TAC honors grassroots advocates

The board of directors of the Treatment Advocacy Center today announced that Karen Gherardini from Illinois, Janice DeLoof from California, and Jeanette Castello from Pennsylvania are the winners of its annual Torrey Advocacy Commendation.

“Individuals are the heart of the effort to reform and improve our nation’s mental illness treatment system,” said president Dr. E. Fuller Torrey. “The system will not change without the untiring fortitude of individuals like Karen, Janice, and Jeanette. Fighting the entrenched establishment, especially on an issue like real treatment for people with severe mental illnesses, is far from easy. But legislators cannot look impassioned family members in the face and deny the need for real reform. That is why their work is so critical, and why I am so proud TAC is recognizing these three tireless advocates. They are tenacious in their personal dedication and commitment to helping a group of people with few real champions.”

The TAC award recognizes the courage and tenacity of those who selflessly advocate – despite criticism and opposition – for the right to treatment for those who are so severely disabled by severe mental illnesses that they do not recognize that they need treatment.

The board of directors of the Treatment Advocacy Center voted unanimously to recognize these three outstanding advocates. More about the recipients...

Pennsylvania's archaic law

Yesterday the Harrisburg Patriot-News published an op-ed by the Treatment Advocacy Center's E. Fuller Torrey and John Snook. The op-ed explores Pennsylvania's outdated law that prevents treatment of severe mental illnesses, and the "rights" that are protected instead. Among those are- the right to be killed in an encounter with law enforcement, the right to hurt someone you love, and the right to be homeless.

Historically, civil rights advocates passed laws protecting the absolute right to self-determination in treatment. But in their fervor to protect people's rights, they in fact trampled on them.

Pennsylvania's civil commitment law is archaic and inhumane, requiring someone to present a clear and present danger before they can be court ordered to treatment. Clearly, that is often too late.

The law ignores their right to be free from psychosis. Read on...

Happy 70th Birthday Dr. Torrey!

An article in Psychiatric News:

"Fuller gets as much credit as anyone for moving American psychiatry from a psychoanalytic foundation to a biological one," said APA Trustee Roger Peele, M.D., who was chair of the department of psychiatry at St. Elizabeths Hospital in Washington, D.C., and hired Torrey as a staff psychiatrist in 1977.

"His provocative books and his plausible, although yet to be proven, concept as to the cause of schizophrenia contributed to a focus on the biological. His call for change was markedly enhanced by not remaining academic. He is combative—when public agency chiefs heard he was due to be on national TV, they ran to their bunkers—and he has used pithy public pronouncements to hammer home the need for public research monies to be devoted to a biological understanding of people with the most disabling of psychiatric illnesses."

Read more of "Search for schizophrenia's roots started at home"

When Dr. Torrey speaks, people listen

Dr. Torrey made a major presentation to a crowd of about 700 people at the NAMI Convention in San Diego last month. His talk, entitled The Causes And Consequences Of Our Failure To Treat Individuals With Severe Psychiatric Disorders was received enthusiastically. Advocates were motivated to return to their home states and advocate early and sustained treatment for the most severely ill in their families and communities. One advocate wrote:

I attended the NAMI National Conference in San Diego and was fortunate to hear Dr. Fuller Torrey speak. I agreed with everything he had to say. What a wonderful dedicated soul. We need more like him and you!!!

To view Dr. Torrey’s powerful Powerpoint presentation go to the TAC website.

Research update: Parasite as schizophrenia cause?

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

SMRI continues to support promising research on infectious agents as possible causes of schizophrenia and bipolar disorder. Much of this research is taking place in the Stanley Laboratory of Developmental Neurovirology at Johns Hopkins Medical Center under the direction of Dr. Robert Yolken, who is a member of the TAC Board of Directors. In a spring 2007 issue of Schizophrenia Bulletin, Drs. Yolken and Torrey coedited six papers on Toxoplasma gondii as a possible cause of schizophrenia. T. gondii is a protozoan parasite that occurs normally in cats but is transmitted to humans in a variety of ways.

