Julius Graham, and Riverside Park Stabbings

Ray Kelly says the person Julius Graham, the homeless man who allegedly stabbed multiple individuals in Manhattan today (10/1/13) appears to be 'emotionally disturbed'. Following is info for those who want to understand why the NYS mental health system does such a poor job of preventing violence by persons with serious mental ilness. It is not lack of funding. It is lack of leadership.

NY has a “Tragedy Before Treatment” Mental Ilness Policy. We need a “Treatment Before Tragedy”  System.

In NY hearing voices and being delusional is, not enough to get someone treatment if they don’t recognize they are ill. For that to happen, they have to force the issue by bringing on a tragedy. Rather than prevent violence, NY laws require it.

 About 16% of all the people in Office of Mental Health psychiatric hospitals are forensic patients, who gained admission only after a tragedy occurred and a court process forced the state to admit them.

New York went from 600 beds per 100,000 population in the mid-1950s to fewer than 27 today. As a result, Rikers Island is New York’s largest psychiatric institution, holding more mentally ill people than all Office of Mental Health hospitals combined.

State mental health officials are proposing to close more psychiatric hospital beds, thereby making hospitalization even more difficult. They claim few of the existing beds are used, but that is only because the Office of Mental Health discharges patients “sicker and quicker” to artificially reduce the count. Experts say, to meet minimum standards, NYS needs 4300 more beds to serve those with serious mental illness. Here's what we need to do.

Mental Health First Aid Unproven & Should Not Be Funded

• Mental Health First Aid (MHFA) lacks sufficient proof it helps people with serious mental illness. 
• The venders of the program and those who want to purchase it, have convinced Congress to introduce a bill to have taxpayers pay for it. 
• Those funds would be better used on programs proven to help people with serious mental illness.

(Note: If anyone has research contrary to that which we discuss, please post it in comments section. Our goal is to make sure our information and conclusions are accurate. Thank you)

Background: Mental Health First Aid (MHFA) is a commercially available training program created in Australia and now sold by the National Council for Community Behavioral Healthcare, the Maryland Department of Health and Mental Hygiene, and the Missouri Department of Mental Health to non-profits in the United States. The training program purports to teach people to identify the symptoms of mental illness in others and connect them to help. They also license others to be trainers for a fee. Participants get a certificate saying they received the training.

As part of his “Now is the Time” initiative in response to the shootings at Newtown, President Obama announced support  for  Mental Health First Aid. The organizations above, plus NAMI, MHA and others are now lobbying Congress to spend $20 million dollars for passage of The Mental Health First Aid Act of 2013 (S. 153/H.R. 274). The program is shown to make those who receive and give the training feel better, but has not been shown to have an impact on those they are supposed to be helping: people with serious mental illness.

Congress should not fund MHFA, and instead use the funds for programs that work. (Read more)

Rep. Tim Murphy Announces Important Mental Health Legislation

This is big news.

Rep Tim Murphy (R. PA) is a former child psychologist, and head of the Mental "Health" Caucus. In spite of that,  he totally gets serious mental "illness" in adults and what the important versus tangential issues are.  He is as good as a Wellstone or a Domenici, and better than a Kennedy (who tended to focus on mental 'health' versus mental 'illness')

Rep. Tim Murphy has held extensive hearings where he listened to others focused on the most seriously ill including Dr. E. Fuller Torrey, Sally Satel, Joe Bruce , Ed Kelly. He also received extensive input from consumers around the country who contacted him. He  announced the results of his hearings today and the legislation he intends proposing.  It includes preserving hospitals, AOT (a/k/a Kendra's Law), revising HIPPA Handcuffs ( so families can get the info they need to help mentally ill loved ones), reigning in SAMHSA's anti-treatment activities , increasing police training, increasing NIMH budget for serious mental illness, and other key issues. I am very excited. 

 I am no Washington Insider, so I have no knowledge if it will fly or not. But at least someone is focused on right issues, not just PC tangential ones. Please support these efforts. He is totally on the right track. His press release and link to the floor speech follows: (Read more)

Tell Governor Brown to Sign SB 585 to allow MHSA Funds for Laura's Law

(Updated 9/3/13)

Urgent: Contact Governor Jerry Brown immediately (Sept. 2013) and URGE HIM TO SIGN SB 585 which will help clarify that Mental Health Services Act (Prop 63) funds may be used to fund Laura's Law.  Phone: (916) 445-2841.  Fax: (916) 558-3160 and use his online contact form.

