Iowa’s cold-hearted system leads to hypothermia

Photo from Gazette.com: "Personal items and trash are strewn about the homeless camp under Iowa City's Benton Street bridge Thursday. Transient Sonny Anthony Iovino, 55, was found dead from hypothermia under the bridge Wednesday."

The cause of death for Sonny Iovino is officially listed as “hypothermia.”

But it is clear he was a victim of something equally as chilling – a system that bounced him around, seemingly unable (or perhaps unwilling) to help him.

Iovino was a familiar face to Iowa City police, and was repeatedly picked up in the past 5 years on charges like disorderly conduct, public intoxication and simple assault. In fact, “In the first seven days of November, he'd had five encounters with police.”

So fittingly, it seems from news stories that it was the police who tried the hardest to get him help. Yet all the doors were closed to him because he was severely mentally ill and belligerent – a combination that too often fails to ignite compassion.

When officers took Iovino to the VA Center, he was turned away because he was uncooperative.

When the doctor asked to take his vital signs, Iovino made what reports called an inappropriate comment. "I take that as a no," UI Police Officer Alton Poole reported the doctor as saying. The doctor released Iovino back to police.

Yet, when officers then transported him to jail, he was turned away because he was too sick.

Johnson County Sheriff Lonny Pulkrabek told The Gazette the jail won't admit anyone with an immediate medical need. He said the doctor's note indicated Iovino needed hospitalization for mental illness.

He was behaving erratically, and was, in fact, nearly naked in a city where the average temperature in November hovers at 31 degrees. Yet he couldn’t get the help he clearly needed.

The spokesperson for the medical center that released him back to police said hospital officials did all they could:

"If somebody doesn't want to be treated, you can't treat them."

Whether officials are ignorant of state law or willfully ignore it, the result is the same. In reality, Iowa has the option of assisted outpatient treatment, and actually uses its law to a certain extent, but not as much as it could, mainly because of its restrictive eligibility standard.

Iowa's commitment standard basically holds that to be eligible for outpatient treatment or hospitalization, the person must lack sufficient judgment to make responsible decisions concerning treatment AND is either (1) a danger to self/others, including that of serious emotional injuries to family members and others OR (2) unable to satisfy need for nourishment, clothing, essential medical care, or shelter so that it is likely that the person will suffer physical injury, physical debilitation, or death.

From news reports, it sounds like Mr. Iovino met that criteria. Perhaps everyone was tired of trying to help him. Perhaps his attitude and belligerence made him unpleasant to interact with. Perhaps everyone was busy and didn’t want to take the time.

The end result should shame everyone involved.

Tragic endings to a bad situation

Over the weekend we were reminded again of the role law enforcement is forced to play in dealing with severe mental illness. The failure of the mental health community to properly treat those with severe illnesses so often ends in tragedy across the country.

In Florida –
A sheriff’s deputy in Indian River County shot and killed Byruss Green, a man with a mental illness who had not been taking his medication.

In Illinois –
A jury determined that officers were not to blame in the March 2000 shooting of Joseph T. Zagar that had been called a suicide-by-cop. Officers had been to the home of Zager multiple times and had taken him in for mental health treatment. This time, Zager was threatening the officers with what they thought was a gun.

In Kentucky –
Brenda Joy Woosley, a woman with a mental illness had been driving erratically and avoiding police attempts to pull her over. Two officers fatally shot her after she drove her car into them.

In New York –
A man with a mental illness in Brooklyn was fatally shot by police officers after he repeatedly charged at them with a broken bottle. Before charging the officers, Dragan Kostovski stabbed his roommate.

Evidence-Based Advocacy

While personal stories and anecdotes can help to inspire elected officials to make change, they also need to present evidence to their colleagues to persuade them to adopt reforms. Sadly, many state mental health services provide little information about assisted treatment – how many people need it, how many people do not receive it but are repeatedly in crisis, how many petitions are filed for involuntary psychiatric evaluations, how many orders are issued for hospitalization, how many orders are issued for outpatient treatment, how often is law enforcement on the front line instead of mental health professionals…

Florida provides a good example of data reporting. The recent Baker Act Report provides an overview of what is happening with some of the most ill patients in their mental health system. For example, the report shows that:

“Nineteen percent of all people experiencing a Baker Act examination [involuntary psychiatric evaluation] in 2006 had more than one exam in that calendar year.”

Does your state keep good records about treatment for people with severe mental illnesses who need intervention? Is it easy for the public to access?

Survey your law enforcement officers

There is no question law enforcement officers are increasingly the ones responding to people with mental illnesses in crisis.

Use this survey to learn the prevalence and extent of the problem from a law enforcement standpoint.

In one study that used a version of this survey, it was revealed that 92 percent of officers reported encountering mentally ill individuals is crises in the month prior to the survey.

Share the results with the Treatment Advocacy Center! If you’ve surveyed your officers we’d love to hear from you. Send us an email at info@treatmentadvocacycenter.org.

Criminalizing mental illness

In Putnam County, Tennessee, a crisis stabilization unit (CSU) was opened on April 30. Since its opening county law enforcement officers have seen a drop in the amount of time deputies are spending transporting people with mental illnesses to facilities in other cities.

Excellent; but deputies are still spending an inordinate amount of time driving people to mental health facilities. In fact Putnam County Sheriff, David Andrews has two deputies designated for mental health transports.

So far this year, Putnam deputies have made 319 mental health transports, compared to a total of 478 last year.

If one or two deputies transports a mental health patient to Moccasin Bend Mental Health Institute in Chattanooga, those officers are off patrol in Putnam County between five and six hours, according to Sheriff Andrews.

