Treatment Advocacy Center

We've Moved!

2008-11-03T14:20:00.001-05:00

The Treatment Advocacy Center blog has moved!

Please visit us at our new website. By moving our blog directly to this new and improved website, readers will be able to better utilize new advocacy tools to help bring timely and effective treatments to people with severe mental illnesses.

Please add our blog and website to your favorites.

Also, please spread the word by telling 10 friends about your work with the Treatment Advocacy Center.

Thank you for your continued readership.

Need for Treatment

2008-10-24T11:08:00.003-05:00

Need for treatment (NFT) standards appear in various forms across the country. Some states specifically identify a need for treatment as part of the criteria commitment and some states have a commitment standard that amounts to a need for treatment through court interpretation. Many states NFT standards appear in their definitions of “gravely disabled.” For instance, some states define gravely disabled as a person who is unable to provide for needed psychiatric care. Arkansas’ law moves the country closer to ensuring that individuals suffering from mental illness receive the treatment they need.

"Mental health experts in Arkansas and I had become frustrated by the law's limitations. We were determined to do more than we had in the past. Last year, we pursued legislation that offered greater flexibility for people in need of mental health services."

Johnson introduced House Bill 2681 to clarify the definition of “clear and present” danger. This bill included criteria similar to the criteria for assisted outpatient treatment under Kendra’s Law in New York. Arkansas’ new law became effective in December, 2007 making Arkansas one of nearly 20 states that have adopted improved treatment standards over the past decade. Arkansas’ new law allows for assisted treatment when a person with a severe mental illness has an impaired understanding of condition, needs treatment to prevent harmful deterioration, and has a history of noncompliance.

Suicide Rate Increases

2008-10-22T14:42:00.003-05:00

A new study found that suicide rates are increasing. Researchers found that from 1999 to 2005, the overall suicide rate in the United States rose 0.7 percent. However, among middle-aged white women, the annual increase was 3.9 percent; among middle-aged white men it was 2.7 percent. The report did not explain why there was such an increase among these populations. According to Susan P. Baker, a professor at the Johns Hopkins Bloomberg School of Public Health,

[I]t's not clear what might be causing the rising suicide rates among middle-aged whites. "We need to study the individual people who have committed suicide and see what were their living circumstances. Were they depressed, was this impulsive? A lot more specific information is needed," she said.

For more information on suicide please see our Briefing Paper, SUICIDE: ONE OF THE CONSEQUENCES OF FAILING TO TREAT SEVERE PSYCHIATRIC DISORDERS

Every Brother, Everyone Deserves Better

2008-10-17T11:54:00.000-05:00

The national policy of blind indifference toward mental illness and the homeless took an ugly turn last week in Los Angeles.

That was when John Robert McGraham was doused with gasoline and set into a flaming death. Police still have no information as to who set the 55-year-old homeless man with severe depression on fire. Perhaps, California should look toward our outdated policies as the killer.

It is a series of bad policies that left McGraham to the dangers of the streets instead of receiving the benefits of treatment. He was a helpless victim. There is a long list of things that could be handled better, but let’s focus on one solution within grasp of policy makers to fix. Los Angeles—and every county—needs to implement Laura’s Law now.

Laura’s Law would bring assisted outpatient treatment to people like McGraham who had family members trying to help, but because of a symptom his own illness, he was refusing or not staying on treatment. The state passed Laura’s Law years ago and left it up to each county to implement. Unfortunately, only one county in the state has put this important measure in place.

McGraham was a brother, an uncle, a real person. A person who deserved better. A person who had a family trying to help. The least California can do is to fix the law from standing in the way of timely treatment.

A Safety Net, Now It's Time for a Treatment Policy

2008-10-14T09:38:00.000-05:00

Since 1937, when the Golden Gate Bridge first linked San Francisco with the north side of the bay, some 1250 people have jumped to their deaths. Now, after decades of debate, the Golden Gate District voted on October 13, 2008, to install anti-suicide nets.

The vote was a long-sought victory for mental health advocates. As it turned out, the symbolic bridge also earned the dubious distinction of being the world’s most popular suicide site.

A safety net is certainly a sound move. There is, however, much more San Francisco, Marin, and all of California’s other counties can take to help ensure that people with severe mental illnesses receive treatment. That is to put in place Laura’s Law.

Laura’s Law can bring assisted outpatient treatment to every county in California. This is a proven way to both ensure that people who need treatment the most receive help. It is a proven way to reduce suicide and to keep people alive and well. Now is the time to put in place this treatment policy in every California County.

Mental Health Parity is Now Law

2008-10-06T12:26:00.001-05:00

After more than 10 years in the making, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act is now the law of the land. This landmark legislation requires health insurance plans that offer mental health coverage to provide the same financial and treatment coverage offered for other physical illnesses.

The idea began in 1996 when the two senators from different sides of the aisle experienced what insurance discrimination of mental illnesses did to their own families. They saw it wasn’t right and championed the movement to make it right. Because of their efforts, millions of American families will be better off.

“We are ushering in a new era of health care for those with mental illnesses. No longer will we allow mental health to be treated as a stepchild in the health care system. If you have insurance, then your mental health care must be equal to the benefits you get for any other disease,” Sen. Domenici said. “I appreciate all the partners I’ve had in this long, long effort but most especially Senator Ted Kennedy, who has been remarkable and stepped up to this work after Paul Wellstone’s tragic death. This has been a labor of love for us.”

Because of the dogged efforts of Senators Domenici and Wellstone, a scaled-down version of parity was enacted in 1996, against fierce opposition from insurance industry lobbyists. Each year, it seemed, the full version would come close to passing but never fully making its way to the president’s desk. This year, as part of the Wall Street rescue measure, it became a must sign piece of legislation. While it took more than 10 years for the full measure, the federal government and many states moved toward mental health parity sooner. The Clinton administration revised Medicaid rules to extend parity for that program. That was a major benefit for many families where someone had a severe mental illness.

Now, as a law, it is also a fitting tribute to cap the career of Sen. Domenici who is retiring at the end of this year. The battle could not have been won without his leadership.

Healthy Minds Draws Thousands

2008-09-30T15:58:00.000-05:00

Thousands of people turned out across the U.S. and in Canada on September 14, 2008, for an unprecedented series of free public forums on how neuropsychiatric research has helped turn the tide on the devastating effects of mental health disorders.

Sponsored by NARSAD, the world’s leading philanthropic organization for research on mental illnesses, the historic day of events served to launch an international public awareness campaign called “Healthy Minds Across America.” Forty-seven unique forums took place at prominent universities and medical centers across the continent, where scientists who are conducting leading-edge research provided some of the latest findings on such conditions as schizophrenia, depression, bipolar disorder, anxiety disorders, including as post-traumatic stress disorder (PTSD), and childhood mental disorders.

The day of events saw nearly 4,000 attendees, including Colorado First Lady Jeannie Ritter, who opened the Healthy Minds Across America forum at the University of Colorado Denver. Among other notable guests at the forums were David Hamburg, M.D., former longtime president of the Carnegie Corporation of New York and an early pioneer of biological psychiatry; Oliver Sacks, M.D., famed neurologist and author; Andrew Solomon, award-winning author of “The Noonday Demon: An Atlas of Depression;” and Barbara Leadholm, commissioner of the Massachusetts Department of Mental Health.

However, most in attendance were patients seeking to learn about potential new treatments for their disorders, parents concerned about their children’s chances of recovery, mental health professionals interested in understanding the causes and mechanisms of mental illnesses and how to better help their clients, special education teachers who wanted to find out how to work more effectively with their students with brain and behavior disorders, and students of psychiatry and neuroscience.

Hopefully, as the result of new research spurred by this event, future Healthy Minds Across America will be able to provide news of new treatments and more answers for consumers and family members.

Sacramento Bee Gets it Half Right

2008-09-29T07:21:00.000-05:00

In a Sept. 28, 2008 editorial, the well respected Sacrament Bee urges the county and the state to fully fund programs for people with mental illness, especially the homeless. The editorial comes in the wake of a tragedy in which Frank Perez was shot by a homeless woman with an untreated mental illness.

“She is an extreme example of what can happen when mentally ill homeless people are left untreated,” writes the Bee. “Most aren't packing guns. In fact, they are more likely to be victims than perpetrators. Still, there is a huge public cost to ignoring them.”

The Bee continues to hit the bull’s eye of the problem.

“Too many end up begging on streets and sleeping in doorways. They turn up at hospital emergency rooms, in jails and in prison. In the end, treating mental illness is far less costly for the public, for the homeless and for rare victims like Frank Perez.”

The paper starts down the road for a solution. In 2004, California voters passed Proposition 63 calling for a tax on the wealthy to ensure programs for people with mental illness didn’t face budget cuts. Unfortunately, it has been ignored and the Bee is 100 percent correct in pointing out this failure.

That’s, however, only half of the problem. Sacramento County as well as the state’s other counties need to enact Laura’s Law. This law, left up to each county to put in place, would provide assisted outpatient treatment for people with mental illness. Laura’s Law will increase the cost effectiveness of treatment that the Bee so rightly identifies and—most importantly—it will save lives.

Lawsuit Dropped, Now Put in Place Laura's Law

2008-09-26T10:29:00.000-05:00

El Dorado County, Calif. inched a little closer to justice as two sheriff’s deputies dropped an outrageous lawsuit against 67-year-old Karen Mies whose son with a severe mental illness killed his father and then lost his own life in a gun battle with the deputies.

