A week of tragic consequences

The tragic consequences of untreated severe mental illness were evident across the country this week.


In Georgia, a 33-year-old man bludgeoned his girlfriend to death. Shannon Marrow has schizophrenia and had been in and out of treatment centers for years. He had recently stopped taking his medication


In Maryland, Timothy Hayes Marsh was fatally shot in the head. His sister says Marsh struggled with bipolar disorder for years, and had substance abuse problems from self-medicating. She suspects Hayes was in the midst of a drug deal when he was killed.

In New York, David Tarloff had been in and out of hospitals for years before he killed psychologist Kathryn Faughey. Tarloff has schizophrenia and relatives say he had recently stopped taking medication.

In Florida a mother has been declared insane and sent to a psychiatric hospital after she repeatedly stabbed her 5 year-old daughter. Olga Fererra has a history of mental illness including bipolar disorder and psychosis.

Danielle Steel urges treatment

"When people aren't medicated it can be lethal," she said, adding that she hadn't realized that when dealing with her own son. "I thought it could ruin his life. I really didn't understand how high the possibility was that it could cost him his life."

Steel -- who will release her 72nd novel "Honor Thyself" on February 26 -- believes the laws need to be changed to allow mentally ill people to be hospitalized against their will.

"Usually bipolars present extremely well and they can bounce into court ... look very together and be a complete mess three hours later on the streets somewhere," she said. "There's nothing you can do."

- Author Danielle Steel in an interview with Reuter's about Britney Spears

Consequences of Nontreatment: Victimization

The media and general public often overlook tragedies facing those with untreated severe mental illnesses. The reality is that they are much more likely to be victimized than the general population.

In fact, multiple studies have shown that individuals with severe psychiatric disorders are especially vulnerable to being victimized. This frequently involves acts such as theft of clothing or money but also includes assault, rape, or being killed. Women who have a severe psychiatric disorder are especially vulnerable. Some of the studies suggest that individuals who are victimized are less likely to have been compliant with their medication. This association is strongly supported by the 2002 North Carolina study by Hiday et al., which showed that individuals with severe psychiatric disorders who were on outpatient commitment, and thus were taking their medication regularly, were victimized only half as often as those who were not on outpatient commitment.

Outpatient commitment (aka AOT) is a humane intervention that can help some to get the treatment they need to avoid becoming victims of psychosis and criminal behavior.

The only place that can't refuse to take you

“Prior to 2000, the Alabama Department of Corrections didn’t consider mental-health treatment part of our mission,” [said Corrections Commissioner Richard] Allen

Yet now that is a primary responsibility. The results have been pretty horrible.

Allen noted something stunning in his presentation to a legislative committee. Of the 25,000 people in Alabama's state prisons, 20% (5,000 people) need treatment. Yet

"4,400 of those people would be considered outpatients were they not also
convicted of crimes."

So if Alabama were using outpatient treatment to intervene BEFORE these people committed crimes, the number of people needing treatment behind bars would be reduced dramatically … to less than 3% of the prison population instead of 20%.

That would save not only lives, but money.

Allen said the state prison system budget will fall short by $31 million this
year, and the cost of treating mental illness has contributed to that.

Shouldering the burden of inadequate treatment

When we think about the added burden untreated mental illness causes for law enforcement, we often think of things like overcrowding in jails or the increased risk in responding to a call for someone who has been deemed an imminent danger.

But untreated mental illness also burdens law enforcement in less apparent ways. Take the case of Mark L. Jackson – a man who allegedly made multiple bomb threats in the Chesapeake, Virginia area. Obviously, every threat of this type must be taken seriously, requiring significant law enforcement resources and manpower. But this isn’t the sort of cost that can be easily included in a budget request – it’s simply another hidden cost of Virginia’s failure to provide effective mental health care.

Forest fires and untreated mental illness

Colorado is a dangerous place to be homeless. In Colorado Springs temperatures hover in the low 20s in December and January.

The freezing temperatures drive many chronically homeless to build fires rather than seek shelters.

Recently in Colorado Springs and Manitou Springs a fire tore through area forests destroying 30 acres and causing $30,000 worth of damage. The fire was believed to be started by a homeless camp.

Dr. Bob Holmes an advocate for the homeless says the fire is a by-product of a bigger problem.

“The bigger problem is an issue that plagues many of the nearly 2,000 homeless people living in Colorado Springs and Manitou Springs, mental illness. We have some mental health issues that are pretty rampant with the chronic homeless. That's why they are chronically homeless. There's not enough treatment available for them."

Homelessness, victimization, suicide, and now forest fires – some of the many consequences of failing to treat severe mental illness.

Oprah on bipolar and violence

Andrea Petrosky killed her child. On The Oprah Show today, she talks about it, and about her bipolar disorder.

Petrosky is one in a long line of mothers whose untreated or wrongly treated severe mental illness had such a sickening result. In fact, of children killed by a parent, 15.8 percent of defendants had a history of untreated mental illness.

What she has to say about it sounds very familiar.

Andrea says the person who killed her son "wasn't me. It wasn't the real me. It was a very sick me, because I would never hurt him. Never," she says.

