Tuesday, January 31, 2012

Mental Health Services Act Fails To Serve Mentally Ill in California

Dr. Larry Poaster, the chair of the Mental Health Services Oversight and Accountability Commission (MHSOAC) wrote an op-ed in Capital Weekly criticizing families of people with severe mental illness who criticize how Mental Health Services Act (MHSA) funds are spent. He claims the program is working well. But it's not. For one, the oversight committee itself is diverting MHSA funds meant to help people with severe mental illness to other causes. In their case, it's to hire a PR firm to further the oversight committee's claim that all is well. How does hiring a PR firm help people with severe mental illness? Is that why taxpayers voted to tax themselves? They felt a dearth of PR firms? To cite another example, the California Mental Health Services Authority made a multi-year commitment to fund a "Center for Dignity, Social Inclusion and Stigma Elimination."  Instead of providing treatment and services to people with severe mental illness, it will provide ads and brochures to the public.

When the myriad of examples like this are documented, Dr. Poaster claims that critics are "use(ing) single anecdotes out of context and ignore overwhelming facts."  But it is Dr. Poaster who fails to present the big picture.

As part of his claim that MHSA is working well, he points to a report that shows MHSA Full Service Partnerships (FSP) reduced hospitalizations, arrests and incarcerations. Those claims are probably true. It's a good and important program. But he fails to disclose that these programs are exclusively for voluntary patients. The homeless psychotic people on the streets who 'know', they are Jesus or the FBI planted a transmitter in their head--the most severely ill who refuse treatment can not get access to these programs. They are turned over to police and law enforcement in record numbers. As a result of realignment, many may soon to be discharged back into the communities where service providers will again refuse to serve them.

Dr. Poaster correctly notes that 20% of total MHSA funding goes to "Prevention and Early Intervention" programs. The law requires those programs to be "designed to prevent mental illnesses from becoming severe and disabling." But the oversight committee's guidelines to counties say, "(P)revention programs are expected to focus on individuals prior to diagnosis of a mental illness. (emphasis in original)". 20% of MHSA funds meant to help people with mental illness are now being diverted from their proper destination. The mentally ill are specifically excluded.  Dr. Poaster claims these programs are effective but MHSOAC minutes show their evaluation "is based on what counties said they were going to do, rather than actual on-the-ground assessment."

In defense of the status-quo, the Oversight Commission chair claims that counties, not the committee set priorities and that millions were spent on a process that included "the diverse segments that are affected by mental health: schools, law enforcement, homeless programs, social services, faith communities and countless others." Prop 63 was not passed to improve mental health (make people happier) it was passed to  reduce the long-term adverse impact... resulting from untreated serious mental illness." Including these 'countless others' led to a money grab free-for-all and counties developing amorphous something-for-everyone plans that focused primarily on 'social services'   rather than treatment and services for those with severe mental illness. Lack of housing, education and employment were defined as 'risk factors' for poor mental health, and therefore housing, education and employment programs were showered with money that should have been spent helping people with severe mental illness. Except in the case of Nevada County (and more recently Los Angeles county) none of the county plans included implementation of Laura's Law, and making services available to those enrolled. Services for Laura's Law recipients is the exact type of "new and innovative" services MHSA should be funding.

Millions continue to be spent on process, committees, consultants, PR firms, publishers, art directors, and writers instead of programs for people with severe mental illness. Orange County just published an expensive glowing report on their use of MHSA funds, but no useful financial data that would help the public see where the money was going. And the report was fifty pages long.

As Rusty Selix, executive director of the California Council of Community Mental Health Agencies stated in reviewing where we are "In many ways, conditions are horrendous and difficult, but we're kind of used to that."

As the family member of someone with severe mental illness, I am not used to that. The problems with MHSA are not 'isolated incidents'.

