Wednesday, October 29, 2014

Biggest Police Group Endorses Greater Use of Assisted Outpatient Treatment (AOT)


“AOT helps prevent mental health officials from offloading 
the most seriously mentally ill to jails, shelters, prisons and morgues.” 

(Oct. 29, 2014) The International Association of Chiefs of Police (IACP) took steps to improve care for people with serious mental illness and protect the safety of officers by endorsing greater use of Assisted Outpatient Treatment (AOT) at their 2014 annual meeting in Orlando, FL. Research collected by Mental Illness Policy Org shows AOT reduces arrest, suicide, hospitalization and violence by people with the most serious mental illnesses over 70% each. By replacing more expensive and liberty-depriving inpatient commitment and incarceration with less expensive outpatient treatment, AOT cut taxpayers’ costs in half. DJ Jaffe, Executive Director of Mental Illness Policy Org. said “Police step in when one condition has been met: the mental health system failed. This resolution will encourage mental health departments to do the right thing. If implemented it will save the lives of patients and police.”

AOT allows judges to order a small group of the most seriously ill to stay in six months of mandated and monitored treatment while they live in the community. It is limited to those who have already accumulated multiple episodes of homelessness, hospitalization, violence, arrest or incarceration associated with going off treatment. Representative Tim Murphy (R. PA) included funding for AOT in the Helping Families in Mental Health Crisis Act (HR 3717). AOT is known as “Kendra’s Law” in New York and “Laura’s Law” in California after two women who were killed by persons with untreated serious mental illness. Families of the seriously ill in those states had been arguing for AOT to help their ill family members get treatment, but could not get mental health departments to listen to them until after the tragedies.

As the result of the mental health system’s refusal to deliver services to the most seriously ill, and preferring to treat the highest functioning, there are now ten times as many mentally ill incarcerated as hospitalized according to the Treatment Advocacy Center. New Windsor, NY Police Chief Michael Biasotti conducted a survey of 2400 senior law enforcement officers and recently told CongressWe have two mental health systems today, serving two mutually exclusive populations: Community programs serve those who seek and accept treatment. Those who refuse, or are too sick to seek treatment voluntarily, become a law enforcement responsibility.” “AOT will help return care and treatment of the seriously mentally ill back to the mental health system where it belongs” said Jaffe. The National Sheriff’s Association and Department of Justice previously endorsed AOT as has almost every major organization concerned about care and treatment of the most seriously ill. Chief Michael Biasotti and outgoing IACP President Yost Zakhary were responsible for obtaining the IACP endorsement. Mental Illness Policy Org urges local chiefs to encourage their mental health departments and legislatures to make greater use of it.

A copy of the IACP Resolution follows or get PDF version to share with local law enforcement and mental health officials. Learn about AOT in New York (Kendra's Law) and about AOT in California (Laura's Law)

Mental Illness Policy Org. is an independent science based think tank on serious mental illness (not mental health) @MentalIllPolicy

IACP Endorses Assisted Outpatient Treatment 
Resolution adopted by IACP October 28, 2014
PDF VERSION

WHEREAS, law enforcement officers are often the first responders to individuals in mental health crisis; and
WHEREAS, law enforcement officers continue to experience an increase in interactions with people with severe mental illness[1]; and
WHEREAS, such interactions consume a disproportionate amount of limited law enforcement resources[2]; and
WHEREAS, approximately forty percent of individuals with severe mental illness are not receiving treatment, primarily because the illness affects their ability to voluntarily participate in needed care[3]; and
WHEREAS, noncompliance with treatment, specifically non-adherence to medication, is strongly associated with hospitalization,[4] suicide,[5] victimization,[6] violence[7] and relapse;[8] and
WHEREAS, noncompliance with treatment is also strongly associated with arrest and incarceration,[9] resulting in a disproportionate representation of individuals with severe mental illness in the criminal justice system; and
WHEREAS, a 2014 report found that 10 times more mentally ill persons are in prisons and jails than are receiving treatment in state psychiatric hospitals[10]; and
WHEREAS, Assisted Outpatient Treatment (AOT) provides court-ordered treatment in the community for high-risk individuals with severe mental illness and a history of treatment noncompliance, as a less restrictive alternative to inpatient hospitalization; and
WHEREAS, more than two decades of research and practice document AOT as an effective tool to improve outcomes for this focus population, including reduced hospitalizations[11], arrests[12], incarcerations, crime[13], victimization[14] and violence[15] while increasing treatment adherence[16] and substance abuse treatment outcomes; and
WHEREAS, numerous state and local law enforcement associations support and have championed the passage and implementation of AOT programs; and
WHEREAS, the Department of Justice deemed AOT to be an effective evidence-based program for reducing crime and violence[17]; and
WHEREAS, studies amply demonstrate AOT’s effectiveness in reducing arrests and incarcerations, e.g., a recent study of New York State’s signature AOT program (“Kendra’s Law”) concluded that the “odds of arrest in any given month for participants who were currently receiving AOT were nearly two-thirds lower” than those not receiving AOT[18]; and
WHEREAS, AOT also produces significant taxpayer/system cost savings, ultimately increasing overall service capacity and leading to greater access for both voluntary and involuntary recipients. A cost-impact study in New York City found net cost savings of 50% in the first year and an additional 13% in the second year; a study in North Carolina reported similar cost savings of 40%[19]; now, therefore be it
RESOLVED, that the International Association of Chiefs of Police (IACP) recommends the authorization, implementation, appropriate funding, and consistent use of Assisted Outpatient Treatment (AOT) laws to ensure treatment in the least restrictive setting possible for individuals whose illness prevents them from otherwise accessing such care voluntarily.



