Excerpts from Speech to NAMI/NYS Convention
By DJ Jaffe
Exec. Dir. Mental Illness
Policy Org.
November 15, 2013
I am supposed to talk on legislation
here and in Washington, and I would be glad to talk about that. But before
beginning I want to make clear that like most of you, I am not a mental health
advocate.
Like most of you, I am a
mental illness advocate. I think we need
less mental health spending and more mental illness spending. It is the most seriously ill not the worried-well,
who disproportionately become homeless, commit crime, become violent, get
arrested incarcerated or hospitalized. 360,000 are behind bars and 200,000
homeless because we are now focused on improving mental health, rather than
treating serious mental illness.
My number one message is that
we have to stop ignoring the most seriously ill. Send them to the front of the
line for services rather than jails shelters prisons and morgues. I’ll talk about how mental health advocates ignore
the seriously ill, followed by how the debate between mental health and mental
illness is being reflected in legislation in Washington and Albany.
Now before beginning, I admit
the boundary between mental health and mental illness is debatable, but the
extremities are clear. 100% of the population can have their mental health
improved. 20% have some sort of illness that can be found in DSM, mainly minor
illnesses like anxiety. And most of the illnesses in DSM are minor. But only
4.2% have a serious mental illness like schizophrenia, treatment resistant
bipolar, major severe depression or another illness that prevents them from
functioning.
Historically, people with
serious mental illness were a priority because our budget was spent on the
hospitalized. But mental health advocates have changed our focus. The federal
government spends $130 billion mental health dollars, much on improving the
mental health of all Americans-or as former NYS OMH Commissioner Michael Hogan
argued, “to create hope filled environments where people can grow”
I say we stop ignoring the
seriously mentally ill.
That distinction between
mental health and mental illness is the main debate going on today around the
country and is certainly at the core of the two bills Congress is now
considering and was at the core of some bills being considered in New York like
the SAFE Gun Control Legislation. NAMI/NYS
is one of the few groups doing both. They
have always done a stellar job at trying to improve the mental health of the
20% and they also advocate for the 4%. So if
someone asks me, “Where do I stand” it is with NAMI/NYS. Although I should
add, my comments today are mine, not theirs.
Let me talk about how mental
health advocates drive care away from the most seriously ill.
Mental "health" advocates claim everyone is well enough
to volunteer for treatment. That is
simply not true. As Congressman Murphy-who is also a psychologist, mentioned
last night, some have anosognosia: They are so sick, they don’t know they are
sick because the brain is impaired so insight is lacking. When you see someone
walking down the street screaming they are the Messiah it is not because they
think they are the Messiah. They know it. Their illness tells them it is so.
We have to stop ignoring the
seriously ill
Other mental "health" advocates claim mental illness affects everyone and claim
all mental illness is serious. They are wrong. All mental illness is not
serious. Many people I worked with including myself, have had or have depression,
anxiety, have trouble sleeping, take Zoloft or Prozac, or nothing and do quite
well. We don’t need funds diverted from
the seriously ill to the highest functioning.
Mental "health" advocates claim everyone recovers. That is False. Some do not. They actually hide those
who don’t recover. You won’t see the homeless and psychotic in their Mental
Health Awareness Week PSAs because they want everyone to believe all mentally
ill are high functioning. Trying to gain sympathy for mental illness by only
showing the high functioning is like trying to end hunger in Africa, by only
showing the well-fed.
We have to stop ignoring the
seriously ill
There are two trade associations here in Albany that
do some good work for the high functioning, but claim to speak for those with
serious mental illness. They want OMH to close hospitals that serve the
seriously ill and turn the money over to them.
That would be wrong. We are short 95000 hospital beds, nationwide
and 4000 in NY, even if we had perfect community services. When hospitals go down incarceration goes up. There
are so few hospitals, today it’s harder to get into Bellevue than Harvard and
once in you’ll be discharged sicker and quicker. Here in Albany last week
Desmond Wyatt was released from the Capital
District Psychiatric Center and
killed his mother the next day. His brother
told police Desmond was hearing voices but that didn’t stop the hospital from
releasing him.
We have to stop
ignoring the seriously ill.
Mental health advocates work to convince the public
that violence is not associated with mental illness. That may be true for the high functioning but violence is clearly associated with untreated serious mental illness. To convince the
public mentally ill are not more violent, mental health advocates quote studies
of the treated. Those studies prove treatment works, not that the untreated are
not more violent than others. Or they quote studies of the 20% with any mental
illness not the 4% with serious mental illness. Their studies are of those in
the community and therefore exclude the violent: those in jails, in prisons,
involuntarily committed, or have completed suicide.
They argue even talking about
violence causes stigma. Talking about violence is a prerequisite to reducing it.
It is violence by the small minority that tars the non-violent majority. Their failure
to admit to violence is preventing us from implementing policies to reduce it.
We have to stop ignoring the
seriously ill.
Current laws prevent people from
getting treatment until after they become danger to self or others. That’s
ludicrous. Laws should prevent violence not require it. Think seatbelts. But
mental "health" advocates want civil commitment to be even more difficult. They
argue involuntary treatment is bad without recognizing jail and prison are
worse. They argue against medications and restraint and as the NY Times pointed
out on Monday that is causing hospitals to become dangerous places. Patients
can’t be restrained so hospitals call police. Mental health advocacy is causing
seriously mentally ill patients into prisoners.
