Monday, June 30, 2008

Three States Celebrate Progress

As the nation is about to head into the 4th of July holiday, it is an appropriate time to note three new state laws to improve treatment for the mentally ill. Illinois, Louisiana, and Idaho join a growing number of states in improving the ways someone with a severe mental illness can be treated.

Five years in the making, a new Illinois law took effect that allows for early intervention for people with incapacitating symptoms of illnesses like schizophrenia and bipolar disorder. The effort marks years of work by Karen Gherardini who own struggle to get a family member into treatment ignited the change.

Tragedy sparked quick action by the Louisiana governor and legislature to improve that state’s commitment law. In January 2008, 24-year old police officer Nicola Cotton was overpowered while making an arrest to a rape suspect. The suspect shot and killed Cotton with her own gun. The man, who had been in and out of treatment his adult life, was not in treatment or taking his medication at the time of the tragedy, according to his sister. The incident—captured on a surveillance camera—prompted Governor Bobby Jindal and state Sen. Cheryl Gray to push for the change.

Idaho took a giant step forward in April, passing a sweeping reform of its commitment process. The reform also allows courts the option of ordering individuals in crisis to receive outpatient treatment rather than releasing those in need of treatment into the community to await another crisis.

Each of these efforts points to progress than can be replicated in other states.

Friday, June 27, 2008

When Medicine Got it Wrong

The title makes you stop and think. The pause makes you wonder. When did it happen? Who was the patient? Who was the doctor? What was the disease? It wasn’t one patient. It was essentially everyone who had schizophrenia. While reminiscent of the witch trials, it wasn’t in the 1600s it was the 1970s.

When Medicine Got it Wrong, is the title of an upcoming PBS documentary by filmmakers Katie Cadigan and Laura Murray. It is the story of how parents in San Mateo County, Calif. banded together to fight the notion that schizophrenia was the result of bad parenting. In the early 1970s this activism coincided with the closing down of psychiatric hospitals. The film explores this well-intentioned bit of social planning gone amok.

“It was a fabulous dream,” says Cadigan, who has a brother with schizophrenia. “The problem is, when they shut down the hospitals, there was the promise that community care would be set up. That care was never set up. So the sickest of the sick—young men and women with schizophrenia and severe bipolar disorder—ended up being flushed out of the system with no care, no medication, no doctors available, no treatment programs that would take them.”

Add deinstitutionalization to the widespread blaming of parents by psychiatry and that brings us to today. People with a disease are out on the streets and in jails, instead of receiving treatment. Those working with the Treatment Advocacy Center and others need to understand this important underpinning to today’s commitment laws. Trying to write a wrong, no matter how well intentioned, is not an easy task. The story behind When Medicine Got it Wrong will provide inspiration or this decade’s unfinished work. Stay tuned for more information on when this important film will air.

Thursday, June 26, 2008

Celebrities on the Mend

News of celebrities coping with severe mental illnesses and related problems often spills over from the gossip pages to real news. The news of the problems typically grabs more attention than recovery efforts. Some news out of Hollywood now shows some hope for Britney Spears. Her struggle with bi-polar disorder has led to host of other problems, most involving custody of her two sons. Now she is being granted some overnight stays with her children, reports USA Today and other sources. The reason is that she has had treatment and the effects were clear to the judge granting the overnight stays.

Spears getting treatment came from a court order. Once again, evidence that treatment works. Certainly her life is moving in the right direction as a result. The estimates of people with a severe mental illness who aren’t receiving treatment range from 35 to 54 percent. Let’s hope that attention drawn to celebrities getting help encourages others to do the same.

Wednesday, June 25, 2008

Progress in the Battle to Erase Stigma

            Mental health issues top of the list of reasons why Americans seek medical treatment, according the government’s most recent count.  Mental health problems prompted 156 million visits to doctors’ offices, clinics, and hospital outpatient departments in 2005, according to the Agency for Healthcare Research and Quality

            The number represents a 30 percent increase in less than a decade and a quantum leap above the previous one, when coming forward to admit a mental illness was still considered virtually unthinkable. 