[1] Biasotti, Michael C. Management of the severely mentally ill and its effects on homeland security. Naval Postgraduate School Monterey Ca. Dept. of National Security Affairs, 2011.
[2] Biasotti, Michael C. Management of the severely mentally ill and its effects on homeland security. Naval Postgraduate School Monterey Ca. Dept. of National Security Affairs, 2011.
[3] Substance Abuse and Mental Health Services Administration. (2013). Results from the 2012 National Survey on Drug Use and Health: Mental Health Findings. NSDUH Series H-47, HHS Publication No. (SMA) 13-4805.
[4] Valenstein, M., Copeland, L., Blow, F., et al. (2002). Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission. Med Care 40:630–639.
Weiden, P., Kozma, C., Grogg, A., et al. (2004). Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia. Psychiatric Services 55:886–891.
Gilmer, T., Dolder, C., Lacro, J., et al. (2004). Adherence to treatment with antipsychotic medication and health care costs among Medicaid beneficiaries with schizophrenia. American Journal of Psychiatry 161:692–699.
Ascher-Svanum, H., Faries, D., Zhu, B., et al. (2006). Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care. Journal of Clinical Psychiatry 67:453–460.
Velligan, D., Weiden, P., Sajatovic, M., Scott, J., Carpenter, D., Ross, R., Docherty, J., (2009). The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness. Journal of Clinical Psychiatry. 70 Suppl 4:1-46; quiz 47-8.
[5] Muller-Oerlinghausen, B., Muser-Causemann, B. & Volk, J. (1992). Suicides and parasuicides in a high-risk patient group on and off lithium long-term medication. Journal of Affective Disorders, 25(4),261-269.
Leucht S., Heres S. (2006). Epidemiology, clinical consequences, and psychosocial treatment of nonadherence in schizophrenia. Journal of  Clinical Psychiatry, 67(Suppl. 5), 3–8.
Nordentoft, M. (2007). Prevention of suicide and attempted suicide in Denmark. Epidemiological studies of suicide and intervention studies in selected risk groups. Danish Medical Bulletin, 54(4),306-69.
Chapman, S.C., Horne, R. (2013). Medication nonadherence and psychiatry. Current Opinion in Psychiatry, 26(5),446-552.
[6] Hiday, V., et al. (1999). Criminal Victimization of Persons with Severe Mental Illness. Psychiatric Services, 50, 62-68.*
*Individuals with severe psychiatric disorders who were not taking medication were found to be 2.7 times more likely to be the victim of a violent crime (assault, rape, or mugging) than the general population.
[7] Swartz, M., Swanson, J., Hiday, V., Borum, R., Wagner, H., Burns, B. (1998). Violence and severe mental illness: The effects of substance abuse and nonadherence to medication. American Journal of Psychiatry, 155, 226-31.
Substance abuse, medication non-compliance and low insight into illness operate together to increase violence risk. Van Dorn, R., Volavka, J., Johnson, N. (2011). Mental disorder and violence: is there a relationship beyond substance use? Social Psychiatry and  Psychiatric Epidemiology.
Witt, K., Van Dorn, R., Fazel, S. (2013). Risk factors for violence in psychosis: Systematic review and metaregression analysis of 110 studies. PLOS  ONE, 8, e55942.
Belli, H., Ozcetin, A., Erteum, U., et al. (2010). Perpetrators of homicide with schizophrenia: sociodemographic characteristics and clinical factors in the eastern region of Turkey. Comprehensive Psychiatry, 51,135-41.
Alia-Klein, N., O’Rourke, T., Goldstein, R., et al. (2007). Insight into illness and adherence to psychotropic medications are separately associated with violence severity in a forensic sample. Aggressive Behavior, 33, 86–96.
Elbogen, E., Van Dorn, A., Swanson JW, et al. (2006). Treatment engagement and violence risk in mental disorders. British Journal of Psychiatry, 189,354–360.
Swanson, J., Swartz, M., Essock, S., et al. (2002). The social-environmental context of violent behavior in persons treated for severe mental illness. American Journal of Public Health, 92, 1523–1531.
Bartels, J., Drake, R., Wallach, M., et al. (1991). Characteristic hostility in schizophrenic outpatients.  Schizophrenia Bulletin, 17, 163–171.
[8] Robinson, D. (2010). First-episode schizophrenia. CNS Spectrum, 15 (Supplement 6), 4-7.