Her voice is an eerie echo of many who have been through similar circumstances. Like Naomi Gaines, who killed her 14-month old twins.

"I know how I was feeling that day. I know I was not the same Naomi who got up with my kids a million times before and fed them and bathed them and walked them and breast-fed them and cared for them," she says. "I wasn't that same person. So I know that I would never hurt them if I had had my sanity."

It isn’t the disease that leads to violence, it is the lack of timely and effective treatment for that disease.

People with severe psychiatric disorders are not more dangerous than the general population - if they are being treated. But without treatment, some commit acts of violence because of their delusions and hallucinations. Many of the cases in the news eventually uncover the fact that the person who killed their child was not taking medication. And research shows that the most common reason that people with severe mental illness refuse treatment is because they are too sick to realize they need treatment.

Don’t believe the hype you will hear today from some in the mental health community – that these cases are extremely rare. In Texas just last week, Alysha Green doused her three-, five-, and seven-year old daughters with gasoline and lit them on fire. The three-year-old has since died. Alysha’s husband says his wife had a history of mental illness with a past diagnosis of bipolar disorder. She was prescribed medication. She stopped taking her medication and, her husband reported, her behavior deteriorated in the three weeks prior to the tragedy. That same week, Helen Kirk was found insane in her murder trial in Massachusetts – she told police she believed her son Justin was “the devil” after she strangled him.

Oprah also talks to General Hospital star Maurice Benard and actress Jenifer Lewis from their perspectives as people with bipolar disorder. Benard returns to the issue of violence when he recounts what happened one evening when he was off medication.

“I started yelling. And I told [my wife] if she didn't stop [crying], that I was going to kill her—in my mind I didn't believe I would."

As much as we don’t want it to be true, violent behavior is one of the consequences of failing to treat. Even NIMH gets that now.

Oprah doesn’t delve into the concept of assisted outpatient treatment, which is too bad. The obvious question after a show like this is “how can we help people before they get so sick?” Maybe in a future show, they will include the perspectives of so many who can attest to the importance and value of earlier intervention.

Until then, we call this a good beginning.

The danger of dangerousness

Regular readers of this blog already know that Australia has been publishing very interesting work on mental health and treatment. And now, a Sydney psychiatrist is making a powerful argument that dangerousness standards delay necessary treatment by as much as six months.

Dr Olav Nielssen, a psychiatrist at Sydney's St Vincent's Hospital, found that the length of untreated psychosis was 25 weeks longer on average in countries that utilize dangerousness standards rather than “need for treatment” based standards for admission to mental health care. “That is staggering,” he said, “and not surprising really because you can't get treatment until you're dangerous, which means you've hurt or killed someone or at least threaten to. This 'dangerousness' criteria means delayed treatment and that need to be changed to save lives.”

Closing state hospitals doesn't eliminate need for care

The use of general hospitals to treat serious mental illnesses increased 34.7% between 1995 and 2002 according to a new study published in Psychiatric services this month. This raises a number of questions, not the least of which is whether psychiatric units in general hospitals are equipped to provide the kind of treatment, rehabilitation and discharge planning that state psychiatric hospitals can provide.

Take Virginia for instance. In 2006, the average length of stay for acute admissions to a state psychiatric hospital was 47.2 days compared to 5.4 days in community psychiatric inpatients beds. The abbreviated treatment provided in general hospital psychiatric beds may account for these hospitals’ “revolving doors” through which 3,514 patients passed 3 or more times in 2002 at a cost of about $111 million. Maybe closing state psychiatric hospital isn’t such a good thing – for patients or budgets.

Analysis of U.S. Trends in Discharges From General Hospitals for Episodes of Serious Mental Illness, 1995–2002, Shinobu Watanabe-Galloway, Ph.D. and Wanqing Zhang, M.D., M.Ed., Psychiatr Serv 58:496-502, April 2007

Gov. Richardson: Demand NM legislators get it right

Statement from TAC Executive Director Mary Zdanowicz:

New Mexico is again on the verge of denying critical treatment to the sickest people with severe mental illnesses, discriminating against them because they are too ill to ask for help.

Gov. Bill Richardson has publicly supported mandated community treatment legislation since Rep. Joni Marie Gutierrez first introduced it in 2006. Despite passing the House this year, the bill stalled in a Senate committee, a victim of political infighting and the work of one of Gov. Richardson’s own cabinet members, Secretary of Human Services Pam Hyde, who refused to rise in support of the measure despite her Governor’s position.

We urge Gov. Richardson to right this wrong, following up his supportive words with real action. He should add to his list of expectations for legislators that they exhibit true concern for people with debilitating brain diseases and the inability to choose treatment. Other bills to be addressed in a special session purport to protect the rights of New Mexico families and prevent them from violent harm – these criteria are also the case with the mandated community treatment legislation.

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Nontreatment costs more

$40,000: Annual cost to taxpayers for each homeless person who needs but does not receive mental health services. This cost, estimated by the Kansas Department of Social and Rehabilitation Service, includes 911 calls, emergency room care and jail.

$6,500: Annual cost for each homeless person receiving community mental health services through county providers …

- Dec 31, 2005, Wichita News