June Update: Mental Illness Around the Country

1. Make Greater Use of Assisted Outpatient Treatment

• Assisted Outpatient Treatment is less expensive, less restrictive, and more humane than it’s alternative: inpatient commitment or incarceration.
• AZ: He met his case manager on Monday and was dead by Friday, showing the need for AOT.
• NY: As the result of police stabbings by people with mental illness, the bill to close cracks in NY’s Kendra’s Law (A6987/S4881) gathered new attention. The bill sponsors wrote an op-ed in the NY Post on how their legislation would require mental health authorities to evaluate mentally ill prisoners and involuntarily committed psychiatric patients before they are discharged from prisons and hospitals to see if they need Kendra’s Law or other treatment to stay healthy and safe. Research shows it works. It is supported by virtually everyone (public, patients in the program, families, and law enforcement). The only opposition is from the mental health system itself, which simply does not want responsibility for the most seriously ill when they can offload them to shelters, jails, prisons and morgues. Thanks to Mental Illness Policy Org., op-eds and editorials have appeared in Albany Times Union, NY Post, NY Daily News, Staten Island Advance, Buffalo News, Ithaca Journal, Schenectady Gazette, NY News, and elsewhere. We identified 90 tragedies that might have been prevented had the cracks in Kendra’s Law been closed in 2005 when first identified. Call Assembly speaker Sheldon Silver at 518-455-3791 and Governor Cuomo at: (518) 474-8390. Urge them to Pass the Kendra's Law Improvement Act (A 6987) to Close the Cracks In Kendra's Law
• CA:    Laura’s Law has had tremendous results in California, but a powerful anti-treatment coalition is preventing widespread adoption of the law. The Fullerton Homeless Task Force recommended Orange County adopt Laura’s Law. Laura’s Law is up for renewal and the California LPS Reform Task Force is urging supporters to send letters in support of Laura’s Law  to the Senate Health Committee c/o State Capitol, Room 2191; and to the Assembly Health Committee in Room 6005, Sacramento, CA, 95814.  Articles and op-eds on the importance of Laura’s Law appeared in San Luis Obispo,
• NJ put out a contract to start Gregory’s Law
• TN passed a pilot AOT program
• Bexar County, TX is considering starting an AOT Pilot and a jail In San Angelo is trying to send mentally ill back to the mental health system

2. Focus more resources on serious mental “illness” rather than mental “health”

• National:  Articles by Marvin Ross in Canada, Dr. E. Fuller Torrey in Washington, Carlat Psychiatry Blog, and MIPO, all criticized Robert Whitaker’s, Anatomy of an Epidemic for using pseudo science to make the case that medicines don’t help people with mental illness. Natasha Tracy wrote “Why it’s ignorant to write off psychiatry” And the Lancet published a meta analysis that shows Whitaker is wrong. Meds do work
• Are we arbitrarily diagnosing people with mental health problems? Asks Pete Earley.
• AZ may see more mental health resources invested in the community as a result of a recent lawsuit settlement
• NH: We criticized New Hampshire officials for patting themselves on the back when there are more mentally ill incarcerated than hospitalized in that state.
• NY As incredible as it sounds, NYAPRS, a trade association of mental health providers in NYS actually started lobbying for less medical treatment for people with serious mental illness.
• WA: A seriously mentally ill man who was without treatment shot 5 in Seattle and then himself.
• California is unique in that it has plenty of money as a result of Proposition 63 which funded the mental health services act which is supposed to help people with serious mental illness. Unfortunately county and state officials continue to squander the money.

3. Preserve enough hospital beds so seriously ill can get access

• Bloomberg News ran a terrific piece picked up in Business Week and elsewhere suggesting that we have gone too far in cutting hospital beds for seriously mentally ill. And Dr. Stephen Moffic criticizes the American Psychiatric Association for failure to focus on inpatient crisis.
• CA mentally ill languish in jail due to budget cuts.
• GA sheriff argues to keep mentally ill out of jail

 

4. Change Not Guilty By Reason Of Insanity So it Helps People

• Legal argument why people with mental illness should be exempt from death penalty
• Not guilty by Reason of Insanity is likely to get more attention as the alleged killer of Etan Patz may plead mental illness.
• TX has a grizzly plan to medicate someone so they can execute him

5. Reform Involuntary Treatment Laws so they prevent violence, rather than require it

• CA: The LPS Reform Task Force issued their latest report. Sign up for their emails.

In Brief

 

• 3 Reasons I didn’t celebrate Mental Health Awareness Month
• Dr. E. Fuller Torrey on how to reduce stigma
• Peer Support can hurt people with mental illness
• In 2008, Vince Li, who has schizophrenia and rejected treatment beheaded someone on a Greyhound Bus. In this jailhouse interview he says he wishes someone would have forced him to stay in treatment.
• Stigma campaigns may decrease chance mentally ill get treatment
• Saying Goodbye to someone with mental illness: When not to help

California Bill To Extend Laura's Law Scheduled For Vote

ALERT FROM CALIFORNIA TREATMENT ADVOCACY COALITION
FROM: Carla Jacobs, Randall Hagar, Chuck Sosebee & Mark Gale
May 22, 2012

We need your help now! AB 1569, a bill to extend Laura's Law, will be heard in the Senate Committee on Health June 13 at 1:30 p.m. at the state capitol, Room 4203. Please reach out to the committee and your senators and urge them to support the bill.

(Laura's Law allows courts to order a narrowly defined group of seriously ill individuals to stay in treatment as a condition of living in the community. It also allows courts to order the mental health system to provide the treatment.)

Send or direct letters of support to Senator Ed Hernandez, chair of the Senate Committee on Health and to Senator Tom Harman, vice chair. Let them know that Laura's Law saves money - and lives. Contact information is below:

Senator Ed Hernandez, chair (Senate district 24)
Fax: (916) 445-0485
Mailing address: State Capitol, Room 4085, Sacramento, CA 95814-4900
Phone: (916) 651-4024
Email: senator.hernandez@senate.ca.gov

Senator Tom Harman, vice chair (district AD 73)
Fax: (916) 319-2173
Mailing address: State Capitol, Room 5094, Sacramento, CA 95814-4900
Phone: (916) 651-4035
Email: senator.harman@senate.ca.gov

Mail and Fax are Preferred to Email.
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Visit http://treatmentadvocacycenter.org/lauras-law or http://lauras-law.org/ to learn more.

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.

California Mental Health Services Act Fails to Focus on Serious Mental Illness

The chair of the California 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, the chair of the committee, Dr. Larry Poaster wrote 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 the committee chair's 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 its 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 provisionfrom 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 caused 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.

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.