The deputies’ $19.2 million lawsuit was the ultimate insult to injury to the Mies family. The family had struggled to get their son Eddie the help he needed to battle schizophrenia. Unfortunately, the law wasn’t on the family’s side. Laura’s Law hasn’t been put in place in El Dorado County. That law would have made assisted outpatient treatment available to the Mies family. It might have prevented the tragedy.

The lawsuit drew the ire of many, including this blog on two occasions. The deputies were wrong for filing the suit in the first place. It only inflicted further pain and suffering on the Mies family. However, dropping the suit isn’t enough.

The best way for El Dorado County to improve the situation, and help other families from experiencing the same type of tragedy facing the Mies family, is to put in place Laura’s Law. Now is the time.

Another Virginia Warning Call

2008-09-24T06:51:00.000-05:00

What minimal mental health treatment reforms made in the wake of the Virginia Tech tragedy are at risk of being undone, the latest result of tight budget cuts.

Advocates are issuing a warning call in hopes that Virginia Governor Timothy Kaine will hault the looming cutbacks from putting more people at risk.

“It will be a real setback, both locally and statewide,” said Tom Spurock, the father of a son with a severe mental illness and a tireless advocate for better treatment.

As a result of the 2007 shootings of 32 Virginia Tech students by Seung-Hui Cho, the state clarified the criteria before a person can be involuntarily committed to treatment and established minimal procedures for assisted outpatient treatment. Cho had been ordered outpatient treatment but disappeared after making only one appointment at a clinic and never showed up again before he opened fire on the campus.

Spurlock and other advocates wanted to see the reforms go much further, and brought closer inline with laws in New York, Louisiana, Idaho, and other states that have made major treatment reforms. Governor Kaine signed the legislation, but he too would have liked to have seen more reforms.

The pending cuts would place a state mental health system already near exhaustion over the edge. With a serious shortage of psychiatric hospital beds, overcrowded emergency rooms unable to provide psychiatric treatment, jails struggling to care for inmates who have no other place to go, and too many loopholes still left in treatment laws, now is not the time to make cuts.

Indeed, Virginia and other states are facing tough budget times. Cutting vital mental health services, however, will prove penny wise and pound foolish. There is a better prescription for Virginia’s mental health woes. Governor Kaine should place a protective shield around mental health issues so to help ensure there is no sequel to the 2007 tragedy and he should ask the state assembly to take a closer look at making Virginia’s treatment laws a model for the rest of the nation. Doing so would build a living memorial to those who lost their lives that fateful April day.

Protection and Advocacy for Lawyers

2008-09-23T09:01:00.000-05:00

Imagine lawyers as a protected class who need public support and help. It now seems that’s exactly what’s happening as so called “Protection and Advocacy” attorneys are circling the wagons to aid and abet the misdeeds of one of their own in Maine.

The lawyer posse was formed after an Aug. 16, 2008, front-page Wall Street Journal story detailed the handy work of the Maine Disability Rights Center and their lead attorney Helen Bailey in making sure that in 2006, William Bruce, a 24-year old man with schizophrenia was released from hospital care and his family was prevented from making sure he received treatment. Despite that the doctors described Bruce as, “Very dangerous indeed for release to the community,” Bailey insisted she knew best.

As it turned out, Bruce was released because of Bailey’s legal handiwork and later killed his mother.

The National Disability Rights Network has been busy trying to cover the tracks left in the carnage of Bailey’s legal tricks. No wonder, there is no good that has come out of Bailey’s work. The larger question remains: Why keep defending what is clearly indefensible?

Bailey expressed her true sentiments of how she views her job to The Wall Street Journal. “My job is to get the patient’s voice into the mix of where decisions are made,” she told the reporters. “No matter how psychotic, that voice is still worthy of being heard.”

Neither Bailey nor her legal posse has shown any remorse for what happened in the Bruce case. “There is nothing in the William Bruce case that is contrary to the way we do business,” she says.

Hardly comforting words for a family in grief. Here is how highly Bailey views the opinion of family members compared to her own sound legal judgment, “There are some God damn nasty families out there.”

Bailey considers this as business as usual, using taxpayer dollars. As it turns out, they used those funds—in part given to them by the Bruce family and other law abiding citizens who pay their taxes and play by the rules—to offer protection from doctors trying to treat the sick. Beyond that, Bailey’s group lobbied the Maine legislature to make sure she would get to keep her business as usual scheme going. Did Bailey use federal dollars to lobby? Did the Maine legislature believe her?

The answer to the first question is unknown and one would suspect Bailey has another Cracker Jack team of accountants carefully covering her tracks. As for the second, the Maine legislature didn’t buy her phony argument that not providing medical care to someone with a severe mental illness was in that person’s best interest. Has that fully stopped Bailey? No. She is now trying to use the courts, and likely public funds, to override the will of the people of Maine.

Putting Families and Doctors at the Center of Treatment

2008-09-16T10:21:00.000-05:00

In the wake of recent preventable tragedies in Washington State, the venerable Seattle Post-Intelligencer has done an outstanding job of restoring reason to the debate on mental illness. In both reporting and editorials, the paper has examined what the state can do, instead of dwelling on the tragic events.

Here is what the paper’s editorial board concludes:

“For all the strengths of our system here, including mental health courts and the early adoption of parity for mental illnesses in health insurance, we can do better.

“The Skagit killings highlighted the near impossibility of committing dangerously mentally ill individuals to treatment. P-I reporter Carol Smith found Washington is one of the few states where families and doctors cannot directly petition to have a mentally sick person treated against his or her will. Families and physicians should be put in the center of treatment efforts.

“We’re also a state where involuntary treatment is almost never performed in the community instead of a hospital. The community practice in other states makes enormous sense: By requiring treatment when someone is still well enough to be in the community, there would seem to be a good chance of staving off worsening illness.

“Smith and reporter Daniel Lathrop also discovered the state spends $1.8 billion yearly on mental illness or its aftermath, but only about $530 million on direct treatment. One result: Not enough hospital beds for the mentally ill. Overall, the spending pattern is a warning signal that we need to refocus.

“It’s still possible we need to spend more. But money must be spent effectively and not be tainted by politics, as when King County government last year structured some funding from a new mental health tax to fit a powerful union's organizing efforts.”

At the core of this sound reasoning is putting families and physicians at the center of treatment efforts. If more states take this message to heart, much can and will be accomplished.

Hospital Beds Continue to Dwindle as Budgets Get Cut

2008-09-12T13:33:00.000-05:00

It looks as if two Ohio mental health hospitals will soon close as the result of state budget woes. On Sept. 11, 2008, Gov. Ted Strickland proposed $540 million in budget cuts; on top of previous cuts it will reduce the state’s budget by a total of $1.27 billion. The economy is taking its toll and there are probably few good choices when that much of a budget gets slashed.

Considering Ohio has a critical shortage of hospital beds for people with mental illness, the state should look elsewhere to make up the shortfall. In the larger scope of over a billion dollars in cuts, saving the beds amounts to little more than knick. When one considers the risk of a preventable tragedy, it’s not worth the risk.

Dying With Your Rights On

2008-09-11T14:10:00.000-05:00

The following is an excerpt from a World magazine interview with Dr. E. Fuller Torrey.

WORLD: What is “dying with one’s rights on”?

TORREY: Dr. Darold Treffert, a psychiatrist in Wisconsin, originally used the term. He kept track of the increasing number of deaths of individuals with serious mental illnesses who died from accidents, suicides, starvation, etc., because of the new laws making it difficult to treat them. Dr. Treffert wanted to emphasize the fact that the new slaw were effective in protecting the person’s civil liberties and their right to refuse treatment, but in doing so the laws put the person in danger. Dr. Treffert is one of only a few American psychiatrists who have spoken out forcefully regarding the abysmal job we are doing in providing appropriate care for individuals with severe mental illnesses.

Today, someone, somewhere with a mental illness died with their rights on.

Washington State: Change or No Change

2008-09-10T09:07:00.001-05:00

“I Kill for God. I Listen to God,” 28-year old Isaac Zamora told a judge at his court hearing on Sept. 5, 2008, after being arrested for shooting and killing 6 people, and wounding 4 others in Skagit County, Wash. Zamora, suffering from severe mental illness, was kept from the treatment his family had sought, treatment that likely would have prevented this devastating event. Washington law stood in the way of the Zamora family’s ability to get Isaac the treatment he so clearly needed, and the consequences are disastrous.

The Zamoras are far from being the only Washingtonians affected by treatment laws surrounding mental illness. Liz Browning, mother of a young man suffering from schizophrenia, knows all too well the barriers in getting help for a loved one with a mental illness. Liz and her mentally ill son, Marcus, visited several mental hospitals to find help. However, Marcus and Liz were repeatedly turned away during their hospital visits, being told that Marcus was not ill enough to warrant treatment. “You almost hope they are really, really bad,” Browning told the Seattle Post-Intelligencer. “And that's just so wrong.”

Dr. Peter Roy-Byrne is the chief of psychiatry at Harborview: one of the hospitals the Brownings visited on their quest for Marcus’ treatment. Dr. Roy-Byrne feels that the hospitalization of a mentally ill person has made a transformation, turning from a medically based judgment into a legal decision. "It's like if someone came into the ER with chest pain or cardiac arrhythmia, and we had to tell them, until they have a heart attack or need a heart transplant, we can't do anything," the doctor said of the state’s restrictive mental illness treatment standards.

