Learning about treatment laws from Britney

Britney Spears is in the headlines again – for another psychiatric hospitalization. This USA Today story notes that there is still no public confirmation of a diagnosis. The reality is that we do not know what the situation is for her, or what her family is doing to try to help her.

We do know that the media is shedding the spotlight on California’s treatment law and providing some much needed education to the public about what happens when there is an intervention for someone who might need treatment, but will not voluntarily seek it. The story even includes the information that transporting officers and mental health professionals are required to provide a patient brought in under a “5150” for a psychiatric evaluation and hold.

The real cost of assisted outpatient treatment

Virginia has the opportunity to enact meaningful mental health reform by passing Senate Bill 177. This Assisted Outpatient Treatment (AOT) bill enjoys bipartisan support and will allow for people incapacitated by severe mental illnesses to be placed in court ordered community treatment. The availability of such a program might well have prevented the terrible tragedy that happened at Virginia Tech last April.

Sadly, the passage of Senate Bill 177 is now threatened by those who mistakenly claim it will impose too great of a financial burden. This is a myth.

The implementation of AOT as provided by Senate Bill 177 will not be expensive. This program will not mandate any services that individuals with serious mental illnesses are not already eligible to receive. AOT orders merely require the system to facilitate treatment compliance for noncompliant individuals by providing them with the existing services they need to remain stable and to prevent the severe consequences associated with untreated mental illnesses.

The proof that AOT will not require the creation of new services can be found within the language of Senate Bill 177 itself. One of the requirements for granting an AOT order under this new law is a finding that:

“the community services board that serves the jurisdiction where the person resides has the capacity to provide the prescribed treatment or services.”

Not only will AOT not be expensive, it will ultimately save Virginians millions and millions of dollars in alternative costs that come from hospitalizations and incarcerations of persons who do not benefit from the availability of court supervised treatment. In other states where AOT has been enacted, such as New York and North Carolina, participants have experienced a dramatic decrease in both hospitalizations and incarcerations.

Virginians must separate fact from fiction so that true reform can finally occur. The greatest cost that will be paid by Virginians is not in implementing AOT but in failing to do what is necessary to provide for effective and timely treatment for people lost to acute psychiatric illnesses like Cho Seung-Hui.

Washington state continues to fail

Anthony Williams refused to take medication for his paranoid schizophrenia. He had been evaluated by mental health workers at least three times in the last year, but Williams wasn’t deemed an imminent risk to himself or others, so wasn’t ordered to treatment.

So, why do county designated mental health professionals insist that someone be "imminently" dangerous when the word "imminent" doesn't even appear in the Washington standard? Forty-one other states let families directly petition a court to get treatment for a loved one in crisis. Why does Washington State require county designated mental health professionals to be the “middle man” in their process?

In the past Williams had threatened to kill a community corrections officer and had told a psychiatric social worked that “God told him to "shoot bad people" and that he carried a knife to protect himself from both God and the devil.” But Williams wasn’t deemed dangerous enough for treatment.

In September Williams threatened the landlord at his apartment. Police said he was a “a threat to the safety of officers and those around him," and found an 8-inch butcher knife in his sweat-shirt pocket. Williams was found guilty of harassment, but wasn’t deemed dangerous enough to be committed into treatment.

Williams was considered high risk by police, the Department of Corrections and community health staff, and the DOC had logged 50 contacts with him in the past six months.
Yet- King County mental health workers said Williams still didn’t meet the threshold to be committed to treatment.

On New Year’s Eve, Williams fatally stabbed 31- year-old Shannon Harps outside her house. Now will Williams get treatment?

Virginia needs more than lip-service reform

A statement from TAC's executive director- Kurt Entsminger:

"Virginia’s mental illness treatment laws are among the most restrictive in the nation. To get help via involuntary commitment, the state requires someone obviously incapacitated by the symptoms of an illness like schizophrenia to be an immediate physical danger to themselves or others.

Last April, the failures of Virginia’s treatment laws stunned the nation, and the General Assembly finally began to pay attention. The result is literally dozens of commitment law bills now under discussion.

Unfortunately, the majority of the proposed bills only marginally change Virginia’s antiquated laws. They will give legislators a photo op and a warm feeling, but will not bring real help to the people who most need it.

People who are clearly psychotic and dangerous to themselves or others should get mental illness treatment. But Virginia needs to do better. Virginia needs a law like Kendra’s Law, and must also allow outpatient intervention before someone is in crisis." read more...

