Monday, June 24, 2013

Anti Stigma Effort Fortunately Fails in New York State

We are happy to report that the effort to get a donation check-off put on NYS Tax forms (A5953) to encourage people to make a donation to 'stigma' did not pass and the legislative season is over.

We would support a bill to encourage donations to support services to people with serious mental illness, but opposed a check off that limits the support to fighting stigma. (By the way, we don't believe stigma exists).

According Skale's Rule: 

The role of stigma in inhibiting care (if any) is inversely related to the severity of illness. Stigma may possibly inhibit some high functioning individuals from accessing care, but stigma is not why homeless psychotic people can't access care. 

Tuesday, June 18, 2013

Darrell Steinberg's CA Bill Dangerous to Families of Mentally ill, Mentally Ill, and Public

Imagine if someone who wanted to call 911 to report a crime in progress had to give their name and know that it would be provided to the criminal directly? Either 911 calls would be cut down or the caller would have to agree to place himself at potentially huge risk. California Senate Leader Pro Temp Darrell Steinberg is pushing a bill that just does that if the caller is a family member of someone with serious mental illness who wants to report they are becoming dangerous.

Steinberg's SB 364  requires the identity of families who call police alleging someone needs involuntary commitment to be provided to the person with mental illness along with their reasoning if that information was used to determine whether there was probable cause to take someone in for evaluation(1). This disclosure happens even if the police officer makes his/her own determination the person is danger to self or others. The disclosure applies to the families, but Steinberg--perhaps understanding the risk caused by his bill--exempted mental health professionals from having their names disclosed.

Steinberg's bill could cause retribution, when a seriously mentally ill person discovers it was the parents who asked doctors to evaluate the loved one for involuntary commitment. At minimum, it increases the potential for hostility and damages the familial relationship. If, for example a son knows his mom is the one who called police and said he is mentally ill and becoming dangerous, the son may attack the mom when released or could decide he doesn't want to live with mom, become homeless, deteriorate...and then who knows what could happen?

  •  Steinberg's bill makes it less likely that parents will call for help for their seriously ill kid. This is the exact opposite of what everyone is saying should be done for persons with mentall illness: get them help earlier. Again: this puts patients and public at risk.
  • According to the Treatment Advocacy Center, releasing the name of a citizen informant to a patient who may be in need of involuntary care is in direct conflict with other provisions of code and violates professional ethical standards regarding not releasing records that could be harmful. They state this sort of disclosure is unprecedented in any other state’s mental health law and or other civil or criminal procedures.  
  • Steinberg's language significantly increases potential for further deterioration of an individual’s psychiatric condition by postponing or eliminating intervention. 

 This bill which harms people with mental illness was almost certainly drafted by Disability Rights California (DRC) (mis)using MHSA funds intended to help people with mental illness. Eduardo Vega, a board member of DRC was able to use his recently expired position as an MHSA Oversight Commission Director to funnel $3 million in MHSA funds to DRC, ostensibly to identify laws that 'cause stigma'. It is a barely disguised misuse of MHSA funds by DRC to ensure that certain seriously mentally ill individuals are not allowed to be treated until after they become 'danger to self or others'.

Other problematic provisions of the bill:

It changes the legislative intent of 5150 in order to provide a basis for future challenges
It removes the obligation to provide treatment for someone who is dangerous in a hospital
It allows counties to dumb down the qualifications of individuals providing care for persons with serious mental illness
It holds family members libel, but exempts mental health workers from liability if they provide false information

Send your letter to the Assembly Committee on Health expressing your opposition to SB 364. If you are affiliated with an organization be sure to include that information in your letter.
Letters can be addressed to Chair Pan and emailed to  or mailed or faxed to: 
Assembly Committee on Health
Assembly Member Richard Pan, Chair
P.O. Box 942849
Sacramento, CA 94249-0009
Fax: (916) 319-2109 

For more information: 
Serious mental illness and Laura's Law in California
Mental Health Services Act (MHSA) Waste and Fraud in California
Policy Information on Serious Mental Illness
Serious Mental Illness, NYS/OMH, and Kendra's Law in New York

Follow us on Facebook and Twitter @MentalIllPolicy

(1) An earlier version was not clear that the family members identity is disclosed of the officer or crisis intervention team used that information as part of their determination that the person needed evaaluation.