Ayuso-Gutierrez, J., Del Rio, V. (1997). Factors influencing relapse in the long-term course of schizophrenia. Schizophrenic Research, 28, 199-206.
Morken, G., Widen, J., Grawe, R. (2008). Non-adherence to antipsychotic medication, relapse and rehospitalisation in recent-onset schizophrenia. BMC Psychiatry, 8,32-8.
Suppes, T., Baldessarini, R., Faedda, G., Tohen, M. (1991). Risk of recurrence following discontinuation of lithium treatment in bipolar disorder.  Archives of General Psychology, 48(12),1082-1088.
Franks, M., Macritchie, K., Mahmood, T., Young, A. (2008) Bouncing back: is the bipolar rebound phenomenon peculiar to lithium? A retrospective naturalistic study. Journal of Psychopharmacology, 22(4), 452-456.
[9] Munetz, M.R., Grande, T.P., & Chambers, M.R. (2001). The incarceration of individuals with severe mental disorders. Community Mental Health, 34:361-71.* * Nearly 90 percent of a sample of individuals with severe mental illness in a local jail were partially or completely non-complaint with medication in the year before they were incarcerated.
Lattimore, P. K., Broner, N., Sherman, R., Frisman, L., & Shafer, M. S. (2003). A comparison of prebooking and postbooking diversion programs for mentally ill substance-using individuals with justice involvement. Journal of Contemporary Criminal Justice, 19(1), 30-64.* *Individuals with co-occurring mental illness and substance abuse who are noncompliant with medication have a threefold increase in risk for arrest and are significantly more likely to be at risk for violent behavior.
Ascher-Svanum, H., Nyhuis, A.W., Faries, D.E., Ball D.E., & Kinon B.J. (2010). Involvement in the US criminal justice system and cost implications for persons treated for schizophrenia. BMC Psychiatry, 10:11.
Shelton, D., Ehret, M. J., Wakai, S., Kapetanovic, T., & Moran, M. (2010). Psychotropic medication adherence in correctional facilities: A review of the literature. Journal of Psychiatric and Mental Health Nursing, 17(7), 603-613.
[10] Torrey, EF, Zdanowicz, MT, Kennard, AD, et al. The treatment of persons with mental illness in prisons and jails: a state survey. Treatment  Advocacy Center and National Sheriff’s Association, April 8, 2014.
[11] Swartz, M., Swanson, J., Wagner, H., Burns, B., Hiday, V., & Borum, R. (1999). Can involuntary outpatient commitment reduce hospital recidivism: Findings from a randomized trial with severely mentally ill individuals. American Journal of Psychiatry 156: 1968-1975.
Swartz, M., Swanson, J., Steadman, H., Robbins, P., & Monahan J. (2009).  New York state assisted outpatient treatment program evaluation. Duke University School of Medicine.
[12]Gilbert, A., Moser, L., Van Dorn, R., Swanson, J., Wilder, C., Robbins, P., Keator, K., Steadman, H., & Swartz, M. (2010). Reductions in arrest under assisted outpatient treatment in New York. Psychiatric Services 61: 996-999.
[13] New York State Office of Mental Health. 2005. Kendra’s Law: Final Report on the Status of Assisted Outpatient Treatment.
[14] Hiday, V., Swartz, M., Swanson, J., Borum, R., & Wagner, R. (2002). Impact of outpatient commitment on victimization of people with severe mental illness.  American Journal of Psychiatry, 159: 1403-1411.
[15] Phelan, J., Sinkewicz, M., Castille, D., Huz, St., & Link, B. (2010). Effectiveness and outcome of assisted outpatient treatment in New York state. Psychiatric Services 61: 137-143.
[16] New York State Office of Mental Health. 2005. Kendra’s Law: Final Report on the Status of Assisted Outpatient Treatment.
[17] National Institute of Justice, Program Profile Assisted Outpatient Treatment (AOT). Retrieved August 27, 2014, from  http://www.crimesolutions.gov/ProgramDetails.aspx?ID=228
[18] Gilbert, A., Moser, L., Van Dorn, R., Swanson, J., Wilder, C., Robbins, P., Keator, K., Steadman, H., & Swartz, M. (2010). Reductions in arrest under assisted outpatient treatment in New York. Psychiatric Services 61: 996-999.
[19] Swanson, J., Van Dorn, R.,  Swartz, M., Robbins, P., Steadman, H., McGuire, T., & Monahan, J. (2013). The cost of assisted outpatient treatment: Can it save states money? American Journal of Psychiatry 170:1423-1432.