"Heck of a job, New Mexico"

We hope New Mexico legislators who failed to pass Kendra’s Law last year are thinking hard about the consequences of their failure to act. And we hope New Mexico’s correctional facilities are prepared to help more people like Justin Quintana, since apparently killing your mother and being incarcerated is the clearest way to treatment in that state.

Patrick Kuchma said he has a "tremendous amount of anger" toward Quintana and feels he should spend the rest of his life in prison or in a mental health facility. Kuchma said he doesn't view lifelong incarceration as a tool for revenge, rather he views it as a way for Quintana to receive treatment that he has in the past refused to undertake.

"Basically what I'm getting at is, I don't think needs to be out in the public," Kuchma said. "He does not need to be out on his own because the fact still remains, he's mentally ill, he is a paranoid schizophrenic and he has the capability of not taking medication and this could happen to somebody else."

AOT patients benefit from agency collaboration

In Summit County, Ohio thousands of seriously mentally ill people have benefited from court ordered outpatient treatment. The effectiveness of assisted outpatient treatment (AOT) in decreasing hospital admissions in Summit County was clearly established over a decade ago, when they documented a decrease from 1.5 to 0.4 per year before and after AOT (Munetz et al. 1996). AOT also increased patients’ compliance with outpatient psychiatric appointments from 5.7 to 13.0 per year and with attendance at day treatment sessions from 23 to 60 per year (Munetz et al. 1996).

I recently joined a team of Treatment Advocacy Center representatives who traveled to Akron, Ohio to learn more about this highly successful program. During our two day visit, we interviewed representatives from many different agencies and heard from people who depend upon services from Summit County for treatment of their mental illnesses.

Over 15 years ago, mental health officials in Summit County established a new framework for continuing court supervision of mentally ill people once they were released from inpatient care. While well designed on paper, the ultimate success of this program comes from the way that all of the participating agencies work together to uphold the program’s purpose. Assisted Outpatient Treatment thrives in Summit County because judges, lawyers, mental health professionals, caseworkers, and law enforcement officers all recognize the benefits of AOT as a legal mechanism and also share the same strong desire to see seriously mentally ill people stay well.

The outpatient commitment process in Summit County begins with the release of a person from inpatient care. The judges of the Summit County probate court reasonably interpret Ohio’s commitment laws as allowing outpatient care for patients who are released from hospitalization but who still need court ordered treatment to avoid rapid deterioration. Taking into account all relevant circumstances, the courts carefully balance the patient’s need for continued supervised treatment against their ultimate right to return to the community without restrictions.

In turn, county case workers who assist these seriously ill patients in the community readily acknowledge that this continuation of court ordered treatment greatly increases treatment compliance and decreases practical problems for patients. The understanding that he or she is subject to an ongoing court order and may be ordered back for further evaluation is a sufficient inducement for most patients to comply with their treatment plans.

A horrific ending

A few weeks ago a homeless man in Fairfax County, Virginia was shot and killed by police officers after he lunged at them with a knife. As the public railed against the officer for using lethal force, one blog comment added a bit of perspective.

However, this incident just highlights how poorly we treat the mentally ill in this country. This homeless man was clearly not of a sound mind. If he were cognizant of reality, he would not have been jabbing anyone, much less a cop, with a knife, totally at random. This man (and literally thousands of more like him) should be in hospitals, receiving treatment.

Yet, because over 70% of all state mental facilities were closed in the late 70’s to early 90’s, we have no place to house these broken people. Many end up in jail. Many more end up on the street. Far too many end up dead.

We cried at the last spring's tragedy at Virginia Tech. We point fingers at ineffective police reactions. Yet, we don’t want to do anything to fix our mental health situation.

If we don’t push for change, what happened at the Rose Hill Shopping Center on Friday will become more common than rare.

There’s no doubt this story had a horrific ending. Rather than be horrified by the police perhaps the horror should be pointed at the mental health system.

What it takes...

"At one point I stood up in court and said, 'What is it going to take for him to get some help?'" Barbara Strandberg said during a recent interview. "I think I've got my answer now."

"Society has sacrificed human sanity..."

"I believe it is time to restore common sense to a society that has literally sacrificed human sanity in the name of personal privacy. I consider it a great honor and privilege to join this effort."

- TAC executive director, Kurt Entsminger in an interview with Schizophrenia Connections' Robin Cunningham

The spoils of psychosis

Joshua Hoge is confined at Western State Hospital after being found not guilty by reason of insanity for murdering his mother. He is now trying to claim all or part of his late mother's estate, despite a Washington State law that prevents someone from profiting from killing someone else.

The bulk of the estate that he is trying to claim - $800,000 - came from a lawsuit filed against the clinic that kept Joshua from getting the treatment he needed for his schizophrenia - treatment that might have prevented him from stabbing his mother and brother to death with a butcher knife in the first place.

