Monday, April 30, 2012

Three Reasons I Won't Celebrate Mental Illness Awareness Week

1. MIAW is based on the false premise that there is stigma to having a mental illness.

This first full week in Week in May is being celebrated as Mental Illness Awareness Week. In celebration, well meaning mental health advocacy organizations are busy hosting events to reduce the “stigma” of mental illness. But there is no ‘stigma’ to having a mental illness. Serious mental illnesses, like schizophrenia, are real biologically based disorders that are no ones fault. Serious mental illness or ('consuming mental health services') is not, “a mark of shame or discredit”, or “a mark or token of infamy or disgrace”.

It used to be said there was stigma to being “black”, “gay”, “short”, ”tall”, “lefty”, “righty”, inny, outy or having cancer.

But over time all these groups found a cure: they simply decided that there was no stigma to having being gay, lesbian or lefty or having cancer. It was not, as some claimed, a "mark of shame" or "token of disgrace."

They killed stigma and recognized that what they were really suffering was discrimination. It’s time for mental health advocates to do the same. Fight discrimination (what others do to you) and stop running ads about how you feel about yourself (suffer stigma).

2. MIAW diverts attention away from those who are most seriously ill

The second reason I won’t celebrate MIAW is that it diverts attention away from the most seriously ill. The anti-stigma campaigns are premised on the belief that the key to reducing ‘stigma’ is to convince the public that “the mentally ill are just like you and me” and “with proper supports can recover and become productive members of society”. Hence, only the high functioning and happy appear in the promotional materials and PSAs. They focus on the 40% who may during their life have a mental “health” issue.

The efforts focus on mental “health”, not mental “illness”.

But what about the three percent to five percent of Americans who are the most seriously mentally ill -- like those suffering from untreated schizophrenia or treatment-resistant bipolar disorder? And what about the homeless psychotic, eating out of garbage cans, sleeping in cardboard homes, and living with festering wounds under layer after layer of filthy clothes because they have a mental illness than makes them unable to help themselves? You won’t find them in the Mental Illness Awareness Week PSAs.

Trying to gain sympathy and resources for serious mental illness, by only displaying the highest functioning individuals, is like trying to end hunger by showing the well-fed. And new research shows it doesn't work. There is no less 'stigma' today than when these efforts started.

Try this test. Google "mental illness" and Google "mental health". Look how many results are returned.

Hardly anyone is still fighting for people with serious mental illness. In fact, it is no longer even considered politically correct to use the term "mental illness". One must say "mental health". You are not allowed to say "patients", you are supposed to say "consumers" as in "consumers of mental health services."

The homeless people we see under twelve layers of smelly lice-infected clothing talking to themselves, fearing their hallucinations as they forage through garbage cans looking for food are not "consumers". They should be patients, but no one wants them.

MIAW is premised on the false belief that the major problem we face is that people won’t self-identify.

That is small potatoes and possibly true for those with mental “health” isssues, but it is not true for those with serious mental illnesses.

People with serious mental illness almost always self-identify. They do it through their psychotic ramblings, delusional explanations, ritualistic behaviors. It is not hard to identify people with serious mental illness, it is hard to get them treatment.

In 1955 there were 340 public psychiatric beds available per 100,000 U.S. citizens. By 2005, the number plummeted to a staggering 17 beds per 100,000 persons.

If someone is so ill they don’t know they are mentally ill, current law requires them to become ‘danger to self or others’. Rather than prevent violence, the law requires it.

While services are available to a wider swath of people with “mental health” issues as we medicalize normality, services are rarely available for the most seriously ill.

By spreading the false meme that the problem is identification, rather than the provisioning of services for the most seriously ill, Mental Illness Awareness Week celebrants—as well intentioned as they may be—do the seriously ill great harm.

Wednesday, April 25, 2012

Laura's Law could save California's mentally ill and keep public safer

The murder of 61-year-old Earlene Grove by her mentally ill daughter Sunni Jackson, in Paso Robles, San Luis Obispo most likely wouldn’t have happened if the San Luis Obispo Board of Supervisors had implemented Laura’s Law.

Laura’s Law allows courts to order certain individuals with serious mental illness – like Sunni, those who have a history of non-compliance with psychiatric treatmen and a history of violence – to stay in treatment as a condition of living in the community. They get full due process and the right to help develop their own treatment plan.

Laura’s Law helps patients and keeps the public and police safer. When Nevada County implemented Laura’s Law it found it reduced incarceration of people with mental illness by 65 percent. It reduced hospitalization, 46 percent; cut homelessness 61 percent, and emergency contacts 44 percent. That’s why it is supported by organizations as diverse as the California State Sheriff’s Association, California Psychiatric Association, and San Luis Obispo Alliance on Mental Illness.

The supervisors can’t claim they didn’t know Laura’s Law saves lives. In 2010, when mentally ill Cliff Detty died in restraints at a mental health facility that he wouldn’t have been in had he received community treatment, his father told reporters Laura’s Law would have saved his life. Op-eds by experts said the same thing.

In 2011, after mentally ill Andrew Downs was committed to a hospital for the Christmas Day shooting of two women, Diane O’Neil, the past president of a local National Alliance on Mental Illness chapter wrote an op-ed on behalf of parents of the mentally ill explaining how Laura’s Law would have prevented the tragedy. It goes on and on. The supervisors don’t have to wait for the next death to act. But they probably will.

