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

NYAPRS proposes reducing funding for medical treatment of mentally ill

Medicaid realignment in New York is expected to generate $10 billion in savings over five years and the plan is to spend much of it on medical care for people with serious mental illness. That's good news to everyone except the NYS Assoc. of Psychiatric Rehabilitation Services--the trade association for providers of non-medical services to voluntary mental health patients. In a blog, NYAPRS wrote

(C)oncerns have been raised (about) a general emphasis on medical approaches that provide insufficient attention to expanding rehabilitation, peer support and culturally competent ones.

As if giving medical care to someone is the opposite of cultural competence.

As a result of the lack of medical care more people of color are incarcerated for mental illness than hospitalized. And disproportionately so. That is one reason why Kendra's Law is supported by groups made up almost entirely of people of color, like the local Harlem Alliance on Mental Illness. (Consumers too). Extensive Kendra's Law research shows it helps those enrolled, get well and stay well. Yet the trade association is trying to preserve cracks in Kendra's Law that allow their members to avoid treating people with serious mental illness.

I recognize that the trade-association only provides non-medical rehabilitation services and focuses on mental health not mental illness. And I understand that when you see a bucket of money, you want to divert it to your own members. But many people with schizophrenia need, gulp, medical services. Specifically, symptom amelioration. That is what enables them to reach the point where they can benefit from rehab services. NYAPRS wants to take those medical services away, so the funds can go to their association members. The employees of association members are then urged to also lobby for more money for their members.

What is especially disingenuous is that in an op-ed the trade association, as part of their continuing battle against Kendra's Law (a less restrictive, more humane alternative to incarceration or commitment) recently wrote that instead of Kendra's Law

A better approach is to back new programs designed by the governor’s Medicaid Redesign Team to make our mental-health services more effective.

On the one hand they argue that Medicaid Redesign is going to help the most seriously ill and on the other write they don't want the Medicaid used for medical care.

You can't have it both ways. But that's unlikely to stop them from trying.

New York Needs Kendra's Law: You can help

(May 2012, New York) Kendra's Law allows courts to order a small subset of people with serious mental illness who have a past history of violence to accept treatment as a condition for staying in the community. Kendra's Law has been very successful at keeping patients healthier and preventing needless deterioration to violence. See Kendra's Law op-ed in Albany Times Union.

But Kendra's Law has giant cracks in it that send the most seriously ill to jails, prisons, shelters and morgues. A bipartisan Kendra's Law Improvement Act has been proposed to close the cracks that has wide-ranging support including by NAMI/NYS, NYS Chiefs of Police and many others who want better care for people with mental illness. But it is being vigorously opposed by OMH funded community mental health providers and county mental health directors who don't want to have to treat the most seriously ill. They prefer to cherry-pick the easiest to treat for admission to their programs and bury their head in the sand about the most seriously ill.

Please 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
We have generated media attention, but not enough calls
This is critical.

The legislative session is coming to an end and Cuomo, Silver and Skelos will be deciding whether or not to help people with mental illness by closing cracks. The NYS mental health industry is lobbying them heavily to preserve the cracks.

Thank you for all you do. Spread the word. Forward to friends.

The media is on our side, but we need more calls:

Op-ed in Today's Albany Times Union
Op-ed in Yesterday's Buffalo News
Editorial in NY Daily News
Op-ed in NY Post by Bill Sponsors
Op-ed in Ithaca Journal:
Letter in Schenectaday Gazette
Op-ed in NY Daily News
Editorial in Staten Island Advance

DJ Jaffe
Executive Director
Mental Illness Policy Org.
http://kendras-law.org

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.
--
Visit http://treatmentadvocacycenter.org/lauras-law or http://lauras-law.org/ to learn more.

NYS Mental Health "Leaders" Race to Avoid Mentally Ill. Call Now

Please call Assembly speaker Sheldon Silver at 518-455-3791 and Governor Cuomo at: (518) 474-8390 and urge them to Close the Cracks In Kendra's Law. This is critical. Now is the time. Tell others to call too.

Research shows there are giant cracks in Kendra's Law and these cracks are putting patients, public, police and families at risk:

1. People with mental illness who are being released from Involuntary Treatment (i.e, were already danger to self or others) are not being evaluated by hospitals for inclusion in Kendra’s Law or other community treatment.
2. Mentally Ill Prisoners who are being released from jails and prisons (i.e, already committed a crime) are not being evaluated for inclusion in Kendra’s Law or other community treatment.
3. Mentally Ill people who have previously attacked family members, are not being considered for Kendra’s Law or other community treatment, especially if the family has not reported attacks.