Sunday, June 2, 2013

Obama's Mental Health Conference: Irrelevant at Best and Likely Harmful

President Obama and Vice President Biden are gathering the usual suspects for a mental health conference today focused on 'stigma'. While ostensibly in reaction to tragedies like Newtown, it ignores the elephant in the room:  people with serious mental illnesses.

Obama simply does not understand the difference between poor mental health and serious mental illness and the 'experts' he is relying on are happy to keep it that way. Everyone can have their mental health improved, but only 5-9% have serious mental illnesses. Obama keeps focusing on the former and ignoring the later.  Yet it is people with serious mental illness who are responsible for headline grabbing horrific acts of psychotic-feuled violence. It is people with serious mental illnesses, not low self-esteem who have increased incidence of homelessness, suicide, arrest, incarceration, and hospitalization.  It is people with serious mental illness who as a kind and compassionate society we should be helping.

After his last mental health conference in April, mental 'health' advocates convinced Obama to spend $140 million more to identify people with mental illness. As we wrote after that conference
Jared Loughner, who shot Gabrielle Giffords; James Holmes, who shot up a movie theater in Aurora, Colo.; John Hinckley Jr., who shot President Reagan; Aaron Bassler, who shot a former mayor of Fort Bragg, Calif.; Ted Kaczynski, the Unabomber, who mailed explosive packages around the country; Ian Stawicki, who shot five others and then himself in Seattle; Eduardo Sencion, who shot five National Guardsmen at a Nevada IHOP restaurant; Russell Weston, who shot two guards at the U.S. Capitol building; and Adam Lanza, who shot his mother, 26 others, and himself in Newtown, Conn. -- all were known to be ill before they became headlines. The problem wasn't lack of identification. It was lack of treatment.
If Obama wants to get serious about serious mental illness, he should invite criminal justice experts to the White House. The mental health system 'treats' the worried well and off loads the seriously ill to shelters, jails prisons and morgues.  There are now three times as many mentally ill incarcerated as hospitalized. Police, sheriffs, district attorneys, correction officers, parole officers, and forensic hospital workers  go where the mental health system won't: to the aide of people with serious mental illness. No sane mental illness policy can be contemplated without their perspective.

There are five steps President Obama can take to help people with serious mental illness, keep patients and public safer, and save money. They will not likely be discussed at today's conference because he has only included mental 'health', not mental illness experts in the dialogue.

  1. Fund Assisted Outpatient Treatment (AOT) laws so rather than requiring people with serious mental illness to become "danger to self or others" , we can prevent people from becoming danger to self or others. 
  2. Change HIPPA privacy laws so parents of seriously mentally ill individuals can get the information they need to help their loved ones get care.
  3. End federally sanctioned Medicaid discrimination against the seriously mentally ill incorporated in the "IMD Exclusion". It allows the federal government to refuse to reimburse for inpatient hospital care for persons with serious mental illness. While Obama is correctly adamant that private insurers end discrimination against the mentally ill, he has been silent on federal discrimination. 
  4. Send those with serious mental illness to the front of the line for services rather than the back as is current practice.
  5. Eliminate SAMHSA (the Substance Abuse and Mental Health Administration) which is funding nationwide activities designed to prevent the most seriously ill from receiving treatment. Any useful programs can be transferred to NIMH, CDC, and other agencies with better focus.

When I campaigned for Obama he promised to "listen to good ideas no matter where they come from." So he should listen to Representative Tim Murphy (R-PA), a former psychologist. He has done a brilliant job in Energy and Commerce subcommittee hearings of looking at what real solutions might be to prevent the arrest, incarceration, violence, suicide, homelessness, and hospitalization of the most seriously ill. As a Democrat who volunteered for Obama, I don't like admitting the best expert is a Republican, but I care about people with serious mental illness more than political persuasion.

I believe Obama wants to help. But if the definition of insanity is trying the same thing over and over and expecting different results, then Obama qualifies. He should reach out to those who want to change the status quo, not those invested in maintaining it.