            This astounding mainstream awareness has helped shrink the stigma associated with mental illness.  The advent of new treatments, public education, anti-stigma campaigns by organizations like NAMI, and other efforts have paid off. 

            Stigma has shrunk but not disappeared, and   the problem is different today than it was a decade or two ago.  Much more is known about effective treatments, especially for severe mental illnesses.  The transformation has reversed the stigma equation.  A generation ago stigma prevented people from seeking treatment.  With mental illnesses topping the list of why people are in the waiting room, stigma is no longer a major factor stopping people from seeking treatment. 

The stigma around mental illness now stems from those who most need treatment but aren’t getting help.  The number is much smaller, but the problems are no less severe.  Multiple studies have demonstrated that people with severe psychiatric disorders who are inadequately treated or receiving no treatment are more likely to harm themselves or others than the general population.  The flip side is also true:  People who are being treated – the majority of those with such illnesses – are no more likely to be violent that the general population. 

The acts of violence that grab headlines are the main source of the stigma that prevents people from seeking treatment.  Policies that prevent people with severe mental illnesses from receiving treatment are the chief cause of these headline-producing acts – those policies are the ultimate enemy in today’s battle to erase stigma.  Changing those barriers is the battle plan laid out in The Insanity Offense, the new work by Dr. E. Fuller Torrey, founder of the Treatment Advocacy Center.   It is time to take a new offensive to eliminate stigma once and for all.


Tuesday, June 24, 2008

A Supreme Parallel

The U.S. Supreme Court on June 22, 2008, ruled 7-2 that a person with a severe mental illness can be competent to stand trial but at the same time not competent enough to fire a lawyer and represent himself in court. The court used strong logic to reach this decision that will allow judges to “take realistic account of the particular defendant’s mental capacities.” The goal is a fair trial.

"A right of self-representation at trial will not affirm the dignity of a defendant who lacks the mental capacity to conduct his defense without the assistance of counsel," Justice Stephen G. Breyer wrote for the majority. "To the contrary, given that defendant's uncertain mental state, the spectacle that could well result from his self-representation at trial is at least as likely to prove humiliating as ennobling."

The case involved an Indiana man, Ahmad Edwards, who stood trial for attempted murder for firing shots outside an Indianapolis department store after attempting to steal shoes. Edwards suffers from schizophrenia and delusions.

The two dissenters in the case, Justices Antonin Scalia and Clarence Thomas, put forward the familiar argument that it is better to be the master of one’s own fate than the ward of the state. In the instance of someone standing trial, however, having a legal representation rendered inadequate by the active symptoms of a severe mental illness would have the likely impact of making someone a ward of the state, potentially with a life sentence.

In many respects, the court house is not much different than the hospital. The ability to make decisions has a direct impact on the dignity of life. A noble notion does not always translate into a dignified or free life.

Without treatment, Edwards committed the preventable tragedy of shooting an innocent person. Without legal representation, the state would commit another tragedy of justice. Justice Breyer is correct in seeing it as more humiliating than ennobling, in the court room and in the doctor’s office.

Monday, June 23, 2008

Taking 'the Insanity Offense'

Every once in a while there is a book that has the ability to make change. Dr. E. Fuller Torrey’s, The Insanity Offense, is one such text. For many readers here, the plot is familiar. America’s failure to treat the seriously mentally ill endangers its citizens. Dr. Torrey’s diagnosis hits a bull’s eye and his prescription for change is compelling.

The Insanity Offense" is "about one of the great social disasters of recent American history," Dr. Torrey writes. "It began within the lifetime of many of us, is continuing, and today affects approximately 400,000 individuals and their families. In the annals of twentieth-century American history, it should be included among the greatest calamities."

In just a few short days of publication, those words ring so true that the book is receiving attention of biblical proportions.

“There are times and situations that call for prophets,” writes Johns Hopkins University Professor Dr. Paul McHugh in The Wall Street Journal. “Not fortunetellers or soothsayers, but biblical prophets like Amos or Jeremiah who furiously proclaim the old truths, puncture our pretensions and predict from current tribulations worse to come if what lies deeper than sin -- idolatrous worship of false gods -- continues. E. Fuller Torrey, a psychiatrist who cares for patients with schizophrenia and manic-depression, is to my mind the doctor nearest in character to an ancient Hebrew prophet.”