Hopefully, the obstacles to accessing treatment that plagued the Brownings and the Zamoras are not set in stone. Due to the magnitude of the situation, Washington Gov. Chris Gregoire ordered a review of Zamora’s case overseen by the head of the Washington Association of Sheriffs and Police Chiefs, as well as a prosecutor from the Washington Association of Prosecuting Attorneys. The anxiously awaited report is due next week. Hopefully, it will include the changes needed that will save lives.

How Many More Names Will it Take?

2008-09-08T11:45:00.000-05:00

New York has Kendra’s Law, California has Laura’s Law, Michigan has Kevin’s Law, and Louisiana has Nicola’s Law. Those are just a handful of state that have passed assisted outpatient treatment laws to help people with severe mental illnesses after a tragedy sparked lawmakers into action. A number of other states, New Jersey, Nevada, Pennsylvania, and others have witnessed preventable tragedies and have pending legislation to reform their mental health treatment laws.

The question is: How more names have to be added before a state acts?

This question was recently posed by New Hampshire’s Concord Monitor.

“Will some unfortunate New Hampshire resident,” writes the paper, “have a similar law named for her? If the state's mental health system continues to be starved for resources and the state's laws governing involuntary commitment aren't revised to better balance civil liberties with public safety, it's a distinct possibility.”

Thinking before another tragedy occurs is the right course of action.

As the Concord Monitor added, “The state's prisons and its county jails are packed with people whose crimes might have been averted had they received good mental health care. Most of those inmates will return to society, and some, given the state of the law and New Hampshire's mental health system, will pose a serious danger to the public. The Legislature shouldn't wait for a victim who can give a name to the new law before acting.”

There is no time to act like the present.

Tragedy Strikes on New Jersey Train Platform

2008-09-05T14:40:00.000-05:00

Michael Fuccile was waiting for his train to work on Sept. 4, 2008, at the Liberty State Park light rail station when 26-year old Elgin Louis Taylor, Jr., who had been diagnosed with schizophrenia since age 16, stabbed and killed him.

The murder was a surprise. Taylor’s illness and lack of treatment were not.

“I've been fighting the system for years to get the power of attorney to make him go to the hospital and make them keep him until he’s well,” said his distraught father.

This tragedy could have very likely been prevented. In 2006, the New Jersey Senate unanimously passed a version of “Gregory’s Law” that would have brought assisted outpatient treatment in the Garden State. Unfortunately, the bill didn’t move out of the Assembly and onto the Governor’s desk.

The bill was named after 11-year old Gregory Katsnelson who, like Fuccile, was killed by someone with a severe mental illness who refused treatment. Gregory would have turned 17 next month.

New Jersey has strong leaders, including Senate President Richard J. Codey, who pushed for the measure. Now is the time to make the final push so New Jersey is no longer one of a small handful of states that has no assisted outpatient treatment law.

Washington State Tragedy Draws Reactions

2008-09-04T16:06:00.000-05:00

The shooting tragedy that left six dead in Skagit County, Wash., has sparked strong reactions from average citizens all the way up to Governor Chris Gregoire, who has ordered a 10-day review of what happened.

Below is an expert from one of the many blog comments received in response to a story in the Seattle Post-Intelligencer. The Governor’s review panel should take note.

“Most people don't understand mental illness, nor do they care about the mentally ill until something like this horrible tragedy happens. Then everybody gets upset...and talks about how horrible it is and then...nothing happens.

“Unless you have experience with it, you can’t imagine how hellishly frustrating it is to try to get an extremely ill family member into treatment who is convinced that they are not ill. It is simply impossible to scale that wall of delusion without professional help and long term care.

“But the laws leave the people who could help with their hands tied behind their backs. Even if they were allowed to, there is now no place for people who have fallen off their meds to get back on them in a safe and controlled environment, because all but a few of the mental hospitals were shut down years ago, victims of more spending cuts.

“The mental health system here is BROKEN and is being held together with Band-Aids and glue, and thank God by some incredibly caring but overworked, underpaid and understaffed social workers and mental health professionals whose caseloads have gone from maybe 10 in the 70's to up to as many as 75 now. How can anyone be expected to truly track and care for that many ill people?

“It is our mental health system that is really insane.

“My heart goes out the victims’ families, but also... to the family of the shooter...he should have been in treatment, not on the street.”

The Washington State Roadblock Tragedy

2008-09-03T12:25:00.000-05:00

The headlines are as chilling as they are too familiar. “Six dead in Skagit County shooting rampage,” reads the September 3, 2008 Seattle Times headline.

The shooter, 28-year-old Isaac Zamora has a history of mental illness and was living alone in the woods, despite attempts by his family to get him the help he needs. The help that might have saved the lives of six innocent people who were left dead along Interstate 5 north of Seattle.

One of the victims, Anne Jackson a Skagit County sheriff’s deputy, was aware of Zamora’s history of mental illness and had told his family to call her anytime for help.

This raises many, many questions.

Why put a law enforcement officer in this type of situation?

Why wasn’t Zamora in treatment?

Why didn’t county officials do more to help the Zamora family get their son treatment?

In the days to come, some of these questions will be answered and many others will be raised.

Earlier this year, another tragedy in Washington State raised some of the same questions. Anthony Williams refused to take medication for his paranoid schizophrenia. His family tried to get help. He had numerous contacts with law enforcement over violent threats. Finally, on New Year’s Eve, he fatally stabbed 31-year old Shannon Harps outside her house.

Prior to the tragedy, county officials said Williams did not pose an “imminent” threat, even though Washington’s law does not insist that someone be “imminently” dangerous to receive treatment. Washington State does, however, require a county designated mental health professional to act as a middle man when a family tries to get someone help. This was a roadblock to treatment then, and remains a roadblock today after six more people have lost their lives on the side of an Interstate.

Washington State needs to remove the roadblock to care before another tragedy strikes.

People Recognize When Something is Wrong

2008-09-02T13:15:00.000-05:00

In a previous post, this blog covered a case of Misguided Justice where a California mother of a mentally ill son who was killed under police fire was being sued by the very same police officers who opened fire. The legal action has caught the ire of many others, and rightly so.

“Despicable,” was the word used by El Dorado County Supervisor Ron Briggs to describe the law suite against 66-year widow Karen Mies.

“The citizens are appalled, and they are right to be appalled,” Briggs told the Sacrament Bee. “I do not believe that public servants should be suing the people they serve. It's a fundamental problem that breaks the trust.”

Briggs is not the only one who is upset. Hundreds of letters to the editor, blog comments, and other public statements share the outrage.

The boss of the two officers suing Mies was among those expressing his outrage.

“As sheriff, I am embarrassed at the filing of the civil tort against the Mies family by two law enforcement officers,” Jeff Neves said. “I recognize that there are situations and circumstances which, in my opinion could warrant the filing of a civil lawsuit; this is absolutely not one of those cases.”

With any good fortune, the suit will be dropped and Mies left alone.

The next, and larger step, will be for El Dorado County to implement Laura’s Law. Providing assisted outpatient treatment will help give both parents and police a greater change that tragedies like the one impacting Mies family can be avoided. It only makes common sense and provides what is just.

What You Don't Know Can Hurt You

2008-08-29T14:22:00.000-05:00

The single most significant reason why individuals with schizophrenia and bipolar disorder fail to take their medication is because of their lack of awareness of their illness (anosognosia).

The interesting fact is that the vast majority—9 out of 10—realize their illness after treatment and stay on their medications.

Critics of assisted outpatient treatment will frequently give other reasons. The medications don't work. There are too many side effects. These can be dangerous red herrings.

Think about heart disease and all that was unknown decades ago. What was unknown was a danger. Doctor’s couldn’t prevent high cholesterol because it was largely unknown. Today, having your cholesterol checked is standard operating procedure.

Medical science has proven that anosognosia is often part of severe mental illness. Yet there are some who would rather put decisions about care in the hands of lawyers rather than doctors. This, for the lack of a better term, is a backward policy that needs to be changed.

Helping Police on the Line

2008-08-28T14:22:00.000-05:00

“It could be your uncle, your cousin, your sister, your baby, your son or your daughter. You never know who's going to come up with mental illness.” That was the advice given recently to Wichita, Kan. police by Carr Floyd at a training session aimed at better protection for people with mental illness by law enforcement.

Floyd, who suffers from a mental illness, could see fear from both sides of the issue as her mother was a police officer.

“I know you’re just as scared as we are, at least that’s what Mom always said,” Floyd commented. “She said that you never know what you’re stepping into. But realize we’re just as scared of you as you are of us.”

Studies show that in such situations it is more often than not the person with mental illness who becomes the victim. This is something that people with a mental illness, like Floyd intuitively know.

“I can tell you if you come in aggressive with someone with mental illness, someone is going to get hurt. And it's probably going to be the person with mental illness,” Floyd told the Wichita Eagle.

While it is unfortunate that the lack of treatment for people with mental illnesses too often put police officers in avoidable situations, the more such trainings occur the better, at least until assisted outpatient treatment is made more widely available.

Political Campaigns and Mental Illness

2008-08-26T12:11:00.001-05:00

As the political season is entering full swing, it’s important to keep your ears open to what the candidates are saying. Better yet, if you don’t hear much discussion about mental illness from the candidates, ask.

For many candidates at the national level, the discussion of mental illness is often tied into broad statements about health reform and the need for parity in treatment for mental illnesses. Having statements of support from Barack Obama, John McCain and other prominent national officials is important. This is a much needed step but there are other steps to be taken.

