When Mental Illness Gets Very Political

A June announcement that Massachusetts state Sen. J. James Marzilli, Jr. suffers from bipolar disorder, following his arrest from accosting four women, left many wondering.  They wondered how could someone so prominent and so far along in his career go this long unchecked and untreated. 

Perhaps this will sound a wake-up call to Sen. Marzilli’s colleagues that a severe mental illness knows no demographic limits.  Even politicians can get sick too.  The good news, for politicians and people in every walk of life, is that treatment works.  Sen. Marzilli likely did not recognize he was sick.  Many with bipolar disorder and other mental illnesses don’t. 

Clearly the four women in the parking garage he accosted knew something was wrong. 

Let’s now hope other Massachusetts state senators will now take a look at the state’s laws and make it easier for all people in the state with severe mental illnesses to receive treatment. 

Moving Beyond the Fear of Treatment

There is much medical information on the Internet.  Some of it very good, other based more on misconceptions.  One area where myths pervade the web is on the effects of treating someone with a severe mental illness who initially refuses treatment.  Many people with severe mental illnesses such as schizophrenia often refuse treatment because they don’t believe they are sick.  Medically this is called anosognosia and it affects approximately 40 percent of people with schizophrenia. 

There is information floating around on the Internet that’s its better not to treat someone who refuses treatment because they don’t think they are sick.  The evidence, however, flies in the face of this notion.  Once a patient is being treated, they soon realize that the treatment works.

Medically, the sooner someone with a severe mental illness such as schizophrenia is on treatment, the greater the likelihood of success.  Early treatment is key to reducing other risk factors associated with severe mental illnesses.  The consequences of waiting—alcoholism, addiction, violence, and even suicide—are too great to wait. 

The Urgency of Now

What is the genetic basis for mental illnesses?  While there is better insight into this link than there was 20 years ago, the exact correlation remains unknown.  Finding out is long overdue.

It is known that schizophrenia is a brain disease.  Debate on that topic is no longer waged, with the exception of some fringe groups.  Through brain imaging and other technologies it has been established that is not a purely genetic disease and that other biological factors play a role. 

The mapping of the human genome was complete in the year 2000.  Why is so much still unknown?

One answer is that the federal agency in charge of mental health research, the National Institute of Mental Health, has been slow to respond.

The Institute just recently issued a request for proposal calling for some of this research.  “With the initial stages of the Human Genome Project complete,” reads the government’s July 24, 2008, application to researchers.  News flash:  The complete sequencing of the human genome was completed in April 2000. 

Quality research does take time.  This is not to say the NIMH should cut corners on what it takes for scientists to do their job.  However, the Institute does need a better understanding of the urgency of now facing people with a severe mental illness.

 

States Focus on Mental Illness

Providing better care for people with severe mental illness is gaining increased attention across the U.S. 

Louisiana, Illinois, and Idaho recently passed much improved and much needed legislation to helping people with severe mental illnesses receive the treatment they need.  Virginia, even though not as far as the state should have gone, did make some improvements. 

California is launching an effort to help implement Laura’s Law in more counties across our largest state. 

These and other state activities are available in the latest issue of Catalyst from the Treatment Advocacy Center.  Join the list, it’s a great way to stay informed.

 

Does This Look Like a Hospital?

The building shown above is the Women’s Detention Center in Baltimore, Md. It is where 31-year old Vernice Harris has waited seven months for treatment for bi-polar disorder. Social workers involved in her case estimate it maybe another six months to a year before a bed becomes available in a mental health facility.

Harris is not alone. There are too few beds available to treat people. Harris is in Maryland which has more available beds than 36 other states, according to a report by the Treatment Advocacy Center.

In the meantime, Harris’ condition grows worse.

Trouble in the Heartland

Badlands you gotta live it every day

Let the broken hearts stand

As the price you've gotta pay

Keep pushin' till it's understood

And these badlands start treating us good

--Bruce Springsteen

Thinking of the issue of mental illness in jail and the images of New York, Los Angels, Houston, or Chicago prisons may quickly come to mind. The issue, however, isn’t contained to big cities.

Consider this headline, “Little help for mentally ill inmates.” It comes not from the New York or Los Angeles Times but from the Argus Leader in South Dakota.

