"Imminent Danger" in the Washington Post

Two opinion pieces in yesterday’s Washington Post addressed the “imminent danger” standard in Virginia.

An editorial from the Washington Post:

Virginia currently requires that authorities determine that an individual poses an "imminent danger" to self or others, or be unable to care for himself, before they can order involuntary detention. That high hurdle, once embraced by a majority of states, has kept many unstable and dangerous people from receiving the care they need.

An op-ed from Pete Earley describing his experience in getting treatment for his son who has a severe mental illness:

When I rushed my college-age son -- in the throes of a psychotic breakdown -- to a Fairfax hospital, I was told he wasn't "sick enough." He could not be treated involuntarily until he posed an "imminent danger" to himself or someone else, doctors said. His mental illness had been diagnosed two years earlier, he had been hospitalized twice and he had done well on medication. But still doctors couldn't legally intervene.

Required reading for psychiatrists ...

In Crazy, Earley provides a remarkable and fresh look at the US mental health system. He does so in a balanced, honest, self-reflective, and informed way. Crazy offers a unique and sensitive perspective on questions America is reluctant to address. It should be required reading for psychiatry residents, forensic fellows, and any psychiatrist interested in public sector psychiatry ...

Placing his argument in historical context, he describes deinstitutionalization as a well-intentioned but poorly reasoned outgrowth of the antipsychiatry movement, which began in the 1960s ... Earley describes deinstitutionalization as an "unplanned social disaster," which ... has created an environment as abusive to the mentally ill as the dreaded state hospitals of the past ... Earley poignantly reflects on a society that accepts homelessness as a civil right ...

- Journal of the American Medical Association (JAMA), January 2, 2007

The forgotten floor

Miami's CBS station broadcast a two-part news series spurred by Pete Earley's book Crazy. The jail psychiatrist calls conditions in the Miami-Dade jail "morally incomprehensible" for inmates with severe mental illnesses. Miami Judge Steven Leifman is outraged.

“There are five times as many people in our jail with mental illness than any psychiatric hospital in Florida,” pointed out Judge Leifman. “Five times, right here.” ...

Judge Leifman said, “It’s a tough place. It’s not a great condition for anybody that is sick because it is not conducive for treatment. People with mental illness stay in jail eight times longer than sometime without mental illness for the exact same charge and it cost the taxpayers seven times more to treat him here. It doesn’t really accomplish anything here. It’s a warehouse.”

Watch part 1 and part 2 on the website, or read the transcripts.

Short bits

• TAC executive director Mary Zdanowicz is interviewed for Officer.com on law enforcement and the mentally ill. [Also see our briefing paper on this subject.]
• Pete Earley will be a guest on "Community Matters Weekend Edition" at 6 a.m. Sunday (Sept. 17, 2006) on KPTK-AM (1090) in Seattle. Pete is the author of "Crazy: A Father's Search Through America's Mental Health Madness." (Already read his book? Let him know what you thought.)
• "I am unable to talk with him about anything except his delusions now," a social worker says about Rosario "Russell" Miraglia.
• Christine Wilhelm accepts plea deal.

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.

Your tax dollars and hospital closures ...

"Deinstitutionalization is a thing of the past" – at least that is what most people think.

But, in fact, psychiatric hospital closures have proceeded at a furious pace over the last 15 years. There were so few beds when this new assault started that the people who remain in institutions are those who really need intensive care. Some can be “integrated” with sufficient support, but for others, life becomes a living hell once they are “freed.”

There are many factors driving the closures, but the most egregious is that the very groups that are paid by the federal government to “protect” the mentally ill, Protection and Advocacy (P&As) are the ones forcing many of the closures.

And when the doors are closed, the displaced residents are on their own.

In his book Crazy, Pete Earley investigates the tragic life and death of Deidra Sanbourne, the named plaintiff in the Florida P&A 1988 suit to close a hospitals (pg. 108 – 207).

The Bazelon Center, another group heavily funded by the federal government, joins many of these suits … and they aren’t satisfied with closing hospitals. In New York, Bazelon brought a suit to close boarding homes. In Connecticut, Bazelon brought a suit to get the mentally ill out of nursing homes. Where do they expect seriously ill people to live?

One need only read about M., who was placed in his own apartment when Harrisburg State Hospital closed. The P&A was nowhere to be found when M. ended up lying on a sidewalk – he was scared of his apartment.

For years, these federally funded “advocates” have imposed their own values on people who don’t have the resources to live independently. Rather than advocating to improve conditions in hospitals, boarding homes, and nursing facilities – they try to close them down.

"Bring him back after he tries to hurt you ..."

"Bring him back after he tries to hurt you or someone else."

Award-winning author Pete Earley tells his story on the syndicated radio show Criminal Justice Forum.

Earley's new book, “Crazy: A Father’s Search Through America’s Mental Health Madness,” is a compelling recount both of the story of his own struggle to keep his own son in treatment for a severe mental illness and of his encounters with the people he met on the Miami Jail’s 9th floor, where the most severely ill prisoners are held.

From Florida and want to hear more about the Baker Act? Listen to CJF's piece on Baker Act reform.

Vicky Armel took up for my son when the system wouldn't

Thank You, Detective
Vicky Armel Took Up for My Son When the System Wouldn't
By Pete Earley (Washington Post, May 12, 2006)

Fairfax County Police Detective Vicky O. Armel, who was murdered Monday during a shooting rampage by a troubled teenager, had helped people with severe mental illnesses. I know because she helped my son.

