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

Recent Trends in Mental Illness

Trend: More psychiatric hospitals close. Local NAMIs start to fight back.

The trend towards closing state psychiatric hospitals in spite of a massive psychiatric hospital bed shortage is continuing in states like Massachusetts in Illinois, in Alabama, and Washington and elsewhere. NYS announced massive closures and the NY Daily News ran our op-ed in opposition. And when they tried to close a psychiatric unit at Cedar Sinai in Los Angeles, LA NAMI protested. NAMI E. Flatbush NY protested the closing of Kingsboro Psychiatric Hospital in Brooklyn. Historically, NAMIs have accepted hospital closures in return for the promise of community services that never materialize. Nice to see them not falling for it again. It would be great to see state level organizations join in.

Trend: Criminal Justice Systems are taking lead in advocating for better care for seriously mentally ill because Mental Health Departments are failing so miserably.

As a result of mental health departments taking a laissez faire attitude towards serious mental illness, there are more people incarcerated for mental illness than hospitalized. For example, the shooter of seven at Western Psychiatric Hospital turns out to have been mentally ill, known to mental health system, and left untreated. Incidents like this are causing some law enforcement officials to make getting better treatment for people with mental illness a priority, so they don't have to step in.

• American Police Beat Magazine ran a story we wrote, "Police overwhelmed by Mentally Ill", based on a survey by Police Chief Michael Biasotti.
• An Ohio Sheriff announced he is refusing to allow police to drop people with mental illness who are violent off at his jail. He wants them to get treatment instead. This was fantastic news and the first time we've ever heard something like that. MIPO supported the Sheriff .
• A sheriff in Cook County, IL has threatened to sue the mental health department to stop them from refusing to treat people with serious mental illness.
• The Department of Justice issued Community Policing Guidelines which endorsed AOT as a way to return treatment to mental health departments. Another announcement from DOJ is imminent.

Trend: Consumers buck consumertocracy

More and more consumers are exercising their independence and speaking out. Natasha Tracy, a great consumer blogger wrote, "Human Rights and AOT" and about non-compliance.

My favorite quote this month, was from Consumer Blogger Andrew Behrman in "Dump Stigma and Focus on Recovery" who wrote, "The stigma started with me. I initiated it. It was my own fault & result of my naivete"

The Substance Abuse and Mental Health Services Agency (SAMHSA) conducted a survey asking their largely consumer constituency what the top advances in care were over the last twenty years. Assisted Outpatient Treatment made top five. Unfortunately, SAMHSA has a habit of ignoring issues that only affect people with serious mental illness. As we wrote on Huffington Post, SAMHSA's widely quoted report on Mental Illness in America ignored 500,000 seriously mentally Ill

On the other side some government funded professional consumers ("consumertocracy") are still promoting nonsense.

• One professional consumer wrote that because there is no biological test for schizophrenia, it must not exist. That's kind of like arguing that colon cancer didn't exist before the colonscope was invented. (BTW, there is no biological test for Parkinsons either. Yet it exists.)
• Many professional consumers are using the fact that people with mental illness die earlier than others as an argument against medications. But many of these premature deaths are due to side effects of non-treatment. For example suicide, homelessness, incarceration, and lack of medical care.
• Robert Whitaker's Anatomy of an Epidemic repeated many of these arguments without any information on the other side.

In Brief

• Major study says 'art therapy' does not work for people with schizophrenia
• Scientist asks for proof that anti-stigma campaigns work
• APA Task Force Report on Outpatient Services for the Mentally Ill Involved in the Criminal Justice System argues for preserving psychiatric hospitals and using mandated outpatient treatment
• Short Sweet Video of Dr. E. Fuller Torrey on his updated book: The Insanity Offense, which includes the most comprehensive information on Jared Loughner who suffered from untreated mental illness and shot Gabrielle Giffords. (Must-reading)
• "Crazy in America: The Hidden Tragedy of Our Criminalized Mentally Ill" by Mary Beth Pfeiffer is really wonderful. She shows how tiny episodes of mental illness feuled behavior can snowball and result in permanent incarceration. Two thumbs-up. (Don't confuse this with another excellent book: Pete Earley's, "Crazy: A Father's Search Through America's Mental Health Madness")
• Treatment Advocacy Center Preventable Tragedies database lets you search incidents of violence by and to people with mental illness in your own state. Powerful tool to advocate for changing laws

Around the states

California

Laura's Law and ever increasing incidents of violence by mentally ill individuals took center stage in California. A bill to Extend Laura's Law was introduced and given huge support by San Francisco Chronicle. A brilliant Sacramento Bee op-ed by psychiatrist Gary Tsai says cuts to mental health programs shift burden to law enforcement. To help people keep up, we launched a special site on Laura's Law and the Mental Health Services Act with lots of useful information. Unfortunately mental health directors, Disability Rights California, and consumer groups have formed a coalition designed to prevent people with mental illness from receiving treatment until after they become dangerous. While done in the name of 'civil rights', this results in people becoming incarcerated and losing all rights.