“More than half of the nation's inmates report symptoms of mental illness, but in South Dakota, far fewer are being treated,” report the paper. “Advocates say those inmates deserve better care. Without treatment, they are vulnerable to abuse behind bars and struggle in the community after release, often leading to return trips to jail.”

Sounds very much like this blog earlier this week examining the prison in Houston.

From the Badlands to the city, the issue remains the same.

Ten Major Problems

In Surviving Schizophrenia, Dr. E. Fuller Torrey writes, “Having the misfortune to be afflicted with schizophrenia brings with it many problems, both for those affected and for their families.  Of all those problems, 10 stand out as among the most common, the most persistent, and the most perplexing.”

They are:

1. cigarettes and coffee
2. alcohol and street drugs
3. sex, pregnancy, and AIDS
4. victimization
5. confidentiality
6. medication and noncompliance
7. assisted treatment
8. assaultive and violent behavior
9. arrest and jail
10. suicide

It is difficult enough to have to deal with schizophrenia and these 10 problems.  Unfortunately, laws and policies can make matters worse.  Specifically, many states put in place barriers to help people with schizophrenia enter into assisted treatment programs.  People need to know there are options for assisted treatment, no matter where they live.  Some states make these options easier, some make it more difficult.  Many resources can be found by visiting the Treatment Advocacy Center’s website. 

Finding Escape Behind Bars

Consider this recent headline and story from the Houston Chronicle. “Finding escape behind bars,” reads the banner. “When jail is the only place mentally ill inmates get treatment, they come back, and it costs. $87 million."

If someone is surprised that our prisons have become de facto mental hospitals, you shouldn’t.

When a person with a mental illness leaves jail, treatment is often unavailable. Most aren’t receiving medication. They get sick again and that often leads to another crime. People who commit crimes usually get caught. They end up back in jail.

The result is that police officers and prison officials have become front line mental health workers. It jeopardizes their safety and provides less than adequate care for those in need.

On just one day in June, the Harris County prison population of homeless people with a mental illness included:

• A 39-year-old woman booked 45 times since 2001.
• A man, 26, booked 30 times since 1999.
• A man, 52, booked 33 times since 1992.
• A man, 25, booked 20 times since 2001.

The cycle needs to be broken. It’s not helping people who need help and taxpayers are paying too large a price for an inevitably bad outcome.

Correcting Misinformation

With this week’s news of the upcoming demise of the Salem, Ore. mental health hospital immortalized in the film, One Flew Over the Cuckoo’s Nest, one should recall the various ways that movies, books, television, and other media have spread misinformation about schizophrenia. 

"Schizophrenia is a cruel disease,” writes Dr. E. Fuller Torrey in the essential book for family members and patients, Surviving Schizophrenia.  “The lives of those affected are often chronicles of constricted experiences, muted emotions, missed opportunities, unfulfilled expectations. It leads to a twilight existence, a twentieth-century underground man... It is in fact the single biggest blemish on the face of contemporary American medicine and social services; when the social history of our era is written, the plight of persons with schizophrenia will be recorded as having been a national scandal."

Research has now clearly demonstrated that schizophrenia is caused by changes in the brain and that these can be measured by changes in both brain structure and brain function. Over 1,000 such research studies have been published. Schizophrenia is thus a disease of the brain in exactly the same sense that Parkinson’s disease, multiple sclerosis, epilepsy, and Alzheimer’s disease are diseases of the brain.

 

A Small Step in the Desert

Officials in Palm Springs, Calif. made the right decision in reversing plans to close Coachella Valley’s only long-term facility for people with mental illness.  It was a small but important victory. 

Closure of the 34-bed facility in Riverside County would have a ripple effect in the desert area.  A near-by homeless shelter fears that if the other facility closed its doors they would see between two to three hundred more people with severe mental illness a year.  The 100-bed shelter is already beyond capacity.  Ray Arredondo, the director of the shelter raised an important question.  “Once mental health closes and we're overflowing, what happens then?”

It’s often the question policy makers don’t want to answer and it’s exactly how leaving mental illness untreated has become such a widespread problem.

Leaving a small facility open is only one step.  The next step Riverside County and others in California need to take is to put in place Laura’s Law.  That law is a very progressive step that will help people with severe mental illness get treatment.  Riverside, like all the counties in the state, can and should take this important step.  Join the campaign to save lives in California.