Kendra’s Law (court-ordered outpatient commitment) is proven to reduce violence, arrest, incarceration, hospitalization, homelessness and suicide when used, but is not used for the most seriously ill because neither hospitals, prisons, jails, local mental health directors or NYS OMH wants to accept responsibility.

NYS Senator Catherine Young and Assemblywoman Aileen Gunther introduced The Kendra's Law Improvement Act (A6987/S4881) to close these cracks by requiring officials to accept responsibility for the most seriously ill, but mental health officials oppose it.

Head in the sand" approach to the seriously ill.
The main sticking point is that mental health officials do now want to even know about people with serious mental illness, much less be obligated to provide treatment.

1. Hospitals are objecting to provisions that ask them to evaluate patients prior to release to see if they could benefit from Kendra's Law.
2. Jails and prisons are objecting to provisions that ask them to evaluate the incarcerated mentally ill prior to release to see if they could benefit from Kendra's Law.
3. Local Mental Health directors are objecting to being informed by families, hospitals, or prisons about people with serious mental illness who may need help.
4. OMH is objecting to having to oversee and monitor Kendra's Law to ensure people with serious mental illness who could benefit form Kendra's Law gain access.
5. The trade association for those who provide non-medical voluntary mental "health" services (NYAPRS) objects to more attention being paid to those not well enough to volunteer for treatment.

Since no one wants responsibility, individuals with serious mental illness are being sent to the streets, jails, prisons and morgues instead of treatment.

Please call Assembly speaker Sheldon Silver at 518-455-3791 and Governor Cuomo at: (518) 474-8390 and urge them to pass A6987 to Close the Cracks In Kendra's Law. This is critical. Now is the time. Spread the word. Tell others to call too.

Providing services to the most seriously ill should be, the core function of mental hygiene directors and the office of mental health. Their raison d’etre. Unfortunately, this core function of providing services to the most seriously ill is often ignored in favor of providing services to others. This approach sends the most seriously ill to jails, prisons, shelters and morgues and puts public and police at risk. Improvement of care for the most seriously ill is almost always and exclusively obtained by legislation or law suits. The Kendra’s Law Improvement Act is one such piece of legislation. It not only allows courts to commit the seriously ill to accept treatment, it commits the mental health system to meeting their core responsibility of providing it.

Assemblyman Felix Ortiz and Lack of Care for Mentally Ill

Earlier this month New York City Police Officer Eder Loor was stabbed in the brain by Terrence Hale, 26, a young man allegedly with untreated mental illness. His mom had tried unsuccessfully to get mental health authorities to treat him. They wouldn't. The stabbing ensued.

It was oh so predictable. And it's likely going to happen again possibly because of Brooklyn Assemblyman Felix Ortiz who heads the Assembly Mental Health Committee. Over the last few years, I and other advocates for the mentally ill and advocates for public safety have met with Assemblyman Felix Ortiz to urge him to pass legislation that would strengthen New York's Kendra's Law. As I explained in a New York Daily News op-ed this week

Kendra's Law allows courts to order a very small group of 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. Courts can also order the recalcitrant mental health system to provide treatment to these seriously mentally ill people .

The results of Kendra's Law have been outstanding in terms of reduced dangerous behavior, violence, arrest, trial, incarceration, homelessness, hospitalization, suicide and more.

But the law has giant cracks in it that New York State Assemblymember Aileen Gunther-a former nurse with psychiatric room experience, and State Senator Catherine Young proposed closing. Their bill (now A6987/S4881) would

• Close the crack in the system, whereby prisoners who relied on mental health services while imprisoned or have been involuntarily committed are discharged without determining if they need mandatory treatment to stay healthy and prevent them from becoming dangerous again.
• Close the loophole whereby if a person under court order moves to a different county, the new county isn't informed so it can continue to provide treatment.
• Close the crack in the system whereby court orders can expire without a review of whether they should be renewed.
• Clarify that a county should investigate reports of individuals in need of Kendra's Law services received from family members.
• Require physicians to make a reasonable effort to gather useful information from the patient's family or significant others.
• Allow doctors to presume under certain conditions that patients who materially violate their treatment orders should be taken to a hospital to see if they need admission.

Had these been in place, Officer Loor may not have been stabbed. Terrence Hale's mom did try to get mental health authorities to treat her son and they did not listen. Terrence Hale had been released from a jail without local officials being alerted he may need community-based mental health treatment. The bill would have made both those scenarios less likely. But Assemblyman Ortiz is still waffling. The mother of Kendra Webale whom Kendra's Law is named after told a Daily News reporter she

blamed Ortiz, chairman of the Assembly's Mental Health Committee, for bowing to pressure from advocates for the mentally ill and blocking the Young/Gunther bill. "I have gone head to head with Ortiz and his office, and at times he has seemed extremely, genuinely supportive. And then the tune would change."