The other big California story is Proposition 63/Mental Health Services Act money being diverted away from serious mental illness. For instance, it is funding the opponents of Laura's Law. Mary Ann Bernard, Of counsel for Mental Illness Policy Org wrote a great piece in California Progress Report on this, and DJ Jaffe, ED of MIPO wrote a a separate story, "Proposition 63 fails to serve seriously mentally ill" in Capital Weekly.

New York

MIPO testifies that NYS Commission on Quality of Care fails mentally ill and we wrote an op-ed in New York Daily News criticizing proposed closings of psychiatric hospitals.

VA

Pete Earley on failure of Virginia mental health system

TX

Judge rules mentally ill incompetent to stand trial are being held in jail for too long before being moved to hospital

VT

Report calls for better care to prevent incarceration of mentally ill

MA

MA agrees to treat mentally ill prisoners better and revised their Civil Commitment practices.

Thank you for your support of Mental Illness Policy Org. This is a labor of love, and if you can afford it, we can use your tax-deductible donations.

 

Closing New York State Psychiatric Hospitals is Cruel & Dangerous

Michael Hogan, Commissioner of the New York State Office of Mental Health recently announced the proposed closure of Kingsboro Psychiatric Hospital in Brooklyn and others. This is the latest step by the New York State Office of Mental Health (OMH) to get out of the business of providing treatment to people with serious mental illness. In the last twelve months, OMH announced they are "reducing census"--i.e., kicking the mentally ill out of--Bronx, Mohawk Valley and Sagmore Psychiatric Center.These came on top of previously announced closings at Rockland Psychiatric Center, Pilgrim Psychiatric Center, Mid-Hudson Forensic Psychiatric Center, Hudson River Psychiatric Center, and Buffalo Psychiatric Center. Unions and families of people with serious mental illness are mad.

New York State Office of Mental Health Commissioner Michael Hogan and Governor Andrew Cuomo say patients will get the same services elsewhere. Some will. Most won't.

The impact of this insane let-em-lose-to-fend-for-themselves policy is cruel to people with mental illness who desperately need and want treatment. But it's also dangerous to the public.

According to the Daily News, late last month, "A 25-year-old mentally ill Brooklyn man stabbed his mother and kid brother and beat them with a hammer." Near where Buffalo Psychiatric Center reduced beds, 6,300 homes experienced a blackout when a recently released allegedly mentally ill man used a chain saw to cut down utility poles. Near where Rockland Psychiatric Center reduced beds, police rescued a suicidal mentally ill man who was off medications, barricaded in his home and brandishing a pellet gun. And earlier this month, between where Rockland County Psychiatric Center and Hudson River Psychiatric Center reduced beds police shot and killed allegedly mentally ill Tim Mulqeen who brought a loaded shotgun and 50 rounds of ammunition to a city court.

When will this madness end? New York went from 599 psychiatric beds per 100,000 citizens down to twenty eight. And the new closures take us even lower. OMH is simply transferring the seriously ill to the criminal justice system. New York incarcerated 14,000 people with serious mental illness largely because OMH only has beds for 3,600. There are more mentally ill in a single jail, Riker's Island, than all state hospitals combined. The most conservative estimates are that if New York had the best community services available -- and we don't -- it would still need 4,311 more hospital beds to meet the minimum needs of seriously mentally ill New Yorkers.

A new study on "Homeland Security and Mental Illness" by Chief Michael Biasotti, vice-president of the New York State Association of Chiefs of Police found law enforcement is being overwhelmed by this "policy change that in effect removed the daily care of our nation's severely mentally ill population from the medical community and placed it with the criminal justice system." Families of people with serious mental illness are up in arms. In New York, hospital closures mean you are now more likely to be arrested for having a serious mental illness than hospitalized.

One would think ensuring the seriously mentally ill get treatment would be the core mission of the Office of Mental Health. But it hasn't been ever since Michael Hogan was appointed commissioner. His stated goal is to "create hope filled, humanized environments and relationships in which people can grow" not getting medications to the seriously mentally ill. One can understand what drives his hospital closure policy--"Hey Gov., look how much money I'm saving!" But it's harder to understand how Cuomo doesn't recognize the impact on people with serious mental illness, public safety, and how Hogan's efforts to save OMH money are costing the criminal justice system and the state much more. Robbing Peter to pay Paul?

OMH should not be kicking patients out of hospitals. It should be sending it's sickest citizens to the front of the line for services, not the rear.