What's the answer?
1. The legislature should require distributors of MHSA funding to follow the language and clear intent of the law and only distribute MHSA funds to programs that focus on "severe mental illness." They can accomplish that by adopting the National Institute of Mental Health's definition of 'serious mental illness', which covers no more than 8% of the population and require all or the majority of MHSA funding to be spent on this targeted population. By using this definition, California can avoid the wrangling that would result from trying to create it's own definition.
2. The state should use its "clarification" power under Section 18 of MHSA to eliminate regulations that are contrary to law and direct desperately needed MHSA funds towards uses consistent with MHSA.
3. Rose King, a veteran California political consultant who was involved in writing MHSA legislation makes a good case for the legislature to reexamine the maintenance of effort provision, which created a two-tier system: those with serious illness who received minimal and substandard services prior to MHSA are now routinely and intentionally denied any MHSA funded services, while those who are barely ill, or not ill, get comprehensive services.
4. Carla Jacobs of the Treatment Advocacy Center says the legislature should remove the sunset provision from Laura's Law because it discourages counties from making the long-term plans needed to correctly implement it. Once Laura's Law is implemented, MHSA funds could be used to serve those enrolled in Laura's Law in programs already serving others.
5.  MHSA boards should be independent of the organizations they fund. End the conflict of interest cause by board members, employees, former board members and former employees of MHSA recipients serving on the oversight committees.

 The critics of MHSA do not have an MHSA-funded PR firm on their side. But they do have the facts.

Monday, January 30, 2012

Problems at NYS CQC and P&A Programs

The NYS Commission on Quality of Care (CQC) is supposed to be an outside monitor of the quality of care received by people with mental illness in New York State. They accomplish some of their work through administering the Protection and Advocacy Program (P&A). Following is our testimony to be given at hearings on Feb. 2

CQC has failed to act on the most important issues.
They focus exclusively on quality of care and ignore lack of care

P&A has focused on preventing care and illegal lobbying


NYS is Short 4,311 psychiatric Hospital Beds needed to treat the Most Seriously Ill– NYS has 5% of the beds it had in 1955. 5,269 private and public beds are available, but at minium 9,580 are needed meaning there is a shortage or 4,311 beds. In addition, many of the 5,296 are for sexually violent predators and patients involuntarily committed meaning even fewer available for people who need it. In spite of this massive unmet need of beds for people with serious mental illness, the NYS Office of Mental Health continues closing beds and CQC and P&A do nothing.

4,000 Seriously Mentally Ill NYers are Incarcerated Because OMH Refused to Treat them. In NYS you are more likely to be incarcerated for mental illness than hospitalized. Riker's Island is state's largest psych hospital. Marcy State Psychiatric Hospital was turned into a jail with some of same people in it. Of 92K NYS prisoners, 15% (14K) are mentally ill. But there are only 12K patients in all hospitals. While OMH transfers mentally ill to prisons and jails, CQC does nothing.

Number of Homeless Mentally Ill skyrocketing: 38 percent of discharges from a NYS hospital had “no known address” six months later. 96.6 percent of homeless going to Bellevue for treatment had a previous psychiatric hospitalization. CQC does nothing about the skyrocketing homelessness among mentally ill

$665 million of OMH budget (1/3) wasted per Dr. Llloyd Sederer: “Thus, taken together, $665...was spent, perhaps unnecessarily, on people with mental disorders, principally for the serious medical illnesses that they frequently suffer.” In spite of this waste, the NYS CQC and P&A Program do nothing.

NYS Office of Mental Health ignores most seriously ill. OMH serves 650,000. Only 3,600 are seriously mentally ill individuals in state hospitals and 1,871 are in assisted outpatient treatment programs. Maybe 100K are in other programs that help seriously mentally ill. Due to mission-creep, the majority of people OMH serves are not the seriously ill. OMH policies transfer the seriously ill to shelters, prisons, jails and morgues. CQC and P&A do nothing. They acquiesces to the mission-creep and OMH that puts the seriously ill at danger.