We have to stop ignoring the
seriously ill.
Mental Health Advocates are working to stop Assisted Outpatient Treatment (Kendra’s Law). AOT is the most successful treatment for the small group of the most
seriously ill who already accumulated multiple incidents of violence, arrest,
incarceration, or needless hospitalization because of their refusal, actually
their inability, to be well enough to volunteer for treatment. Kendra’s allows
courts to order six months of mandated and monitored community treatment. It is less restrictive than the alternatives: inpatient commitment and incarceration. It reduces
arrest, suicide, hospitalization and violence among people with serious mental
illness over 70% each and cut costs in half creating more funds for services
for all.
Peer support may do something. But it is not proven to do anything like what Kendra’s Law does. But
mental health advocates want to replace Kendra’s Law with peer support.
We have to stop
ignoring the seriously ill
Mental "health" advocates encourage government to spend
more on prediction and prevention. As
we heard in multiple sessions yesterday, we don’t know how to predict or
prevent serious mental illness because we don’t know what causes it. They
argue we should focus our spending on children because half of all mental
illness begins before age 14. But the statement is only true if you include
substance abuse. The study the claim is based on actually EXCLUDED serious mental illnesses like schizophrenia and bipolar. Serious mental illness begins in late teens and early twenties
and continues after that. That’s where we have to focus our attention.
Mental "health" advocates argue mental illness is
associated with bad grades, poverty, single parent households, and their latest
cause, bullying and cyberbullying so
we should divert funds meant to help the seriously ill to improve grades, end
poverty, improve marriages and address cyberbullying. Those are worthy social services issues but
are not mental illnesses. Spending mental health funds on those diverts
attention from mental illness. Mental "health" advocates claim trauma is a
mental illness. Trauma is not a mental illness. PTSD is. It can be extreme
or mild.
Stop Diverting the Money!
Mental "health" advocates blame
police when something goes wrong, and want more CIT training as do I. But
police only step in when one condition has been met: The mental health system
failed. And mental health advocates fail to recognize that as their diverting funds to the tangential rather than the consequential is largely responsible for the system failing. As mental 'health" advocates abandoned advocating for the seriously ill, criminal justice has stepped up: Largely
thanks to Chief Biasotti, the International and NYS Associations of Chiefs of
Police, Dept. of Justice, National Sheriffs Association, and others have become
the leading voices on how to improve care for the seriously ill.
Now I’d like to turn to how
this debate between mental health and serious mental illness is playing out in New
York and Washington.
What is interesting to
me, is that generally it is Republicans, not Democrats who are helping the
seriously ill. I am a left wing Democrat
so it pains me to say, but my party is generally oblivious to the fact that
throwing more money at mental health does not improve treatment for people with
serious mental illness. Democrats have been captured by mental health advocates
and therefore ignore unpleasant truths like not everyone recovers, sometimes
hospitals are needed; and left untreated a small subset of the most seriously
ill do become violent.
For example, in NY, when Governor Cuomo said he was going to pass legislation requiring
therapists to report potentially dangerous mentally ill to criminal justice so
they could be banned from owning firearms, there was no way to stop it. But Republicans
inserted provisions requiring the reports to go through county mental health
directors rather than directly from therapist to criminal justice. Why? Because
that was a way to force county mental health departments to become aware of
seriously mentally ill who live in their counties. The hope was they would
offer treatment not just take guns away. Directors fought the provision, preferring to
keep their heads in the sand. They
called it an ‘unfunded mandate’. Helping the seriously ill is not an unfunded
mandate, it is their mandate.
Much of the rest of the speech was dedicated to explaining the provisions of the Helping Families in Mental Health Crisis Act (HR 3717), why a competing bill doesn't help, and myths raised by mental health advocates about it.
Much of the rest of the speech was dedicated to explaining the provisions of the Helping Families in Mental Health Crisis Act (HR 3717), why a competing bill doesn't help, and myths raised by mental health advocates about it.
To improve care for people with serious mental
illness money is not missing, leadership is. We have to stop listening to
mental health advocates and start listening to mental illness advocates. We
need to replace mission creep with mission control. As Police Chief Biasotti, testified to Congress,
We have two mental health systems today, serving two mutually exclusive populations: Community programs serve those who seek and accept treatment. Those who refuse, or are too sick to seek treatment voluntarily, become a law enforcement responsibility. …(M)ental health officials seem unwilling to recognize or take responsibility for this second more symptomatic group.”
We have to stop
ignoring the seriously ill.
Thank you.
I respect and appreciate your aspect of mental health and mental illness. In my employment I am a para professional Peer Mentor. My take on mental illness is I help the client recognize and understand that they have a diagnosis but, that is only one part of them and is not who they are and does not have to define them. I then help the clients focus on what is right with them, the areas of the clients life that is mentally healthy. I have lived experience with PTSD and GAD. I am in recovery but, do every once in a great while become symptomatic and have an episode. So I am not saying that the client or myself can be "cured" but I am saying and living the fact that you can recover to a point where you can live with and manage your diagnosis, while functioning as a valuable member of society and this population. Basically I offer hope.
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