More than 40 studies have found that individuals with schizophrenia have increased antibodies to T. gondii compared to unaffected controls. A paper describing these findings is featured on www.schizophreniaforum.org, a useful website for keeping up with schizophrenia research.

Tuberculosis treatment

“Civil libertarians who have argued against mandatory treatment of people with mental illness have not objected to forced treatment for contagious diseases.” –Portland Press Herald, Sept. 28, 2006

Can psychiatry learn from tuberculosis treatment? Dr. Torrey asked that question seven years ago in Psychiatric Services:

To increase medication compliance for tuberculosis, public heath authorities in several states have introduced directly observed therapy (DOT) programs. An outreach worker visits patients twice weekly or more to watch them take their drugs. Compliance with medications is rewarded with food supplements, fast food vouchers, transportation tokens, movie passes, clothing, and sometimes money, with increased rewards for increased compliance ...

People with active tuberculosis who refuse to participate in DOT can be involuntarily hospitalized and treated. In New York City between 1993 and 1995, an average of eight detention orders a month were issued, with a peak of 47 patients involuntarily treated at any one time. According to city health officials, the credible threat of involuntary treatment is an important reason for DOT’s success. Under DOT, the city’s tuberculosis rate decreased 55 percent between 1992 and 1997.

The story in Maine this week notes a TB carrier was jailed as a public risk.

"The patient was not concerned about what tuberculosis meant for his own individual health, " said Dr. Kathleen Gensheimer, state epidemiologist with the Maine Center for Disease Control and Prevention. "If you're not concerned about something that can hurt others, like tuberculosis, then it's our mandate ... to ensure treatment."

“In New York City, 11 percent of patients involuntarily treated for tuberculosis also had schizophrenia,” noted Dr. Torrey. “Some were a danger to themselves and others for both conditions. Their tuberculosis could be treated, but not their schizophrenia, Is there something inherently different in brains and lungs? Or is it that our brains are not thinking clearly?”

Ever-growing DSM met with skepticism

Under the proposed changes in the DSM, "everyone who's had any kind of mood swings in their life becomes bipolar," [Dr. Fuller] Torrey said. "And because of that, the concept loses meaning."

Dr. Torrey has long advocated a research focus on the most severe mental illnesses.

Short bits …

• Pete Earley testified before a congressional hearing, saying that “he was appalled that the government refused to help his son's disorder but would punish him for it.” Earley’s book CRAZY is still a hot seller – get a copy for your vacation reading stack or get your book group to read and discuss.
• Rockthepsychiatryvote on Dr. Torrey’s call to divorce mental illness from mental health …
• Alaska’s state supreme court in Myers corrected an oversight in state law, clarifying that a person’s "best interests" be taken into account when the state exercises its duty to protect an individual from themselves. (Most other state laws and the Treatment Advocacy Center’s Model Law for Assisted Treatment include similar determinations.) Myers is one of many cases decided each year in the state courts that has no real impact nationally, but can hopefully make a difference for some people in Alaska.
• “The mental health consumer needs to recognize that liberty is precious, but not everyone in our cohort can "handle" liberty …”
• Pam Wagner’s (coauthor of “Divided Minds”) recent blog entries on outpatient commitment are compelling reading, as she weighs honestly how she feels about it and hears from blog visitors what they think.

Treatment Advocacy Center honors three of psychiatry's heroes

The board of directors of the Treatment Advocacy Center today announced that Dr. Jeffrey Geller from Massachusetts, Dr. H. Richard Lamb from California, and Dr. Darold Treffert from Wisconsin are the winners of its annual Torrey Advocacy Commendation.

“TAC can change laws and encourage treatment, but ultimately it is the mental health professionals who have to make it happen,” said psychiatrist and board president Dr. E. Fuller Torrey, for whom the award is named. “Psychiatrists such as Drs. Geller, Lamb, and Treffert, and psychologists, social workers, and psychiatric nurses who have a special interest in the severely mentally ill are the bedrock of the system. The battle for treatment is one that they wage every day in ways large and small. It is an effort and sacrifice that should not be ignored.”