 

Cuckoo's Nest Set to Fall

The decision by Oregon officials to close the state hospital in Salem where the 1975 movie, One Flew Over the Cuckoo’s Nest, was filmed ends yet another chapter in the deinstitutionalization of people with mental illness.   Few will shed a tear when the wrecking ball hits the dilapidated brick structure this fall.   

But now what?

Described in E. Fuller Torrey’s landmark book, Surviving Schizophrenia, as “the quintessential film for the counterculture: the mental institution as a metaphor for the abuse of authority,” the image of that hospital helped fuel a well-intentioned but misguided policy that has left the U.S. with too few beds to treat people with severe mental illness.  The movie blurred the line between fact and fiction.  No one does or should like Nurse Ratched.  But as new solutions are developed its important to separate fact from fiction.

The lack of treatment for severe mental illness, including too few hospitals and too few beds for patients, is a danger to the nation.

What’s the plan?

Oregon already has a severe shortage of beds to treat people with mental illnesses, according to a recent report by the Treatment Advocacy Center.  The state plans to replace the storied 685-person hospital with a new 620-bed facility.  Oregon still needs to add 1,300 more beds to meet the mental health needs for a state with 3.7 million residents.  The new facility will still leave more people with mental illnesses in Oregon jails than in hospitals or in assisted out-patient treatment.  Elsewhere in the state, the future of other mental hospitals is in question.  Crowding ever more patients into a newer facility that is still too small isn’t a complete solution.  

 

The Toll of the Disease Itself

In Hawaii this week hikers at a scenic cliff found the decomposing body of Steven Thomas, 36, a computer whiz who made millions as co-founder of the software company Webroot.  Thomas disappeared two weeks ago after expressing suicidal thoughts. 

He had been diagnosed with bipolar disorder just months ago, after he ran naked into a race-walk event in front of his oceanfront home.  His wife said that he refused treatment for his condition and his paranoid actions continued.  After he disappeared, she made a desperate plea to the public for help.

"He thinks everyone on the island is out to get him," Candis Thomas said of her husband's bipolar condition. "He thinks the military is involved, he thinks that aliens are involved, and he's just been in a real delusion state of being fearful."

She predicted what would happen without treatment.

"He needs professional help," she said. "He's been in this state of suffering from severe illness. If he doesn't get the medical help he needs this could be a mess."

Lack of resources or the ability to pay for treatment did not impact this tragic story.  Providing family members, like Mrs. Thomas, with the tools and support to get a loved one treatment can make a difference.  The need for assisted treatment is a result of the disease itself and the horrible toll it takes on the human mind. 

 

Mental Illness Across the Pond

News about mental illness knows no boundaries.  In recent weeks headlines about severe mental illnesses have dominated the news in Australia, Canada, Thailand, and now in Great Britain.  In each instance, the story is much the same as it is in the U.S. 

“Our prison population is at its highest ever’” reports the United Kingdom’s Guardian . “Of the 82,000 prisoners in England and Wales, it is estimated that nine out of 10 have one or more mental health disorders. Yet mental healthcare in prisons is widely overlooked as being a problem in the justice system, with overcrowding and high costs trumping mental health for column inches.”

You can almost see the writing on the wall.  In many respects, our friends across the pond seem determined to repeat some of the same mistakes made in the U.S.

Many of the parallels can be drawn from Dr. E. Fuller Torrey’s latest book, The Insanity Offense.  As this book chronicles how America’s failure to treat the seriously mentally ill was based on the best of intentions, perhaps it should be required reading for mental health advocates in the U.K. so they won’t repeat the same mistakes.

Unaware of Unawareness

Anosognosia is the medical term describing when a patient is unaware they are sick.  Research in the mental health field is only a couple decades old. 

Dr. Fuller Torrey, in his newest book, The Insanity Offense, puts it this way, “Among mental health authorities and state legislators, there is widespread unawareness of unawareness.”

He identifies it at the heart of the problem:

“Most laws governing the treatment of mentally ill individuals assume that such individuals are competent to accept or reject treatment, with the sole exception of obvious dementia.  Yet, contemporary research has established that up to half of all individuals with severe psychiatric disorders are not competent to assess their own need for treatment.  The consequences of this misunderstanding have led to increasing numbers of mentally ill individuals who are homeless, incarcerated, and victimized, and increasing numbers of individuals who commit homicides and other violent acts.  This misunderstanding underlies one of the great social disaster of late twentieth-century America.”

