Mental Illness Policy Org: Stop NYS Psychiatric Hospital Closures

Mental Illness Policy Org: Stop NYS Psychiatric Hospital Closures: Stop NYS Psychiatric Hospitals (The following Mental Illness Policy Org. op-ed appeared in 2/23/12 NY Daily News and is available at http:/...

Stop NYS Psychiatric Hospital Closures

Stop NYS Psychiatric Hospitals

(The following Mental Illness Policy Org. op-ed appeared in 2/23/12 NY Daily News and is available at http://www.nydailynews.com/opinion/mentally-ill-yorkers-article-1.1027041?print

The recently proposed closure of Kingsboro Psychiatric Center in Brooklyn looks like the latest step by the New York State Office of Mental Health to get out of the business of providing treatment to people with serious mental illness.

We should all worry deeply about the consequences of this policy shift.

In the past two months, the Office of Mental Health has announced it is “reducing census” — i.e., kicking many of the mentally ill out — at the Bronx, Mohawk Valley and Sagamore psychiatric centers. These came on top of previously announced ward closings at the Rockland, Pilgrim, Mid-Hudson Forensic, Hudson River and Buffalo psychiatric centers. The bureaucrats insist that when these people can no longer get help at such facilities, they’ll get the same services elsewhere.

The truth is, some will. But most won’t.

As someone with a mentally ill relative, I know the let-’em-loose 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 the Buffalo Psychiatric Center reduced beds, 6,300 homes experienced a blackout when a mentally ill man recently released from another facility used a chain saw to cut down utility poles. Near where the 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 the Rockland and Hudson River psychiatric centers reduced beds, police shot and killed mentally ill Tim Mulqueen after he brought a loaded shotgun and 50 rounds of ammunition to court.

When will this madness end?

New York went from 599 psychiatric beds per 100,000 citizens in 1955 down to 28 in recent years. The new closures will take us even lower.

All this means the state is simply transferring the seriously ill to the criminal justice system. New York currently incarcerates 14,000 people with serious mental illness — largely because the Office of Mental Health, the agency that should be helping these people, has beds for only 3,600. There are more mentally ill in a single jail, Rikers Island, than in 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 study released late last year 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 a “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.”

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 in 2007. His stated goal is to “create hope-filled, humanized environments and relationships in which people can grow” — not to get medications to the seriously mentally ill.

One can understand what drives his hospital closure policy: It saves OMH money. But it is far harder to understand how Gov. Cuomo doesn’t recognize the negative impact on the criminal justice budget, on people with serious mental illness and on public safety as a whole.

Jaffe has a family member with mental illness and is executive director of Mental Illness Policy Org.

Read more: http://www.nydailynews.com/opinion/mentally-ill-yorkers-article-1.1027041#ixzz1nagSmVuE

Jan/Feb. Update

National News

SAMHSA estimated the number of mentally ill as 1 in 5, but an analysis by Mental Illness Policy Org. found out the report left out 500,000 individuals who are incarcerated, institutionalized or homeless. SAMHSA has a long history of ignoring the most severely ill, so this was not surprising.

A recent California court ruling limits some mentally ill from representing themselves in court. This is important and hopefully will spread to other states. Ex. In NYS, mentally ill Colin Ferguson was sentenced to 315 years in prison after shooting 19 on the Long Island railroad and representing himself in court while psychotic.

Dr. Richard Lamb wrote in a Psychiatric Journal on meeting the needs of mentally ill who are likely to be incarcerated.

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On 1/25, the Dr. Oz show ran a terrific piece on electroconvulsive therapy (ECT, a/k/a "shock' (sic)) that featured people who got their lives back as a result of the treatment. Members of the consumertocracy tried to have the show cancelled. At the same time the NY Times ran an op-ed by someone else crediting ECT for their recovery and a consumer who is writing one of the best blogs around wrote on it too.

A court decision suggests preventing people with mental illness from owning handguns may not pass constitutional muster.

USA Today ran a letter by Mental Illness Policy Org answering a professional consumer who wrote an op-ed in the paper with misinformation.

This is a stellar series on the seminal Lessard case in which the Supreme Court ruled on both the dangerousness standard and due-process for people with mental illness. It was followed up with a brilliant op-ed by Dr. E. Fuller Torrey, author, Surviving Schizophrenia. 