Background:

Laura's Law allows courts to order a small group of people who have serious mental illness and a history of dangerousness to stay in treatment as a condition of living in the community. It has reduced arrest, incarceration, hospitalization and length of hospitalization in the two counties that use Laura's Law.

Two Reasons Counties Haven't Implemented Laura's Law:

There are two reasons more counties don't implement Laura's Law. Three million dollars in Mental Health Services Act (MHSA) funds are going to Disability Rights California and they are using those funds to threaten to sue counties that use any MHSA funds to implement Laura's Law even though such expenditure is clearly allowed. Laura's Law requires county boards of supervisors to vote to implement Laura's Law and simultaneously certify that no voluntary programs will be cut to do it.

Steinberg initially promised to help:

 In reaction to widespread outrage that people were being denied access to MHSA funded programs merely because they were so sick they were eligible for Laura's Law, Senator Steinberg introduced SB 585 in early April. The ostensible purpose was to clarify that MHSA funds could be used for people in Laura's Law.  But Steinberg  weakened his own bill. He added back a requirement that other bills by other legislators would have removed. Specifically, he added back a requirement that boards of supervisors vote (directly or through the budget process) to implement Laura's Law. And he added back a requirement that counties certify no voluntary programs will get cut to implement Laura's Law.

Unfortunately, SB 585 is the only bill Steinberg would let pass. And since it does somewhat clarify that MHSA funds can be used for Laura's Law, we are supporting it. Contact Governor Jerry Brown immediately (Sept. 2013) and urge him to sign SB 585 which will help clarify that Mental Health Services Act (Prop 63) funds may be used to fund Laura's Law. Phone: (916) 445-2841 Fax: (916) 558-3160 and use his  online contact form. 

California's Prop 63/Mental Health Services Act Fails Seriously Mentally Ill

In 2004, Californians altruistically passed a 1% tax on millionaires specifically to fund services for people with serious mental illness. As a result of reports that the funds were not reaching people with serious mental illness Mental Illness Policy Org. conducted a study and found many of the complaints to be true. Below is a summary of our report released August 15, 2013. The full report is here Our op-ed in San Diego Union Tribune is here. We shared our concerns with the California State Auditor.

California’s Mental Health Service Act:   A Ten Year $10 Billion Bait and Switch 

An investigation by Mental Illness Policy Org and Individual Californians

August 15, 2013 

Background

In November, 2004 California voters enacted a 1% tax on millionaires (Prop 63) to establish the Mental Health Services Act (MHSA) fund solely to help people with serious mental illnesses.[1] $10 billion has been raised since inception. Voters also created a Mental Health Services Oversight and Accountability Commission (MHSOAC a/k/a “Oversight Commission”) to see the program stuck to its purpose of helping people with serious mental illness.

Primary Findings

Many people with serious mental illness are receiving critical treatment as a result of Prop 63 but billions are being diverted to other purposes:

•  $1-2 Billion of Prevention and Early Intervention (PEI) Funds was intentionally diverted to social service programs masquerading as mental illness programs or falsely claim they prevent serious mental illness.
• ·$2.5 billion of the “Full Service Partnership (FSP) funds were spent without oversight of whether the recipients had schizophrenia, bipolar disorder, or the other serious mental illnesses that made them eligible for MHSA funds.
•  $23 million went to organizations directly associated with Oversight Commissioners.
• $11 million is going to PR firms that make the Oversight Commissioners look good and hide the failure of MHSA to accomplish its mission
• $9 million is going to organizations working prevent the seriously ill from receiving treatment until after they become violent.
• ·Up to $32 million was diverted to TV shows, radio shows, PSAs and other initiatives designed to reach the public without mental illness. Some feature the Senate President Pro Tem Darrell Steinberg

Additional Findings

Two new studies should lead to widespread use of Laura’s Law in California

Two new studies (including one reported in the New York Times) should lead to widespread adoption of Laura’s Law in California as a way to help some people with the most serious mental illnesses. Laura’s Law allows courts to order a narrowly defined group of individuals who have a history of violence to stay in treatment while living in the community. It has reduced violence, incarceration, hospitalization and homelessness wherever it has been used.