There is more that would-be elected officials can do should they emerge victorious, especially at the state and local level. Most of the laws and policies affecting treatment for people with severe mental illnesses occur at the state and local level.

There is also much advocates can do this election year to ensure issues affecting treatment for mental illness receive attention. Attending candidate forums and asking questions can make a big difference. Candidates for state assembly seats, mayors, county and city councils, and sheriff will all be in positions of affecting policy for people with mental illness. Ask the tough questions about why is it so difficult for someone with a severe mental illness to get into treatment. Speak out on behalf of your families and the families like yours who are having difficulty getting treatment for a loved one.

There is a good chance that many candidates for local and state office will be unfamiliar with the complexities of these issues. They may not have a good answer for you right away. Tell them that it is understandable and offer your help in finding better solutions. Offer the Treatment Advocacy Center as a resource to find those answers.

Asking the right questions before someone gets elected could make a big difference in what that person does once they are in office.

Editor’s Note: As a nonprofit organization, the Treatment Advocacy Center does not oppose or endorse any political candidates.

Leaving a Lasting Legacy

2008-08-22T15:33:00.000-05:00

Retiring New Mexico Senator Pete V. Domenici, a true champion for people with mental illness, will leave a lasting legacy to his work.

The newly formed Domenici Public Policy Institute at New Mexico State University will continue to shine the light on needed mental health legislation that Sen. Domenici made a focal point of his career. Among the Senate leader’s many efforts is his commitment to the Treatment Advocacy Center and ensuring people with severe mental illnesses receive the help they need.

Sen. Domenici and his wife Nancy know first hand the importance of working on mental illness. Like many others, they have a daughter who has had to deal with a mental illness.

“That put us in touch with families in the same situation,” Sen. Domenici recently told a New Mexico newspaper. “And it puts us on a path of extraordinary involvement.”

He would know. He has walked the walk.

Healthy Minds Across America

2008-08-21T14:29:00.000-05:00

Imagine a day devoted to the nation learning more about the tremendous advances science has made in the understanding and treatment of mental illness. That is exactly what will happen on Sunday, Sept. 14, 2008 thanks to the good work NARSAD.

Healthy Minds Across America is an unprecedented opportunity for people in large and small cities from coast-to-coast to hear about the state of mental health research today. Some 48 public forums on the progress, challenges, and promise of mental health research will bring some of the leading minds in the field together with family members and others looking for information.

NARSAD, the world’s leading charity dedicated to mental health research, is kicking off this initiative along with a fundraising drive to expand research on mental illnesses. “Funding has remained flat for our federal research agency, the National Institutes of Health,” said Dr. Herbert Pardes, president of NARSAD’s Scientific Council. “But we can’t wait for the federal government. Too many lives are at stake, and we must not lose the momentum in the place of discovery we’ve achieved over the past two decades.”

A list of sites and other information is available on the NARSAD website. Be sure to reserve your seat for Healthy Minds Across America my emailing healthyminds@narsad.org or by calling 1-800-829-8289.

An Aloha State Wake Up Call

2008-08-20T14:36:00.001-05:00

A string of recent tragedies in Hawaii has put mental illness high on the list of state concerns. The most prominent was high-tech millionaire Steven Thomas who disappeared from his home and later hung himself.

Thomas had bipolar disorder and all the financial resources necessary to get help. Unfortunately, like many people with the illness, he didn’t realize how sick he was. His wife did, but she couldn’t get him the help fast enough.

State officials are looking at the recent tragedies as a wake up call, holding hearings at the State Capitol to help figure out how to keep people from falling through the cracks. They are to be commended.

The state would be wise to listen to family members, like Thomas’ wife, who saw the warning signs and could almost foresee tragedy in the making. Providing assisted outpatient treatment will help give options to family members and other loved ones. Resources are important, and certainly Hawaii, like many states should examine ways to allocate more to improving mental health. Resources, however, as the case of Thomas illustrates, aren’t the only barriers to care.

A Grandmother's Quest

2008-08-19T16:10:00.002-05:00

Marjorie Bull has a mission. To save other families from what happened to her own.

On February 3, 2007, her granddaughter Arabella Rose was killed by her mother, Sherri Love who struggled with bipolar disorder. Her grandson survived` the stabbing.

That was just days after Love checked herself out of a hospital. She left without any follow up. Bull believes her daughter needed assisted outpatient treatment, care she could not receive in Nevada, where they live.

Today Love is in prison, sentenced to 56 years to life. Bull is trying to change Nevada’s Law to mirror New York’s Kendra’s Law. She points to the numerous successes of that law. In short, Kendra’s Law works. Bull wants to make sure Nevada stops playing roulette when it comes to treating people with mental illnesses and do the same.

“If Nevada would have had Kendra’s Law, or as I would like to call it, Arabella’s Law, my granddaughter would be here today,” Bull recently wrote in a letter to Governor Jim Gibbons.

Nevada’s law is in great need of improvement. The smart money is on Grandmother Bull.

A Death in the Family

2008-08-18T14:49:00.000-05:00

“William Bruce approached his mother as she worked at her desk at home and struck killing blows to her head with a hatchet,” accounts an August 16, 2008 story in The Wall Street Journal. Just two month before, the 24-year old man with schizophrenia was released against doctor’s orders from the Riverview Psychiatric Center in Augusta, Maine. “Very dangerous indeed for release to the community,” wrote one doctor.

This didn’t stop government-funded patient advocates, none of them doctors, to fight for his right to be psychotic.

“No matter how psychotic, that voice is still worthy of being heard,” said Helen Bailey, one of the William’s former attorneys with the Maine Disability Rights Center.

The convoluted sense of rights is continuing to be pushed in a pending lawsuit in the state, as well as in other actions around the country. Ms. Bailey continues to find new clients and continues to use taxpayer dollars to push a misguided agenda.

Did Ms. Bailey act in William’s best interest? William is likely the best judge. Here is what he told The Wall Street Journal in his first interview about the case:

“I blame the illness, and I blame myself,” William said of his mother's death. “The guilt is...,” he paused, struggling to find a word “...tough.”

William said the first time he came to Riverview, he refused to believe he was mentally ill and approached the advocates because he wanted out.

“They helped me immensely with getting out of the hospital, so I was very happy,” he said. He later added, “The advocates didn't protect me from myself, unfortunately.”

“There are times when people should be committed,” William said. “Institutions can really help. Medicine can help.

“None of this would have happened if I had been medicated.”

Perhaps Ms. Bailey and other advocates should adhere to the first rule of medicine, and that to first do no harm.

The Bruce family story is not an isolated occurrence. The Treatment Advocacy Center is collecting stories from people about their experiences with federally funded Protection & Advocacy attorneys. If you have had an experience where Protection and Advocacy organization tried to keep a loved one from getting needed treatment, or were involved in lobbying against treatment law reforms, please email us your story.

Devolution into America's Largest Mental Hospital

2008-08-15T12:48:00.000-05:00

It’s known as the Twin Towers. It’s not at Johns Hopkins, the Mayo Clinic, Massachusetts General, or some other famous medical institution. It is part of the Los Angeles County Jail.

The Los Angeles County jail houses some 1,400 people with mental illness. Reporters from National Public Radio recently visited the Twin Towers in downtown Los Angeles.

For many in the prison, they were searching for treatment, NPR reports. Treatment that is unavailable in the community.

Dr. Arakel Davtian, one of the psychiatrists at the prison, tells the reporters how easy it is for a person to end up at the Twin Towers.

“Indecent exposure, having open containers, something very, very minor. Peeing on the street, disturbing the peace,” Dr. Davtian says.

The transformation of the Twin Towers into the nation’s largest mental hospital didn’t happen overnight. It devolved from the deinstitutionalization of people with mental illness in the 1970s.

“Rather than leading to quality treatment in small, community settings,” NPR reports, “it often resulted in no treatment at all. As a consequence, thousands of mentally ill ended on the streets, where they become involved in criminal activity.”

It is now time to move from this devolution of social policy, to a more evolved program of assisted outpatient treatment. Los Angeles and the rest of California can help lead the way by implementing Laura’s Law.

More Florida Facts

2008-08-13T16:10:00.001-05:00

With news that a Miami-Dade County Grand Jury has issued a strong call for expanding assisted outpatient treatment in the state, it would be useful to examine some facts about the state.

A recent search found an interesting study from August 11, 2008, the same day as the Grand Jury’s report, from Florida Today. Among the findings:

About 125,000 people annually with mental illnesses requiring immediate treatment are arrested and booked into Florida jails, mostly for misdemeanor and low-level felony offenses.
About 25 percent of the homeless population has a severe mental illness, and more than half have spent time in jail or prison.
Individuals ordered into forensic commitment -- charged with a crime -- "are now the fastest-growing segment of the publicly funded mental health marketplace in Florida."
Florida ranks 12th in the nation in spending for forensic mental health services, but 48th nationally in overall per-capita public mental health spending.

Watching a Fire Burn

2008-08-12T10:40:00.000-05:00

A Miami-Dade County, Fla. Grand Jury issued a report calling for broad, needed reforms in the way the state treats people with severe mental illnesses. The Grand Jury was called to examine Florida’s laws with the aim of preventing a repeat there of what happened at the campus of Virginia Tech on April, 16. 2007. Something the Grand Jury called, “the shots heard ‘round the world.”

State Attorney Katherine Fernandez Rundle and others involved in this effort should be commended for this unique and insightful approach. Their warning should be taken seriously by state elected officials.

