Saturday, July 31, 2010

Knox public defender's office receives grant

The Knox County Public Defender's Community Law Office is one of three offices nationwide to receive a grant from the Center for Holistic Defense at the Bronx Defenders.

The Technical Assistance grant will provide CLO with a six-month training course focusing on holistic defense, a release states.

According to the Bronx Defender's website, holistic defense aims at looking beyond the criminal case of clients and looks to address underlying issues that loom in a client's life that may cause criminal behavior.

Knox County CLO will use skills they learn from the course to continue to intervene in the cycle of poverty, addiction, mental illness and criminal conduct, the release states.

The release states there were 23 applicants from 21 states competing.

- From staff and wire reports, KNS

Thursday, July 29, 2010

Grim Statistics from NIMH On Mental Illness

Tom Insel, director of the NIMH, shared some grim statistics about severe mental illness and showcased the Treatment Advocacy Center in a recent blog on the institute’s web site.

Wrote Insel, “Several facts about mental illness in the United States always seem to surprise those who are not directly involved":

  • Each year, there are nearly twice as many suicides (33,000) as homicides (18,000).
  • The life expectancy for people with major mental illness is 56 years (the average life expectancy in the U.S. is 77.7 years).
  • Mental disorders and substance abuse are the leading cause of disability in the United States and Canada.
“To this list we can now add another statistic—according to the Treatment Advocacy Center (TAC),” he said, citing the study of jails and hospitals we released with the National Sheriffs Association in May.
  • “People with mental illness are three times more likely to be in the criminal justice system than hospitals.”
Insel blamed the 90% reduction in hospital beds over the last 50 years and the popularity of mandatory sentencing laws as prime culprits in criminalizing mental illness.

source:  Treatment Advovacy Center
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Crazy by Pete Earley - Read the 1st Chapter

I had no idea. I'd been a journalist for thirty years and written extensively about crime and punishment and society. But I'd always been on the outside looking in. I had no idea what it was like to be on the inside looking out – until my son, Mike, was declared mentally ill. Suddenly the two of us were thrown headlong into the maze of contradictions, disparities and Catch-22s that make up America's mental health system. Crazy: A Father's Search Through America's Mental Health Madness is a nonfiction book that tells two stories. The first is my son's. The second describes what I observed during a year-long investigation inside the Miami- Dade County jail, where I was given unrestricted access. I feel more passionately about this book than any I have every written. Our nation's jails and prisons have become our new mental asylums. I wrote this book as a wake-up call to expose how persons with mental illness are ending up behind bars when what they need is help, not punishment. ~ Pete Earley

Important note: The word “CRAZY” in the book title refers to the mental health care system.

*Click on the title of this blog entry to read the first chapter of Crazy.

Wednesday, July 28, 2010

Maine Passes Assisted Oupatient Treatment Law

Some of the provisions in the new law include expanding the criteria for involuntary commitment, extending the treatment timeframe from six to 12 months and allowing licensed physicians, registered physician's assistants, certified psychiatric clinical nurse specialists, nurse practitioners and licensed clinical psychologists to sign involuntary commitment papers. Maine's assisted outpatient treatment (AOT) law takes effect July 1 when the current Progressive Treatment Plan expires.

Tuesday, July 27, 2010

Monday, July 26, 2010

AOT in NY: Results Speak for Themselves

(This is an exerpt - click on above title for full article.)

Kendra’s Law reduces the severest consequences from lack of treatment

During the course of court-ordered treatment, when compared to the three years prior to participation in the program, AOT recipients experienced far fewer negative outcomes. Specifically, the OMH study found that for those in the AOT program:

74 percent fewer experienced homelessness;

77 percent fewer experienced psychiatric hospitalization;

83 percent fewer experienced arrest; and

87 percent fewer experienced incarceration.
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Mentally Ill Need Compassion, Not Confrontation

A friend and his family were strolling down Melrose when your standard urban ruckus erupted down the block: a homeless man having it out with inner demons - kicking newsstands, lunging at bicyclists, shoving bystanders, coming right at my friend and his family. Getting more whipped up with every step.

Now, children were present, as was the friend's wife, a chain-smoking woman who might reach 5 feet tall if you put her in high heels and asked her to stand on tiptoe. The friend, a scholarly soul who has been in about as many fistfights as I have, felt his blood rise, like a reflex - "I'm going to have to hit this guy," he thought, panicking, as the transient's wild eyes swiveled and locked onto his.

And now came the madman, full steam and stomping. The friend's hands were rising to defend his family--because that's the instinct, isn't it?-- when, quick as a wink, the wife darted between them, cigarette in her mouth, not a syllable of warning, and put her own hand up, and . . . touched . . . the madman's . . . cheek.

"You're having a bad day, aren't you buddy?" she asked gently.

"Yeah," the man replied, instantly calming. "I am."

"I can tell. You want a cigarette?"


