Treatment of violent mentally ill lowers rates of reoffending. New Study

Important new study: Researchers followed violent offenders (sentenced to 2 years or more) for an average of 10 months following their release and ascertained the rate of violent re-offending. The study included 742 individuals without psychosis; 94 with schizophrenia; 29 with delusional disorder; and 102 with drug-induced psychosis. It also assessed whether the individual’s mental illness was treated in prison, after leaving prison, or not at all.

Is Assisted Outpatient Treatment (Laura's Law, Kendra's Law) "Forced Treatment"?

Someone suggested Assisted Outpatient Treatment (AOT) is "Forced" Treatment (and therefore presumably bad).

1. Describing AOT as "forced treatment" demonstrates a misunderstanding. AOT, by definition, is only used after voluntary treatment fails. They serve mutually exclusive populations. For those individuals who won't access voluntary treatment, perhaps because they are too psychotic or have anosognosia, AOT is a way to reduce forced treatment. It is the last off ramp before patients are put into locked into involuntary commitment wards or put behind locked cell doors. Involuntary commitment to a locked hospital ward or a jail cell is a genuine use of force. The AOT research clearly states AOT reduces the use of those forms of forced treatment.

Affordable Care Act/ACA Fails Seriously Mentally Ill

Many 'mental health' advocates claim that the Affordable Care Act (ACA, a/k/a "Obamacare") combined with "mental health parity" will ensure people with mental health issues get care. The ability to keep a child on your insurance until age 26 will likely help many, since serious mental illness affects people in their late teens, early twenties. Maybe other provisions will help the higher functioning. But as the analysis below shows, overall, it makes things worse for the most seriously ill: those who need long term hospitalization.  Unfortunately, the impact of ACA on the most seriously mentally ill has been largely ignored by 'mental health' advocates.

What is serious mental illness in adults and what is not?

Serious mental illnesses are a small subset of the 300 mental illnesses that are in DSM. While it is fair to debate where the line between serious mental illness (SMI) and poor mental health is, the extremities are clear. The Center for Mental Health Services defined SMI as

mental illnesses listed in DSM that “resulted in functional impairment which substantially interferes with or limits one or more major life activities.” (CMHS 1999)

 By all accounts, serious mental illnesses include “schizophrenia-spectrum disorders,” “severe bipolar disorder,” and “severe major depression” as specifically and narrowly defined in DSM. People with those disorders comprise the bulk of those with serious mental illness. However, when other mental illnesses cause significant functional impairment they also count as a serious mental illness.  

According to the National Institute of Mental Health, serious mental illness is relatively rare, affecting only 5% of the population over 18. Serious mental illness includes schizophrenia; the subset of major depression called “severe, major depression”; the subset of bipolar disorder classified as “severe” and a few other disorders.

Schizophrenia (NIMH defines all schizophrenia as “severe”):  1.1% of the population (FN 1)
The subset of bipolar disorder classified as “severe”:  2.2% of the population (FN 2)
The subset of major depression called “severe, major depression”:  2.0% of the population (FN 3)

Therefore total “severe” mental illness in adults by diagnosis: 5.3% of the population (FN 4)

US mental health spending and mental health non-profits focus almost exclusively on people who do not have serious mental illness, rather than those who do. This is the single major problem with the US mental health system. Money is not lacking. Prioritization is.

Please send letter in Support of Helping Families in Mental Health Crisis Act

If you are part of any organization (state or local NAMI, MHA, Prison Reform, Consumer Group, etc) that wants to help persons with serious mental illness, please send a letter on your letterhead, to Rep. Tim Murphy urging passage of Helping Families in Mental Health Crisis Act (HR 3717). They want as many letters of support from organizations as possible.

You can see the NAMI/NYS letter below and use it as a model. You can see other letters (ex. NAMI National, American Psychiatric Assoc., etc) at http://murphy.house.gov/helpingfamiliesinmentalhealthcrisisact#Letters%20of%20Support

Darrell Steinberg asks Californians to pay twice for same program. Fails Mentally Ill

On December 19, California Senate President pro Tem Darrell Steinberg asked for more money for Mentally Ill Offender Crime Reduction Grants.

If Prop 63/MHSA funds were spent as legislatively required, no new funds would be needed. MHSA already specifically earmarked funds for this. MHSA Sec. 5813.5 (f) says:

Here's what's in the new "Helping Families in Mental Health Crisis" Act

(Left-Representatives Leonard Lance of New Jersey,  Bill Cassidy of Louisiana, a medical doctor, and Congressman Tim Murphy (Psychologist)  introduce the "Helping Families in Mental Health Crisis Act" HR 3717 12/12/13). 