Jared Loughner was found incompetent to stand trial in the death of Gabrielle Giffords, raising the question, "Should we be allowed to medicate people to make them competent to stand trial?" The new edition of Dr. Torrey's, The Insanity Offense, includes an epilogue describing Loughner's history and the failure to treat him and he talked about that in an interview with Salon Magazine. This book is highly recommended for anyone who cares about the treatment of the most seriously ill.

"Anatomy of an Epidemic"by Robert Whitaker has received glowing reviews by people who don't believe mental illness exists, but it has numerous faults which were pointed out in this Huffington Post book review.Also read this blog by a woman with bipolar disorder who is coming under attack for standing up to consumertocracy.

Arizona

Great consumer blogger writing on legal issues faced by people with mental illness in AZ.

California

Bill to extend Laura's Law introduced. Laura's Law is California's Assisted Outpatient Treatment Law. You can learn more about it at our new Laura's Law site at http://lauras-law.org and in this op-ed by Carla Jacobs.

There were incidents of violence involving people with mental illness in Anaheim, Kern County and elsewhere as a result of the failure to implement Laura's Law. Orange County Mental Health Director continues working to prevent implementation of Laura's Law in his county: http://lauras-law.org/states/california/analysishcareport.pdf 

In 2004, via Proposition 63, Californians passed the Mental Health Services (MHSA) act, a millionaires tax specifically to fund services for people with 'serious' mental illness. According to our ongoing monitoring, the counties and provider-community accepted the funding but not the requirement to spend it on people with serious mental illness. Mental Illness Policy Org., Exec. Dir. DJ Jaffe wrote on the waste for Capital Weekly, Mental Illness Policy Org Counsel Mary Ann Bernard wrote on it for California Progress Report and another article on same subject was published by a Whistleblower

Gary Tsai wrote a great op-ed about other problems affecting mentally ill in California in Sacramento Bee

Kentucky

Pastor argues against closing state psychiatric hospital 

Massachusetts

Plans move ahead to close Taunton Hospital and leaving people with mental illness who need inpatient care without any.

New Jersey

NJ issued an RFP for those interested in starting an Assisted Outpatient Treatment program.

New York

New York has an agency (Commission on Quality of Care-CQC) that is supposed to monitor the quality of care for people with mental illness. It also administers the Protection and Advocacy Program which is supposed to help get care to people with mental illness. Mental Illness policy Org testified that CQC has ignored every important issue affecting the most seriously ill (incarceration, homelessness, lack of hospital beds, etc.) and P&A uses the money it receives from NYS to prevent treatment for people with mental illness. 

Barricaded man in Stony Brook off meds for bipolar

Washington, DC/Virginia/Maryland

DC Bar Magazine did an article on mental illness law that extensively quoted DJ Jaffe of Mental Illness Policy Org. Unfortunately, the author also quoted from a professional consumer who believes mental illness does not exist.

Baltimore Sun ran a great letter "Mentally Ill Should Not Have To Commit Crime To Get Treatment"

Pete Earley, author of "Crazy" about incarcerating mentally ill writes a great blog on national and local issues in Virginia. Most, not all posts are about mental illness.

Texas

Court rules incompetent patients are being kept incarcerated too long before they are moved to treatment.

Washington State

Mentally ill man sets fire to police car to bring attention to poor state of mental health system

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.

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

Issues

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 PAIMI – NYS 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


Recommendations

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.

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.

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

PLEASE HELP! YESTERDAY A ANAHEIM HILLS POLICE OFFICER SHOT AND KILLED A 24 YEAR OLD, WHO SUFFERED FROM SCHIZOPHRENIA! HE WAS SITTING UNDER A TREE IN THE POLICE PARKING LOT, APPARENTLY WITH A BIBLE AND A KITCHEN KNIFE. THE SERGEANT WAS IN HIS POLICE CAR, ON HIS COMPUTER. NOW UNDER INVESTIGATION. ROSCOE CAMBRIDGE WAS MY HUSBAND COUSIN, HIS MOTHER WOULD CALL TO TELL ME HOW SHE SUPPORTED MY INVOLVEMENT WITH JUSTICE FOR KELLY. AND EXPRESSED HER FEAR THAT ROSCOE WOULD SUFFER THE SAME FATE. SHE CALLED ME THIS MORNING IN SUCH GRIEF. AND SAID "IT IS JUST LIKE KELLY'. ... GOD HELP OUR SONS AND BROTHERS WHO SUFFER FROM MENTAL ILLNESS....

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.