More …

Read essays by the three winners and more on community psychiatry in a special issue of TAC's newsletter dedicated to community psychiatry.

Schizophrenia and violence

A comprehensive new study confirms violence is not an anomaly for some patients with schizophrenia. Researchers, using data from the National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project, found that 19.1% of participants had a violent incident in a six-month period.

“This study joins a large body of scientific research confirming what we can too easily see each day in the newspaper,” said Treatment Advocacy Center President Dr. E. Fuller Torrey. “Although most individuals with mental illnesses are not violent, violence by a subgroup of individuals with schizophrenia is far from rare. And the violent behavior is almost always associated with the person not having received treatment for their illness. The only solution is treatment.”

The study also found that the symptoms most predictive of violent behavior are positive symptoms, like hallucinations, paranoid delusions, and grandiosity. “Positive symptoms of schizophrenia are not only the ones most predictive of violence, but also the ones most responsive to medication,” noted Dr. Torrey.

Surviving Schizophrenia

JUST RELEASED!

Surviving Schizophrenia: A Manual for Families, Patients, and Providers (5th Edition)
Since its first publication in 1983, Surviving Schizophrenia has helped thousands understand this complex and often stigmatized illness. In clear, sympathetic language, this definitive book describes the nature, causes, symptoms, and history of schizophrenia, taking readers inside the minds of those living with the disease.

This completely updated fifth edition includes the latest research findings, information about the newest treatments, and answers to the questions most often asked by families, patients, and providers.

"A comprehensive, realistic, and compassionate approach... Should be of tremendous value to anyone who must confront these questions." - Psychology Times

"E. Fuller Torrey is a brilliant writer. There is no one writing on psychology today whom I would rather read." - Los Angeles Times

NPR: Fighting for treatment

"The only thing we were good at was emptying the hospitals, everything after that has been a disgrace."

Listen to Pete Earley and Dr. Fuller Torrey on NPR’s Fresh Air – on the struggle to get mental illness treatment for someone you love. Earley’s book, Crazy: A Father’s Search Through America's Mental Health Madness, will be released April 20.

Previously: Riveting new book on fight for treatment
More: Get information to help a family member in crisis Read Chapter one Preorder the book (on sale April 20)

Four appointed to TAC board of directors

Treatment Advocacy Center President E. Fuller Torrey announced the appointment of four new members to TAC’s board of directors. The newest board members bring extensive experience in law enforcement, mental health advocacy, community psychiatry, and business development, as well as personal and family experience with mental illnesses:

* Donald F. Eslinger, Sheriff of Seminole County, Florida.
* Valerie Fox, advocate and writer, New Jersey.
* Jeffrey Geller, M.D., director of public sector psychiatry and professor of psychiatry at the University of Massachusetts Medical School.
* Stephen Segal, president of Family Partners, Inc., Pennsylvania.

"We are pleased to welcome people of such caliber to be stewards for this unique advocacy organization," said TAC president E. Fuller Torrey, MD. "Each has shone not only in his or her chosen field, but also as an advocate for people with severe mental illnesses too ill to fight for themselves. Their collective wisdom, expertise, and passion are an important addition to our board of directors, and will strengthen our ability both to defeat laws and policies that are barriers to treatment and to campaign for practices that ensure timely and sustained treatment."

Read full bios of new and current TAC board members.

CATIE - Phase 2

The National Institute of Mental Health has released further findings from its large-scale examination of treatments for schizophrenia in its Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE).

The initial results were presented last September, and were chiefly a comparison of various anti-psychotics when used as initial or first-line treatments for the symptoms of schizophrenia. The outcomes from the first stage of this large-scale study were widely reported in the national media, principally because an older and far cheaper antipsychotic of the previous generation had results analogous to "atypical" antipsychotic medications that are many times more expensive.