The CSU is a great start to getting people treatment, and relieving the burden of law enforcement acting as mental health professionals. But – the new CSU only takes voluntary patients. People who won’t volunteer for treatment, who are aggressive or violent still have to be treated elsewhere, and that means law enforcement are charged with transporting them.

"I think there's got to be a better way to do this, unless they come out of the jail, a person who has some reason to be transported to a mental health hospital hasn't broken any law in many cases," Sheriff Andrews said. "It criminalizes mental illness to put a mental health patient in the back of a patrol car."

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...

Community members call for better treatment in Virginia

The following quotes are from news coverage of the death of Susanne Thompson, who was stabbed while walking her dog Saturday morning. Johnny Hughes, the man charged with her murder, has a history of mental illness.

He's [Richmond Mayor L. Douglas Wilder] concerned that state law doesn't always allow mandatory treatment of mentally ill people with criminal histories.

“… this situation represents a much larger problem. The real question is how many others are similarly situated across the state and the region who need coordinated mental health resources in order to reduce any possibility of this situation recurring.”

Hughes' younger sister, Chesterfield County resident Jackie Lewis, said the killing could have been avoided.

"We are so deeply sorry for this innocent loss," Lewis said on behalf of her family. "I'm sure if my brother was in his right mind, he would feel the same way."

"Somebody dropped the ball in terms of his care," she said.

Richmond Sen. Henry Marsh: "The purpose . . . is to create an assisted outpatient treatment program so that those mentally ill persons who are capable of being maintained safely in the community with the help of such a program can receive those services."

"The things he [Hughes] was saying, he didn't belong here," said [Richmond Sheriff C.T.] Woody, who has complained that the jail does not have the facilities or resources to care for the hundreds of mentally ill men and women doing time there.

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.

This is the one place that can't say no

The Richmond Times Dispatch has been conducting an extensive expose on the suffering of the mentally ill in Virginia’s corrections system. But as the Times Dispatch’s editorial board laments, for many, it may seem “almost old news.” The most severely ill are increasingly being abandoned by a mental health system all too willing to shift the burden onto law enforcement and corrections. And so Richmond will be forced to invest even more resources for mental health care in its jails, while the mental health system continues to pick and choose who it will treat -a mental health system that cannot even be bothered to know what their treatment laws say.

Does this pattern sound familiar? You call for help for your loved one in crisis, only to be told that nothing can be done until they’re dangerous. So you wait. And worry. And hope that nothing terrible happens. Finally, there’s an incident and you call back, only to be told, “call the police, we don’t come when people are dangerous.”

Most would call that absurd. But for Virginia’s mental health system, it’s business as usual.

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).”

Closing the barn door ...

Lots of bloggers have been posting raves for the recent Time Magazine article "Decriminalizing Mental Illness." It, like many other articles, is very supportive of CIT - but most all who praise this program seem to miss the fact that by the time someone with an untreated mental illness lands in front of even the most well-trained, compassionate CIT officer, they are in trouble - because they have already deteriorated to the point when law enforcement is involved.

Cheer for CIT if you must, it is certainly better than no CIT. But it is no replacement for earlier intervention - and real help from well-trained, compassionate mental health professionals.

Death sentence in Alabama

"Farron Barksdale will die in an Alabama prison," said the prosecutor when Barksdale was last week sentenced to life without parole.

Doubtful she knew how soon those words might come true.

Today Farron Barksdale is on life support. [UPDATE: Barksdale has since died.]

Prison is a notoriously terrible place for those with severe mental illnesses - and whether something happened to Barksdale during intake, as some reports indicate, or whether he succumbed to record-breaking heat in a facility with no air conditioning, the fact remains that Barksdale walked through the door of Kilby Correctional Facility and will come out in a hearse, whether it is this week or 50 years from now.

Barksdale, who has schizophrenia, had called 911 for help - when two officers pulled up in his mother's driveway, he brutally shot and killed them with a high-powered rifle. Records and Barksdale's attorneys indicate Barksdale believed microwaves were being aimed at his brain - in fact, he tore the cable out of his mother's home because of his belief "they" were using the wires and television to tap into his brain. At the request of Barksdale's mother, a probate judge had committed Barksdale to mental institutions five times previously. Yet he was off medication when the murders occurred.

Three people died because one man was not getting treatment.

Nice job, Alabama.

Thin blue line isn't a safety net

Anyone who doubts that law enforcement are increasingly the ones responding to people with mental illnesses who are in crisis needs only to read the news.

Two stories today show examples, from different angles, how the safety of both law enforcement and citizens is compromised when the mental health community abdicates their responsibility to care for people with the severest mental illnesses.

In a courtroom in Athens, Alabama jurors listened to police radio transmissions from the day Farron Barksdale killed two officers. Barksdale had called police asking to be directed to the FBI. When police arrived at his home Barksdale shot ten rounds from an assault rifle at the police cars.

Barksdale, who suffers from paranoid schizophrenia, was sentenced to life in prison without parole.

In Texas, police were called when Jose Vasquez, who was diagnosed with schizophrenia, got “out of control”. When Jose charged at his family with a garden hoe, officers fatally shot him.

Policing mental illness

A local TV station in Houston, TX recently followed police officers as they encountered people with mental illnesses. The TV station- KPRC – found that officers were well- trained in working with people with mental illnesses.

Perhaps what is most interesting and startling about the investigation, however, is that the officers used this training so often throughout the day. According to the report:

Officers encounter mentally ill people more often that you might think on the job.

Robert [KPRC reporter] tells us the department believes that at least 10 percent of all the calls an officer handles every day involves a person who is mentally ill.

That is 10 percent of each officer’s day that he or she spends as a mental healthcare provider. Perhaps its time to start providing meaningful treatment before encounters with law enforcement.