OMH impeding execution of Kendra’s Law OMH tells hospitals wanting to enroll patients in Kendra’s Law that there is a long wait for beds, thereby giving hospitals an incentive to release patients without needed treatment. OMH funds the organizations that oppose AOT, opposes making AOT permanent. CQC and P&A support the opposition to the program that has reduced hospitalization, arrest, incarceration, suicides and homelessness among mentally ill.

No oversight of PAIMINYS P&A Programs are have taken on legally impermissible responsibilities, have violated congressional mandates against lobbying and have sometimes even lobbied against laws that would benefit mental health consumers. Ex.NYSLPI lobbied against Kendra’s Law, used P&A funds to create a false report alleging racism which forced OMH to have an independent report done which found their report false. P&A has brought suits to make it more difficult for docs to get medical records, and has engaged in other prohibited anti-treatment activities. CQC renews their contracts year after year.

Failure to investigate systemic failures OMH refuses to correct. Andrea Peyser did an article on how Steve Muccio at P.E.O.P.L.E. was being paid to act as a representative payee for a client to ensure the client did not go off medications and on illegal drugs. At a conference attended by NYS OMH Commissioner Michael Hogan, Mr. Muccio bragged that he gave the client all the money so the client could buy drugs. When this was brought to CQC attention, they referred it to Commissioner Hogan who never responded


Change Law so CQC reports to Legislature not Governor.
There is a conflict of interest when the agency charged with monitoring OMH reports to the person responsible for hiring the commissioner.

CQC should focus on the most seriously ill and issues important to them
CQC focuses on those treated by OMH. But most seriously mentally ill are refused treatment by OMH and get it in shelters, jails and prisons, so CQC should focus on seriously ill independently of whether or not OMH does.

Change law so CQC focuses on lack of care, not just the quality of care delivered by mental health department
Most people with serious mental illness do not receive treatment from OMH. OMH through unbenign neglect, transfers them to shelters, prisons, jails and morgues.

Reform P&A
1. Audit to see if they are engaged in prohibited lobbying activities, end contracts with those that are, and prohibit them from bidding again.
2. Open the contracts to public bidding so NAMI and other groups concerned about treatment delivery can compete for the funds

Propose Eliminating OMH and Merging it with DOH
Putting OMH within DOH will help eliminate the $665 million Sederer says is wasted and could help end mission creep and refocus the department on the most seriously ill. This could be done in concert with the SAGE Commission

Propose OMH use the NIMH Definition of Serious Mental Illness and focus efforts on this population.
To end mission-creep, OMH should be forced to focus at least 80% of its expenditures on those with the most severe mental illnesses. By using the existing NIMH definition, we could eliminate the politics of coming up with their own definition.

Focus on what is happening to the most seriously ill (incarceration, homelessness) rather than the quality of care OMH delivers to the few seriously ill they treat

Investigate impediments to Laura’s Law put in place by OMH

Highlight the dearth of psychiatric hospital beds for the most seriously ill.

Additional Reading. This is a fantastic law journal article on how the Protection and Advocacy Program inhibits people with serious mental illness from receiving care.

Sunday, January 22, 2012

SAMHSA Ignores 500,000 Seriously Mentally Ill

The Substance Abuse and Mental Health Agency's most recent and widely-quoted report on the prevalence of 'any' mental illness and 'serious' mental illness in America failed to count the 300,000 individuals with serious mental illness in jails and prisons, the 200,00 who are homeless and the 51,000 mentally ill who are in hospitals. Excluding these individuals led SAMHSA to understate the incidence of serious mental illness and overstate the percentage who receive treatment.

The new report acknowledges in the introduction and methodology sections that they ignored the incarcerated, institutionalized and homeless, but did not do so in their press release which is what most media apparently worked off of. Excluding these populations led to understating the number with serious mental illness, and since the chances of homeless or incarcerated receiving good treatment is next to nil, also understating the percentage who receive treatment.

