Friday, February 29, 2008

Suicide by cop

Barron Harvey Davis had bipolar disorder and had taken more than 20 pills before he started shooting at a police officer.

Davis told family members over the phone that he wanted officers to kill him.

After he was tasered and taken to jail Davis continually pounded his head against a brick wall and had to be restrained. Davis later died in his jail cell.

A friend of Davis’ said his death could have been avoided if he was given proper care.
“I told them you need to do something to help him,” Graham said, explaining she told officers at the scene he had taken too many medications and was overdosing.

“We knew if they would have gotten him to a psychiatric care unit somewhere this probably would not have happened,” she said. “Who knows him better than we do?”

There’s little question Davis should have been getting care and treatment before he shot at officers and asked to be killed by police officers. Whether officers acted appropriately in this situation is up for debate, but the mental health community almost certainly didn’t.

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Wednesday, February 27, 2008

Using Laura's Law in California

Too many times we are reminded that having laws on the books providing for Assisted Outpatient Treatment (AOT) does not necessarily translate into the actual use of the treatment mechanism.

In California, Laura’s Law was passed in 2002, offering every county the opportunity to adopt an AOT program. In Los Angeles, a small pilot program was implemented soon after the law was enacted and has been helping a few dozens of people with severe mental illnesses each year. California’s first county-wide program will soon start in Nevada County. However, so far, Laura’s Law has not yet been implemented anywhere else in the state.

This is largely because the initial bill was saddled with limitations by opponents during the legislative process. Laura’s Law now provides that it is up to each county to decide whether or not to implement the law and to establish a program for it. Among other cumbersome restrictions, the law also requires a finding at the county level that no voluntary mental health program will be reduced as a result of adopting an AOT program, that AOT can only be used in conjunction with an extremely costly and often unnecessary outpatient service program and that counties must have very high thresholds of general services, most of which are unrelated to the use of AOT.

Thankfully, Senator Leland Yee from San Francisco has recently introduced SB 1606 that aims to remove many of the limitations included in the initial law. If passed, this law will make the treatment tool available in all counties throughout California.

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Tuesday, February 26, 2008

"How many people have to lose their lives..."

A recent letter to the editor in response to an editorial in the Washington Post:

I wonder how many people will have to lose their lives in Virginia because someone in need of medication for mood and behavior regulation is not monitored to ensure that he takes that medication?

Virginia's failure to protect its residents in this area is truly a disgrace. Why don't lawmakers just fire all the traffic police, too?

I am the mother of a Virginian who was fatally shot in 1999 as she lay sleeping.

My daughter had been seeking help for the young Virginia man who killed her.

There was no law on the books that would have protected my daughter in 1999, and there still is no law on the books that would protect her today.

Wake up, Virginia!
- Laura Hawley - Jarvis

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Monday, February 25, 2008

Imprisoned because of psychosis

After stealing a car in 1995 and violating parole by making harassing phone calls in 1998, Carl Scherer was sent to prison for seven years. Not surprisingly, the symptoms of his paranoid schizophrenia worsened while in prison.

His records indicate that the medications were constantly being adjusted or changed, such that at no time was he stable for any lengthy period of time," Gottlieb wrote. He also reported that Carl often refused his medication, which led to repeated cycles of psychotic behavior.

Just before Carl was released on parole in 2001 he became so ill he was sent to Cresson State Correctional Institute. Shortly after, Carl’s parole was revoked. Carl was to be kept in prison- a place never meant as a treatment facility- to get treatment for his schizophrenia.

"They took away his only opportunity to get the care he needed and left him in there, not because he didn't meet the criteria for being paroled, but because he has a mental illness. I mean, it's outrageous in my mind. …

"That's not the point of the correctional institutions — to house individuals with mental illness."

Shortly after Carl was returned to the general prison population, he was killed by his roommate.

Carl Scherer was apparently too ill to be paroled, but not sick enough to be kept in treatment.

Why are we relying on prisons to provide psychiatric care? Better yet - Why wasn’t Carl getting treatment long before he was entangled in the Pennsylvania prison system in the first place?

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Friday, February 22, 2008

A plea for people neglected by a broken system

“I come to present the strong claims of suffering humanity. I come to place before the Legislature of Massachusetts the condition of the miserable, the desolate, the outcast. I come as the advocate of helpless, forgotten, insane men and women; of beings sunk to a condition from which the unconcerned world would start with real horror.”
Dorothea Dix, 1841

Today, one hundred and sixty seven years later, this plea must still be made on behalf of hundreds of thousands of Americans who remain in peril due to the failure of our mental health system to provide the treatment they need and deserve.