The first study was conducted in Australia and found 25% of individuals with schizophrenia were charged with a criminal offense during their lifetime. 6.4% of those with schizophrenia and 22.8% of those with schizophrenia plus substance abuse were charged with violent crimes compared to only 2.4% in the control group.

Unfortunately, California’s non-profit mental health industry continues to deny a relationship between violence and untreated serious mental illness and therefore oppose programs like Laura’s Law that can reduce the violence. They also claim it is too expensive.

A second study from Duke University studied New York’s version of Laura’s Law and found any increase in cost is dramatically offset by reduced hospitalization and incarceration costs.

Two Studies Should Lead to Radical Change in Mental Illness Treatment

The first study was conducted in Australia and found  individuals with schizophrenia – even those who do not have substance abuse problems – are significantly more violent than the general population.  The study found

·      25% of individuals with schizophrenia were charged with a criminal offense during their lifetime, compared with 10% of community controls.

·      6.4% of those with schizophrenia were found guilty of a violent offense, and 22.8% of those with schizophrenia plus substance abuse were found guilty of a violent offense compared to 2.4% of the general population

Assisted Outpatient Treatment for Seriously Mentally Ill Cuts Costs in Half

According to a just released study in the July 30, 2013, American Journal of Psychiatry, mandating Assisted Outpatient Treatment (AOT) for a narrowly defined group of persons with serious mental illness results in substantial savings. AOT allows courts to order individuals with serious mental illness and a history of treatment noncompliance to stay in treatment as a condition of staying in the community. It is only available for those who are so ill, they have a past history of going off the treatments that prevented them from becoming hospitalized, arrested, homeless or incarcerated. For this small group of the most seriously ill, AOT is a less expensive, less restrictive, more humane alternative to involuntary inpatient commitment and incarceration.

Researchers at Duke found that treatment costs declined 50 percent in New York City after the first year of AOT, and another 13 percent the second year. Even larger cost savings were reported in five other New York counties. Previous studies have proven AOT dramatically improves care for people with serious mental illness who have trouble staying in treatment voluntarily.

Anti Stigma Effort Fortunately Fails in New York State

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

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

According Skale's Rule: 

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

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

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

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

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

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

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

Other problematic provisions of the bill:

It changes the legislative intent of 5150 in order to provide a basis for future challenges

It removes the obligation to provide treatment for someone who is dangerous in a hospital

It allows counties to dumb down the qualifications of individuals providing care for persons with serious mental illness

It holds family members libel, but exempts mental health workers from liability if they provide false information

Send your letter to the Assembly Committee on Health expressing your opposition to SB 364. If you are affiliated with an organization be sure to include that information in your letter.

Letters can be addressed to Chair Pan and emailed to benjamin.russell@asm.ca.gov  or mailed or faxed to: 

Assembly Committee on Health
Assembly Member Richard Pan, Chair
P.O. Box 942849
Sacramento, CA 94249-0009

Fax: (916) 319-2109 


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

Follow us on Facebook and Twitter @MentalIllPolicy

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

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

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

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

After his last mental health conference in April, mental 'health' advocates convinced Obama to spend $140 million more to identify people with mental illness. As we wrote after that conference

Jared Loughner, who shot Gabrielle Giffords; James Holmes, who shot up a movie theater in Aurora, Colo.; John Hinckley Jr., who shot President Reagan; Aaron Bassler, who shot a former mayor of Fort Bragg, Calif.; Ted Kaczynski, the Unabomber, who mailed explosive packages around the country; Ian Stawicki, who shot five others and then himself in Seattle; Eduardo Sencion, who shot five National Guardsmen at a Nevada IHOP restaurant; Russell Weston, who shot two guards at the U.S. Capitol building; and Adam Lanza, who shot his mother, 26 others, and himself in Newtown, Conn. -- all were known to be ill before they became headlines. The problem wasn't lack of identification. It was lack of treatment.

If Obama wants to get serious about serious mental illness, he should invite criminal justice experts to the White House. The mental health system 'treats' the worried well and off loads the seriously ill to shelters, jails prisons and morgues.  There are now three times as many mentally ill incarcerated as hospitalized. Police, sheriffs, district attorneys, correction officers, parole officers, and forensic hospital workers  go where the mental health system won't: to the aide of people with serious mental illness. No sane mental illness policy can be contemplated without their perspective.