SAMHSA has come under increasing criticism for their failure to focus on serious mental illness. A recent article by leading researcher Dr. E. Fuller Torrey in National Review, is but the latest example. I have written on SAMHSA waste of taxpayer dollars for DC Insider, a whistleblower group and Washington Times. Those articles highlight the mission-creep, waste, and counterproductivities at SAMHSA and suggest eliminating it would save money for taxpayers and improve care for people with serious mental illness. Worthwhile programs within SAMHSA (and they do exist) could be transferred to the Center for Disease Control (CDC), National Institute of Mental Health (NIMH), National Institute on Drug Abuse (NIDA) and other organizations that are much more effective, efficient, and focused than SAMHSA.

Friday, January 20, 2012

Allegedly Knife-Wielding Mentally Ill Roscoe Cambridge Shot By Anaheim Police

According to the Orange County Register, on Thursday, Anaheim police shot and killed Roscoe Cambridge, who was wielding a knife. Like Kelly Thomas, who also died in police custody, he was apparently mentally ill. Tracy Bowden, his cousin's wife posted on the "Justice for Kelly Thomas" Facebook page that her family " feared that Roscoe could be a victim of the police, because of his schizophrenia." "Justice for Kelly Thomas" is a group formed in memory of Kelly Thomas who is also alleged to have suffered from untreated schizophrenia before he was shot by police in Fullerton, CA. Roscoe Cambridge's Family started their own Facebook Group

The Facebook posting went on to say

Families and advocates for the mentally ill have argued that Orange County needs to adopt Laura's Law to prevent incidents like this, but Orange County supervisors have failed to act, many believe because the Orange County Behavioral Health Care Department gave the supervisors highly misleading information about the law. Carla Jacobs of the California Treatment Advocacy Coalition is leading families of people with mental illness who want Laura's Law adopted. According to her, Laura's Law would allow courts to require a very narrowly defined group of seriously mentally ill individuals (only those with a past history of violence or multiple arrests or hospitalizations) to stay in treatment while in the community. It is not known if Mr. Cambridge would meet the criteria, but the family of Kelly Thomas has stated Kelly would have. Likewise the father of Aaron Bassler says his son also had untreated schizophrenia before he shot several people in Mendocino, CA and was himself killed by police. James Bassler believes his son Aaron would have met the criteria. The father of Kelly Thomas and the father of Aron Bassler have both become proponents of Laura's Law because they believe it would have helped their children live safely in the community.

Background Docs:
New Survey of CA Law Enforcement Officers shows they are overwhelmed caring for seriously mentally ill who are abandoned by Mental Health Officials.
Mental Health Services Act can be used to fund Laura's Law
Orange County Health Care Agency Misleads Supervisors on Laura's Law
Laura's Law Orange County Homepage

Should Parent Guardians of Mentally Ill Be Allowed To Mandate Abortion

I recently came across one of the most confounding 'cases' I have come across, even if one takes away the fact that it centers around abortion. What do you think:

BOSTON (AP) — A Massachusetts court on Tuesday overturned a ruling by a judge who ordered a mentally ill woman to undergo an abortion against her wishes and be sterilized.
The Massachusetts Appeals Court said the woman, who has schizophrenia and bipolar disorder, had described herself as "very Catholic" and made it clear she did not want an abortion.
The ruling reverses a decision by Family and Probate Court Judge Christina Harms, who found that the 32-year-old woman was not competent to decide whether to get an abortion.
Harms found the woman would choose to end her pregnancy if she were competent and agreed to appoint her parents as guardians "for the purpose of consenting to the extraordinary procedures of abortion and sterilization," the Appeals Court said.
The judge reasoned that if Moe were competent, she would opt for an abortion to benefit from medication that otherwise could not be given to her because of its effects on the fetus.
The Appeals Court said the judge also directed the clinic to sterilize the woman at the same time "to avoid this painful situation from recurring in the future."
The Appeals Court reversed the order, saying no one had requested it and the judge "appears to have simply produced the requirement out of thin air." The judges sent the case back to the lower court.