In an editorial the Daily News wrote

As chairman of the Mental Health Committee, Brooklyn Assemblyman Felix Ortiz bears responsibility for squashing Young and Gunther's measure. He bottled it up without a vote despite a mountain of evidence showing that severely disturbed mental patients who enter court-ordered treatment are less violent, less likely to be homeless, less likely to abuse drugs or alcohol and less likely to attempt suicide than those who do not.

In a follow-up editorial they explained

For too long, supposed mental health advocates have prevailed in Albany with the preposterous argument that mandating medicines for the mentally ill to save their lives and the lives of others is a violation of civil rights.

How true. One trade association for providers of non-medical services to people with mental illness said we need better trained police units, as if the problem was Officer Loor didn't duck the knife well enough. Assemblyman Felix Ortiz released a statement echoing these 'advocates' by claiming the important battle is not knives in the hands of untreated mentally ill who stab cops, but the use of 'stigmatizing' language.

I have a mentally ill relative. This bill is supported by the Alliance on Mental Illness of New York State and many others who like me, love people with mental illness and want to keep them, the public, and the police safer. The mental health committee should immediately pass this legislation to prevent the next tragedy. Assemblyman Ortiz can be reached at (718) 492-6334 or (518) 455-3821.

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.

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.

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.

Connecticut tries to help treatment providers hear from parents of people with mental illness

A big problem that people with serious mental illness have in getting the best possible care, is the treatment providers rarely have complete information, and many treatment providers specifically reject sharing information with, or receiving information from families of the ill person. This is absurd.

Families tend to have the most comprehensive information about the treatment of their loved ones. Only by receiving this information can doctors give the best possible care. For example, a doctor needs to know if a medication they are suggesting has been used in the past and whether it worked or not and what the side-effects, if any, were. Sometimes the individual with mental illness can't or won't communicate that and the records are incomplete.

In addition, people with mental illness are often released from facilities to go back to live with their parents, yet information on diagnosis and treatment is withheld from the parents. As Rael Jean Isaac famously said in "Madness in the Streets": the family has become the institution, but they are an institution without training, without financing, and without the ability to enforce compliance" (although I did the quote from memory so check me on it.)

Some doctors and treatment providers say they can't share information because of federal Health Insurance Portability and Accountability Act, commonly referred to as HIPAA (pronounced Hip-a). It is arguable as to whether HIPPA prevents providing information to parents of people with serious mental illness, but it is inarguable that it does not prevent doctors from receiving information.

Connecticut Senate Bill 452 attempts to clarify this. It revises certain laws pertaining to the treatment of people with mental illness. Connecticut law already says

Every patient treated in any facility for treatment of persons with psychiatric disabilities shall receive humane and dignified treatment at all times, with full respect for his personal dignity and right to privacy. Each patient shall be treated in accordance with a specialized treatment plan suited to his disorder. Such treatment plan shall include a discharge plan which shall include, but not be limited to, (1) reasonable notice to the patient of his impending discharge, (2) active participation by the patient in planning for his discharge, and (3) planning for appropriate aftercare to the patient upon his discharge.

But this bill adds a section stating:

Subject to the privacy protections afforded a patient under federal law, including, but not limited to, the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191) (HIPAA), as amended from time to time, the head of a facility may direct that any person involved in the formulation of the patient's treatment plan or discharge plan communicate with, and obtain medical records from inpatient and outpatient health care providers who have previously treated the patient. In addition, when formulating such treatment plan or discharge plan, persons involved in the formulation of such plans may also communicate with any person with whom the patient has resided in the twelve-month period prior to being admitted to the facility and with the patient's spouse, parents, siblings or children in order to better understand the patient's medical needs.

It's a smart idea.

Statement on Kingsboro Psychiatric Hospital Not Closing

The provision that would have closed Kingsboro Psychiatric Hospital in Brooklyn was removed from the New York State budget, meaning the hospital will stay open for the time.

"We are very happy that at least some New Yorkers who have serious mental illness will have a hospital to go to as the result of saving Kingsboro, but New York State is still short 4,311 beds for seriously mentally ill"

DJ Jaffe
Executive Director
Mental Illness Policy Org.