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

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

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

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

Representative Tim Murphy Calls out SAMHSA For Failure to Help Seriously Mentally Ill

Opening Statement of the Honorable Tim Murphy Subcommittee on Oversight and Investigations Hearing on “Examining SAMHSA’s Role in Delivering Services to the Severely Mentally Ill”

May 22, 2013
(As Prepared for Delivery)

Since I became the Chairman of the Subcommittee on Oversight and Investigations, shortly after the December 14, 2012, elementary school shootings in Newtown, we began looking into the federal programs and resources devoted to mental health and mental illness. We did so to ensure federal dollars devoted to mental health are reaching those individuals with serious mental illness and helping them obtain the most effective care.

One lesson we must immediately draw from the Newtown tragedy is that we need to make it our priority to get those with serious mental illnesses, who are not presently being treated, into sound, evidence- based treatments.

In 2009, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that about 11 million U.S. adults had serious mental illness, and 40 percent of these individuals did not receive treatment. While the vast majority of individuals with a mental health condition are nonviolent, Director of the National Institute for Mental Health, Dr. Thomas Insel, told this subcommittee at our March 5 public forum that effective treatments, which include medication adherence and evidence-based psychosocial therapy, can reduce the risk of violent behavior fifteen-fold in persons with serious mental illness.

Getting these individuals into treatment is a crucial first task and SAMHSA, as the federal agency whose mission includes reducing the impact of mental illness on America’s communities, should be playing a central role in this effort. But based on our work to date, SAMHSA has not made the treatment of the seriously mentally ill a priority. In fact, I’m afraid serious mental illness such as schizophrenia and bipolar disorder may not be a concern at all to SAMHSA.

Testimony: SAMHSA FAILS TO HELP SERIOUSLY MENTALLY ILL

Mental Illness Policy Org has written on problems at the Substance Abuse and Mental Health Services Agency (SAMHSA).  The Energy and Commerce Subcommittee on Oversight and Investigations held hearings 5/23/13 at which Dr. Fuller Torrey and Sally Satel testified. Their testimony is below.  Joe Bruce's testimony is in a separate blog. Torrey and Satel highlighted how SAMHSA fails to serve the most seriously mentally ill; how many of their programs actually harm people with serious mental illness and suggested SAMHSA make greater use of Assisted Outpatient Treatment. Joe Bruce described how SAMHSA funded lawyers 'freed' his son from a psychiatric hospital after which he killed his mother with a hatchet.

Joe Bruce Testimony to Congress: My Mentally Ill Son Killed my Wife:

Late one afternoon in June 2006, Joe Bruce of Caratunk, Maine, came home from work to find his wife dead. He called 911 and told the dispatcher that his 24-year-old schizophrenic son, William, had killed her, that he couldn't find the son, and that he was arming himself for self-defense. Below are excerpts from the transcript of that call made available to The Wall Street Journal.  Following that is Joe's 5/23/13 testimony to the House Energy and Commerce Committee subcommittee on Oversight and Investigations. They were holding hearings and Joe testified that SAMHSA funded the lawyers who 'freed' his son from the hospital, resulting in the killing of his wife.

'My Son Has Killed My Wife'

Caratunk, Maine, June 20, 2006, at 4:49 p.m.

Dispatcher: 911. What is the address of the emergency?

Mr. Bruce: My name is […] I live at […] in Caratunk. Um, my son has killed my wife, he is schizo -- completely out of his mind.

Dispatcher: Where is your wife now?

Mr. Bruce: She is in the bathtub, she is dead. I just came home from work, her car is gone. […] I don't believe anyone

has been here, there is no sign the neighbors are aware of anything going on. His name […]. He is 24 years old.

* * *

Dispatcher: How old is she?

Mr. Bruce: She's 48 years old. Please, please don't put this out over the scanner. Just send someone up somehow. Would you please just do me that favor?

Darrel Steinberg pseudo-support for Laura's Law

(Updated 9/3/13)

Urgent: Contact Governor Jerry Brown immediately (Sept. 2013) and urge him to sign SB 585 which will help clarify that Mental Health Services Act (Prop 63) funds may be used to fund Laura's Law.Phone: (916) 445-2841 Fax: (916) 558-3160 and use online contact form.