The Florida Grand Jury found that their laws, much like Virginia’s and other states, have too strict a standard to get someone with a mental illness needed care. The current system doesn’t allow for help to be given until there is a crisis. This jury wants to avoid the crisis.

The results “are akin to having a forest ranger posted in a forest to watch for fires. However, the law says the ranger cannot call the firefighters at the first sign of smoke,” the Grand Jury report states. “Of course, by the time he is able to confirm that a fire is in fact blazing, significant damage has already been done.”

The Grand Jury wants the system changed so that treatment is provided, “at the first wisp of smoke.” They point to the Treatment Advocacy Center’s Model Law as a way to clear the smoke.

“We believe,” the Grand Jury concluded, “the TAC Model Law should form the framework for changes to Florida’s involuntary inpatient and outpatient treatment laws. Making these changes will surely cause a shift in the way we have dealt with the mentally ill for years.”

Making these changes will not be easy. Less than 24 hours after the Grand Jury issued the report, critics were already lining up. Nice ideas, but too expensive. Really? This is what the jury of their peers had to say.

“The fire is out of control. The total costs, as it relates to the amount of time, effort and resources it will take to extinguish the raging inferno have grown exponentially from the point in time when a ranger spotted the first wisps of smoke.”

Misguided Justice

2008-08-11T13:16:00.000-05:00

Here is an example of a “Catch 22” created by a system limiting the rights of a family to get treatment for a loved with a mental illness, yet allows another legal battle to ensue because the family failed to control the same loved one.

In 2007, Eddie Mies gunned down his father, resulting in a shootout with El Dorado County deputies that left Mies dead and two of the deputies injured. A year later, the deputies have filed an $8 million civil law suite against the widow and the estate of her deceased husband, Arthur, and her son.

The story, detailed in the Sacramento Bee, is tragic. Nothing can undo that June 5, 2007 day. Given the limited income and financial resources of 66-year old Karen Mies, the lawsuit is as unrealistic as it is misguided.

“June 5 was a tragic day for me and my family, and it was a tragic day for the deputies who were injured,” Karen Mies told the Bee. “We were all victims that day. But this lawsuit is victimizing our family again. What do they want? My husband's dead, my son’s dead. Do they want my house and my 10-year-old car?”

Here is a better solution that won’t eat up additional resources in court and provide a public policy aimed at prevent future tragedies. El Dorado County should implement Laura’s Law. This law would give families like the Mies’ the ability to get help for a loved one who needs it, but denies they are sick.

Another Family Tragedy Strikes

2008-08-08T11:07:00.000-05:00

He was described as a “ticking time bomb” by some family members. Those who were related to Ronald Weed felt his schizophrenia would someday lead him to harm those closest to him.

Now the whole New Jersey family’s worst fear turned to grim reality.

Weed is facing charges of killing his mother in her home and the stabbing of his 12-year-old twin nieces who were visiting their grandmother.

His family kept trying to get him help, but their options were limited and their hands tied by outdated New Jersey laws. Weed had spent as much as six weeks in a psychiatric hospital. When released he wouldn’t take his medication.

The tragic story is all too common. Without changes in New Jersey and other states laws to provide for assisted outpatient treatment, the risk of another tragedy occurring again is all too great.

Jail or Treatment?

2008-08-06T13:07:00.000-05:00

Readers to this blog will be familiar with this choice and how it impacts people with a mental illness. Now you can vote.

Let your voice be heard.

Should mentally ill people be treated in hospitals and outpatient facilities rather than imprisoned for their disabilities?

Even the Strongest of the Strong Can Need Help

2008-08-05T14:00:00.000-05:00

Professional football fans recently learned why the Philadelphia Eagles two-time Pro Bowl player Shawn Andrews wasn’t showing up for practice. He was sick. Not just any disease. Andrews told his team and the larger public that he is battling depression.

Not an easy thing for anyone to admit, and certainly not easy for someone who builds a career based on strength.

“I’m willing to admit that I’ve been going through a very bad time with depression,” Andrews told the Philadelphia Daily News. “I’m on medication, trying to get better.”

Last year Andrews got scared of going in for treatment, fearing a fan might recognize and spot him.

There was a lot of speculation—most of it wrong—about why Andrews was missing practice, a decision costing him $15,000 a day.

“The consequences are what they are. I'm willing to accept them,” Andrews said. “Football is important, it's a means to an end, but my mental health, I feel like, is a lot more important . . . It is a ton of money, but, at this time, I don't feel like I can put a price tag on my mental state.”

Andrews was most worried about what his teammates would think. Turns out he wasn’t alone.

Another Eagle, Brian Dawkins had this to say. “As a guy who went through that early in my career, taking the medication, I certainly understand.” Dawkins said he was treated for depression as a rookie in 1996. Dawkins said he eventually eased off the medication and thinks he resolved his problem through “prayer and having people around me that I knew cared about me.”

Andrews sought treatment before something really bad happened. He is all the much stronger for doing so. A speedy recovery to him.

Preventable Tragedies

2008-08-04T09:33:00.000-05:00

“Yet another death that was preventable,” reads the headline from The Oregonian. Unfortunately, it is all too common.

This preventable tragedy involved 20-year old Andrew Hanlon who had schizophrenia and was off treatment when he was shot by a police officer. A few months earlier, his family out of frustration called 9-1-1. That was enough to a police officer to get Hanlon to a hospital. That got him evaluated but not much more. There was no outpatient care to help Hanlon stay on treatment.

“Hanlon should be alive today,” read the editorial. “His death was preventable. Had he received appropriate treatment, he wouldn't have been pounding on a stranger's door at night and the police wouldn't have been called. If the officer on the scene had been better trained to deal with a mentally ill person, Hanlon wouldn't have been killed.”

The Police and People with Mental Illness

2008-08-01T12:00:00.000-05:00

From coast to coast, mentally ill people, without reliable access to the costly on-demand care they need, are left to fend for themselves. In the aftermath of the movement in the 1970s to close large mental asylums, many of today's mentally ill are left to their own devices; they are often homeless and without full-time advocates. With government unable or unwilling to properly serve this population, the criminal-justice system is left to pick up the slack.

Is the above passage from a Treatment Advocacy Center report? You might think it was, but it is from a recent web article from Newsweek.

“Experts on treatment say the police for the most part do a good job handling the millions of interactions they have each year with the mentally ill,” the article continues. “But is it irresponsible to ask them to undertake duties that perplex even trained, savvy professionals?”

A very good question indeed.

When Mental Illness Gets Very Political

2008-07-30T15:21:00.000-05:00

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

2008-07-29T09:50:00.000-05:00

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

2008-07-28T14:03:00.000-05:00

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

2008-07-25T11:45:00.000-05:00

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?

2008-07-24T10:40:00.002-05:00

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

2008-07-23T10:14:00.002-05:00

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

2008-07-22T13:40:00.000-05:00

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:

cigarettes and coffee
alcohol and street drugs
sex, pregnancy, and AIDS
victimization
confidentiality
medication and noncompliance
assisted treatment
assaultive and violent behavior
arrest and jail
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

2008-07-21T11:16:00.001-05:00

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

2008-07-18T14:29:00.000-05:00

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

2008-07-17T13:53:00.000-05:00

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

2008-07-16T15:40:00.000-05:00

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

2008-07-15T10:36:00.000-05:00

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

2008-07-14T09:57:00.000-05:00

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

2008-07-11T16:30:00.000-05:00

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

2008-07-10T14:06:00.000-05:00

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

2008-07-09T14:46:00.000-05:00

“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"

2008-07-08T12:13:00.000-05:00

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

2008-07-07T11:15:00.000-05:00

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

2008-07-03T11:36:00.000-05:00

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

2008-07-02T14:19:00.000-05:00

“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

2008-07-01T12:15:00.001-05:00

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?

Three States Celebrate Progress

2008-06-30T16:07:00.001-05:00

As the nation is about to head into the 4^th 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.

When Medicine Got it Wrong

2008-06-27T10:08:00.001-05:00

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.

Celebrities on the Mend

2008-06-26T10:16:00.000-05:00

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.

Progress in the Battle to Erase Stigma

2008-06-25T14:21:00.000-05:00

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.

A Supreme Parallel

2008-06-24T15:16:00.001-05:00

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.

Taking 'the Insanity Offense'

2008-06-23T15:51:00.003-05:00

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.

Starving for Help

2008-06-18T09:53:00.000-05:00

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.

A Texas Size Problem

2008-06-16T12:03:00.000-05:00

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?

Joking Aside: Why a Bus Ticket?

2008-05-29T12:27:00.001-05:00

Earlier this month New Orleans Mayor Ray Nagin caused a bit of a stir suggesting the way to solve the city’s post-Katrina homeless problem would be to give all the people living on the Big Easy’s streets a one-way bus ticket out of town.

He later explained he was joking, of course. But not before The New York Times and other major media outlets took notice.
Unity of Greater New Orleans, a network of agencies that help the homeless, reports that some 40 percent of the people living on the city’s streets suffer from a mental illness and an additional 19 percent face a combination of mental illness, disability or addiction.

This summer will mark three years since Katrina tore its path of destruction through the Gulf coast. For those 59 percent of New Orleans homeless with some form of mental illness, there is a good chance they received very little care before the storm struck. Now, proper mental health treatment is at best sparse.

So why a bus ticket?

Why not so many other things?

A new look at treatment and commitment laws should be high on that list.