"Here. Take a couple. Voices talking to you today? Telling you to do things? They're gonna get you into trouble, y'know."

Within five minutes, the man--now quiet--had been persuaded to take a time out, go sit in a park, have a smoke, get it together, maybe go where a professional might help him. "That was amazing," my friend told his wife afterward, as the shaken family resumed their stroll down Melrose.

"He didn't need a fight. He needed someone to tell him it was going to be all right," she replied. "That man had a riot going on in his head."

Can you see yourself reacting that way, in a run-in with a deranged street person?

Me neither. It's scary, mental illness. The urge to shove it away or run in the opposite direction is so knee-jerk, it's as if some ancient instinct warns us that this thing called madness could wipe out the very species. What reflex is more compelling than the urge to avoid the truculent, unlovely, ungrateful nut case muttering at a lamppost? Who doesn't recoil at the wild eyes, the filthy teeth, the unwashed feet?

It takes a brave person to muster compassion for the tortured and raving. Most people are not that brave. This is why so much of this particular urban crisis, here and elsewhere, has been fobbed off on the police, who, as it turns out, aren't so reliably brave either. For details, see this week's jarring report by Times staff writers Steve Berry and Josh Meyer, documenting the LAPD's heartbreaking reaction: 37 shootings of the mentally ill over the past six years, including 25 deaths.

The report--culled from the LAPD's own paperwork--dealt with officer-involved shootings of people who were suicidal, who'd forgotten their medication, who were not only unbalanced but also drug-addled, who didn't always turn out to have been armed. Sometimes they were physically threatening, but more often--as in the matter of the diminutive bag lady Margaret Mitchell--the larger threat actually seemed more psychological.

One shooting occurred after the officer slipped while backing away from a man who was stabbing himself and shouting, "Kill me!" Another when a babbling stranger who'd thrown a grapefruit at a cop car began to yell wildly and reach for his fanny pack in the dark. Yet another stemmed from an "expressionless" stare from an otherwise compliant paranoid schizophrenic; unnerved, the officer put a hand on his holstered gun, prompting the paranoid man to lunge at him. The paperwork noted the officer's rising "state of hysteria," as he cried repeatedly that the mental patient was going for the weapon; only after the cop's partner had opened fire did anyone realize that the gun had remained holstered throughout.

But you have to be brave to look into the abyss that is mental illness--brave enough to overcome the most fundamental sort of fear. This is why more police training and more nonlethal equipment options, though both are desperately needed, would provide only part of the answer. It's not fair to anyone to pretend that a profession with an innate cultural abhorrence of weakness will, overnight, acquire a gift for handling the grotesquely weak.

There must be more competent treatment, more alternatives to dumping people in the street, more funding. And more understanding of these riots that erupt in people's heads. We panic because, at some level, we know that health is relative, that the sick and the well are more alike than we prefer to acknowledge. There are few scarier realizations than "There but for the grace of God . . . "

Shawn Hubler
November 11, 1999
Copyright 2010 Los Angeles Times

Thursday, July 22, 2010

Would we?

"Would we withhold life-saving medicine from an AIDs patient or turn our backs on a person with Down Syndrome and let them eat out of garbage cans and sleep under bridges? Of course not, yet every day in our nation, we ignore the medical needs of people with chronic brain disorders, men and women who could be helped, and instead allow them to be neglected and abused on our streets. Under the guise of civil rights, we demand that they heal themselves even though many of them don't even realize that they are sick. Assisted Outpatient Treatment, with built-in safeguards, is a sensible way to help ill people become stable and to reclaim their lives. If I had a chronic mental illness and there were medicines that could help me recover, I would want my loved ones and doctors to make certain that I got them, not to stand by and watch me suffer."

Pete Earley, Author of CRAZY: A Father's Search Through America's Mental Health Madness

Tuesday, July 20, 2010

So where was the Crisis Intervention Team?

Tennessee may be only one of six state without a Kendra's Law, but we have done one thing right on the far west side of our great state when it comes to dealing with folks in the community with severe and persistent mental illness.  Kudos, Memphis!

In 1988, the Memphis Police Department joined in partnership with the Memphis Chapter of the Alliance for the Mentally Ill (AMI), mental health providers, and two local universities (the University of Memphis and the University of Tennessee) in organizing, training, and implementing a specialized unit. This unique and creative alliance was established for the purpose of developing a more intelligent, understandable, and safe approach to mental crisis events. This community effort was the genesis of the Memphis Police Department's Crisis Intervention Team and has served as a model for other cities, i.e. Houston, TX and Portland, OR.

Neighbor of man killed by OR police talks about incident

"I hope he can just take hold on this second chance at life". So very sad.

‘Spirit’ pushed hero into lake - Oak Ridge, TN - The Oak Ridger

Family seeks answers in police-involved shooting

Family seeks answers in police-involved shooting

More sad details emerge regarding Oak Ridge resident shot, killed by police

Fault Lines - Mental Illness in America's Prisons

Monday, July 19, 2010

Written with a Heavy Heart

Before reading this, please go back and read Friday's entry on preventable tragedies because this (in a Deja Vu-ish sort of way) is exactly what I'm going to write about again today.