Background:

Laura's Law allows courts to order a small group of people who have serious mental illness and a history of dangerousness to stay in treatment as a condition of living in the community. It has reduced arrest, incarceration, hospitalization and length of hospitalization in the two counties that use Laura's Law.

Two Reasons Counties Haven't Implemented Laura's Law:

There are two reasons more counties don't implement Laura's Law. Three million dollars in Mental Health Services Act (MHSA) funds are going to Disability Rights California and they are using those funds to threaten to sue counties that use any MHSA funds to implement Laura's Law even though such expenditure is clearly allowed. Laura's Law requires county boards of supervisors to vote to implement Laura's Law and simultaneously certify that no voluntary programs will be cut to do it.

Steinberg initially promised to help:

 In reaction to widespread outrage that people were being denied access to MHSA funded programs

How to Fix New York State Office of Mental Health (OMH)

Testimony of DJ Jaffe, Executive Director, Mental Illness Policy Org

to NYS Office of Mental Health  

May 3, 2013, NYC

(Note: NYS OMH is the largest agency in the state ($3 billion) and still has no director. The acting director seems intent on following the failed policies of her predecessor which moved OMH from an organization dedicated to helping the most seriously ill, to one focused on "improving the mental health of all New Yorkers." She has stated unequivocally that she wants to close state psychiatric hospitals. NYS has fewer than 4,000 beds and probably 50% of those are for people unfit to stand trial, not guilty by reason of insanity, or were convicted and are mentally ill. -ed)

Thank you. We are a non-profit think tank providing unbiased science-based information to policymakers and media on serious mental illness, and not mental health. We are the only group in New York and one of only two in the country that is focused exclusively on those the NIMH defines as “seriously” mentally ill (primarily schizophrenia, the subset of bipolar disorder classified as “severe bipolar”, the subset of major depression called ‘severe major depression’ and a few others) In order to be considered serious, these diagnosis must be diagnosable currently or within the past year and continue to result in serious functional impairment, which substantially interferes with or limits one or more major life activities in persons 17 years or older.

It is people with serious mental illness who are most likely to become homeless, incarcerated or a headline that stigmatizes the others. It is people with serious mental illness who are likely to commit suicide or become victimized.  

We have two recommendations for you:

1. Prioritize the most seriously ill and
2. Make greater use of Kendra’s Law, if for no other reason, than because you have to in order to comply with Olmstead.

Mental Illness Awareness and Improvement Act (S-689) Not Written To Help Mentally Ill

Mental Illness Awareness and Improvement Act (S 689) may go to Senate this week. It will increase funding for "Mental Health First Aid", a program sometimes taught by consumers certified to teach it. It is well-intentioned. It will make legislators feel better, and the trade association representing mental health providers richer, but it won't help people with serious mental illness. Many sections focus on children, but serious mental illness doesn't start until late teens. It funds programs not proven to help and likely don't help. Here is our analysis, footnotes, Notes on the study of MHFA, and analysis of other sections.

Mental Health First Aid is Unproven yet Government Subsidized
Analysis by Mental Illness Policy Org (3/18/12)

SUMMARY

As part of his “Now is the Time” initiative in response to the shootings at Newtown, President Obama announced support for $15 million to Mental Health First Aid Program and a $20 million dollar bill was introduced.  (1, 2)  Mental Health First Aid is a commercially available training program created in Australia and now sold by non-profits elsewhere. The training program teaches people to identify the symptoms of mental illness in others and connect them to help. (3) It also licenses others to be trainers for a fee.

There is no evidence Mental Health First Aid has any impact on persons with mental illness.