Monday, September 8, 2014

We're going about suicide prevention the wrong way


Suicide is rare among the general population. It is more common, but still rare, among people with serious mental illness. There are about 38,000 successful suicides per year (American Foundation for Suicide Prevention 2010). There are at least 380,000 attempts. The lifetime risk to those with schizophrenia is only 5%. (Hor and Taylor 2010). The lifetime risk to those with bipolar is only 10-15%. (Center for Disease Control and Prevention 2014). Of the 37.5 million Californians, only 3,823  (.01%) took their own lives, and 16,425 (.04%) were hospitalized for self-inflicted injuries in 2010. (California Mental Health Services Authority 2012).   
Advocates regularly overstate the prevalence of suicide and attempts among persons with mental illness in order to curry funding for their programs. At the high end, the National Alliance on Mental Illness claims, “More than 90% of youth suicide victims have at least one major psychiatric disorder.”  (National Alliance on Mental Illness (NAMI) 2013)  Mental Health America, a trade association for providers of mental ‘health’ services estimates “30% to 70% of suicide victims suffer from major depression or bipolar (manic-depressive) disorder” (Mental Health America n.d.).
Suicide is not always the irrational act of a sick mind.  Mental illness in people who commit suicide is often diagnosed after the fact. After someone takes his or her own life, we look for a cause. If they take their life after having had lost their spouse or job, gotten a bad grade in school, or received a new medical diagnosis we chalk it up to depression and put the suicide in the mental illness column. 
In spite of being overstated, it is clear that suicide disproportionately affects people with mental illness. Dr. E. Fuller Torrey looked at studies of the prevalence of suicide among the seriously mentally ill and studies of the prevalence of serious mental illness among those who suicide, two sides of the same coin, and in both cases found about 5,000 of the 38,000 suicides (about 14%) were in people with serious mental illness. This is still three times their presence in the general population.  (Torrey n.d.).

Suicide can not be reduced through advertising and public relations

Every suicide is a tragedy for the individual, their family and the community. Many of these suicides could be prevented if persons with mental illness were provided care. Instead of doing that, the industry is funding ineffective feel good campaigns targeted at the general public.

Friday, August 22, 2014

About Assisted Outpatient Treatment (AOT)

Assisted Outpatient Treatment (AOT) is for a very small group of the most seriously mentally ill who already accumulated multiple incidents of hospitalization arrest or incarceration associated with their failing to stay in voluntary treatment. AOT allows judges, after full due process to require certain mentally ill to accept six months of mandated and monitored treatment as a condition for living in the community. It provides an off ramp before incarceration. As Linda Dunn said, Assisted Outpatient Treatment is like putting a fence by the edge of the cliff rather than an ambulance at the bottom. (Barnidge 2014)

The research on AOT is extensive and positive. (Mental Illness Policy Org 2013). Six months of mandated and monitored treatment has been shown to reduce homelessness 74%; hospitalization 77%; arrest 83%; incarceration 87%, physical harm to others 47%; property destruction 46%; suicide attempts 55%; and substance abuse (48%). By replacing expensive incarceration and hospitalization with less expensive community care Assisted Outpatient Treatment cuts costs to taxpayers in half. (Swanson, et al. 2013). AOT also reduces victimization. (V.A. Hiday 2002). These results are particularly outstanding because AOT is limited to the most seriously ill, often a very hard to treat population.

