SAMHSA Slammed by Congress ... And for Good Reason

Thanks for this, DJ Jaffe.

http://www.huffingtonpost.com/dj-jaffe/congressional-hearings-hi_b_3325117.html

Few SAMHSA programs reduce the impact of mental illness on communities – on rates of incarceration and homelessness * SAMHSA is under-populated by staff with expertise in the nature of the treatment of severe psychiatric disorders * The emphasis on recovery as a goal steers policy away from the needs of the most severely disabled

Examining SAMHSA’s role in delivering services to the severely mentally ill - Society and Culture - AEI

TODAY'S TESTIMONY BEFORE HOUSE COMMITTEE BY COURAGEOUS FATHER, JOE BRUCE. Examining SAMHSA’s Role in Delivering Services to the Severely Mentally Ill.

HOUSE COMMITTEE ON ENERGY AND COMMERCE

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

Examining SAMHSA’s Role in Delivering Services to the Severely Mentally Ill

Statement of Robert “Joe” Bruce and Exhibits

10:00 a.m. May 22, 2013

My name is Joe Bruce.  I live in Caratunk, Maine.

On February 6, 2006, my son William Bruce, age 24, was involuntarily committed to Riverview Psychiatric Center in Augusta, Maine.  On April 20, 2006, with help from federally funded patient rights advocates from the Disability Rights Center of Maine (DRCM), Will was discharged early from Riverview without the benefit of any medication.

As is most often the case with severely and persistently mentally ill persons across the country, 

Will returned home.  Fears his mother and I had voiced to his doctors that Will would hurt or kill 

someone came true. On June 20, 2006 I returned home to find the body of my wife Amy.1  Will, in a 

state of deep psychosis, had killed her with a hatchet.2

Will was advised that without his consent, his parents had no right to participate in his treatment, or have access to his medical records. Will believed there was nothing wrong with him, that he was not mentally ill, a condition characteristic of many persons with severe bipolar disorder or paranoid schizophrenia, particularly of younger ages such as Will's.  He would not consent to our involvement with his treatment, and because he was an adult, his mother and I were barred from all access to his treatment. The doctor’s decision to release him, which resulted in such a tragic outcome, was made without the benefit of all of Will’s history or any input from Amy and me.

1 Pictures of Amy and  Will appear behind Tab 1.

2 A transcript of my call to the 911 operator is annexed behind Tab 2.

After his commitment to Riverview by the criminal court, I applied to become his guardian. Will was 

agreeable to this until, incredibly, a patient advocate told him, “The guardianship is a bad idea.  

It would give your father complete power over you.”

The attending physician (a new doctor), undoubtedly at the urging of DRCM, refused to provide the 

evaluation required in the guardianship application. He told me, “I could never participate in 

anything that would cause your son to be considered an incapacitated person.” Bear in mind that at 

this point in time, Will had been placed in the hospital after being found incompetent to even 

stand trial!

Suffice it to say, I finally did become guardian, and I was able to participate in Will’s treatment 

and to obtain the medical records of his prior treatments.  Until then, I had not known the role 

the patient advocates had played in Will’s premature and unmedicated release.

The medical records revealed exactly what the patient advocates had recklessly done and said to 

encourage Will to avoid the treatment he so desperately needed.  His doctor had recorded verbatim 

what the patient advocates said to Will in the meetings from which Amy and I had been excluded.

– The patient advocate, a Trish Callahan, told the treating doctor that DRCM regarded Amy and me as 

a “negative force in Will’s life.”  Amy and I had never met any of these people or even heard of 

Disability Rights Center of Maine.

– In the treatment meetings, she acted like a criminal defense lawyer.  She openly coached Will on 

how to answer the doctor’s questions so as to get Will the least treatment and the earliest 

release.  She did this in the face of strongly contrary evidence of Will’s unsuitability for 

unmedicated release.

– She repeatedly pressed for his early release despite knowing or recklessly disregarding that he 

was unsuited for it.3

DRCM willfully neglected Will’s need for treatment, and their pressure on the doctor to release 

Will led directly to Amy’s death.  But neither the patient advocates nor the DRCM has ever 

acknowledged they did anything wrong.  They have not changed their procedures and Trish Callahan, 

the advocate who helped fuel Will’s paranoid hostility towards his mother and contributed to her 

death, continued to work on the same unit at Riverview for years afterwards.

Lest anyone believe this is a local, isolated occurrence, the National Disability Rights Network, 

responding to the Wall Street Journal’s page one article4 concerning Will’s case, defended the 

actions of DRCM, 5 and even prepared talking points to deflect criticism.6 The patient advocates 

can do this with impunity because they are literally accountable to no one. But

my experience with the patient advocates did not end here.

I have come to know the stories of many other families, and their experiences with the advocates’ 

surprising approach to these issues.