RESEARCH DOES NOT SHOW ANY BENEFIT TO PERSONS WITH MENTAL ILLNESS

Thirty-six of the 55 studies on Mental Health First Aid were authored or co-authored by the founders and owners of the approach, Betty Kitchener or

My Mentally Ill Son versus Your Son With Another Type of Illness

Laura Pogliano, a mother and advocate in Maryland wrote on the difference between her experience of having a child with serious mental illness and your experience having a child with another type of illness:

Your child's illness gets 500, 000 likes on Facebook when you post a picture or ask for prayers

My child's illness gets about 5, from people who already know us and know of our struggle

Your child's illness gets copious amounts of tax dollars to fund more research for cures; your child's illness has a congressionally approved budget

My child's illness gets funds cut by 25-40% due to the sequester, or whenever social services are on the chopping block, which is nearly every single time a budget is passed

Your child's illness gets the sympathy of complete strangers, world wide

My child's illness gets labeled by people in the press every day: pscyho, headcase, lunatic, maniac, nutjob, monster, freeloader

Your child's illness gets insurance coverage so he can actually get well

My child's illness gets 30 days coverage per year, with an average inpatient stay of 11 days, with no social workers, therapists, or psychiatric coverage

4 New Laura's Law/MHSA Bills Could Help Mentally Ill in California

Bills Clarify MHSA Funds Can Be Used For Laura's Law and Make Other Improvements

Following is our preliminary analysis of the four California bills introduced 2/22/13

SB 585 (Steinberg/Correa) clarifies Mental Health Services Act (MHSA/ Prop 63) funds may be used by counties to implement Laura's Law. 

SB 664 (Yee/ Wolk) states counties may implement Laura's Law without first forcing County Boards of Supervisors to undertake a special vote or represent that they they will treat everyone else in the county before they treat those who need Laura's Law. (Unfortunately it allows counties to limit the number of individuals in Laura's Law.) 

AB1265 (Conway along with Achadjian/Beth Gaines/Gorel/ Hagman/Harkey/ Morrell) allows individuals under Laura's Law to receive treatment for up to one year (instead of the six month max previously allowed). It would also, smartly, require facilities discharging involuntarily committed patients first evaluate them to see if they could benefit from Laura's Law. They would then notify county officials so they can file a Laura's Law petition. 

AB 1367 (Mansoor along with Achadjian/ Alle/ Conway/Beth Gaines/Gorel/ Hagma/ Harkey/ Morrell). Like SB 585 (but using different language ) it clarifies that MHSA funds may be used to implement Laura's Law. It also makes changes (not necessarily improvements) to Prevention and Early Intervention (PEI) funds.

Ed Koch, Billie Boggs, and Mental Illness

In the 1980s, when Ed Koch was mayor, the streets of New York were full of homeless psychotic mentally individuals who had been abandoned by the mental health system. This was before Mayor Rudy Giuliani decided to implement his "three strikes and you're out" laws to incarcerate the mentally ill for loitering, urinating, sleeping and other things the mentally were forced to do in the streets.  

Ed Koch recognized that sleeping on the streets when temperatures were below freezing was a 'danger to self'. So he had outreach workers try to get the homeless mentally ill who were about to freeze into shelters where they wouldn't. But some people who are psychotic don't understand their need for treatment.  

The first homeless psychotic mentally ill person he tried to help who didn't recognize she was ill was Billie Boggs (Joyce Brown).

Crowd Source Better Care for Mentally Ill in California

We are going to improve care for persons with serious mental illness in California by crowd-sourcing the hunt for waste and fraud in Prop 63/Mental Health Services Act (MHSA)

MHSA funds meant to help seriously mentally are being diverted

MHSA funds are supposed to help people with serious mental illness. And many do. But funds are also being diverted elsewhere. The media has reported on MHSA funds being used for Wilderness Adventure Tours, Gardens for people of Hmong ancestry, massage chairs and tons of other programs not related to serious mental illness. They have also reported on programs that may be worthy and/or politically correct social services (ex tutoring, ending poverty, etc.)  but don't serve people who have mental illness. We have also reported on diverting, wasting, or giving away MHSA funds to well-connected 'consultants' and insiders. 

California State Auditor is investigating

Because of the media attention, the California State Auditor is looking closely at how California Counties (And especially Sacramento, LA, San Bernardino and Santa Clara) are not spending the money to provide real services to people with serious mental illness.

The Auditor Needs Our Crowdsourcing To Find the Waste and Fraud

Are mentally ill more likely to be victims or perpetrators (and does it matter)?

