We're going about suicide prevention the wrong way

Suicide is rare among the general population. It is more common, but still rare, among people with serious mental illness. There are about 38,000 successful suicides per year (American Foundation for Suicide Prevention 2010). There are at least 380,000 attempts. The lifetime risk to those with schizophrenia is only 5%. (Hor and Taylor 2010). The lifetime risk to those with bipolar is only 10-15%. (Center for Disease Control and Prevention 2014). Of the 37.5 million Californians, only 3,823  (.01%) took their own lives, and 16,425 (.04%) were hospitalized for self-inflicted injuries in 2010. (California Mental Health Services Authority 2012).   

Advocates regularly overstate the prevalence of suicide and attempts among persons with mental illness in order to curry funding for their programs. At the high end, the National Alliance on Mental Illness claims, “More than 90% of youth suicide victims have at least one major psychiatric disorder.”  (National Alliance on Mental Illness (NAMI) 2013)  Mental Health America, a trade association for providers of mental ‘health’ services estimates “30% to 70% of suicide victims suffer from major depression or bipolar (manic-depressive) disorder” (Mental Health America n.d.).

Suicide is not always the irrational act of a sick mind.  Mental illness in people who commit suicide is often diagnosed after the fact. After someone takes his or her own life, we look for a cause. If they take their life after having had lost their spouse or job, gotten a bad grade in school, or received a new medical diagnosis we chalk it up to depression and put the suicide in the mental illness column. 

In spite of being overstated, it is clear that suicide disproportionately affects people with mental illness. Dr. E. Fuller Torrey looked at studies of the prevalence of suicide among the seriously mentally ill and studies of the prevalence of serious mental illness among those who suicide, two sides of the same coin, and in both cases found about 5,000 of the 38,000 suicides (about 14%) were in people with serious mental illness. This is still three times their presence in the general population.  (Torrey n.d.).

Suicide can not be reduced through advertising and public relations

Every suicide is a tragedy for the individual, their family and the community. Many of these suicides could be prevented if persons with mental illness were provided care. Instead of doing that, the industry is funding ineffective feel good campaigns targeted at the general public.

About Assisted Outpatient Treatment (AOT)

Assisted Outpatient Treatment (AOT) is for a very small group of the most seriously mentally ill who already accumulated multiple incidents of hospitalization arrest or incarceration associated with their failing to stay in voluntary treatment. AOT allows judges, after full due process to require certain mentally ill to accept six months of mandated and monitored treatment as a condition for living in the community. It provides an off ramp before incarceration. As Linda Dunn said, Assisted Outpatient Treatment is like putting a fence by the edge of the cliff rather than an ambulance at the bottom. (Barnidge 2014)

The research on AOT is extensive and positive. (Mental Illness Policy Org 2013). Six months of mandated and monitored treatment has been shown to reduce homelessness 74%; hospitalization 77%; arrest 83%; incarceration 87%, physical harm to others 47%; property destruction 46%; suicide attempts 55%; and substance abuse (48%). By replacing expensive incarceration and hospitalization with less expensive community care Assisted Outpatient Treatment cuts costs to taxpayers in half. (Swanson, et al. 2013). AOT also reduces victimization. (V.A. Hiday 2002). These results are particularly outstanding because AOT is limited to the most seriously ill, often a very hard to treat population.

New Report: California Mental Health Services Act Fails Seriously Mentally Ill

California Mental Health Services Act Oversight Commissioners (MHSOAC) just issued a press release saying Prevention and Early Intervention (PEI) programs (20% of total MHSA Funds) are working. 

http://www.mhsoac.ca.gov/MHSOAC_Publications/docs/PressReleases/2014/PR_Programs-Work_080514.pdf

However, they didn't even study adults with serious mental illness.

NAMI/National less than honest with members

Call 202 224 3121 or go here and urge your U.S. Representative to co-sponsor HR 3717, the Helping Families in Mental Health Crisis Act.

NAMI State and local chapters do brilliant work trying to improve care for people with the most serious mental illnesses and provide comfort to them and their families. NAMI/National is ignoring the most seriously ill in order to be politically correct.

Representative Tim Murphy (R. PA) has proposed HR3717 the “Helping Families in Mental Health Crisis” that does much of what NAMI local and state members have been begging for.