Thursday, August 14, 2014

New Report: California Mental Health Services Act Fails Seriously Mentally Ill

California Mental Health Services Act Oversight Commissioners (MHSOAC) just issued a press release saying Prevention and Early Intervention (PEI) programs (20% of total MHSA Funds) are working. 
http://www.mhsoac.ca.gov/MHSOAC_Publications/docs/PressReleases/2014/PR_Programs-Work_080514.pdf

However, they didn't even study adults with serious mental illness.

Wednesday, August 13, 2014

NAMI/National less than honest with members


Call 202 224 3121 or go here and urge your U.S. Representative to co-sponsor HR 3717, the Helping Families in Mental Health Crisis Act.

NAMI State and local chapters do brilliant work trying to improve care for people with the most serious mental illnesses and provide comfort to them and their families. NAMI/National is ignoring the most seriously ill in order to be politically correct.
Representative Tim Murphy (R. PA) has proposed HR3717 the “Helping Families in Mental Health Crisis” that does much of what NAMI local and state members have been begging for.

Sunday, August 10, 2014

SAMHSA FAILS SERIOUSLY MENTALLY ILL

A bill in Congress (HR3717, the Helping Families in Mental Health Crisis Act) would change SAMHSA and some wonder why change is needed. SAMHSA (Substance Abuse and Mental Health Services Administration) was created by Congress to “reduce the impact of…mental illness on America’s communities” and “target … mental health services to the people most in need”. SAMHSA has failed to do either. SAMHSA refuses to require its funds reach the most seriously ill and enacts policies to see they don't.

SAMHSA largely ignores the most significant impacts of mental illness on the communities, specifically violence, incarceration, hospitalization, homlessness and suicide. Instead, SAMHSA focuses on improving metrics like 'feeling of empowerment' 'hopefullness' and other softer outcomes.

Thursday, July 24, 2014

Info on mental illness related violence in PA


Facts about Pennsylvania Mental Health System and Violence

List of Acts of violence by untreated mentally ill in PA
http://mentalillnesspolicy.org/states/Pennsylvania/preventabletragediesPA.pdf
Pennyslvania needs 3800 more psychiatric beds for the most seriously ill assuming they had perfect services
Chart two at http://mentalillnesspolicy.org/imd/shortage-hosp-beds.pdf

Pennsylvanians are 2X as likely to be incarcerated for mental illness as hospitalized
http://mentalillnesspolicy.org/NGRI/jails-vs-hospitals.html

Wednesday, April 30, 2014

If You Don't Ask Your US Rep to Cosponsor Helping Families in Mental Health Crisis Act, You are Part of Problem.

Call your US Rep to ask them to co-sponsor HR-3717, the Helping Families in Mental Health Crisis Act for the 6 reasons below:
Background

Five percent of Americans have serious mental illness (i.e., schizophrenia, severe bipolar). Twenty percent have “any” mental illness (i.e., some form of depression, stress, anxiety, social phobia, etc.).  It is the 5% who are most likely to become homeless, suicidal, criminal, arrested, incarcerated and violent. Up to 40% of the most seriously ill are so ill they do not know they are ill (“anosognosia”). While most mentally ill are not violent, that does not hold true for the untreated seriously mentally ill with anosognosia. We can not ignore them. Following are provisions in HR3717 that most directly improve care for the seriously ill and reduce the chance of violence, homelessness, suicide:

Monday, April 14, 2014

Does Assisted Outpatient Treatment Violate Civil Liberties

Does Assisted Outpatient Treatment violate civil liberties of persons with mental illness?  Courts say no, and courts are the arbiters. Courts have decided that since AOT is limited to such a small group (those with a past history of arrest, violence, needless hospitalizations) that AOT is an appropriate use of police power (to protect citizenry) and parens patraie powers (to help those who can't help themselves). 