 

 

Hope for Katrina's Most Vulnerable

A New York Times editorial recently pointed to a model in their city where the city of New Orleans would be wise to use some new federal money to help those still left homeless in the aftermath of Katrina.  The successful New York City project, Common Ground, has shown that homeless people with psychiatric and other problems need more than just a place to live to succeed.  Indeed.

Louisiana was wise to use one New York product, Kendra’s Law, as a model.  The state was right to pass the assisted outpatient treatment law, called “Nicola’s Law,” which permits judges to court-order outpatient treatment for some people with untreated severe mental illnesses. 

New York found that among participants in their program 74 percent fewer experienced homelessness.  Additionally, some housing operators indicated a greater willingness to work with the patients in the program because they knew that they were participating in treatment. 

These laws are increasingly important because approximately one-third of our nation’s homeless population have a severe mental illness.  Many of them, as a symptom of the illness, are too ill to know that they need treatment and do not voluntarily access the medications and services that will help them stabilize.

 

 

Jails Down Under Are a Lot Like Home

“Our jails have become psychiatric hospitals,” reads a recent headline in The Australian.  A doctor in Australia was recently killed by a patient with schizophrenia he was trying to help. 

The story resembles a lot of what has been reported in the U.S. 

Despite evidence of acute psychosis by the patient, “he was held in a regular prison without psychiatric assessment or treatment and allowed to represent himself in court for seven months,” the paper reports. 

Starting to sound familiar?

Read on.

“Far from being an isolated case, it is at the tip of the iceberg of the over-representation of people with mental illnesses in the criminal justice system. Jails have become the largest psychiatric hospitals in Australia.”

Close enough to home yet?

"The magnitude of schizophrenia as a national calamity is exceeded only by the magnitude of our ignorance in dealing with it,” Dr. E. Fuller Torrey as quoted in The Australian.

 

The Value of Being Politically "Incorrect"

In his recent book, The Insanity Offense, Dr. E. Fuller Torrey challenges many politically correct assumptions on how misguided theories about mental illness have created a dangerous situation.  He creates a reasoned prescription for change that is attracting large support.

Charita Goshay, an Ohio news columnist, recently discovered much the same thing. She spoke out after near tragedy affecting a local police officer and someone with a severe mental illness.  She wrote hoping to prevent a real tragedy but fearing a backlash from those touting civil liberties.

“In this politically correct era, I fully expected to be flayed and accused of being insensitive for calling for more inpatient treatment for seriously mentally ill people,” she wrote.  “Instead, what I received were a number of telephone calls and e-mails from relatives of people suffering from serious mental illness, all of whom had heartbreaking horror stories regarding their futile efforts to get inpatient treatment for their loved ones.”

She noted there are “but matters of degrees” between near tragedy and “a full-metal bloodbath.”

Of the people who contacted her she reported, “They're people who live in daily, mortal fear that their loved one is going to hurt someone else or themselves, and that only then will someone finally listen to what they've been saying all along.”

The hope is that policy makers will listen before the next preventable tragedy strikes.

 

What People Have to Say

Reading the news can often evoke thoughts about many things.  Now, on most newspaper website, readers can share their thoughts.  One such article posted on the Treatment Advocacy Center’s news ticker details a Miami woman’s decline from mental illness.  The article in the Miami Herald provoked some very insightful reader comments.  Here is just a sample.

“…the mental health system around here is terrible. Jackson Memorial [Hospital] gives their patients meds for 3 days and then releases them into the wild. No wonder they end up back in the Crisis Center every few weeks or months.”

“I had a family member with the same diagnosis but her situation never got this bad. She was delusional from time to time but never dirty or totally unmanageable. The system is not here to support mentally challenged people, it is here to cater to the rich and connected people unfortunately. Like everything else there is an urgent need for serious mental health facilities and assistance.”

“Why can't the police department implement the Bacon Act, and have her committed and then she can obtain medication. She is a danger to herself...”

“Mental illness is a brain disease. If we saw someone clutching their chest suffering from heart disease, we would call 911 and they would be rushed to the hospital. It's odd that we treat people with a brain disease so differently.”