Dr. Torrey, as he has done so many times before, lays out a path to follow. The job ahead is to push forward. The obstacles are familiar. The forces against change are well known, well organized, but wrong. The obligation to act is clear. Let’s join Dr. Torrey and take the offense to improve American’s health.

Wednesday, June 18, 2008

Starving for Help

Brian Corrigan starved to death in the middle of a large city. He also had schizophrenia; his body was discovered in his Cincinnati apartment about one year ago. After an investigation by the Cincinnati Enquirer with the help of Corrigan’s sister Kathleen, more is now known about this preventable tragedy. Brian Corrigan should be alive today. While no one was specifically faulted for his death, those who were around to help faced too many roadblocks because of Ohio’s restrictive commitment laws.

One could say that the same system that spent significant amounts of taxpayer’s dollars to provide Corrigan with caseworker and an emergency crisis team, yet refused to listen to his sister when she asked for him to be admitted into a psychiatric hospital so he could receive his medicine, was the true cause of death.

"Mental health has gone much the other way in terms of protecting their rights and putting such barriers up," Kathleen said. "Maybe this is what this is about at the end of the day. They're so worried about lawsuits and privacy issues than the actual act of assisting and doing what is actually in the best interest of the person they're helping."

Corrigan’s caseworker took him grocery shopping and provided other services. An emergency team looked in after him. While Corrigan reportedly told them he was “fine,” he continued to lose weight and to not eat. The team didn’t think he posed “substantial risk” to himself or others. For almost three weeks prior to his death, Corrigan wouldn’t let this team into his apartment.

The system kept spending money, yet not giving Corrigan what he needed most. Cases like this make it easy to see why schizophrenia costs our nation at least a $193 billion a year. Taxpayer funds were used to buy groceries for a man “the system” let starve to death. An editorial accompanying this economic cost study in the American Journal of Psychiatry writes, “A little more than 5 years ago, Dr. Michael Hogan, chair of the President’s New Freedom Commission on Mental Health, noted that ‘we are spending too much on mental illness in all the wrong places’. This is even more true in 2008 than in 2002.”

Corrigan’s sister living in Canada wanted something done. There is an email trail between her and the caseworker discussing using the courts to get a commitment. The caseworker didn’t think Brian met the Ohio standard for commitment. The law forbade the treatment needed to keep Corrigan alive.

Last year, Ohio balked on passing legislation to give its commitment laws badly needed reform. The starving need for action remains.

Monday, June 16, 2008

A Texas Size Problem

A series of news reports out of Houston, Tex. is documenting what is becoming a program of Texas-sized proportions. The lack of funding and lack of beds in mental hospitals is overcrowding Texas jails and courts with people with severe mental illness.

Every month more than 1,700 people are locked up in the Harris County jail who are suffering from a mental illness, making the Houston-area prison the largest mental health hospital in the state.

For readers to this website, this is not new news. The Treatment Advocacy Center’s recent report on the shortage of public hospital beds for the mentally ill outlines the results. The consequences of the severe shortage of public psychiatric beds include increased homelessness; the incarceration of mentally ill individuals in jails and prisons; emergency rooms being overrun with patients waiting for a psychiatric bed; and an increase in violent behavior, including homicides, in communities across the nation.

"The criminal justice system should not be the primary provider of psychiatric medical care," Harris County Judge Jan Krocker said. "I'm supposed to know about blood spatters and ballistics and understand criminal law, yet a huge portion of my job deals with the mentally ill," said Krocker.

Krocker said about a third of the people charged in criminal court are mentally ill.

Without proper treatment, many of the mentally ill are often released late at night and end up back in jail “before the sun is even up,” reports KPRC channel 2 news in Houston.

All this come at the cost of $132 to house an inmate in jail’s mental health unit.

This should lead Texans to ask: Why is so much being spent for so little?