Another way to look at it is that AOT generally does not affect persons with mental illness. Having a mental illness is not enough to qualify someone for AOT. At most, 123,000 people would be eligible for AOT and research shows that even when AOT is funded, only roughly one-third of those eligible will ever be put on it (41,000 individuals). There are 58 million people who had  a mental illness diagnosis in past year. Therefore the maximum number of people it will affect, is .07% of individuals with mental illness.  

Clearly, not all people with mental illness are being put "at risk". It does not result in the massive depravation of rights claimed by opponents.

The upside is AOT has been proven to work. AOT reduces homelessness, arrest, violence, incarceration over 70% among those enrolled. It is constitutional, does not violate civil liberties; keeps patients public and police safer, is racially neutral, has support from consumers who actually experienced it, and cuts costs to taxpayers in half

AOT is smart policy to help deliver treatment to a very small group of the most symptomatic. 

Tuesday, April 1, 2014

Assisted Outpatient Treatment Pilot Program Grants Passed by Congress


On Monday, March 31, 2014, the Senate passed H.R.4302 which included $60 million for Assisted Outpatient Treatment Pilot Programs. Following is the text of the legislation (Followed by the text of the Excellence in Mental Health Act which was also included in HR 4302) 


SEC. 224. ASSISTED OUTPATIENT TREATMENT GRANT PROGRAM FOR INDIVIDUALS WITH SERIOUS MENTAL ILLNESS.

(a) In General- The Secretary shall establish a 4-year pilot program to award not more than 50 grants each year to eligible entities for assisted outpatient treatment programs for individuals with serious mental illness.

Thursday, March 20, 2014

Treatment of violent mentally ill lowers rates of reoffending. New Study

Important new study: Researchers followed violent offenders (sentenced to 2 years or more) for an average of 10 months following their release and ascertained the rate of violent re-offending. The study included 742 individuals without psychosis; 94 with schizophrenia; 29 with delusional disorder; and 102 with drug-induced psychosis. It also assessed whether the individual’s mental illness was treated in prison, after leaving prison, or not at all.

Wednesday, March 19, 2014

Is Assisted Outpatient Treatment (Laura's Law, Kendra's Law) "Forced Treatment"?

Someone suggested Assisted Outpatient Treatment (AOT) is "Forced" Treatment (and therefore presumably bad).

1. Describing AOT as "forced treatment" demonstrates a misunderstanding. AOT, by definition, is only used after voluntary treatment fails. They serve mutually exclusive populations. For those individuals who won't access voluntary treatment, perhaps because they are too psychotic or have anosognosia, AOT is a way to reduce forced treatment. It is the last off ramp before patients are put into locked into involuntary commitment wards or put behind locked cell doors. Involuntary commitment to a locked hospital ward or a jail cell is a genuine use of force. The AOT research clearly states AOT reduces the use of those forms of forced treatment.

Monday, February 24, 2014

Affordable Care Act/ACA Fails Seriously Mentally Ill

Many 'mental health' advocates claim that the Affordable Care Act (ACA, a/k/a "Obamacare") combined with "mental health parity" will ensure people with mental health issues get care. The ability to keep a child on your insurance until age 26 will likely help many, since serious mental illness affects people in their late teens, early twenties. Maybe other provisions will help the higher functioning. But as the analysis below shows, overall, it makes things worse for the most seriously ill: those who need long term hospitalization.  Unfortunately, the impact of ACA on the most seriously mentally ill has been largely ignored by 'mental health' advocates.

Sunday, February 23, 2014

What is serious mental illness in adults and what is not?

Serious mental illnesses are a small subset of the 300 mental illnesses that are in DSM. While it is fair to debate where the line between serious mental illness and poor mental health is, the extremities are clear.

 According to the National Institute of Mental Health, serious mental illness is relatively rare, affecting only 5% of the population over 18. Serious mental illness includes schizophrenia; the subset of major depression called “severe, major depression”; the subset of bipolar disorder classified as “severe” and a few other disorders.

Schizophrenia (NIMH defines all schizophrenia as “severe”):  1.1% of the population (FN 1)
The subset of bipolar disorder classified as “severe”:  2.2% of the population (FN 2)
The subset of major depression called “severe, major depression”:  2.0% of the population (FN 3)

Therefore total “severe” mental illness in adults by diagnosis: 5.3% of the population (FN 4)

US mental health spending and mental health non-profits focus almost exclusively on people who do not have serious mental illness, rather than those who do. This is the single major problem with the US mental health system. Money is not lacking. Prioritization is.