In the midst of all that needs to be rebuilt in New Orleans, there is an opportunity. There is a chance to build a new mental health infrastructure and to do it right for the start. Reformng Louisiana’s restrictive laws is another critically needed step. Such changes make much more sense than a one way ticket to nowhere. Perhaps the mayor’s ill attempt at humor will shine some light on what needs to be done.

“Max Blake was 7 the first time he tried to kill himself.”

2008-05-23T12:56:00.001-05:00

The opening sentence of Mary Carmichael’s article about Max Blake, a child with bipolar disease, is both disturbing and heart breaking.

The Blakes may have a rough road ahead. Max has not yet reached the age of majority, so his parents have control over his treatment plan. Unfortunately, the Blakes will face even more hurdles when it comes to getting treatment for their son Max when he turns 18. Like so many other parents whose grown children have a severe mental illness, they will try to get him help, but will likely encounter a harsh reality when it comes to treatment laws in their state.

In most states, a child (sometimes as young as 14) has the right to refuse treatment - forcing parents to resort to the commitment process. Many times the law leaves parents with no voice in the treatment of their son or daughter. Parents and loved ones of individuals with a severe mental illness are often the driving force behind compliance with treatment plans – they many times have to be for people with a severe mental illness who do not even recognize that they are ill. As it stands now, many states require that a person be immediately dangerous before they may be involuntarily treated, forcing many parents to wait in agony as their child deteriorates before being able to get them treatment.

The number of bipolar diagnoses in children is rising, which is just another pressing reason we need to continue to eliminate barriers to the timely and effective treatment of severe mental illnesses.

Building Awareness that Treatment Works

2008-05-22T13:47:00.000-05:00

May is Mental Health Awareness Month. The last several weeks have been marked by studies, events, commemorations, and other activities normally associated with similar markings. For people who have successfully overcome severe mental illnesses, it is indeed a month to be proud.

Sen. Sherrod Brown (D-Ohio) used this month to tell his colleagues in the Senate about one of his constituents with a remarkable story. Many in the field of psychology are well aware of the work of Dr. Fred Frese. Dr. Frese is currently an Assistant Professor of Psychology in Clinical Psychiatry at Case Western Reserve University and Northeastern Ohio Universities College of Medicine. It was at Western Reserve Psychiatric Hospital where he spent 15 years as a department head and author of numerous books, research articles, and studies. His body of work earned him the American Psychological Association’s highest honor, the Hildreth Award. In addition Dr. Frese gives generously of his time in talents in many ways, including serving on the Board of Directors of the Treatment Advocacy Center.

Dr. Frese’s professional accomplishments speak for themselves. But there is much more to his life. Dr. Frese has been living with paranoid schizophrenia since 1966. He is like many people with schizophrenia who are living proof that treatment works.

“Dr. Frese is remarkable,” Sen. Brown notes, “But his recovery is not unusual.”

That is just the point. The consequences of not treating severe mental illnesses like schizophrenia are too familiar. Highlighting the lives of people like Dr. Frese is a great way to break the stigma associated with mental illness. Treatment is the key to more of these success stories.

“Imagine a world where individuals with mental disorders are supported and treated, not marginalized and discriminated against,” Sen. Brown says. “Imagine a world where we see individuals first and disability second. Imagine the wealth of talent and resources that individuals with mental illness can realize with treatment.”

Personal encounters with untreated mental illness, stigma & YouTube

2008-05-20T13:37:00.000-05:00

A key and understandable focus of many mental health organizations is fighting stigma. Educating, and sometimes chastising, journalists who propagate derogatory stereotypes is a common way to try and prevent the most severe manifestations of mental illnesses from being associated with all who have them.

Yet would stigma be eliminated if advocates were given the final say on every article, movie and TV Show? Hardly. Opinion is forged through personal experience.

People who have overcome mental illnesses don’t wear tags marked “I have Bipolar Disorder” or “successfully dealing with Schizophrenia.” Many of those in the grips of the untreated symptoms of such illnesses make their conditions distinctly apparent. An encounter with someone in the midst of a psychotic episode can shape an individual’s opinion about mental illness for life. E-mails, phone calls, and media education can’t prevent such encounters – only treatment can.

Nafiza Ziyad is “an ambitious, bright and happy person.” She also has bipolar disorder, but “thinks she can do without the medicine.” A manic episode recently led to Ziyad angrily, confusingly confronting an elderly woman on an Atlanta train and to becoming the face of mental illness for most of the other passengers.

As it happens, Ziyad’s behavior also provided an “education” for many others. It was recorded and posted on YouTube. The video is entitled “Crazy Girl on Train.”

Currently, 847,638 people have viewed the sad incident and 10,274 have posted written comments concerning it. Should you wish to watch the video of this sad episode, please be aware that it contains a great deal of profanity.

And does this create stigma?...below are a sample of comments from the YouTube posters (profanity has been excised).

“Oh my God...what a horrible person.”

“That was scary”

“what a nutcase.”

“She needed to be popped in the mouth.”

“some forgot to take her meds..”

“i'd hit her in the middle of the face with a baseball bat if i was just sitting there in the train going home or anything. i'm pretty sure i would have support”

“Yall can't see that this girl is mentally insane.”

“shes disturbeddd”

“If i had been on the train i would have ------ kicked her in the face.”

“that chick needs to be medicated.”

“THIZ FEMALE CRAZY”

“Somebody call the doctor. This girl is obviously not healthy in the head”

“Definitely psychotic”

“Schizophrenia is a terrible illness of the mind. She needs meds STAT! Or she needs to up her dosage.”

“This girl is having a psychotic episode. Somebody should have called the doctors in white coats to take her to the nearest state mental hospital.”

“...wow...get this b---- a straight jacket...”

“nuuuuuuuuuuuuuuuttssssssssss”

Protection?

2008-05-19T14:19:00.002-05:00

“I’m sorry, we are not allowed to share that information with you.” Is a phrase that family members seeking information about their loved one hear frequently. HIPAA (Health Insurance Portability and Accountability Act of 1996) is a long and complicated statute that most people, including many mental health professionals, do not understand. The Treatment Advocacy Center routinely receives phone calls from family members who are frustrated by the privacy laws concerning patient medical records.

Although many times it makes sense for patient medical records to be protected, countless situations challenge whether absolute confidentiality is the best option for patients and the public. What many families seeking information may not know (and mental health professionals for that matter) is that a covered entity (i.e., health care provider) can provide family members with information if the entity obtains informal permission from the patient by either asking the person outright or by circumstances that clearly give the person the opportunity to agree or object to the disclosure. This “protection” of information many times functions as an impairment to individuals with severe mental illness.

At What Cost?

2008-05-13T13:57:00.001-05:00

Serious mental illness cost the U.S. at least $193 billion a year in lost earnings, estimates a new study by the National Institute of Mental Health. This staggering figure just begins the scratch the surface of the financial toll schizophrenia and other serious illnesses cause.

In fact, we know this study included very few people with schizophrenia. Nor did it access people in hospitals or prisons. The number is undoubtedly much, much higher. This leads to some obvious question:

Why did a NIMH study leave these patients out?
How much higher could the real figure be? Twenty percent? Fifty percent? Double?

And, most importantly: At what cost do we as a nation get serious in providing access to treatment?

Oops, Wrong Patients

2008-05-12T12:59:00.000-05:00

A new study published online by the Journal of Clinical Psychiatry concludes that there may be a serious problem with the over diagnosis of bipolar disorder. Mark Zimmerman who oversaw the study at the Rhode Island Hospital stated:

“We hypothesize that the increased availability of medications that have been approved for the treatment of bipolar disorder might be influencing clinicians who are unsure whether or not a patient has bipolar disorder or borderline personality disorder to err on the side of diagnosing the disorder that is medication responsive.”

If this study is correct, it means that many psychiatrists may be subjecting patients who do not even meet the clinical criteria for a bipolar disorder diagnosis to unnecessary treatments and medications. The great irony is that while many such patients may be receiving improper diagnoses and treatments they don’t need, literally hundreds of thousands of other people who are most severely ill and who are imprisoned by their psychosis are receiving no treatment at all.

We desperately need a mental health system that prioritizes helping the sickest of the sick.

A Quest For Answers

2008-05-09T11:51:00.001-05:00

Everyday people contact us in a quest to navigate their state’s commitment laws and fractured mental health systems. Many times they are seeking help to get treatment for family members and friends who have stopped taking their medication and who no longer recognize that they are ill. For anyone that has a loved one who may need involuntary treatment at some point, it is imperative to become acquainted with the commitment process now, rather than waiting for a crisis to occur. The illogical and confusing process of commitment is difficult to understand at anytime, let alone during a crisis. One important step is to look up your state’s commitment laws. The more you know about the law in your state the more effectively you will be able to act in a crisis situation.

Learn what forms you will need to fill out and who you will need to contact if a crisis arises. A good place to start is the courthouse in the county where your loved one lives. Many times, the clerk of the court is a great resource for finding out the procedures for filing an involuntary commitment petition in your county. Another resource is your state/local mental health departments. They may have helpful materials that they can provide. Also, the local NAMI chapter in your family member’s area is a great resource. Most of the NAMI members have been in similar situations and can give you the benefit of their experience.

More tips and strategies, including information on preparing for a crisis and creating a CARE kit, are available on our website.

Increasingly Popular Skid Row

2008-05-08T10:24:00.000-05:00

Employees of an Orange County hospital are accused of driving a psychiatric patient 42 miles, past multiple homeless facilities, in order to dump the man in L.A.’s Skid Row. If the allegation is correct, it would not be the first such reprehensible shirking of responsibility by a hospital.

