“Treating The Mentally Ill Makes Financial Sense”

The nation’s jails and prisons hold hundreds of thousands of people with severe mental illness who receive inadequate treatment and many times do not belong incarcerated. As a reporter for the Detroit Free Press points out:

“Locking up people who commit minor crimes because they need mental health treatment is ineffective, expensive and wrong. Mental health courts, along with more community treatment options, would ease the problem; the House must show more foresight than the Senate by funding them.”

As reader in Tennessee states in response to an article written about the inhumane treatment of an inmate with a mental illness, “[t]reating the mentally ill makes financial sense.” In the article the Davidson County Sheriff, Daron Hall, reports that people with mental illness make up 20 and 25 percent of every prison and jail population in Tennessee. According to a study conducted by U.S. Department of Justice, the average annual operating cost per State inmate in 2001 was nearly $23,000, and the cost for prisoners with severe psychiatric disorders far exceeds that average. In Michigan, mentally ill prisoners can cost the taxpayers $50,000 a year per inmate, and in some cases even more. Considering that many of those inmates ended up incarcerated only as a result of their mental illnesses, wouldn’t it make sense to insist on treatment for those most at risk in order to prevent their incarceration?

The Real Cost of Psychiatric Hospital Beds

A request for funding to renew staffing for 25 psychiatric beds at Catawba Hospital near Roanoke, Virginia failed in the 2008 Virginal Legislature. This state hospital is located less than 50 miles from Virginia Tech where 33 people died in last April’s shooting rampage by Seung-Hui Cho.

This proposal for $2.2.million was defeated for budgetary reasons. Yes, staffing more public psychiatric beds in Virginia will cost taxpayers more money. But having too few beds is already costing Virginia and other states more than they will ever realize.

The Treatment Advocacy Center recently released a new study The Shortage of Public Hospital Beds for Mentally Ill Persons. This study not only reveals the serious shortage of beds that exists in Virginia and other states but also examines the devastating consequences. Some of the consequences that come from a system that does not have adequate facilities to treat the sickest of the sick include greatly increased homelessness, the warehousing of mentally ill people in jails and prisons, overcrowded emergency rooms, and a disturbing increase in violent crime.

While fiscally conservative lawmakers continue to count the monetary cost of adding new beds at state mental hospitals, who will be responsible for counting the enormous social costs that come with a broken system that currently tolerates far too few beds?

Bipolar Disorder

A writer in Michigan sheds some light on what it’s like to have bipolar disorder and the importance of effective treatment:

“…What does this mean: it means that without being on medication and taking care of myself the way I do my personality can go from very highs to very lows.

The truth was that it was really a chemical imbalance in my brain that I had no control over. It was an element that my body was lacking. To be exact it was a little pill called lithium that my body didn't have enough of. Easy enough. Take a pill and things would be better.

It sure beat either acting like I had super powers or sitting alone in my room crying for no specific reason.

I do not go around advertising that I have this disease nor, up until now, have too many people in my life known this. I suppose the reason I am talking about it now is because there have been so many people in recent years that have done crazy things when off their medication.

Not everyone with this problem is violent to either themselves or to others. There are a lot of people in the world who can lead perfectly good lives, take their medication, monitor their blood and never show any signs of this at all."

Biloxi blues - setting the bar low

The study The Shortage of Public Hospital Beds for Mentally Ill People performed by the Treatment Advocacy Center is complete and the results are dismal. Since 1955, the number of public psychiatric beds across America has dropped from 340 per 100,000 people to 17 per 100,000 people. There is now a shortage of nearly 100,000 public psychiatric beds in the United States.

A panel of experts concluded every state should have at least 50 public psychiatric beds per 100,000 people to meet minimum acceptable standards. That assumes that all other mental health services are optimum.

The one very small silver lining in this dark gray cloud is that Mississippi, of all states, meets the minimum standard of 50 beds per 100,000. Every other state fell short, and most fell very short. In the last census, Mississippi ranked last among all states in per capita income. If a state as resource poor as Mississippi can meet the minimum number of public psychiatric beds, then what possible excuse can the other 49 states have?

Why doesn't Oregon have Laura's Law?

A blogger in Oregon recently posed the question – why doesn’t Oregon have Laura’s Law?

I wonder why we don't have something like Laura's Law (see previous entry) in Oregon. Is it because we don't have the resources? When you think of all the damage that happens without Laura's Law, doesn't it make sense that we find the resources? In the end, I believe it would be cost-effective, since it could keep people out of the hospital and/or jail and could help them to function better through counseling and meds. Doesn't this seem like a humane way to deal with people who are deteriorating, by keeping them from getting worse? Families would have some sort of recourse when their loved one starts going out of control. It just seems a shame we aren't looking at this law as being one of our solutions.