The supervisors can’t claim there is no money to implement it for two reasons. First, Laura’s Law saves money. Nevada County found it saved $1.81 to $2.52 for every dollar invested. Los Angeles County estimated it saved taxpayers 40 percent for the care of each person enrolled. The savings come from reduced hospitalization, arrest, trial and incarcerations.

The second reason is that San Luis Obispo County receives well over $2 million annually in Proposition 63/Mental Health Service Act proceeds they are supposed to use to help the most seriously ill get treatment. But rather than use it provide services to people with serious mental illness and implement Laura’s Law, the Mental Health Services Agency used a chunk of it to fund a documentary on “stigma” to put on a website and then congratulated themselves for doing it.

Is that why Californians voted to tax themselves with Proposition 63? They didn’t feel there were enough documentaries on websites? And think about it. Will a documentary on a website saying there should be no stigma ever be enough to overcome the stigma caused this past week by letting mentally ill Sunni Jackson go untreated and ultimately commit matricide?

As the Surgeon General’s report on mental illness pointed out, it is fear of violence by people with untreated serious mental illness that causes stigma. If San Luis Obispo wants to reduce stigma, implement Laura’s Law.

What the supervisors will most likely claim is that a recommendation didn’t come from the mental health department. They don’t have to wait for one. They can lead. Few mental health departments want to implement programs that require them to focus on the most seriously mentally ill as opposed to the worried well. Don’t wait. Act.

The county Mental Health Services Agency may tell the Supervisors that MHSA proceeds can’t be used for Laura’s Law, echoing opponents of the law. But as California mental health advocate Mary Ann Bernard notes, the now extinct State Department of Mental Health issued a regulation saying they can. As Carla Jacobs of the California Treatment Advocacy Coalition points out, “Nevada County uses their MHSA funds for Laura’s Law. Los Angeles County uses their MHSA funds for Laura’s Law. Why can’t San Luis Obispo County?”
Ed. Note: DJ Jaffe is the executive director of Mental Illness Policy.

Wednesday, April 18, 2012

Assemblyman Felix Ortiz puts police, public and mentally ill at risk

A version of this appeared in NY Daily News on April 18.

Yesterday, the mother of Terrence Hale called New York’s Finest about her mentally ill son who was off medicine and acting out. When Officer Eder Loor arrived to help, Mr. Hale stabbed him. Earlier this month, Easter Sunday, Benedy Abreu’s mother called police about her mentally ill son, who was also off medications and barricaded in the apartment. When officers William Fair and Phillip White of the 50th precinct knocked on the door, Mr. Abreu opened it and lunged at them with a knife stabbing both.

Why are so many people with serious mental illness being allowed to deteriorate and become violent, putting themselves and public at risk? Why has the mental health system turned over care of the mentally ill to the police making their already dangerous job, even more dangerous?

Who’s to blame? I nominate Felix Ortiz, Chairman of the New York State Assembly Mental Health Committee. Back in 1999, at the request of families of people with serious mental illness, New York State politicians came together and passed Kendra’s Law, named after Kendra Webdale who was pushed to her death in front of a train by a young man with schizophrenia who the mental health system also allowed to go untreated.

Kendra’s Law allows courts to do two things. They can order very seriously mentally ill patients who have a history of violence or incarceration to accept violence preventing treatment as a condition of living in the community. This keeps them healthier and happier. Perhaps more importantly, courts can also involuntarily commit the recalcitrant mental health system to provide the treatment to these seriously mentally ill people, something they are notoriously reluctant to do.

It’s been a huge success. By requiring certain seriously mentally ill people to stay in treatment—with full due process protections, Kendra’s Law reduced arrest, dangerous behavior, violence, incarceration, homelessness and suicide. It saved money and improved the quality of life for those living with serious mental illness. It keeps the public and the police safer.

So what’s the problem? Kendra’s Law is rarely used. Less than 2,000 seriously mentally ill people are in Kendra’s Law because the mental health system refuses to ask courts to use it. Terrence Hale was never on it and Benedy Abreu was on it, but allowed to go off. As a result, neither was on the medicines that could have prevented the horrors experienced by the officers, and preserved their own ability to live unincarcerated.

To fix this problem, two years ago Assembly member Ailleen Gunther and Senator Catherine Young introduced a bill (A6987/S4881) that would require officials to investigate claims of family members, like the parents of Mr. Abreu and Mr. Hill instead of sending them to the police. It would require jails to notify mental health officials when releasing a prisoner who was on psychiatric medications while incarcerated so the officials can determine if they should be in Kendra’s Law. That might have helped prevent Mr. Hale from stabbing Officer Loor yesterday as Mr. Hale had a rap sheet. Another provision requires hospitals to notify mental health officials when someone who was involuntarily committed-- already been determined to be 'danger to self or others-- is being released. Again: that allows mental health officials to see if they need mandatory treatment in community. The bill would also require that mental health officials to review expiring court orders to see if they should be renewed. That might have kept Benedy Abreu in treatment and prevented Officers White and Fair from being stabbed.

Makes sense? Of course it does. That’s why it’s endorsed by the Alliance on Mental Illness of New York State, made up of parents of people with mental illness who want better treatment for their loved ones, and the New York State Association of Chiefs of Police, who want to keep the public and officers safer.

But Assemblyman Felix Ortiz Chair of the Mental Health Committee, for the second year in a row is refusing to bring the bill up, pass it, and refer it to the legislature so it can become law. He can be reached at 718-492-6334 or 518-455-3821.