Call your Representative and ask him/her to support HR 3717. To find your Rep phone number, enter your zip code at http://www.opencongress.org/people/zipcodelookup 

BACKGROUND

SPENDING AND SCOPE OF PROBLEM

In 2014, the U.S. will spend $203 billion on mental health. Due to mission-creep, the funds are now spent ‘improving mental health’ rather than treating those with serious mental illness. Moms who have children known to be seriously mentally ill are virtually powerless to see they receive care. While the public becomes aware of the failure of the mental health system after high-profile rare acts of violence, the everyday tragedies faced by people with serious mental illness and their families go unnoticed.

Wellness Recovery Action Plan (WRAP) Lacks Independent Verification and is not Evidence Based

WRAP labeled as 'evidence based' by SAMHSA. 

But is it?

When we ask “is a program evidence-based’, at Mental Illness Policy Org we break that question down into three components:

1.  Does it help people with serious mental illness (ex. schizophrenia, bipolar, major depressive disorders) or is it a program designed to improve the mental health of anyone who feels their mental health can be improved. 
2. Does the program improve a meaningful outcome? To be evidence based, we require it to improve a meaningful independent measure such as reducing suicide, homelessness, hospitalization, violence, substance abuse, arrest, incarceration, etc. Self reports of greatier happiness (“improved mental health”) are not sufficient or unique to WRAP
3. What is the quality and independence of the research.

WRAP (Wellness Recovery Action Plan) has been certified by SAMHSA National Registry of Evidence Based Practices and Programs (NREPP) as an evidence-based intervention. This certification encourages states to implement it. But the evidence is not clear that WRAP improves any meaningful measure like decreasing hospital days, decreasing incarceration, decreasing homelessness or that it is for people with serious mental illness. The certification of unproven programs leads states to waste money.

New NAMI Needed: National Alliance on SERIOUS Mental Illness (NASMI)

I think there needs to be a National Membership Org that focuses exclusively on Serious Mental Illness including important politically incorrect issues that NAMI refuses to address like preservation of enough psychiatric hospital beds, expansion of Assisted Outpatient Treatment (AOT), and relaxation of civil commitment laws.

One way to get it going would be to get former NAMI National Board Members to lend their name, form a nucleus. Perhaps call the new organization the National Alliance on Serious Mental Illness (NASMI)

State and local organizations can eventually make a decision as to whether they prefer to be part of the existing NAMI, or the one that makes serious mental illness their number one priority.

I believe the following former National NAMI Board Members might be willing to help: Eleanor Owen, Bernie Schell, Gerald Tarutis, Carla Jacobs, perhaps Fred Frese, Richard Lamb,and moi. If you know of more names, add them to this post.

Here is the National Alliance on Serious Mental Illness Facebook Page where you can discuss the idea https://www.facebook.com/seriousmentalillness

Obama Mental Illness Parity Regulations Fail to Help the Most Seriously Mentally ill

The Obama administration announced new regulations requiring private insurers to do what the federal government wont: provide health care coverage for mental illnesses equal to that provided for other physical illnesses. The new regulations will help many, but only few of the most seriously mentally ill. And while requiring private insurers to end discrimination against mental illness is to be lauded, it is unconscionable, dangerous and expensive to allow the federal government to continue its own discrimination.

President Obama should focus any incremental social service and health care programs on those who need it most, rather than the higher functioning.

NYC Mental Health Dept. must Prioritize Serious Mental Illness Rather than Mental Health

Testimony by DJ Jaffe, to NYC Dept of Health and Mental HealthNov. 1, 2013

My name is DJ Jaffe. I am Executive Director of Mental Illness Policy Org.

NYC and State used to focus all their resources on people with serious mental illness, but both are engaged in massive mission-creep that now leaves the most seriously ill to fend for themselves. Bullying is the newest cause celebre used by NYC to justify ignoring serious mental illness[1]. The fact that bullying isn’t a mental illness matters not a whit when it comes to spending money. Peer support-in spite of lack of evidence that it reduces violence, arrest, homelessness, suicide and incarceration is flooded with money while Kendra’s Law proven to help the most seriously ill is largely ignored.

NYC has largely abandoned efforts at symptom amelioration for the most seriously ill and instead focuses on ‘recovery’ and ‘wellness’ services for those who are higher functioning. The mental health system, which used to be a mental illness system, has offloaded the most seriously ill to the shelters, prisons, jails and morgues. As a result Riker’s Island is now the primary provider of services to the seriously ill in NYC. There is no known way to prevent mental illness, but ‘prevention’ ranks high in the department’s activities. “Early Identification” is the  new buzz word, when those identified can’t get treatment. Mission-creep and ignoring the elephant in the room: untreated serious mental illness has become policy.

We would ask that NYC stop shunning the seriously mentally ill, end mission creep and return to making serious mental illnesses like schizophrenia and treatment resistant bipolar disorder a department priority.

Here is how NYC can help people with serious mental illness 

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?