Beginning in 2007, I joined with other family members of some of the most severely mentally ill 

individuals in the State of Maine to seek legislative change to laws that had prevented our loved 

ones from receiving treatment. We took our concerns to the lawmakers in the Maine legislature.

To the shock of all of us we met with fierce lobbying opposition from Disability Rights Center of Maine.  Nonetheless, we were successful in obtaining helpful legislation in 2007

--------------------

3 A summary of the patient advocate’s statements and actions appears behind Tab 4, and a more 

detailed chronology of Will’s medical records appears behind Tab 5.

4 A copy of the Wall Street Journal’s August 16, 2008 article, “A Death in the Family, is annexed 

behind Tab 7.

5 A copy of the NDRN response to the Wall Street Journal’s article is annexed behind Tab 8.

6 A copy of the NDRN’s talking points is annexed behind Tab 9.

--------------------

providing for medication over objection in appropriate cases. Having failed in the legislature, the 

lawyers at DRCM filed a legal action challenging the law, which thankfully was unsuccessful.

At the time of Amy’s death, the courts in Maine only had two options at a commitment hearing: to 

place someone in the hospital or to release them unconditionally.  In 2008 and 2009 I and other 

Maine families worked to give the court a third option, that of releasing an individual into the 

community on the condition that he remain on medication.  These types of laws are known as Assisted 

Outpatient Treatment laws and they have been opposed across the Nation by PAIMI organizations.  

Maine was no exception.

DRCM mounted a well-orchestrated lobbying attack on the proposed AOT law.  It was joined in this 

effort by the Advocacy Initiative Network of Maine, another SAMHSA funded organization. Their 

campaign included proffering 20 or so consumer witnesses in opposition to the law, but these 

consumers were completely aware of their mental illness, stable on medication and successfully 

living in the community – the very goals that the proposed law was designed to achieve for our 

loved ones.  DRCM had persuaded them to oppose the law by misrepresenting its essential provisions. 

This cynical opposition to the AOT law (which failed, because the law ultimately enacted) shocked 

me and the families.  The incident illustrates the national policy of the PAIMI program to oppose 

any form of involuntary treatment.

The PAIMIs, like DRCM, are so concerned that one person may be inappropriately treated 

involuntarily that they seek to prevent anyone from being medicated.  In Will’s case, once I became 

his guardian, medication over his objection was his route to recovery.

As another example of DRCM’s lobbying influence in this area, while the Maine families and I were 

busy working on the AOT law, DRCM was successful in getting a bill through the Maine legislature to make it more difficult for families to become guardians.  Becoming a guardian is the only way families of adult patients can be involved in the treatment of their loved ones where the patients are unwilling or unable to consent.  Why do PAIMIs want guardianship to be more difficult?  Because a guardianship lifts HIPAA secrecy and allows the guardians into the treatment meetings.

*               *               *

Will is still in Riverview, to which he was committed by the criminal court.  Once he was committed, he got the care he should have gotten before.  Ironically and horribly, Will was only able to get treatment by killing his mother.  We have found a medication that works.  He leaves the hospital frequently on supervised release with staff or family members.  He is being successfully treated and he is doing extremely well.7  He now recognizes that if he had been treated his mother would still be alive today.  He stated to the Wall Street Journal, “The advocates didn’t protect me from myself.  None of this would have happened if I had been medicated.”

Tragedy visits families every day.  That is a sad fact of life.  But an unbearable aspect of Amy’s 

death is that my own tax dollars helped make it possible.  A retired nurse from Riverview may have 

summed it up best.  She wrote: “Mr. Bruce . . . Your losses didn’t happen for reasons other than 

your family’s misfortune to become involved with the mental health system, when politics (now) 

override sound medical decisions.”8

Thank you for hearing my testimony.  I would be happy to answer any questions you might have.

--------------------------

7 Behind Tab 3 is a transcript of the hearing that resulted in Will’s commitment to Riverview, in 

which a psychiatrist testified to the “remarkable change” that occurred in Will’s condition once he 

was given antipsychotic medications. At page 51.

8 A copy of the nurse’s letter is annexed behind Tab 10.  She has given me permission to use it 

publicly.

- 5 -

- 6 -

Exhibits to the Testimony of Joe Bruce

1.         Pictures of Amy and Will.

2.         Transcript of Joe Bruce’s call to 911 operator, June 20, 2006.

3.         Transcript of hearing in State of Maine v. William Bruce, March 27, 2007. (Once Will 

started antipsychotic medication in December 2006, it brought about “remarkable change” in his 

insight into his need for treatment.  At

51.)

4.         The Role of the Patient Advocates, A Summary of the Medical Records of

William Bruce, prepared by Robert D. Owen, counsel to Joe Bruce.