Friday, February 21, 2014

Please send letter in Support of Helping Families in Mental Health Crisis Act

If you are part of any organization (state or local NAMI, MHA, Prison Reform, Consumer Group, etc) that wants to help persons with serious mental illness, please send a letter on your letterhead, to Rep. Tim Murphy urging passage of Helping Families in Mental Health Crisis Act (HR 3717). They want as many letters of support from organizations as possible.

You can see the NAMI/NYS letter below and use it as a model. You can see other letters (ex. NAMI National, American Psychiatric Assoc., etc) at http://murphy.house.gov/helpingfamiliesinmentalhealthcrisisact#Letters%20of%20Support

Friday, December 20, 2013

Darrell Steinberg asks Californians to pay twice for same program. Fails Mentally Ill

On December 19, California Senate President pro Tem Darrell Steinberg asked for more money for Mentally Ill Offender Crime Reduction Grants.

If Prop 63/MHSA funds were spent as legislatively required, no new funds would be needed. MHSA already specifically earmarked funds for this. MHSA Sec. 5813.5 (f) says:

Thursday, December 12, 2013

Here's what's in the new "Helping Families in Mental Health Crisis" Act


(Left-Representatives Leonard Lance of New Jersey,  Bill Cassidy of Louisiana, a medical doctor, and Congressman Tim Murphy (Psychologist)  introduce the "Helping Families in Mental Health Crisis Act" HR 3717 12/12/13). 

Call your Representative and ask him/her to support HR 3717. To find your Rep phone number, enter your zip code at http://www.opencongress.org/people/zipcodelookup 

BACKGROUND
SPENDING AND SCOPE OF PROBLEM
In 2014, the U.S. will spend $203 billion on mental health. Due to mission-creep, the funds are now spent ‘improving mental health’ rather than treating those with serious mental illness. Moms who have children known to be seriously mentally ill are virtually powerless to see they receive care. While the public becomes aware of the failure of the mental health system after high-profile rare acts of violence, the everyday tragedies faced by people with serious mental illness and their families go unnoticed.

Sunday, December 1, 2013

Wellness Recovery Action Plan (WRAP) Lacks Independent Verification and is not Evidence Based

WRAP labeled as 'evidence based' by SAMHSA. 

But is it?

When we ask “is a program evidence-based’, at Mental Illness Policy Org we break that question down into three components:
  1.  Does it help people with serious mental illness (ex. schizophrenia, bipolar, major depressive disorders) or is it a program designed to improve the mental health of anyone who feels their mental health can be improved. 
  2. Does the program improve a meaningful outcome? To be evidence based, we require it to improve a meaningful independent measure such as reducing suicide, homelessness, hospitalization, violence, substance abuse, arrest, incarceration, etc. Self reports of greatier happiness (“improved mental health”) are not sufficient or unique to WRAP
  3. What is the quality and independence of the research.


WRAP (Wellness Recovery Action Plan) has been certified by SAMHSA National Registry of Evidence Based Practices and Programs (NREPP) as an evidence-based intervention. This certification encourages states to implement it. But the evidence is not clear that WRAP improves any meaningful measure like decreasing hospital days, decreasing incarceration, decreasing homelessness or that it is for people with serious mental illness. The certification of unproven programs leads states to waste money.

Sunday, November 10, 2013

New NAMI Needed: National Alliance on SERIOUS Mental Illness (NASMI)

I think there needs to be a National Membership Org that focuses exclusively on Serious Mental Illness including important politically incorrect issues that NAMI refuses to address like preservation of enough psychiatric hospital beds, expansion of Assisted Outpatient Treatment (AOT), and relaxation of civil commitment laws.

One way to get it going would be to get former NAMI National Board Members to lend their name, form a nucleus. Perhaps call the new organization the National Alliance on Serious Mental Illness (NASMI)

State and local organizations can eventually make a decision as to whether they prefer to be part of the existing NAMI, or the one that makes serious mental illness their number one priority.

I believe the following former National NAMI Board Members might be willing to help: Eleanor Owen, Bernie Schell, Gerald Tarutis, Carla Jacobs, perhaps Fred Frese, Richard Lamb,and moi. If you know of more names, add them to this post.

Here is the National Alliance on Serious Mental Illness Facebook Page where you can discuss the idea https://www.facebook.com/seriousmentalillness