Monday, October 24, 2016

NYC's New Helpline Not What Seriously Mentally Ill Really Need

On Oct. 24, with great fanfare, NYC First Lady Chirlane McCray announced a new HelpLine for Mentally Ill (Call 1-888-NYC-WELL or text, "WELL" to 65173). When pressed by a reporter, Ms. McCray admitted that it was little more than 1 800 LIFENET with the addition of text capability.

Ms. McCray is widely hailed by the mental health industry for introducing THRIVE/NYC an $800 million mental health plan. But it largely ignores the seriously mentally ill.



WHY THRIVE/NYC IS FAILING

IT THROWS MONEY HERE[1]
THAT SHOULD BE USED HERE

Evidence
Mental Health First Aid (MHFA)
Peer Support
Assisted Outpatient Treatment[2]
Hospitals
Housing
Cuts Homelessness
No

No
Yes
Yes
Yes
Cuts Arrest
No
No
Yes
Yes
Yes
Cuts Incarceration
No
No
Yes
Yes
Yes
Cuts Suicide
No
No
Yes
Yes
Yes
Cuts hospitalization
No
No
Yes
Yes
Yes

THRIVE/NYC shuns the seriously ill and focuses on “improving mental wellness” in all others.
  • ·      Thrive/NYC funds “prevention” but serious mental illness can’t be prevented because we don’t know what causes it.
  • ·      Thrive/NYC funds “early intervention” but we can’t predict who will become seriously ill until after the symptoms first appear.
  • ·      Thrive/NYC funds “trauma,” but trauma is not a mental illness. Everyone loses a loved one, loses a job, experiences accidents, etc. PTSD is mental illness and even that runs from mild to severe.
  • ·      Thrive/NYC diverts mental health funds to programs that do not help seriously mentally ill.


NYC needs an “all hands on deck” approach to reducing homelessness, arrest, incarceration, suicide, and hospitalization of seriously mentally ill. Mental Illness Policy Org promotes ideas to accomplish that. Join us on Facebook and Twitter and subscribe to our email list at http://bit.ly/2eKarUd

Here is an article that appeared in City Journal that got it right. Also read this one in Daily News


De Blasio’s Mental-Health Blindspot

By Seth Barron (City Journal Online 10/20/16)


On Tuesday, an NYPD sergeant shot and killed 66-year-old Deborah Danner, an emotionally disturbed woman who attacked officers, first with a pair of scissors and then with a baseball bat. Mayor Bill de Blasio and police commissioner James O’Neill wasted no time blaming the sergeant for not following correct police protocol for responding to mentally distressed individuals. It may well be the case that the responding officers made serious errors. It may be that the sergeant’s actions were criminal. But the real mistake was the city’s Department of Health and Mental Hygiene’s neglect of Danner’s serious mental illness.
Danner’s case was known to the city. Her sister, with whom she lived, was Danner’s legal guardian, and the NYPD had been called to their house many times. Like many seriously mentally ill individuals, Danner had cycled through the city’s police-medical complex, and was apparently non-compliant with her medical regimen—that is, she didn’t take her anti-psychotic medicine as prescribed. “It’s the classic situation: someone is supposed to take meds and they go off their meds,” de Blasio said at a press conference. “Because of their illness they choose not to take their meds. Once they don’t take their meds it is very hard to get them to engage another kind of treatment.”   
Listening to the mayor, one would think that the paradox he outlined has never been addressed before. But New York, like almost every state, has a robust set of laws known generally as assisted outpatient therapy (AOT). Locally, the statute is known as “Kendra’s Law.” It has proven effective at keeping the mentally ill out of hospitals and shelters and promoting compliance with doctor’s orders. Kendra’s Law covers cases where a non-compliant and seriously mentally ill individual has previously been hospitalized, and is judicially and medically judged to pose a danger to himself or others. The law provides for a six-month period of supervision, during which the subject must comply with treatment or face possible commitment to a hospital. This rarely happens. 
Kendra’s Law is remarkably successful at helping the seriously mentally ill live relatively stable lives. The statistics are stunning: violent or harmful behaviors decrease by 44 percent; hospitalizations decrease by 77 percent; drug and alcohol abuse decrease by half. Patients report high levels of satisfaction with their participation in AOT, and the costs of care decline substantially, because outpatient treatment is so much cheaper—in financial and human terms—than incarceration or hospitalization.
Despite AOT’s track record of success, New York State rarely chooses to apply Kendra’s Law, even in seemingly obvious cases like Deborah Danner’s. Liberal critics of involuntary psychiatric commitment, still shuddering from the 1972 Willowbrook exposé, argue that any hint of coercive intervention is a violation of the civil liberties of the mentally ill. Meanwhile, the mental-health industry prefers to focus on mental illness as a public-health problem, like venereal disease or typhus. Publicity campaigns advise people on how to identify the signs of depression in themselves or their associates, or warn about the problem of stigmatizing mental illness. This epidemiological approach to mental illness fails because untreated schizophrenia is not contagious, nor is it hard to identify.
Thousands of homeless or incarcerated mentally ill New Yorkers aren’t living on the streets or in Rikers Island jail because they fear the stigma of mental illness. Rather, the city’s mental-health establishment has chosen not to deal seriously with their care.  
De Blasio speaks magnanimously about his grand approach to treating mental illness through his ThriveNYC plan, but that plan includes virtually nothing for the seriously mentally ill. Instead, the mayor is spending millions of dollars on feel-good advertising campaigns promoting peer counseling and awareness. His wife, Chirlane McCray, announced a collaboration this week between ThriveNYC and Tumblr, where people will be encouraged to submit quilt patches representing “a creative expression around changing the conversation around mental health and an individual’s relationship with mental illness.” 
Awareness isn’t the most pressing issue regarding the mentally ill in New York City. New Yorkers are already aware of the many suffering people in their midst. By making the police take up the slack for the city’s failed mental-health policy, de Blasio is being cynical and careless. Kendra’s Law is a working solution to the problems of people like Deborah Danner, but the mayor refuses to use it.





[1] MHFA Research at http://mentalillnesspolicy.org/samhsa/mental-health-first-aid-fails.html. Peer support studies showing no benefit beyond ordinary care: Cochrane Collaborative, “Consumer-Providers of Care for Adult Clients of Statutory Mental Health Services." American Psychiatric Association “Guideline Watch: Practice Guideline for the Treatment of Patients with Schizophrenia.” "BMC Psychiatry, A Systematic Review and Meta-Analysis of Randomised Controlled Trials of Peer Support for People with Severe Mental Illness.”  
[2] Assisted Outpatient Research at http://mentalillnesspolicy.org/national-studies/aotworks.pdf

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