Laura’s Law or assisted outpatient treatment (AOT) is an effective and humane way of helping people with severe mental illnesses who need treatment.

Oregon does have AOT, but it’s rarely used, and a person must be a danger to themselves or others before it’s ordered.

The question posed by the blogger is an excellent one for Oregon legislators – Why does Oregon make it so difficult for its citizens with severe mental illnesses to get outpatient treatment?

New Report: Deficit of nearly 100,000 public psychiatric beds

The Treatment Advocacy Center released a report today that shows a nationwide shortage of nearly 100,000 public psychiatric hospital beds.

In 1955 there were 340 public psychiatric beds available per 100,000 U.S. citizens. By 2005, the number plummeted to a staggering 17 beds per 100,000 persons. Mississippi was found to have the most beds available in 2005 (49.7 per 100,000 people), while Nevada (5.1) and Arizona (5.9) had the least.

“The results of this report are dire and the failure to provide care for the most seriously mentally ill individuals is disgraceful,” said lead author, Dr. E. Fuller Torrey, president of the Treatment Advocacy Center. “Our communities are paying a high price for our failure to treat those with severe and persistent mental illness, and those not receiving treatment are suffering severely. In addition, untreated persons with severe mental illnesses have become major problems in our homeless shelters, jails, public parks, public libraries, and emergency rooms and are responsible for at least 5 percent of all homicides.” More...

Read the full report

Jails, prisons, and preventable tragedies

Approximately 218,000 individuals with severe psychiatric disorders are incarcerated in the nation’s jails and prisons at any given time. That means, sadly, stories like the one below are not as uncommon as we might think.

In Auburn, California near Sacramento, 46-year -old Herman "Tim" Van Bragt, fatally stabbed his mother’s friend earlier this week.

Van Bragt had dreamed his mother’s friend Robert Haggquist was going to kill his mother. When Van Bragt was home alone with Haggquist he fatally stabbed the 72-year-old.

Van Bragt’s mother said he had stopped taking medication for bipolar disorder:

She said her son subsequently stopped taking medication for his bipolar condition and crashed his vehicle.

"I'll never get over it. My son is very sick with bipolar disorder."

An ounce of prevention

Three weeks ago, Derek Johnson was shot to death by police in Flowood Mississippi.

Johnson was suffering from severe mental illness and engaged in bizarre behavior. A neighbor observed Johnson naked and screaming that Armageddon was coming. When the police arrived, Johnson came at them wielding a boxcutter. Johnson was shot and killed.

The brother of Derek Johnson claims the Flowood police overreacted and should have been more sensitive to his mental illness. A representative for the police claims that the responding officers felt their lives were in danger and made a reasonable choice to use deadly force. The courts will inevitably sort out this particular tragedy.

In the meantime, the overall factual pattern and its tragic consequences are far too common. Every year, an alarming number of people struggling with mental illnesses and dedicated police officers lose their lives in altercations similar to this one.

The most important question to ask when we read stories about people such as Derek Johnson is not whether or not the police acted properly. Rather we should be asking why a person like Derek Johnson with such a severe mental illness was not being properly treated in the first place.

The best solution to address this national problem is to ensure better treatment for all people overcome with severe mental illnesses.

"If he had been on his medication..."

33 year-old Lakane Murphy was sentenced to life in prison today for killing Malachi Lofton. Murphy's attorney said he had struggled with bipolar disorder.

"The sad thing is had he been on his medication ... Mr. (Malachi) Lofton would be here," Pope said.

Assisted outpatient treatment is helpful

"There is no question . . . that outpatient commitment can be very helpful for some individuals."
- John Petrila in Psychiatric Services

Housing for the homeless, and treatment too

In Australia an effort is underway to house many of the chronically homeless. Experts involved are working to stem the underlying causes of homelessness by providing not just housing, but treatment too.

"It's futile to try to treat a mental health problem if the patient doesn't have a decent place to live," he [Dr. Nicholson] said.

"Similarly, it's very hard for that patient to sustain a tenancy if they have a florid mental health problem or alcohol and drug problem, so the answer has to be a much more integrated response from our service provision."

AOT: Effective but underused

As regular TAC Blog readers know, 42 states have Assisted Outpatient Treatment (AOT) laws that permit a court to order community based treatment for some people with severe mental illness who meet the state’s strict eligibility requirement. This legal mechanism has been proven to reduce consequences of nontreatment like hospitalizations, incarcerations, victimization, and violence.

Florida passed its law - known in that state as “The Baker Act Reform” and “Involuntary Outpatient Placement” - in 2005. At the time the legislature was considering the measure, opponents asserted that the law would affect several thousand people resulting in a total hardship on the courts, public defenders, and the mental health system. As it turns out, the reality is that it is used for a very select few individuals and to great benefit.