Whenever there is "Psychotic Killer on Rampage" headline, some mental health advocates claim persons with mental illness are more likely to be victims than perpetrators. That statistic surprises me.  I wrote on many of the statistical tricks used to claim persons with mental illness are no more violent than others. Some studies artificially reduce rates of violence by:

• Defining mental illness so broadly it includes up to 50% of the population
• Including only the most serious acts of violence (homicide) and excluding knifings etc.
• Excluding suicide or self-harm
• Excluding the most seriously ill patients in jails, prisons, shelters, psychiatric hospitals, from the population being studied 
• Including only patients who are receiving treatment and excluding those who are not.
• Excluding mentally ill who also abuse substances

By using these tricks one can draw the conclusion that persons with mental illness are no more violent than others.

However, using some of the same tricks--which basically exclude the most seriously ill and only include the highest functioning-- should also show that that group is also no more likely to be victims.

So I looked into it just a little bit. It needs more investigating, but what  I think is happening is that

Psychiatrists are Wrong To Not Help Reduce Gun Violence By Mentally Ill

 The New York Times and Wall St. Journal reported on an argument being made by psychiatrists and psychologists that would allow them to escape provisions of the gun control law that would help persons with serious mental illness. Psychiatrists and psychologists are opposing a requirement inserted in NYS Gun Control legislation that requires them to tell county mental health directors when a mentally ill patient is likely to become dangerous. They fear making this report infringes on patient confidentiality and might, sometime in the future dissuade someone with mental illness from coming in or telling the truth, for fear it could result in them losing the ability to own a firearm.

The reporting requirement is exceedingly important in a way that the mental health industry is avoiding mentioning: by providing directors of county mental health programs with the names of people with serious mental illness who may become dangerous, it allows the mental health directors to prioritize their resources. They can ensure these most seriously ill and potentially dangerous individuals--a very small group--go to the front of the line for services, rather than the jails, prisons, shelters, and morgues they are historically sent to.

MENTAL HEALTH PROVISIONS OF NYS SAFE GUN LAW (S-2230 A-2388)

Following are the major mental illness provisions of the SAFE  NYS GUN LAW (S-2230 A-2388)  passed by NYS Senate and Assembly and expected to be signed by Governor Cuomo today.  
       Much of the credit must go to Senator Catharine Young (R) and Assembly member Aileen Gunther (D) who long ago identified ways to improve Kendra’s Law and proposed the original bill on which today's action is based. We especially thank the NYS Chiefs of Police and it's President, Michael Biasotti for their help in improving care for the most seriously ill. For more info visit http://kendras-law.org/

KENDRA’S LAW LOOPHOLES THAT WERE CLOSED

1. It closes the crack that allowed mentally ill individuals to be released from state prison forensic hospitals without evaluating them for inclusion in Kendra’s Law before they are released. If the person meets the criteria, the prison director must file a petition or notify the director of mental health services in the community the released prisoner is expected to reside.  (See Loopholes not closed)
2. It closes the crack that allowed court orders to simply expire without determining if they should be renewed. Requires Directors of Community (mental health) Services to establish procedures so that court orders that are expiring get reviewed prior to expiring. Historically, Directors of Community Services just let many orders expire without review.  
3. It closes the crack that allowed a court order to become unenforceable if a patient moves to a different county. Requires Directors of Community (mental health) Services to notify directors in other counties if a patient in Kendra’s Law moves to the other county. The director in the new county becomes responsible for provisioning services for the patient. 
4. Allows court orders to extend for up to one year. Research shows when a court order is for one year or more, the beneficial effect of the court order continues, even when the order itself expires. This provision also saves money.
5. Extends the sunset from June 30, 2015 to June 30, 2017. 

KENDRA’S LAW LOOPHOLES NOT CLOSED:

Which persons with mental illness can and can't buy guns

Many are concerned by proposals to create lists of persons with mental illness with the purposes of limiting access to guns. The question has arisen as to who is listed?

The following cites may help: 1968 Omnibus Crime Control Act, 1998 National Instant Criminal Background Check System (NICS)  excluded only people previously 'adjuticated as mentally defective' from owning guns. That phrase means there has previously been "A determination by a “court…or lawful authority that a person…is a danger to himself or others or lacks the mental capacity to contract or handle his own affairs” or "A finding of insanity in a criminal trial" It would include people who have been involuntarily committed, but not those who have been voluntarily hospitalized. Interestingly, it would include those who have previously been involuntarily committed due to substance abuse (some of whom have a higher propensity towards violence than persons with serious mental illness).