There's a great deal of gnashing of teeth over the possibility of Joshua "winning" this money - which would likely be used to support him if and when he is ever permitted to transition into a group home and back into society.

While Seattle University law professor John Strait acknowledges that this is "nutty logic," he agrees that Hoge may very well be entitled to the money. "For all intents and purposes, there is no crime," he says. "We don't punish people for being really sick."

Unless you count forcing them to remain psychotic, stab their family members, and spend their lives in a forensic facility ...

Criminal court first; treatment second

Two judges in Rock Island County, Iowa are demonstrating deep compassion for helping those with severe mental illnesses. The judges, who already have heavy case loads, have started a mental health court to divert people with mental illnesses who have committed a crime from jail into treatment.

The judges are making a difference in the lives of many people with severe mental illnesses by helping them get treatment and keeping them out of jails and prisons.

Conklin, 58, and Bell, 54, are sharing the load, and both are aware they are breaking new ground. They credit their successes to the defendants themselves, along with the case managers who are the real mental health experts.

Despite the help, it isn’t easy.

“Some days you just have to tell people what time it is, and that’s not real nice,” Conklin said. “While some of these people have waited in jail, they’ve become caged animals. We have to get them back before we can get them better.”

Sadly, people with severe mental illnesses aren’t getting this type of compassionate intervention and tough-love before they commit a crime. No- to see Judges Conklin and Bell you must make it to criminal court.

Join the Treatment Advocacy Center

Know someone who wants to help fight to restore balance and common sense to America’s mental illness treatment system? The Treatment Advocacy Center is looking for a legislative and Policy Associate to help remove barriers to the timely and effective treatment of severe mental illnesses. Full job description here...

Treat severe mental illness like any other illness

ER doctor Greg Christiansen gave striking testimony on Friday at a Virginia House of Delegates subcommittee hearing focused on mental health. As we have previously highlighted on this blog, Virginia’s outdated treatment laws unnecessarily handcuff treatment providers – the question becomes not, “does this person need care?” but “is this person imminently dangerous, and will the local Community Service Board (CSB) agree with me?”

His testimony eloquently laments the sorry state of affairs that marks Virginia’s mental health system – "If you come in as a trauma patient, I have to treat you, if you come in as a psychiatric patient, I have to get permission."

Blue in Baltimore

This week in Baltimore, the fire department issued a rare “blue alert” – usually seen during only the most severe weather emergencies. It overrides all other directives and allows medics to take patients to the nearest ER regardless of how crowded it is.

Why?

Across Maryland, beds are full in the ERS – many filled by those in psychiatric crisis.

Dr. Jeff Sternlicht, director of emergency services at the Greater Baltimore Medical Center … said that the unusual issuance of a blue alert in Baltimore County is the direct result of a growing problem in Maryland and across the country.

"There are not enough emergency beds or hospital beds in Maryland right now or nationwide. But the problem is worse in Maryland," he said.

Sternlicht admitted the problem is complex.

He said that overcrowding is caused by growing patient need, due in part to a shift in primary care abilities, decreasing hospital beds, and, in Maryland, inadequate psychiatric care that leads patients who need mental help to the ER for care.

"Rights not only to life, but also to liberty and the pursuit of happiness..."

In a blog previewing an upcoming interview with TAC executive director Kurt Entsminger (stay tuned…) Robin Cunningham of Schizophrenia Connections writes of the constitutional rights to life, liberty and pursuit of happiness. Certainly the constitution didn’t intend those rights for everyone except those with severe mental illnesses.

At a time in our nation's history when there was little or no hope of recovery from serious brain diseases, the nation, spurred on by the demands of Dorthea Dix, ensured what it could for those suffering from these illnesses. It ensured life by providing subsistence levels of service. Liberty and the pursuit of happiness seemed unobtainable and were compromised.

In my next blog, I will present portions of an interview with Kurt Entsminger who is the newly named Executive Director of the Treatment Advocacy Center. His organization is at the center of the debate concerning how to guarantee to those of us living with schizophrenia our constitutional rights to not only life, but also liberty and the pursuit of happiness.

Is a double homicide a requirement for getting treatment?

Lizards and frogs were reading his lips, CSPAN newscasters were calling him a terrorist, he was the target of a conspiracy involving the KKK and the CIA, and comedians on BET were making jokes about him, but Franklyn "Frankie" Duzant wasn’t getting treatment for his mental illness.

There was no treatment until -19 months ago -Duzant slashed his son and wife to death with a sword because he believed his wife was going to be kidnapped and his son was going to be tortured by dogs.