5.         William Bruce: Chronology of His Medical Records and Treatment, prepared by Robert D. 

Owen, counsel to Joe Bruce.

6.         Preliminary Appointment as Guardian, In Re: William H. Bruce, Piscataquis County (Me.) 

Probate Court, Feb. 8, 2007.

7.         “A Death in the Family: Aided by advocates for the mentally ill, William

Bruce left the hospital -- only to kill his mother,” WALL ST. J., August 16,

2008.

8.         National Disability Rights Network “Summary in Response to WSJ Article.”

9.         National Disability Rights Network talking points memo.

10.       Letter dated Dec. 16, 2006 to Joe Bruce from Maria Champine, a registered nurse who 

worked at Riverview.

“Troubled Minds”: Mental Illness and the Church’s Failure to Address it

http://www.patheos.com/blogs/cultivare/2013/05/troubled-minds-mental-illness-and-the-churchs-failure-to-address-it/

Survey says more Oahu homeless mentally ill - Hawaii News Now - KGMB and KHNL

Survey says more Oahu homeless mentally ill - Hawaii News Now - KGMB and KHNL

HIPAA Handcuff Hearings: HIPAA (patient privacy) laws often prevent parents from getting info they need to see their loved ones get care.

The US House of Rep., Committee on Energy and Commerce, Subcommittee on Oversight and Investigations will hold a hearing on:  

"HiPAA HANDCUFFS" 

Friday, April 26, 2013, at 9:00 a.m. in 2123 Rayburn House Office Building 

“Does HIPAA Help or Hinder Patient Care and Public Safety?”. 

PLEASE contact members of the committee and tell them you support reform of HIPAA so relatives of seriously mentally ill can help their loved ones get better more appropriate care.

This is as far as we've ever gotten to reform HIPAA, so lets see what we can do.

At 18, loved ones have full control of their health decisions. Laws need to change.

Rachel Pruchno is director of research at the New Jersey Institute for Successful Aging. She is also author of the forthcoming memoir, Surrounded by Madness.  

Reprinted from USAToday with author's permission.

(Photo: MSNBC file photo)

STORY HIGHLIGHTS

• My daughter suffers from mental disorders. Once she turned 18 I was treated like a pariah.
• In most states, getting treatment requires that the person exhibit dangerous behavior.
• But what about people like my daughter, who has not been violent, but needs treatment?

I've been dealing with the mental health system since my daughter was 12. Diagnosed with bipolar disorder at 16 and borderline personality disorder at 18, I thought I'd seen it all. Once she turned 18, however, I went from valued member of the health care team to its pariah.

America's mental health system is in crisis largely because families are excluded from participating in the care of loved ones. The National Institute of Mental Health estimates that 11.4 million Americans suffer from serious mental illnesses, including schizophrenia, bipolar disorder and major depression. About half of people with mental illness suffer from a lack of awareness about their illness, compromising their abilities to make informed decisions.

Yet, legally, at 18 they have full control of their health care and other life decisions. In many states, getting treatment requires that the person first exhibit dangerous behavior.

But what about young people such as my daughter, who has not exhibited violent behavior, but nonetheless needs treatment? Before my daughter turned 18, my husband and I consulted a mental health attorney. He told us that while we could petition the court for guardianship, he advised against it because it would be expensive, unlikely to be granted, and temporary, typically three to six months in duration.

Too many barriers

Doing the right thing should not be so difficult. Laws need to be changed for the sake of people with mental illnesses, their parents and for society.

Other parents have also tried to help their children, including some who began exhibiting odd, but not violent, behavior. The inability to persuade — or force — these young men to get help resulted in deadly consequences.

Details emerging last week revealed that the parents of Jared Loughner, 24 — whokilled six and wounded Rep. Gabrielle Giffords and 18 others in Arizona — disabled their son's car each night to try to prevent him from harming others. They confiscated his shotgun after Pima County College police warned that their son might be a danger to himself or others. They pleaded with their son to get help. He refused.

James Holmes was not living with his parents when he killed 12 and injured 58 peopleat the Aurora, Colo., movie theater. Holmes was on the radar screen of mental health professionals at the University of Colorado before the massacre, yet even they were powerless to intervene.

Reasons for change

There are good reasons to give parents more legal leverage over adults with mental illnesses:

• Most severe mental illnesses are diagnosed in the early years of adulthood, 75% before age 24. Many first experience disorganized thought as college students.
• When families are involved, health care providers gain a more accurate understanding of the patient's history. This, in turn, guides better treatment decisions.
• Research shows that when families are involved, rates of treatment adherence are higher and rates of hospitalization are lower.

My daughter is 20. She is addicted to methamphetamine and lives on the street. Her father and I have begged to help her. She continues to refuse treatment.

Laws should take a more reasoned approach that empower families who know when there are problems and want what's best for all involved. It is time to realign laws with science and compassion.