A chief reason to not just dump a patient but to do so far away is to ensure that, when the almost inevitable next crisis occurs, the inadequately treated and discharged patients end up at someone else’s door, i.e., another hospital or a jail. Skid Row dumping in L.A. is emblematic of our mental health system’s failure, sometimes even blatant refusal, to take responsibility for the most problematic patients in the post-deinstitutionalization treatment framework.

For those with acute mental illnesses that psychiatric treatment providers do abandon to skid row, there remains the hope of getting help from L.A. County Sheriff's Deputy Craig McClelland – a fitting symbol of our mental health system’s growing abdication of its responsibilities to criminal justice facilities, programs and personnel.

Where is the mental health community?

2008-05-02T13:25:00.000-05:00

The mission statements of local departments of mental health frequently declare a goal to, “[ensure] … the availability and accessibility of effective, efficient, culturally competent services.”

Unfortunately, everyday tragedies prove that the current laws do not provide access to those individuals most in need. How can someone who doesn’t even realize they are ill access mental health services?

Everyday we are faced with countless tragedies where a family was unable to get treatment for their son/brother/mother because the law would not allow it. Weak treatment laws often require a person to be a danger to themselves or others before they can get help. Where is the mental health community when those individuals most in need of help are unable to access treatment?

A Benefit of Outpatient Commitment Often Overlooked – Preventing Victimization

2008-05-02T09:48:00.000-05:00

On Saturday night, Troy Green's body was found on the sidewalk in a crime-prone section of Los Angeles. The 23-year-old had been shot and then died alone.Green’s sister Lillian knew that his mental illness, which she believed to be paranoid schizophrenia, left him vulnerable to harm on the dangerous streets he refused to leave. A few hours after her brother’s death a police officer came to Lillian Green’s door. “The officer got out only two words – ‘your brother’ -- and she broke down and cried.”

Lillian Green also commented on California’s restrictive commitment laws: "It shouldn't be that way. It should be based on whether they need help."

A group of published research articles collectively know as the Duke Studies are the largest and most respected of the controlled examinations of assisted outpatient treatment (AOT). The Duke Studies proved the remarkable benefits of assisted outpatient treatment for people overcome by severe mental illnesses to the point of being incapable of maintaining obviously needed treatment.

Some of the findings from the Duke Studies have more prominence than others. Best known are the eye-opening reductions in hospitalizations, arrests and violent acts.

The researchers found that assisted outpatient treatment for 6 months or more combined with routine outpatient services (3 or more outpatient visits per month):

· Reduced hospitalizations by 57% and the average length of hospital stays by 20 days;

· Slashed arrests by almost three-quarters (12% versus 45%) for a subgroup with a history of multiple hospitalizations as well as prior arrests and/or violent behavior; and

· Cut violent incidents by those in AOT in half (24% versus 48%).

Placed far less often in the public’s eye is another of the Duke researchers’ core findings – AOT can stop people rendered vulnerable by untreated psychiatric illness from becoming the prey of criminals.

AOT also decreased victimization by 43%. Over one year, 42% of those in the Duke control group were victims of crimes like rape, theft, mugging, or burglary versus only 24% of those in AOT for 6 months or more who had routine services.

Reform in Idaho Makes State’s Commitment Law Among the Nation’s Best

2008-04-25T14:08:00.000-05:00

After sweeping through the legislature without the trace of a single nay vote, S.B. 1426 was signed into law by Governor Otter on April 1! The bill improves Idaho’s commitment process and standard and addresses some of the deficiencies in the current law.

S.B. 1426 provides assisted outpatient treatment as an option at all commitment hearings in the state. Assisted outpatient treatment is a less restrictive, less expensive treatment alternative for people who need intervention but do not require inpatient hospitalization.

The new law substantially broadens the definitions of “likely to injure himself or others,” and “gravely disabled,” which are now the eligibility criteria for court-ordered placement in both inpatient and outpatient treatment. 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.
S.B. 1426 takes effect on July 1, 2008.

Sadly, Just Another Monday

2008-04-23T14:16:00.004-05:00

Mount Holly, New Jersey – April 23, 2008

A Superior Court judge ruled yesterday that a man accused of smothering his mother to death in 2004 is not competent to stand trial because of his mental illness.

Two psychiatrists testified that Wiley M. Smith does not want to use an insanity defense because he would rather go to jail than stay in the psychiatric hospital. He also denies that he is mentally ill, the doctors said.

Both doctors, however, said Smith suffers from severe and persistent mental illness, specifically paranoid schizophrenia. However, with medication and other treatment he has made marked improvement during his time at the hospital, they said.

Seattle, Washington – April 23, 2008

A second man was arrested in the beating death of Noel Richard Lopez at a downtown construction site.

According to court filings, Lopez annoyed the arrested man's friends, so he and another man took Lopez to the construction site to "handle this problem and straighten him out." Investigators wrote that the pair knocked Lopez unconscious in a beating that lasted for hours.

Friends reported that Lopez was bipolar and was turned away when they sought help for him at two local hospitals.

Escondido, California – April 23, 2008

The North County Times reported that a mentally ill man who screamed "God bless America" and dived off a top bunk in a Vista jail cell has filed a $15 million lawsuit. The fall broke Henry Kodimer’s neck, leaving him quadriplegic. Kodimer’s attorney contends that various governmental authorities should have steered his client toward treatment, not jail.

Kodimer has suffered from paranoid schizophrenia for most of his life.

Déjà Vu All Over Again

2008-04-22T08:52:00.003-05:00

In 1848 Dorothea Dix helped to usher in an important era of mental health reform all across America. Witnessing the inherent cruelty of warehousing people with severe mental illnesses in prisons and jails, Dix observed:

“Humanity requires that every insane person should receive the care appropriate to his condition…. Hardly second to this consideration is the civil and social obligation to consult and secure the public welfare: first in affording protection against the frequently manifested dangerous propensities of the insane; and second, by assuring seasonable and skillful remedial care, procuring their restoration to usefulness as citizens of the republic, and as members of the communities.”

Today, nearly one hundred and sixty years later, 2,000,000 Americans remain untreated for severe mental illness. With the mass deinstitutionalization of public hospitals, our streets and jails have become de facto asylums. A recent report by the Treatment Advocacy Center confirms that there is a shortage of at least 100,000 public psychiatric beds across our nation. In the meantime, over 10% of our prison population consists of people with severe mental illness, and nearly 300,000 people with severe mental illness live among the homeless.

How Painful Tragedy Can Result In More Treatment And Less Stigma

2008-04-18T14:24:00.001-05:00

Not-for-profit organizations play a vital role in the policy process through research, advocacy, and political activities. However, the impetus for change is many times based on factors outside of advocates’ control.

Unfortunately, the impetus for change in mental health laws tends to occur in the wake of terrible tragedies. Such tragedies occur each day, many times because severe psychiatric disorders are left untreated.

The Treatment Advocacy Center educates legislators, members of the media, and the general public that the failure to treat individuals Incapacitated by severe mental illnesses is a major reason so many of them end up being victimized, homeless, and in jails. The media tends to seize upon extreme examples, which often leads to misconceptions and stereotypes. But, we continue to strive to point out that these headline-grabbing incidents are but extreme manifestations of a far broader and profound societal crisis and to hopefully create opportunities for positive changes in the policy, legislative and social arenas.

Not only can these changes provide treatment to those most in need of care before they become dangerous, but they can also simultaneously help to dispel the stigmas surrounding individuals with severe psychiatric disorders generally periodically created by those most at risk and in need or care.

Common Sense 101

2008-04-16T11:29:00.004-05:00

On April 16, 2007, thirty-two people were killed at Virginia Tech by Seung-Hui Cho, a student whose mental illness and dangerous actions were known to university officials.

In the wake of this tragedy, the Department of Education has proposed new regulations to clarify when an educational institution may lawfully disclose a student’s medical information to parents or others. The new regulation reads in pertinent part:

An educational agency or institution may disclose personally identifiable information from an education record to appropriate parties including parents of an eligible student, in connection with an emergency if knowledge of the information is necessary to protect the health and safety of the student or other individuals. Family Education Rights and Privacy, 73 Fed. Reg. 57 (March. 24, 2008) p. 15601.

The new regulation does not change the conditions under which personal information may be disclosed. Rather, it merely aims to remove confusion about those conditions. Most notably, it seeks to help prevent tragedies such as occurred exactly a year ago at Virginia Tech.

In response to the Virginia Tech tragedy, the Secretary of Education investigated and found that many educators across the United States did not have a proper understanding of existing federal disclosure requirements. These educators generally believed that the existing disclosure restrictions imposed significantly greater limitations than they really did.

Besides clarifying the specific circumstance under which a disclosure to parents or others is lawfully permitted, the new regulation also provides safeguards for students to ensure that these disclosures are not made inappropriately. If a complaint is made about the particular circumstances surrounding the disclosure of a student’s personal information, the Department of Education is authorized to review these circumstances to verify that there was a rational basis for the institution’s action.

Some organizations have already expressed opposition to this proposed regulation. At least one organization has characterized this new regulation as heralding in a new hands-off approach that places at risk the confidentiality of student’s mental health information.

For some, it seems that the need to protect personal privacy always trumps the need to protect people from hurting themselves or others. However, it is high time that we apply common sense in balancing public safety and privacy concerns. The Department of Education should be commended for clarifying that medical information can be properly released in emergency situations in which a student with a mental illness is threatening harm to himself or others.