SAMHSA FAILS SERIOUSLY MENTALLY ILL

A bill in Congress (HR3717, the Helping Families in Mental Health Crisis Act) would change SAMHSA and some wonder why change is needed. SAMHSA (Substance Abuse and Mental Health Services Administration) was created by Congress to “reduce the impact of…mental illness on America’s communities” and “target … mental health services to the people most in need”. SAMHSA has failed to do either. SAMHSA refuses to require its funds reach the most seriously ill and enacts policies to see they don't.

SAMHSA largely ignores the most significant impacts of mental illness on the communities, specifically violence, incarceration, hospitalization, homlessness and suicide. Instead, SAMHSA focuses on improving metrics like 'feeling of empowerment' 'hopefullness' and other softer outcomes.

Info on mental illness related violence in PA

Facts about Pennsylvania Mental Health System and Violence

List of Acts of violence by untreated mentally ill in PA

http://mentalillnesspolicy.org/states/Pennsylvania/preventabletragediesPA.pdf

Pennyslvania needs 3800 more psychiatric beds for the most seriously ill assuming they had perfect services

Chart two at http://mentalillnesspolicy.org/imd/shortage-hosp-beds.pdf

Pennsylvanians are 2X as likely to be incarcerated for mental illness as hospitalized

http://mentalillnesspolicy.org/NGRI/jails-vs-hospitals.html

Statement/Facts on Laura's Law vote in Los Angeles, CA

If You Don't Ask Your US Rep to Cosponsor Helping Families in Mental Health Crisis Act, You are Part of Problem.

Call your US Rep to ask them to co-sponsor HR-3717, the Helping Families in Mental Health Crisis Act for the 6 reasons below:
Background

Five percent of Americans have serious mental illness (i.e., schizophrenia, severe bipolar). Twenty percent have “any” mental illness (i.e., some form of depression, stress, anxiety, social phobia, etc.).  It is the 5% who are most likely to become homeless, suicidal, criminal, arrested, incarcerated and violent. Up to 40% of the most seriously ill are so ill they do not know they are ill (“anosognosia”). While most mentally ill are not violent, that does not hold true for the untreated seriously mentally ill with anosognosia. We can not ignore them. Following are provisions in HR3717 that most directly improve care for the seriously ill and reduce the chance of violence, homelessness, suicide:

Does Assisted Outpatient Treatment Violate Civil Liberties

Does Assisted Outpatient Treatment violate civil liberties of persons with mental illness?  Courts say no, and courts are the arbiters. Courts have decided that since AOT is limited to such a small group (those with a past history of arrest, violence, needless hospitalizations) that AOT is an appropriate use of police power (to protect citizenry) and parens patraie powers (to help those who can't help themselves). 

Another way to look at it is that AOT generally does not affect persons with mental illness. Having a mental illness is not enough to qualify someone for AOT. At most, 123,000 people would be eligible for AOT and research shows that even when AOT is funded, only roughly one-third of those eligible will ever be put on it (41,000 individuals). There are 58 million people who had  a mental illness diagnosis in past year. Therefore the maximum number of people it will affect, is .07% of individuals with mental illness.  

Clearly, not all people with mental illness are being put "at risk". It does not result in the massive depravation of rights claimed by opponents.

The upside is AOT has been proven to work. AOT reduces homelessness, arrest, violence, incarceration over 70% among those enrolled. It is constitutional, does not violate civil liberties; keeps patients public and police safer, is racially neutral, has support from consumers who actually experienced it, and cuts costs to taxpayers in half. 

AOT is smart policy to help deliver treatment to a very small group of the most symptomatic. 

Assisted Outpatient Treatment Pilot Program Grants Passed by Congress

On Monday, March 31, 2014, the Senate passed H.R.4302 which included $60 million for Assisted Outpatient Treatment Pilot Programs. Following is the text of the legislation (Followed by the text of the Excellence in Mental Health Act which was also included in HR 4302) 

---

SEC. 224. ASSISTED OUTPATIENT TREATMENT GRANT PROGRAM FOR INDIVIDUALS WITH SERIOUS MENTAL ILLNESS.

(a) In General- The Secretary shall establish a 4-year pilot program to award not more than 50 grants each year to eligible entities for assisted outpatient treatment programs for individuals with serious mental illness.

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