Dr. Torrey in New York Post

David Tarloff, accused of killing psychologist Kathryn Faughey and trying to kill psychiatrist Kent Shinbach, was known by his neighbors as "the crazy guy." He'd been "in and out of mental hospitals more than 20 times," says his brother, but "they kept releasing him." He did reasonably well when maintaining treatment, but he "frequently went off his medication."

Off medication, in these stories, is when the trouble usually starts...

Violence committed by seriously mentally-ill individuals who are not being treated are merely one manifestation of our egregiously failed mental-health-treatment system...

And there is abundant evidence that all of these problems are getting worse.

We know what to do, of course. Most individuals like Tarloff do very well if they are properly followed up and treated. Kathryn Faughey's killing is a failure not only of the treatment system but also of every New Yorker for not demanding a system that works - first and foremost, by holding hospital and mental-health accountable.

Until we start doing that, each mind-numbing tragedy will keep on being followed by another.

- TAC president, Dr. E Fuller Torrey in an op-ed in today's New York Post

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Thursday, February 21, 2008

Safety must supersede freedom

Three homeless men died on Long Island in the severe weather. Alexander Roberts, a homelessness advocate, writes in Newsday today that those deaths, “would have been avoided last week if police were allowed to force people living on the street into a temporary shelter in the freezing weather.”

He recounts the sad 20 year old story of Billie Boggs, a woman “protected” by civil libertarians from involuntary treatment, who was able to gain her freedom to live with psychosis and without a home.

Robert suggest that the answer should be involuntary shelter for people who are “imminently dangerous” to themselves and will not take care to get themselves out of the freezing cold. An even more helpful solution is for the mental health system to start caring for those who are homeless due to untreated severe mental illness; for mental health professionals to use both the inpatient and outpatient treatment laws to help restore such individuals to a level where they can make competent decisions about the need for shelter; and, for all of us to hold the mental health system responsible for maintaining the safety net for the individuals it so routinely tosses to the elements.

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Wednesday, February 20, 2008

A week of tragic consequences

The tragic consequences of untreated severe mental illness were evident across the country this week.

In Georgia, a 33-year-old man bludgeoned his girlfriend to death. Shannon Marrow has schizophrenia and had been in and out of treatment centers for years. He had recently stopped taking his medication

In Maryland, Timothy Hayes Marsh was fatally shot in the head. His sister says Marsh struggled with bipolar disorder for years, and had substance abuse problems from self-medicating. She suspects Hayes was in the midst of a drug deal when he was killed.

In New York, David Tarloff had been in and out of hospitals for years before he killed psychologist Kathryn Faughey. Tarloff has schizophrenia and relatives say he had recently stopped taking medication.

In Florida a mother has been declared insane and sent to a psychiatric hospital after she repeatedly stabbed her 5 year-old daughter. Olga Fererra has a history of mental illness including bipolar disorder and psychosis.

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Tuesday, February 19, 2008

Responding to tragedy

"A wave of recent school shootings, including the bloody attack in Illinois last week, is again prompting calls around the country for reforms. But in Virginia, where the bloodiest rampage of all took place last spring at Virginia Tech, the initial demands for legislative and regulatory improvements have yielded disappointing results. Other states that have grappled with senseless killings can now look to Richmond as an example -- one not to emulate -- of minimal response to maximum trauma."

- Washington Post Editorial

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Friday, February 15, 2008

Danielle Steel urges treatment

"When people aren't medicated it can be lethal," she said, adding that she hadn't realized that when dealing with her own son. "I thought it could ruin his life. I really didn't understand how high the possibility was that it could cost him his life."

Steel -- who will release her 72nd novel "Honor Thyself" on February 26 -- believes the laws need to be changed to allow mentally ill people to be hospitalized against their will.

"Usually bipolars present extremely well and they can bounce into court ... look very together and be a complete mess three hours later on the streets somewhere," she said. "There's nothing you can do."

- Author Danielle Steel in an interview with Reuter's about Britney Spears

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Thursday, February 14, 2008

Real reform overdue at your public library

Urban public libraries across America are experiencing the inevitable consequences of a mental health system that is broken. There are more than 200,000 people in our nation today who are homeless and have a severe mental illness such as schizophrenia or bipolar disorder. On cold days, many of these people will seek shelter at the local public library.

At Ekstrom library on the University of Louisville campus, students compete with the homeless to get on computers. As one student observes, “If the homeless are using property reserved for paying U of L students, then something needs to be done about it.” However, according to library staff, unless the homeless person is causing a disturbance, they are usually left alone.