Severe Mental Illness, Homelessness & Choice (or lack thereof)

2008-04-15T16:55:00.000-05:00

The San Bernardino Sun offers a poignant profile of and commentary on a homeless encampment in Ontario, California.

One of the commentators is Manuel Aybar, identified as a mental health consultant and a person who has seemingly been involved in projects to aid the homeless population in San Bernardino. "Mental illness is not synonymous with homelessness," Aybar asserts …. "most people who are homeless choose to have that lifestyle."

That is undoubtedly the case for some. But for approximately one-third of the chronic homeless, the condition is far less a choice of lifestyle and far more a symptom of illness. The reporter found convincing evidence of that in her visit to the tent city.

One woman sat hunched over, yelling and swearing into a cell phone. "I'm wondering how lazy you are." "Stop dragging on all day!"

The phone wasn’t working.

Two yards away, a 36-year-old man exclaimed, "You go to the one-hour photo. You go look at the clothes. ... You go to the motel because once you stay at the motel your lens is gonna change."

His response when asked if he had any mental health issues: "Someone is gonna take your blood and drink it. My cholesterol was going up. Now I want to get a place to stay and sleep for a while, but every time I go anywhere the Mexicans follow me.”

He eventually added that he’d been diagnosed with “schizophrenic manic-depressive. ... But I take care of my pops. ..."

Consultant Aybar was reluctant to link mental illness to homelessness; he stressed that “the choice to be homeless is not necessarily a sign of mental illness.” True – not necessarily, but that only highlights the need to help those who have no choice or even the ability to choose.

Character Flaw?!

2008-04-11T14:30:00.001-05:00

Character is a combination of both virtues and flaws that make up an individual’s moral fiber. Everyone has some sort of character flaw. Whether it is arrogance, stubbornness, selfishness… no character is without defect. The idea that an individual is suffering from a severe mental illness because of a “character flaw” is absurd and simply untrue.

As Marya Hornbacher states in a recent interview with the Washington Post, one of the biggest misconceptions about people with a mental illness is, “[t]he idea that [mental illness] is about character, that it's not really an illness and it's a character flaw. I'd invite all those people who believe that to an anatomy-of-the-brain class, and they can learn that it is a brain disease! It's not about being a bad person or committing sin.”

In fact, schizophrenia and bipolar disorder are neurobiological brain disorders that affect over 4 million individuals in the United States alone.

Unfortunately, many state laws do not reflect the current scientific understanding surrounding mental illnesses. The standards in many state statutes do not seek to prevent the deterioration of a severe mental illness. Instead, those laws make families and treatment providers wait for moments of extreme crisis to occur before authorizing the use of involuntary treatment, by which time it may be too late to help the individual. From both a commonsense and medical perspective, these statutes discriminate against those individuals with a severe mental illness whose symptoms are discernible in less violent ways.

Treatment Law Reform’s Scope In Proper Perspective

2008-04-10T13:25:00.000-05:00

As vital is the need for rational treatment laws, it might be surprising that we at the Treatment Advocacy Center often think their significance unduly exaggerated by others in the mental health field.

Progressive treatment laws can be critical in bringing care and stability for those most in crisis, but efforts for them are most emphatically not aimed at whole-scale revision of mental health systems generally. Assisted treatment mechanisms are, by design, targeted at only a small sliver of all those with psychiatric disorders – the sickest of the sick.

According to one opponent, “almost anyone who ever had a psychiatric diagnosis and disagreed with their psychiatrist’s treatment plan could be forced to take drugs in their own home” under a 2007 proposal for assisted outpatient treatment in Virginia.

It is easy to establish that people would not have been physically forced to take medication in their own homes pursuant to that measure (there was no provision for that), but it is much harder to determine how many people with a psychiatric diagnosis would have been affected. That Virginia bill never became law.

We can, however, make a very close comparison. The bill in Virginia was a version of Kendra’s Law, and New York makes available a regularly-updated wealth of data on that program.

Those decrying the 1999 legislation that created Kendra’s Law loudly labeled it a “dragnet,” estimating that 10,000 New Yorkers would be forced into treatment each year. Over nine years later, we are still waiting for that 10,000th person. At the current usage rate, he or she won’t be placed in assisted outpatient treatment until 2013.

About 770 initial outpatient treatment orders are issued each year in New York. That is about one out of every 25,000 of the state’s citizens. Annually, the law is used to help only one out of every 400 people with schizophrenia or bipolar disorder.

And that is about the right amount.

Hollywood and Stigma

2008-04-08T12:09:00.003-05:00

Hollywood loves to make movies with crazed killers, suspenseful moments, and plenty of gore. This weekend, the remake of “Prom Night” will be released featuring a knife wielding psychopath who slices and dices his way through a group of screaming teens.

How do we best fight this stigma?

For some, the answer is simply to deny that people with severe mental illnesses, as a group, are any more dangerous than the rest of society. The good news is that such an assertion is fully sustainable for those people with severe mental illnesses who receive effective treatment.

However, for the more than 2,000,000 Americans overcome with a severe mental illness who remain untreated, no such assertion can be made. The plain truth is that people with untreated severe mental illnesses are statistically more dangerous than people without severe mental illness. Does this mean that all people with untreated severe mental illnesses are more violent? Absolutely not, but there is a heightened propensity to harm others (and themselves) that can sometimes lead to headlines and movie scripts.

Therefore, in the long run, the best way to fight the stigma of severe mental illness is to treat it.

Assisted Outpatient Treatment: Using What is Already In Place

2008-04-04T15:05:00.000-05:00

Various forms of assisted outpatient treatment laws exist in 42 states. When used effectively, assisted outpatient treatment substantially improves the lives of those suffering from severe mental illnesses.

Numerous scientific studies have proven that assisted outpatient treatment is effective in ensuring treatment compliance. However, many states still fail to employ what is at their disposal. Instead, readmissions, homelessness, and incarceration often triumph over the development of protocol. Although states often blame the lack of resources for the problem, restrictive commitment standards based on dangerousness alone are often the reason for not using existing assisted outpatient treatment laws. Other times, it is the simple lack of bureaucratic gumption. We should be seeking changes in both the laws and the processes (or lack of) to ensure that people in need of treatment receive it.

SOMETIMES NEEDED: A PATH TO THE RECOVERY PATH

2008-04-03T11:42:00.004-05:00

A growing focus in the mental health field is the recovery model, which centers on allowing people with severe mental illnesses control over their own treatment. The theory is that being able to direct their own care both allows patients to choose what is best suited to them and empowers them to further capabilities of independence.
It is a good approach. The affects of a severe mental illness can strip away one’s self-appreciation, and the best cure for that is successfully regaining a capable autonomy. Recovery-based treatment models are well-matched to this task, with a goal of instilling the message that “hope and restoration of a meaningful life are possible, despite serious mental illness.”

Yet while the Treatment Advocacy Center encourages recovery-based efforts, some proponents of it view our efforts to promote rational treatment laws as anathema to the care model. We see them as complimentary. Any treatment model – whether medical, intervention, recovery or other – cannot be the one best suited to each and every person with all the varieties of mental illnesses, the varying degrees of them, and the particular manifestation in each individual. Indeed, we support the use of recovery-focused approaches in the vast majority of cases – but there are instances in which the direction of care cannot be left to a person rendered incapable of directing it.

As pointed out by Treatment Advocacy Board Member Fred Frese:

[M]any individuals are so disabled with mental illness that they do not have the capacity to understand that they are ill. Giving such individuals the right to make decisions about their treatment is tantamount to abandonment. …[I]t is inconsistent with the recovery paradigm to allow incapacitated individuals to remain victims of their serious mental illness. For these persons, measures must be taken so that they become well enough to be able to benefit from the recovery model.

We urge you to read the rest of this excellent commentary of Dr. Frese and his fellow authors on “Integrating Evidence-Based Practices and the Recovery Model.”

Public Versus Private Beds

2008-04-01T10:22:00.003-05:00

Some officials defend the emptying of public psychiatric hospitals by pointing to the increase of psychiatric beds in general hospitals. However, as pointed out by the Treatment Advocacy Center’s recent study The Shortage of Public Hospital Bed for Mentally Ill Persons, eighty one percent (81%) of the psychiatric beds in general hospitals are in private versus public hospitals.

According to KRIS TV of Corpus Christi, Texas, the night before Khandi Busby recently threw her two sons off a bridge and jumped herself, relatives sought treatment for her at a local psychiatric hospital. Busby suffered from bipolar disorder, had stopped taking her medications, and was engaging in odd behavior. However, the hospital refused to admit her because she did not have proper insurance coverage.

This is one more reason why states like Texas must take steps to address their severe shortage of public psychiatric hospital beds.

“Treating The Mentally Ill Makes Financial Sense”

2008-03-28T14:51:00.001-05:00

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

2008-03-27T12:06:00.010-05:00

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

2008-03-20T17:04:00.001-05:00

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

2008-03-19T15:06:00.000-05:00

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?

2008-03-18T14:26:00.000-05:00

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

2008-03-17T14:18:00.002-05:00

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

2008-03-14T15:34:00.002-05:00

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

2008-03-13T12:08:00.000-05:00

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..."

2008-03-12T19:07:00.002-05:00

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

2008-03-10T16:50:00.002-05:00

"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

2008-03-07T17:16:00.001-05:00

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."