Four years ago, I rushed my college-age son to a Fairfax Hospital emergency room only to be turned away. Although Mike was delusional and had been hospitalized twice before for treatment of bipolar disorder, a doctor said he was not sick enough -- yet. Mike thought pills were poison, and Virginia's restrictive commitment statutes prohibit doctors from treating a person with a mental illness against his will unless he poses an "imminent danger" to himself or others. I was told to bring my son back after he hurt himself or me. Forty-eight hours later, Mike broke into a stranger's house to take a bubble bath. The homeowners, who were away for the weekend, pressed charges, and Detective Armel was assigned to the case …

MORE: Painful irony in murder of police officer * Pete Earley’s book, Crazy

Painful irony in murder of VA police officer

Michael Kennedy’s delusions that the town was full of aliens may be what led him to kill Officer Vicky Armel and seriously wound two other officers on Tuesday in Fairfax, Virginia.

Ironically, Officer Armel understood that untreated mental illness is a medical problem, not a crime. A few years ago, she personally walked another similarly ill young man through the system with the goal of getting him treatment instead of jail time.

This case reminds us of both the importance of treatment for severe mental illnesses and the fact that untreated mental illness can, in fact, lead to violence.

Law enforcement officers know too well the dangers of lack of treatment. Officers like Vicky Armel also know the importance of getting people help. It is ironic and sad that she never had that chance with Michael Kennedy.

USA Today: “Stuck in a vicious revolving door …”

"Dad, how would you feel if someone you loved killed himself?"

My college-age son, Mike, has stopped taking medication for the mental illness that was diagnosed a year ago, and he is having a relapse. He and I are speeding to an emergency room. Hang on son, I think. The doctors will help you.

But after waiting four hours, a doctor appears and tells me it's illegal to treat Mike. He is not sick enough. He is not in "imminent danger," and because Mike now thinks "pills are poison," the doctor cannot forcibly medicate him under Virginia law. I'm told to bring him back if he tries to kill himself or someone else.

MORE: Riveting new book on fighting for treatment - NPR: Fighting for treatment

"We're still warehousing them. We're just hiding them better ..."

"We might have closed down those state asylum warehouses but we haven’t solved their patients’ problems. We’re still warehousing them. We’re just hiding them better so we don’t have to deal with them." - Pete Earley

When former Washington Post author Pete Earley was doing research for his new book Crazy: A Father's Search Through America's Mental Health Madness, he turned to Miami as an example of the problems the country is facing because of criminalization of those with mental illnesses.

Some statistics from his book ...

• Number of mentally-ill prisoners booked into Miami jails accused of felonies: 3,000 (they often spend months waiting for their cases to be resolved)
• Amount of time it took for the chief psychiatrist at the Miami Dade jail to complete his rounds of the 92 most dangerous and unpredictable mentally ill inmates in the jail’s “primary psychiatric unit”: 19½ minutes (an average of 12.7 seconds per inmate)

Why did he focus on Miami? In his own words ...

"Miami has a higher percentage of mentally ill residents than any other city in the country .... It has a jail system—the fourth largest in the U.S.—that is generally outdated and dangerous to begin with. The 9th floor of the county jail is just about as barbaric as any facility around today. Miami also served as the perfect example of the nationwide tragedy that ensued when state mental institutions were shut down and their patients forced out into the community. When that happened we all acted like the problem was solved. After all, these asylums were horrid places straight out of One Flew Over the Cuckoo’s Nest. In Miami these patients were splintered into 647 boarding homes—with perhaps 20 to 30 mentally ill people per home. Approximately 400 of these have failed to pass the state’s minimum safety and health standards. Two thirds of them are in abysmal shape. But the state continues to let them operate because there’s nowhere else to put the mentally ill. We might have closed down those state asylum warehouses but we haven’t solved their patients’ problems. We’re still warehousing them. We’re just hiding them better so we don’t have to deal with them."

The Treatment Advocacy Center highly recommends this well-researched, thoughtful book, both as a chronicle of one father's struggle to get help for his son from a system seemingly built to bar it, and as an investigative look at what happens in our jails and prisons to people so lost to symptoms of mental illnesses. Earley's passion for reform and compassion for people like his son who desperately need and deserve treatment is a refreshing perspective on one of America's biggest failures - the abysmal way we treat people who are too ill to help themselves.

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)

Riveting new book on fight for treatment

Pete Earley had been a journalist for over 30 years and the author of many award-winning books. Yet he'd always been on the outside looking in.

Then his son Mike was declared mentally ill, and Earley was thrown headlong into the maze of contradictions, disparities, and catch-22s that is America's mental health system.

His new book, to be released April 20, is an intense look at what he found.

My son was so out-of-control that a nurse called hospital security. I was glad. Maybe now they will medicate him, I thought. But before the security guard arrived, Mike dashed outside, cursing loudly. I went after him. Meanwhile, the doctor told my ex-wife that it was not illegal for someone to be mentally ill in Virginia. But it was illegal for him to treat them unless they consented. There was nothing he could do.

"Even if he's psychotic?" she asked.

"Yes."

Mike couldn't forcibly be treated, the doctor elaborated, until he hurt himself or someone else. [Chapter 1]

Crazy is getting intense praise from people like Patty Duke, who calls the book a “godsend,” Bebe Moore Campbell, who says “CRAZY is both a clarion call for change and justice and an enthralling portrait of a father who refused to surrender,” and Senator Pete and Nancy Domenici, who said, “A book as riveting to read as it is important it be read …. Many of the tragic situations he uncovers were preventable. Maybe, with this book, they can be.”