 

Americans Have a Low Schizophrenia IQ

Schizophrenia is twice as common in the U.S. as HIV/AIDS, yet most Americans are unfamiliar with the disease.

The knowledge gap is something detailed in a new survey by the National Alliance for the Mentally Ill (NAMI).  The report, conducted by Harris Interactive, provides a good glimpse of what the public knows and doesn’t know.

The survey found the average age at onset was 21, but a nine-year gap exists between symptoms and treatment.  Other findings include:

• 85% of Americans recognize schizophrenia as an illness, 79% believe that with treatment, people with the diagnosis can lead independent lives, but only 24% are familiar with it. Many cannot recognize symptoms or mistakenly believe they include "split" or multiple personalities (64%).
• 79% want friends to tell them if they have schizophrenia, but only 46% say they would themselves. Even with treatment, 49% are uncomfortable with the prospect of dating a person with schizophrenia.
• Among people living with schizophrenia, 49% said doctors take their medical problems less seriously, even though the report notes that the death rate from causes like heart disease or diabetes is 2-3 times that of the general population.
• A vast majority believe that better medications (96%) and health insurance (82%) would be most helpful to improving their condition,
• Caregivers agree better medications are needed. Approximately 80% have difficulty getting services for loved ones, 63% have difficulty finding time for themselves, and 41% have provided care for more than 10 years.

 

Police Training Yes, Treatment Definitely

“Man dies after scuffle with police,” read the first headline coming out of a police killing of a man with schizophrenia in Rhode Island.  The next day, “Questions linger about man’s death in policy custody,” became the topic. 

This also happened to be the third such police killing this year of someone with a mental illness in the small state.  The tragedies have attracted attention and, to some extent, action. 

 “Kennedy proposes intervention team for mentally ill,” is now the most recent news generated as a result of Rep. Patrick Kennedy (D-RI) stepping forward to talk about potential solutions.  Rep. Kennedy, who has successfully fought for additional federal funding of better police training and other measures, was right to focus attention on the issue. 

While the issue of mental health is in focus, Rhode Island should examine how difficult the law currently makes it for someone suffering from a mental illness to get into treatment.  This would be a major step forward in preventing these tragedies, and in improving the lives of those with mental illness.

Rhode Island currently has a tough standard to meet before someone can be put into treatment.  A person with a mental illness must present signs that there is a substantial risk of harm manifested by grave, clear and present risk to physical health and safety.  A clear and present danger may make for a good Tom Clancy thriller, but it doesn’t make for a good law.  Too often by the time that standard is met, tragedy has struck.

Rep. Kennedy initially called for a statewide crisis team to assist mentally ill people and their families anytime the police are involved.  He suggested the idea admitting that not all the facts were yet known, but that clearly something needs to be done.  Changing the law to assist family members who are trying to get care for a loved one with a severe mental illness would be a good place to start.  That would provide family members, the police, and any crisis team that might be formed with a real tool that could help avoid tragedy before it strikes.

 

The Same Story to Our North

Many often point to Canada as an example of a national health system that works. Leaving that political debate aside for the moment, Canada’s mental health system—or rather lack of a mental health system—is remarkable similar to our own nation’s.

In, “Breakdown: Canada’s Mental Health Crisis,” the Toronto Globe spells out all too many similarities.

“In the past 50 years, Canada has gone from 60,000 long-term beds for people with mental illness, to about 6,000 beds,” reports the Globe. “Most people with mental illness are better off in the community, but only if treatment is available. In the current non-system, the sickest of the sick often end up on the streets, in jail or spiraling downward in grungy rooming houses.”

Adjust the numbers and change the geography and it would be like reading the Treatment Advocacy Center’s study on the shortage of U.S. hospital beds.

“The problem in Canada spills over into the jails, just as it does in the U.S.

In fact, about one in five prisoners in Canadian jails suffers from a diagnosable mental illness, making our jails de facto asylums – a travesty for those who are sick and a huge waste of resources,” according to the Globe.

Sound familiar?

There is, however, one bit of reporting from the Globe that raises a question. The Globe notes that Canada is the only Group of Eight country without a mental-health strategy. If the U.S. has a mental-health strategy, where is it hiding?