But the most important question to ask is, “Does assisted outpatient treatment help some people with severe mental illness to achieve better outcomes?” And the answer in Florida, as in other states and in the research, is a solid “YES.” Results from the most used program in Florida were recently published in a letter in Psychiatric Services. For patients in the program, when the length of time in the program was compared to an identical length of time before the patient entered the program:

• The average number of hospital days per patient decreased from 64.0 to 36.8, a 43% decrease.
• The savings in hospital costs averaged $14,463 per patient.
• The average number of days incarcerated per patient decreased from 16.1 to 4.5, a 72% decrease.

After Virginia Tech - much activity, little accomplishment

On Tuesday, the Virginia legislature sent a package of bills to the Governor containing its proposed changes to the state’s commitment laws. Although the end-result was essentially inevitable after a bill to establish a progressive assisted outpatient treatment system was shuttled off to a study committee, the Virginia Legislature made it official on Tuesday – there was much busy work in the wake of the tragedies at Blacksburg but nothing approaching rational treatment laws for the state.

House Bill 499, the chief bill of the package, reworks the present procedural system for outpatient commitment fairly well and offers a slight improvement to the eligibility standard but still leaves Virginia’s laws among the most restrictive of treatment in the country. Essentially, HB 499 will move Virginia law in this area from among the worst to just plain bad.

With the pressure created by the Blacksburg tragedies, the legislators in Richmond realistically had no choice but to (1) do away with the state’s “imminent danger” standard and (2) shore up of the outpatient commitment procedural provisions that let Seung-Hui Cho be placed on outpatient commitment and then just slip away from the treatment system.

HB 499 does both of these.

1. “Imminent danger” is changed to “the person will, in the near future, cause serious physical harm to himself or others as evidenced by recent behavior causing, attempting, or threatening harm.” That is more or less just substituting “near future” rather than “imminent” in exchange for the new requirement of recent acts, attempts or threats of violence.

2. HB 499 sets out and strengthens outpatient commitment procedures. This includes making sure that assigned treatment providers are involved in the outpatient commitment process and responsible for those placed under orders.

The only significant way in which HB 499 exceeds that “bare minimum” in the wake of Virginia Tech is in a modest but significant addition to the “substantially unable to care for oneself” prong of the present commitment standard.

HB 499 adds a new clause that allows the placement in treatment of a person over come by a severe mental illness who is substantially likely to “suffer serious harm due to substantial deterioration of his capacity to protect himself from harm or to provide for his basic human needs as evidenced by current circumstances.” Although still falling far short of the progressive commitment criteria in many other states, that at least is an improvement for Virginia legislators to justifiably claim as an accomplishment, albeit a small one.

Sadly, a small change is not good enough for Virginian’s with the most severe mental illnesses

Stigma, violence and severe mental illness

A message about violence and severe mental illnesses from the Treatment Advocacy Center’s executive director –

As someone who has been treated for bipolar disorder for 12 years and who has no history of violence, I understand it would be highly unfair and completely inaccurate for any organization to argue or imply that all people with severe mental illnesses are dangerous. That has never been our position.

The Treatment Advocacy Center has repeatedly pointed out that people with severe mental illnesses who receive proper treatment are no more likely to commit violent acts than people without severe mental illnesses. However, we simply cannot ignore the evidence that shows that people with severe mental illnesses who go untreated are more likely to commit violent acts.

We are very sensitive to the need not to stigmatize people with mental illnesses. Again, as a person who has struggled with bipolar disorder, my attitude toward others who struggle with mental illnesses is one of compassion and empathy. Our overriding desire is to help people who may not be able to help themselves – not to cast a negative light on them.

The Treatment Advocacy Center publicizes stories about people with mental illnesses who commit harm to themselves or others to highlight the need for better treatment laws and practices. We are not the source of stigma. Rather, the stigma arises because of the tragic number of incidents in which people neglected by a broken system end up committing harm to themselves or others. Our mission is to bring about more effective and timely treatment for people with severe mental illnesses. When we succeed in fulfilling this mission, violent acts and resulting stigma are reduced.

Cry for help ignored

Cindy Powell entered the emergency room with large knife cuts on her arms. She was sent home with stitches, ibuprofen and brochures on bipolar disorder.

“She said, ‘I wasn’t trying to kill myself’ — she actually said that,” [Dr. Robin]Henderson said. “At that point, we’re not seeing intent, and this particular injury was not holdable. If we do, then we’ve got a civil rights violation on our hands.”

In Oregon, two physicians must find people are a danger to themselves or others before they can be put on a five-day psychiatric hold against their will.

Because Powell said she didn’t want to kill herself and told a nurse that she never had a desire to hurt anyone else, St. Charles’ staff couldn’t keep her, Henderson said.

Three days later, Powell committed suicide.