Cho, Kennedy and other tragedies in Virginia

Today’s Washington Post explores Virginia’s restrictive commitment standard that requires “imminent danger” before a person can be ordered into treatment.

Any mention of “imminent danger” and Virginia’s broken mental health system conjures images of 32 students killed at Virginia Tech by Seung Hui Cho in April of 2007 and memorials for the two officers killed by Michael Kennedy in May 2006. Both Cho and Kennedy had fallen through the gaping cracks of Virginia’s archaic mental health system.

For all of the Virginia Tech and Michael Kennedy stories that grab our attention, there are hundreds more private tragedies that don’t make the news. Virginia families are left helpless as their loved one becomes homeless, threatens suicide, is violent, or victimized. Until their loved one is an “imminent danger”, there is little they can do but wait.

This morning’s Washington Post provides a glimpse into one of the many families in Virginia that was forced to wait.

The Reston man who advocates eliminating the standard called for help recently after his son obsessed that federal authorities were eavesdropping on him. He destroyed a toilet and punched holes in the wall. Fairfax's Mobile Crisis Unit came to their home and "agreed that he was very disturbed," the man said. "But in their judgment, what he was saying and doing would not pass the threshold for imminent danger. And having sat through these hearings before, I had to agree with them."

A few weeks later, with what his father described as "a crazed look in his eyes," the young man attacked his father. The father called police, and the son was arrested. He is being treated in a mental hospital while awaiting trial on an assault charge. It took the criminal charge to get the young man held.

"Ideally, when we see terrible things happening," the father said, "we should have been able, before that point was reached, to say, 'This kid is in danger and needs to be treated.' We just couldn't get past that threshold."

Finding someone to blame

Who is to blame when tragedy results from untreated severe mental illness?

At the end of October in Richmond, VA, Johnny Hughes, a man with untreated schizophrenia, fatally stabbed a woman while she was walking her dog.

The author of a new blog - “families for timely mental health treatment laws” – noticed some of the comments posted on the website of the Richmond Times Dispatch regarding this story. Many blamed the family of Johnny Hughes for not monitoring him.

Posted October 30, 2007 @ 09:55 AM by Anonymousafter reading this man's rap sheet i too am finding compassion a hard sell. i agree the family dropped the ball, this man needed to be under lock and key somewhere and his family should own up to their responcibility.

The author of the “families for treatment” blog responds to these comments with the perspective of someone who has tried to help a loved-one get treatment.

Blame and pointing a finger at families who try desperately to get help for their loved ones and who often are involved in advocating for the changes needed will not resolve the issue of ensuring that someone with a mental illness receives the treatment they need. Enacting common-sense, timely assisted outpatient treatment (AOT) laws with adequate services and programs, as well as providing sufficient support in a hospital when needed, is what should happen.

An exercise in futility

The title of a recent editorial in the Tallahassee Democrat says it all: "Incarerating mentally ill is futile."

"The cost in human suffering by the ill person, by his or her family and any victims is no doubt equaled by the cost to the state when it uses self-defeating systems. Even on county levels, authorities such as Leon County's Sheriff Larry Campbell decry the current system as ineffective, with no end of costs in sight, but no real improvements either."

Bracing for the cold - and bitter tragedy

Every winter, we read sad news stories about homeless people with severe mental illnesses who fall victim to the elements. While the weather gets blamed for the deaths, the truth is more disturbing: About 1/3 of the nation’s homeless are people with severe mental illnesses.

• Many of these individuals are homeless BECAUSE of their illnesses.
• Most are not being treated for their illness and often the lack of treatment is because they have impaired awareness of their illness.
• The headlines overlook the daily victimization and brutal realities on the streets for people with severe mental illnesses.

Next time you read one of these sad stories, consider the fact that Assisted Outpatient Treatment can prevent tragedy. In New York, 74% fewer participants experienced homelessness while in the AOT program as compared to before they entered the program.

Reform is long overdue

Few issues have dominated a political landscape like mental health has in Virginia. With the tragedy at Virginia Tech, the death of two police officers in Fairfax County, and the recent murder of Susanne Thompson in Richmond, it is clear that reform is long overdue.

Virginia Capitol Connections Magazine recognized the unprecedented role that mental health will play in the upcoming legislative session, and made it the subject of their fall issue. Contributors include Governor Kaine, Delegate Phillip Hamilton, and TAC’s own John Snook, who calls on the legislature to recognize the reality of severe mental illness and the need for assisted outpatient treatment.

Housing the homeless...who aren't psychotic

In an op-ed in the LA Times, two experts on homelessness and skid row wrote:

The central antidote to homelessness is not a police sweep or a shelter bed. It's housing.

Once housed and given appropriate support and services, formerly homeless people with mental and addiction disabilities -- those for whom we used to think a bowl of soup and a blanket was the best we could do -- have a good chance of staying off the streets.

Certainly, they are right. For many of the people on skid row housing and services are enough. But what about people with mental illnesses so severe they have anosognosia, or a lack of insight into their illness? What about those who are so sick they will never chose mental health treatment? (Remember Nathanial?)

Without assisted outpatient treatment to accompany housing and services, the sickest of the sick are still being ignored.

Support for assisted outpatient treatment (AOT)

While the Treatment Advocacy Center is the only organization that has a dedicated mission to increasing the use of AOT, numerous other organizations and individuals support AOT including:

• NAMI’s official policy states that AOT should be used as a last resort and that “Court ordered outpatient treatment should be considered as a less restrictive, more beneficial and less costly alternative to involuntary inpatient treatment.”
• The National Sheriffs Association recognizes that “the consequences of non-treatment can also be prevented by having laws that allow a court to order treatment in the community for individuals who are in need of treatment but refuse it (also known as Assisted Outpatient Treatment).”

Few options left

An op-ed in The Day in New London, Connecticut had the following to say about deinstitutionalization:

At the threshold of the 21st century, a disturbing trend has become evident. As the number of hospitalized adults decreased during the second half of the 20th century, the number of prison inmates with serious mental illness was on the rise. In fact, the federal Bureau of Justice Statistics (BJS) reports that the number of inmates in jails and prisons with mental illness quadrupled in just six years — from 283,000 in 1998 to 1.25 million in 2006. This surge coincided with the closure of the last of the hospitals.

The magnitude of the problem is evident upon examination of prison statistics in Connecticut, where the adult population of people incarcerated with moderate to severe mental illness has increased from 2,200 in 2000 to 3,700 in 2005, or from 12 percent to 20 percent.

With few inpatient beds and no law that allows for assisted outpatient treatment, the citizens of Connecticut with severe mental illnesses aren’t left with many options.