Our op-ed calling for saving Kingsboro:
http://articles.nydailynews.com/2012-02-23/news/31092984_1_mental-illness-mental-health-psychiatric-beds

Study showing NYS Psychiatric Hospital Bed Shortage of 4,311 beds.
http://mentalillnesspolicy.org/imd/shortage-hospital-beds.html

Study showing in NYS you are more likely to be incarcerated for mental illness than hospitalized
http://mentalillnesspolicy.org/NGRI/jails-vs-hospitals.html

Department of Justice Certifies Crime Prevention Program for People with Serious Mental Illness

Today the Department of Justice (DOJ) Office of Justice Programs certified Assisted Outpatient Treatment (AOT) as an Effective Crime Prevention Program. This comes on top of previous recognition by the DOJ Office of Community Oriented Policing Initiatives.
AOT allows courts to order mental health departments to provide treatment to certain people: those with serious mental illness who are likely to become dangerous or gravely disabled without treatment and who have a history of violence and refusing treatment. Historically, many mental health departments like California and New York elected to require psychotic individuals who don't recognize they are ill to become "danger to self or others" or "gravely disabled" before offering treatment. Because of this "no-treatment" policy, seriously mentally ill individuals who refuse treatment deteriorate and the police are forced to intervene. Too often, this is after the individual becomes a "psychotic killer on rampage" headline and has resulted in three times as many people being incarcerated for mental illness as hospitalized. AOT laws allow courts to require departments to provide treatment before that happens. In California, Laura's Law reduced hospitalization 46%, reduced incarceration 65%, reduced homelessness 61% and reduced emergency contacts 44%. Results in New York on Kendra's Law were equally impressive.

AOT laws were proposed by families of people with mental illness. The Department of Justice researched implementation of AOT programs like Laura's Law in California and Kendra's Law in New York. DOJ noted

The goal of AOT is to improve access and adherence to intensive behavioral health services in order to avert relapse, repeated hospitalizations, arrest, incarceration, suicide, property destruction, and violent behavior.

Police Chief Michael Biasotti recently released a major survey of senior law enforcement officers that found police and sheriffs are being overwhelmed "dealing with the unintended consequences of 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." A sheriff in Summit County, Ohio recently took action to prevent seriously mentally ill people from entering his jail arguing they need treatment instead. A Sheriff in Illinois is threatening to sue the mental health department to get them to treat people with mental illness. States are closing psychiatric hospitals in record numbers, further shifting the burden of care from the mental health system to the criminal justice system.

AOT programs exist in many states but are rarely used. The Department of Justice lists resources for states that want to implement AOT or expand existing programs.

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.

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.

SAMHSA vote: Assisted Outpatient Treatment one of Most Important Advances

The Substance Abuse and Mental Health Services Agency (SAMHSA) periodically conducts an unscientific online poll of it’s constituency. The most recent poll was to define the most important behavioral health milestones over the past twenty years. The way the poll works is that individuals can enter ideas online and then the SAMHSA constituency votes. The slight issue with this is that if two people enter the same idea, the vote can get split.

The number one and two vote-getter was peer support and consumer driven care. Several people entered it using various wording and individually or collectively it was the clear winner.  This is not surprising. SAMHSA funds peer services. The organizations that receive the funding make sure their members vote to preserve their funding. And because these organizations have SAMHSA-funded staffs they are very effective. But if you combine number one and number two (both peer support) you find the next highest vote getter was a surprise: Assisted Outpatient Treatment

SAMHSA does not usually focus on efforts to help people with the most serious mental illnesses, so seeing AOT come in as the second most important advance was a surprise. 964 individuals voted for “Implementation of AOT” (which Mental Illness Policy Org proposed) and another 181 voted for “Court Ordered Outpatient Treatment” which was proposed by someone else. These are the same, making for a total of 1145 votes which made Asssisted Outpatient Treatment the clear second place winner.  This in spite of the fact that the SAMHSA-funded consumertocracy organized a vote against AOT. (This is kind of like having an election and allowing people to vote for one candidate and also cast a vote against another. It is only the first vote that counts.)

 SAMHSA has previously asked the public to weigh in on issues. Last year they asked what strategic initiatives they should promote and in that poll Increase use of Assisted Outpatient Treatment came in third.  Unfortunately, SAMHSA ignored that poll, and will most likely ignore this most recent one.

SAMHSA has been widely and recently criticized for their failure to focus on serious mental illness and wasting money by Mental Illness Policy Org, Dr. E. Fuller Torrey, the Treatment Advocacy Center and others. Many believe SAMHSA does more harm than good and should be eliminated. If SAMHSA ignores the most recent poll, they will prove their critics right.