’s Law,” in his name – a bill that allows for court-ordered community treatment.

Unfortunately, threats to local TV and radio personnel by people with untreated mental illnesses are more common than many realize.

In a questionnaire answered by 259 radio and TV stations:
  • 123 stations (47.5 percent) reported having at some time received a telephone call, letter, fax, or e-mail from an individual asking the station to stop talking about them or sending voices to their head.
  • The stations had received a total of 3,155 such communications from 284 separate individuals in the past year, with one station reporting having received 1,500 communications.
  • 43 stations reported that an individual had at some time personally come to their station to ask them to stop talking about them or to stop sending voices to their head. The stations reported having received a total of 150 such visits from 61 different individuals in the past year.

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Wednesday, December 05, 2007

Do psychiatric advance directives help?

The Wall Street Journal ran an interesting story earlier this week about Psychiatric Advance Directives (PADs) which points out some of the strengths and weaknesses of using them as a planning tool for treating severe mental illnesses:

With PADs, patients with mental illness can state preferences for, or dislikes of, specific treatments, designate a proxy decision-maker or make other advance decisions about care, says Jeffrey Swanson, associate professor at Duke University, who has researched PADs. Twenty-five states, including Illinois, currently have laws authorizing such directives, and more are considering them, according to the National Resource Center on Psychiatric Advance Directives.

…Most state laws contain such an "override" clause, according to Swanson, but to actually force a treatment or hospitalize patients involuntarily for being a danger to themselves or others requires following state law regarding involuntarily treatment, which often involves a court hearing.

Many clinicians worry that PADs allow patients to refuse all treatment or make unreasonable or unsound demands. There are also questions about how to judge if patients are well enough to create PADs, and what to do if they change their minds later if they appear to be getting more symptomatic.

PADS are one more tool for helping individuals who have capacity to make decisions about the mental health treatment they will get if they become incapacitated. But, PADs are not a replacement for treatment laws. For individuals with chronic and persistent symptoms, PADs only work AFTER someone is stabilized and recovered enough to properly execute a PAD. Sometimes, this might require hospitalization or outpatient commitment. Thus, the treatment laws and PADs are tools to be used for situations that require different treatment solutions.

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Tuesday, December 04, 2007

Where was the mental health community?

Trinidad Ornelas was fatally shot by police officers in Orange County on Sunday after his mother called 911 because he was choking her.

Neighbor Victoria Hernandez said

…family members told her that Ornelas sometimes didn't take his medications [for schizophrenia] which led to outbursts. The mother had called the police in the past to calm her son down.

Hernandez says police have been to the Ornelas house before, “They should have known.”

An attorney for the family – Thomas Beck says, “The officers who responded Sunday were "just brand new to the circumstances.”

The real question should not be whether the officers who responded to the 911 call on Sunday were the same ones who frequently responded to calls to calm Ornelas.

No – the real question should be – where was the mental health community?

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Monday, December 03, 2007

You shouldn’t have to strap a bomb to your body to get someone to help you

Leeland Eisenberg purportedly tried to get help before taking hostages in a dramatic scene on Friday at Hillary Clinton’s campaign office in New Hampshire.

Eisenberg was known for his erratic behavior and for drawing law enforcement’s attention, and yet when he was taking medication, he was a different person.

Family members and friends said that Eisenberg could be a funny and sweet man when he took his medication.

"When he was on his medication he was always making me laugh. He spoiled me. It was perfect in my eyes," Lisa Eisenberg told "GMA." "Without the medication and with alcohol, he turned into a different person."
The Eisenberg case is another in a long line of examples of why our country needs to recognize the importance of early and timely treatment for severe mental illnesses.

The Nation had this:

Without appearing to capitalize on the situation, Clinton, and all elected officials, can and should take this incident as an opportunity to emphasize the importance of mental health services in any health care package, criminal justice reform, and indeed, in any vision of what a more caring, safer America looks like.
One thing a more caring, safer America needs is more inpatient beds and better systems for the sickest people to access those beds. The number of available inpatient psychiatric beds in New Hampshire has dropped dramatically. In May of last year, the Concord Monitor reported on the crisis.

In the past 20 years, alternatives to New Hampshire Hospital, which cares for patients who are a danger to themselves or others, have dwindled.

Lakeshore Hospital closed. Portsmouth Pavilion downsized. The number of beds outside New Hampshire Hospital for patients who need to be involuntarily committed shrunk from 101 in 1998 to 22 in 2002, the report said. In residential acute psychiatric programs, the number of beds plummeted from 52 to 17 between 2000 and 2003 because the reimbursement doesn't cover costs.
Leeland Eisenberg – if he doesn’t land in prison – will likely now qualify for one of those beds. Which is ironic considering the undercurrent of desperation in this story – and of many like it. You shouldn’t have to strap a bomb to your body to get someone to help you.

The family says earlier last week Eisenberg, seeking mental health help, was turned away from a hospital because he had no money or insurance.

Eisenberg apparently went to the Clinton office because he saw an ad on television, in which a New Hampshire man said Clinton helped him get health insurance.

Eisenberg told a family member he was going to do something to get in the hospital. The next day witnesses say he walked into the Clinton office, wearing what he said was a bomb, demanding to speak to the senator. [Good Morning America, December 3, 2007]
It isn’t news that we need more psychiatric hospital beds and better overall systems to care for those who need it. Mr. Eisenberg may sadly have done more than secure treatment for himself – he may have secured some attention for these issues from those who are campaigning to be president.

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