Long road to treatment for Vitali Davydov

At least Vitali A. Davydov won’t be going to prison.

Davydov, 20, pled guilty this week to murdering Dr. Wayne Fenton, a psychiatrist who, as we’ve said before, was the exception in a mental health system that is geared almost exclusively to patients who are able to seek treatment voluntarily. Dr. Fenton embraced the most difficult cases and never turned people away who were really suffering, including Davydov.

"The average psychiatrist in the Washington area is on Connecticut Avenue and he's seeing . . . some executive who got passed over for a promotion and is having a midlife crisis," said Fuller Torrey, a local psychiatrist who often referred severe cases to Fenton. "Wayne was one of the few out here seeing the severely mentally ill. He was strongly committed to providing care and promoting research for the sickest people."

Davydov will be committed to a Maryland psychiatric facility until he is no longer considered dangerous. Hopefully, that means he will finally receive the treatment Dr. Fenton was trying to get him the day he was murdered.

Do state laws place mental health professionals in danger?

Washington State trains county designated mental health professionals to assess whether a person with severe mental illness who is in crisis is also a danger to self or others. If so, the person might qualify for a 72-hour hold and evaluation to determine if hospitalization is needed.

Marty Smith responded to one such crisis and lost his life to a dangerous patient. Now state legislators are considering the “Marty Smith” bill to recognize him and to help improve safety for mental health professionals. While elected officials debate this bill, we also need to ask them some hard questions:

Why do mental health professionals have to wait until a patient deteriorates to a point of dangerousness before they can help?

Why do county designated mental health professionals and judges not use the state treatment law and intervene for people who are “gravely disabled” ?

Why does the state fail to make use of its “less restrictive alternative” provision to provide mandated treatment in the community instead of hospitals?

41 other states let families directly petition a court to get treatment for a loved one in crisis. Why does Washington State require county designated mental health professionals to be the “middle man” in their process?

Violence and schizophrenia

The forthcoming edition of Schizophrenia Research includes an article by TAC board president Dr. E. Fuller Torrey on "Violence and Schizophrenia." Dr. Torrey writes in part, as noted by Swanson and Holzer: “No one is served by ignoring the evidence that mental illness is associated with some increased risk for assaultive behavior.”

The violence issue among individuals with schizophrenia is a treatment issue, nothing more nor less. In virtually every case it has been found that the individuals responsible for such homicides, like the young man who killed Dr. Fenton, were not taking medication.

The problem is that approximately half of all individuals afflicted with schizophrenia have moderate or severe anosognosia; they are neurologically impaired and thus unable to perceive their own illness or need for medication. Laws governing the treatment of mentally ill individuals in the United States ignore this fact and make involuntary treatment exceedingly difficult to carry out.

NY Times on violence and mentally ill

Would that everyone would talk about violence and mental illness as cogently as Dr. Bruce Link.

Dr. Link highlights the problem in the New York Times' careful coverage of the tragic death of Dr. Wayne Fenton ...

Violence is less common among those with mental illnesses than is sometimes assumed. Many people with schizophrenia are withdrawn, more likely to be targets of an assault than to commit one, said Bruce Link, a professor of epidemiology at Columbia.

But studies suggest that those with untreated psychosis — often characterized by intense paranoia and imaginary voices issuing commands — are at least two to three times as likely as people without mental disorders to get into physical altercations, including fights using weapons, Dr. Link said.

Everyone is sad ...

TAC's official statement: In memorium: Dr. Wayne Fenton

Groups like NIMH, NAMI, and AFSP issued statements, and the story was retold around the country, in papers like the LA Times and popular blogs like Liz Spikol's.

No other choice

Dr. Wayne Fenton’s death is a poignant reminder of the woeful inadequacy of options for emergency care when severely mentally ill patient are in crisis and refusing medication. Families struggle with a mental health system that claims nothing can be done until the patient is dangerous.

One of the most tragic aspects of Dr. Fenton’s death is that he was an exception in a mental health system that is geared almost exclusively to patients who are able to seek treatment voluntarily. Like the difficult patients he tried to help, he was a victim of the system that turns a blind eye to patients who lack the insight into their need for treatment.

Dr. Fenton never should have been in the vulnerable position of trying to help his patient alone, but he was in that position precisely because he was a compassionate professional who understood too well the alternatives for the young man he wanted to help. Most of his colleagues would have referred the family to the police, who also have few options in Maryland and Virginia until the patient becomes dangerous.

Perhaps this tragedy will prompt Dr. Fenton’s colleagues to refocus the mental health system on the patients most in need – those Dr. Fenton refused to neglect.

Dr. Fenton's wisdom

"All one has to do is walk through a downtown area to appreciate that the availability of adequate treatment for patients with schizophrenia and other mental illnesses is a serious problem in this country. We wouldn't let our 80-year-old mother with Alzheimer's live on a grate," he said. "Why is it all right for a 30-year-old daughter with schizophrenia?"

- Dr. Wayne Fenton (more from the Washington Post on his murder)

Mourning the loss of Dr. Wayne Fenton

We mourn the crushing loss of Dr. Wayne Fenton. Dr. Fenton was truly one of the good ones – a rare breed of psychiatrists who devote their careers to the most severely mentally ill. Motivated not by political correctness, but by a mission to understand and treat the most devastating symptoms of schizophrenia.

His research was pure – probably in part because he served some of the most difficult patients in his private practice and therefore witnessed the terrible toll of psychosis on patients and their families. He was more concerned about helping the most severely ill than worrying about where his next research dollar was coming from.

The director of the National Institute of Mental Health,where Dr. Fenton was an associate director, called his killing particularly tragic.

"He was without question one of the nation's experts in schizophrenia," Insel said.

He said that Fenton concerned himself particularly with research aimed at making it possible for people with severe psychiatric illnesses to become functioning members of the community.

In addition to his administrative and research work, Insel said Fenton was "a very accomplished clinician" who continued to see patients one-on-one evenings and weekends.

In private practice, Insel said, Fenton worked with people "who would be categorized as psychotic" and therefore subject to a disorder that could make them dangerous if not properly treated.

Dealing with such patients is "a risk one takes" in psychiatry, Insel said.

Fenton was "absolutely committed" to helping people with the most severe psychoses, Insel said.