Now, Duzant is getting treatment. Since the killing he’s been restored to competency and is ready to stand trial. All it took to get there was a double murder.

Freezing with his rights on

As reported by WLBZ of Bangor, Reid Emery, a 61 year old man, was released from the Down East Community Hospital in Machias Maine last Tuesday night. The following morning, he was found dead in a snowdrift just a few hundred feet from the hospital’s entrance.

When Mr. Emery walked out of the hospital, he was reportedly delusional. He was wearing a light jacket and slippers. He left against the advice of doctors. And he walked out into the height of a brutal January snowstorm. Weather records for East Machias show that the low temperature that night dropped to four degrees.

Nevertheless, a hospital administrator, Ann Marie Knowles, explained that there was nothing that could be done to stop Mr. Emery. “Patients have the right to leave against medical advice.”

In Maine, a person may be admitted on an emergency basis for the treatment of mental illness upon a showing that this person suffers from a mental illness and poses a likelihood of serious harm to himself or others.

We know no details about Mr. Emery’s history of mental illness. We also do not know why hospital personnel deemed themselves unable to intervene on Mr. Emery’ behalf. What we do know is that hospital personnel did nothing to stop an elderly, delusional, and under clothed man from stepping out into subfreezing temperatures and a raging snowstorm.

Any caring and reasonable person should have been motivated under these circumstances to take some action to intervene on behalf of Mr. Emery. Instead, we find a hospital trying to justify the practices and procedures that resulted in this tragic and unnecessary death. What is wrong with this picture?

At least those who champion the civil liberties of the mentally ill can take some comfort in knowing that Reid Emery froze to death with his rights on.

Can California's treatment law help Britney Spears?

This weekend news outlets across the world reported that pop star Britney Spears had been taken by medical responders to the hospital for a “mental evaluation.” She was released within 48 hours.

While the media focused on the sensational story, they missed a powerful opportunity to discuss what it means to be taken to the hospital on an involuntary basis for a psychiatric evaluation, what the procedure really entails, how the California treatment law (known as the LPS) is a last resort for helping people, and how the law prevents family members and concerned friends from intervening for an individual who might have clear symptoms of a mental illness until they are in serious danger to themselves or others, or gravely disabled.

The Treatment Advocacy Center tries to educate the media, public, and policymakers about effective mental health treatment laws. To learn more about the California law, check out our online summary. To learn more about mental health treatment laws in other states visit our legal resources section on our website.

While we do not yet know whether Britney Spears has a severe mental illness, we do know that the California law makes it very difficult to intervene and get treatment for an individual with severe mental illness- no matter how obvious the need is to the rest of the world.

Failing society and the person in need

As the Virginia General Assembly prepares to convene next week, the tragedy of Virginia Tech and the need for mental health reform loom large over the Commonwealth. One aspect of Virginia’s flawed mental system health that has received a great deal of notoriety is the commitment standard – one of the most restrictive in the nation.

Many have focused on the commitment standard’s inability to address those who may pose a danger to others, but few have commented on its similar failure to protect the individuals themselves who are in crisis. As Virginia Delegate Dave Albo explains, the current standard renders families just as powerless to help their loved ones in those situations.

"You have to wait for the person to deteriorate so much that they fit that definition [of imminent danger]. You have to wait right up until the very end when the person is about to kill themselves before you call," said Albo.

From street to jail and back again

In Maryland, the cycle from street to jail – but not treatment - continues for Michael Alan Poole.

In the past two years, Poole, a man with bipolar disorder, has been arrested for stomping two cats to death, shoplifting, stalking, and trying to steal a donation jar from a store. On Saturday, Poole’s his family filed trespassing charges. Poole had broken into his mother’s house and had, in the past, attempted to set the house on fire.

Prosecution and defense attorneys say Poole is an example of the failure of Maryland’s mental health system.

…. a shortage of beds and restrictions on admittance prevent some people from getting the help they need.

"His problems are not uncommon for our office," said Assistant Public Defender Karl H. Gordon, who represented Poole in the 2006 animal cruelty case. He estimates that 20 percent of all of the office's clients have mental health problems of some sort.

"The problem that always comes up is that people refuse to take their medication," State's Attorney Frank R.Weathersbee said.

Accepting the reality of mental illness

Blogger and writer for National Review, Jennifer Roback Morse comments on Michael Judge’s moving piece about Sonny Iovino in the Wall Street Journal:

“In my view, the problem is that the modern world is so deeply committed to rationality and autonomy that we can not accept the reality of individuals who are not capable of rational thought or of using their autonomy.”