Chip Ward described the disturbing conditions at the Salt Lake City public library in his poignant op-ed last year.

“People mumbling to themselves, shouting obscenities, and poking nails into celebrity pictures are just some of the problems encountered. Ward observed, “Like every urban library in the nation, the City Library, as it is called, is a de facto daytime shelter for the city's "homeless."

“Homeless” is indeed a misleading term because it clearly focuses on the wrong problem. Most people who remain on our streets over a long period of time do so not because they lack the means to find housing. Rather, up to 70 percent of the homeless are struggling with a serious mental illness, and for them providing housing without treatment is pointless. Remember Nathaniel in California?

Sadly, the general contempt for those who are homeless will only grow as our system continues to ignore the underlying problem. The real solution to this problem will not be found in new library policies. It will be found when our mental health system assumes responsibility to care for people who have mental illnesses so severe they don’t understand they are sick.

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Wednesday, February 13, 2008

Is treating severe mental illness less important than treating a heart attack?

Doctors at the Barnes- Jewish hospital in St. Louis meet periodically to analyze every patient who entered the hospital in previous months in the midst of a heart attack.

Since minutes and even seconds count when treating cardiac arrest, the doctors analyze their response time and what can be done to get life-saving treatment to people faster and more efficiently. Since the hospital began this analysis the Centers for Medicare and Medicaid Services has increased its rating to one of the top 17 hospitals in the nation for treating heart attacks.

Efficient, effective treatment is certainly vital when someone is in cardiac crisis.

It’s also vital when someone is in psychiatric crisis.

Yet in St. Louis, and all across the country, people with severe mental illnesses are forced to wait not minutes or seconds, but weeks and months until they’re sicker or until danger is imminent until they can get treatment.

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Tuesday, February 12, 2008

"We wouldn't be so cruel to somebody with another disease..."

In a poignant op-ed in today’s LA Times, writer Asra Nomani argues that the media needs to leave Britney Spears alone so that she can deal with her illness:

“Mental illness doesn't always elicit compassion; it's hard to see, so it's hard to understand. Perhaps in the wake of Spears' breakdown, California mental health advocates will lobby to change the state's involuntary commitment laws so that those who are sick get treatment, even if they don't realize how badly they need it. In the meantime, all of us should reflect on the fact that we wouldn't be so cruel to somebody diagnosed with another disease. Would we make a sideshow of someone with a brain tumor?”


Monday, February 11, 2008

SMRI Research Update: Infectious agents may cause schizophrenia

TAC relies on its supporting organization, the Stanley Medical Research Institute (SMRI), to carry out research to ascertain the causes of and develop better treatments for schizophrenia and bipolar disorder. A recent update from SMRI follows.

Recent research, funded by SMRI, suggests that infectious agents may cause schizophrenia by getting in the brain several years before the person actually develops symptoms. The research is published in the January issue of the American Journal of Psychiatry and was done by David W. Niebuhr and his colleagues at the Walter Reed Army Institute of Research in Silver Spring, Md.

They examined blood samples taken from military personnel entering service and taken periodically thereafter. Among these military personnel, they identified 200 who developed schizophrenia after they entered the service and compared them with 591 matched controls. The individuals who developed schizophrenia, compared to the controls, had elevated antibodies to Toxoplasma gondii, a protozoa carried by cats, as much as three years before they initially developed symptoms of schizophrenia. This protozoa has also been linked to schizophrenia in several other studies. The Niebuhr et al. paper confirms other data suggesting that whatever causes schizophrenia probably begins several years before the disease symptoms appear.

The current publication is in the American Journal of Psychiatry, vol. 165, pages 99–106. A good review paper on Toxoplasma gondii and schizophrenia is by Torrey EF et al., in Schizophrenia Bulletin (2007), vol. 33, pages 729–736.

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Friday, February 08, 2008

Treatment laws vary by state

The publicity of Britney Spears’ recent involuntary hospitalization and subsequent release is raising awareness about involuntary treatment laws.

Since treatment laws vary from state to state a person receiving involuntary treatment in California may or may not qualify for treatment in another state.

Fortunately for the citizens of Illinois a new treatment law that goes into affect this summer will help people with severe mental illnesses get treatment before they reach crisis levels.

“It offers the hope of getting a loved one with mental illness into treatment,” said Lora Thomas, executive director of Illinois’ National Alliance on Mental Illness. “Illinois can no longer retain the right for people to remain dangerously ill. It means no one needs to hit bottom.”