Results from CATIE’s second phase are reported in the April issue of the American Journal of Psychiatry and evaluate how various antipsychotics perform as second-line medications, i.e., ones that are tried after another is discontinued. The clear winner for performance in CATIE’s second round is clozapine, which was not tested in the first phase. 44% of patients who took clozapine (brand name: Clozaril) after trying another anti-psychotic stayed on it for the rest of the 18-month study, versus only 18% who switched to the other medications tested.

We caution, however, that determining what medication should and can be used for a particular person entails far more considerations than the results of a single study (no matter how large or well-constructed). Different things work for different people.

TAC's Battle for Better Treatment Laws

The Treatment Advocacy Center's battle for better treatment laws is highlighted on the front page of the February 1 edition of the Wall Street Journal.

This is an especially impressive placement on such a heavy news day, following the State of the Union and the confirmation of a new Supreme Court justice, and shows that the Treatment Advocacy Center has indeed achieved the status of being a major player in the field. And that the issue of assisted treatment warrants this level of coverage.

The article talks about the hard work of Dr. E. Fuller Torrey and TAC to improve treatment laws to help those who are the most ill - those lost to the symptoms of schizophrenia and bipolar disorder. It highlights TAC's work to change the laws and the successes we’ve had around the nation.

But it omits many key points – that people with untreated mental illnesses fill our jails and prisons, live homeless and vulnerable on our streets, and are far more often the victims of violent crimes than the perpetrators. That many lack insight into their illness and thus cannot make informed treatment decisions.

It is easy to cast TAC as a villain for being unafraid to include the risk of violence in the list of consequences of lack of treatment. Maybe they wouldn’t have sold as many newspapers if they had actually focused on the research that support these assertions – or read a newspaper.

Many newspapers that same day included the front page story about the woman in California who sprayed bullets through the post office, killing eight people (including herself).

The article also overlooks the real statistics that prove the value of strong assisted treatment laws. Did you know that for those under New York’s Kendra’s Law, 74% fewer experienced homelessness, 77% fewer experienced psychiatric hospitalization, 83% fewer experienced arrest, and 87% fewer experienced incarceration. Individuals in Kendra's Law were also more likely to regularly participate in services and take prescribed medication.

And after receiving treatment, 75% of those interviewed reported that AOT helped them gain control over their lives, 81% said AOT helped them get and stay well, and 90% said AOT made them more likely to keep appointments and take medication.

Those statistics come from the New York Office of Mental Health.

Dr. Torrey talks about CATIE study

TAC President Dr. E. Fuller Torrey will be on the Diane Rehm Show (88.5 FM) Thursday, Sept 22, from 10-11, discussing the results of the CATIE trials comparing antipsychotic medications. NIMH director Thomas Insel will also be interviewed.

Treatment Advocacy Center launches new web blog

The staff of the Treatment Advocacy Center (TAC) is pleased to announce the launch of BLOGTAC, which will focus on the issues surrounding lack of treatment for severe mental illnesses and the need for more humane treatment laws.

Since its inception, the Treatment Advocacy Center has worked to inform and educate, to change ineffective treatment laws and policies and the long-held misconceptions that keep them from being improved and used. Founding president Dr. E. Fuller Torrey noted that TAC exists in part to:

… educate the legal profession, media, and general public that the failure to treat individuals with severe psychiatric disorders is a major reason so many end up homeless, in jails, and being victimized. And that failure to treat leads to episodes of violence that, in turn, are the greatest cause of stigma against individuals with psychiatric disorders. Above all, we must continue to be a coordinating center to geographically link those affected, their families, state legislators, and local media to work together on these problems. [“Truth and courage: Looking ahead for TAC”]

TAC’s web blog will be another means of connecting and communicating, another way to educate and build awareness. We will keep you posted on our efforts, bring context to stories in the news, and shine light both on laws and policies that are working to help people with severe untreated mental illnesses, as well as those that are failing.