For mentally ill people, a hospital stay can relieve or avert a crisis, Hays said.

“I know we have saved innumerable lives by getting people into the hospital and turning their lives in a different direction,” Hays said.

Starting this summer the citizens of Illinois won’t have to wait for crisis to get treatment for a severe mental illness.

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Thursday, February 07, 2008

Worst in the nation is not good enough

The deaths of 33 people at Virginia Tech should have been a wake-up call to legislators to provide real reform to the state’s broken commitment laws. Instead, the General Assembly is considering little more than lip-service reform.

Virginia’s mental illness treatment laws are among the most restrictive in the nation. To get help via involuntary treatment, the state currently requires that someone incapacitated by the symptoms of an illness such as schizophrenia be an immediate physical danger to themselves or others. That’s simply too little, and often too late.

The only proposals now still alive for reform in the General Assembly require that individuals be visibly dangerous before getting treatment. These slight modifications to the existing law would keep Virginia’s treatment standard among the worst in the nation. Read more....

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Wednesday, February 06, 2008

What will it take, Virginia?

British statesmen William E. Gladstone famously observed that “justice delayed is justice denied.” Senate Bill 177 offered Virginians the only meaningful hope for true mental health law reform this year.

Now, Senate Bill 177 has been referred to a subcommittee for further study until next session. When it comes to mental health reform in Virginia, special commissions, blue ribbon panels, and investigating subcommittees abound. Everywhere you look, you can still find some group of experts studying about how to change Virginia’s mental health laws.

However, the time for studying laws has ended, and the time for making real change is here. Some people may hail the small incremental changes in Virginia’s commitment standards that will be made this year as major reform. Don’t be fooled.

If experiencing the worst shooting tragedy in American history is not enough to motivate true reform, then what will it take Virginia?

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Tuesday, February 05, 2008

Consequences of Nontreatment: Victimization

The media and general public often overlook tragedies facing those with untreated severe mental illnesses. The reality is that they are much more likely to be victimized than the general population.

In fact, multiple studies have shown that individuals with severe psychiatric disorders are especially vulnerable to being victimized. This frequently involves acts such as theft of clothing or money but also includes assault, rape, or being killed. Women who have a severe psychiatric disorder are especially vulnerable. Some of the studies suggest that individuals who are victimized are less likely to have been compliant with their medication. This association is strongly supported by the 2002 North Carolina study by Hiday et al., which showed that individuals with severe psychiatric disorders who were on outpatient commitment, and thus were taking their medication regularly, were victimized only half as often as those who were not on outpatient commitment.

Outpatient commitment (aka AOT) is a humane intervention that can help some to get the treatment they need to avoid becoming victims of psychosis and criminal behavior.

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Monday, February 04, 2008

Citizens being warehoused in jails

It is estimated that 16 percent of our jail population is seriously mentally ill. On any given day in the Roanoke Valley, there are about 162 citizens with a serious mental illness being warehoused in our jails. And because they won't be treated by the mental health system, they become the responsibility of the criminal justice system. It is cost shifting of the most cynical kind. It is a return to the 19th-century method of care for our mentally ill citizens.

As a taxpayer, I am outraged at the fraud of this cost-shifting from the mental health system to the criminal justice system. As both a criminal justice and a mental health professional, I am ashamed.

- Roanoke Times op-ed by Isaac T. Van Patten, chairman of the Department of Criminal Justice at Radford University and the principal investigator for a federally funded CIT program and a jail diversion program for the mentally ill

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Friday, February 01, 2008

Britney is an example...

Early Thursday morning Britney Spears was involuntarily hospitalized under California’s under Section 5150 of California's Welfare and Institutions Code. Authorities say despite the paparazzi involvement, Britney’s involuntary commitment is just like the other 20 to 25 involuntary committments the LAPD has each day.
Despite Spears' celebrity, the decision to have her committed involved elements that are typical for many mental health cases in California, said Randall Hagar, head of governmental affairs for the California Psychiatric Assn.

As Spears’ again makes headlines, we hope that she gets effective treatment, and that her story will help increase public understanding of what families all across the country go through to help their loved-one get treatment.

Cases typically involve a family desperate for treatment for a loved one, a patient who appears functional one moment and severely ill the next, and an imperfect legal system struggling to mediate it all, Hagar said.

"Every family will tell you how much they fail before they can finally get a hospitalization," Hagar said.

"I sure hope the conversation shifts from the paparazzi and all of that to how many people in this state and this country need mental health services and don't receive them," said State Sen. Darrell Steinberg (D-Sacramento).

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