Another preventable tragedy occured in our state yesterday in the town of Oak Ridge, about 15 miles up the road from Knoxville.

Two interesting observations on the part of this blogger:

1. According to media contacts, the victim had a lengthy history of severe and persistent mental illness.  He was rescued as recently as this past January when he drove his truck into Melton Hill Lake in Oak Ridge. The KNS article states "Police at that time said the incident might have been intentional."  Wouldn't this act alone have earned a fairly high ranking on the radar of the local police?

2.  The police chief issued a statement this afternoon that the victim had a lengthy criminal history yet nothing was mentioned about his lengthy past history of mental illness. 


It's becoming a well known fact that many criminal histories get their start when folks with severe and persistent mental illnesses are left to survive to their own devices in the community.  Isn't this the reason our jails are over burdened and being filled with folks who need treatment for their mental illness?

Now go back and read my very early Sunday morning blog entry about a new study that shows more mentally ill people end up in jails rather than hospitals.

Deja Vu.  Preventable tragedies are vicious cycles that need breaking. 

God bless the Harris family and provide them with comfort at this most difficult time. 

Sunday, July 18, 2010

Exerpt from The Catalyst, Newsletter of the Treatment Advocacy Center - Summer 2010

Tennessee Update

Tennessee is one of six states without an assisted outpatient treatment
law. In recent years, a few enlightened members of the state legislature
have introduced bills to establish such a law in Tennessee, only to be stymied by opposition from the state’s department of mental health. But when the Legislature re-convenes in 2011, public uproar over recent shootings in public places involving mentally ill individuals just might prove stronger than any bureaucratic resistance to change. The most recent tragedy occurred in Knoxville. As reported in the news, on April 19, Abdo Ibssa entered Parkwest Hospital with a gun and shot three employees, one fatally, before taking his own life. Ibssa was well known to local authorities for his severe mental illness. He allegedly suffered from a delusional belief that a Parkwest doctor had implanted a tracking chip in his body. Earlier in 2010, Ibssa’s family had successfully committed him to a state hospital. But when Ibssa’s condition stabilized, he was released with a prescription and nothing more. Police investigators do not believe he was taking his medicine at the time of the shooting. Much of the local news coverage has focused on how assisted outpatient treatment might have led to help for Ibssa before his condition deteriorated. Advocate Karen Easter wrote in the Knoxville News Sentinel, “The time has come for Tennessee to leave the Dark Ages of mental health care and enact an AOT law ... But if the Parkwest tragedy doesn’t wake up our legislators and mental health officials to this urgent need, I can’t imagine what will.”

Will Tennessee lawmakers take heed? Stay tuned.

More Mentally Ill People in Jails than Hospitals

Click on the title of this post for results of a new study: More Mentally Ill People in Jails than Hospitals.

Resource - Catalyst, Summer 2010

How can someone not know they are sick?

It's not a simple case of denial as you might think.

Impaired awareness of illness (anosognosia) is the single largest reason why individuals with schizophrenia and bipolar disorder do not take their medications. It is caused by damage to specific parts of the brain, especially the right hemisphere. It affects approximately 50 percent of individuals with schizophrenia and 40 percent of individuals with bipolar disorder. When taking medications, awareness of illness improves in some patients.

Click on the title of this post for a briefing paper from the Treatment Advocacy Center explaining more about anosognosia.

Saturday, July 17, 2010

Contacting Legislators

You can show your support for AOT Laws in Tennessee by contacting Senator Doug Overbey, as well as your own State Senator & Representative.

Let them know these proven facts:

Forty-four states permit the use of assisted outpatient treatment, also called outpatient commitment. Assisted outpatient treatment is court-ordered treatment (including medication) for individuals who have a history of medication noncompliance, as a condition of remaining in the community. Studies and data from states using assisted outpatient treatment (AOT) prove that AOT is effective in reducing the incidents and duration of hospitalization, homelessness, arrests and incarcerations, victimization, and violent episodes. AOT also increases treatment compliance and promotes long-term voluntary compliance.

Friday, July 16, 2010

Prevent Tragedy: two simple words, one compelling reason we need AOT laws in TN

pre•vent [ pri vént ] transitive verb
1. stop something from happening: to cause something not to happen or not to be done
2. stop somebody from doing something: to be the reason why somebody does not or cannot do something

trag•e•dy [ trájjədee ] (plural trag•e•dies) noun
1. very sad event: an event in life that evokes feelings of sorrow or grief
2. disastrous event: a disastrous circumstance or event, e.g. serious illness, financial ruin, or fatality

Several tragedies right here in Knoxville come to mind since Kendra's Law was first introduced to the Tennessee legislature back in 2007. The Hooters shootings. The senseless attack and murder of the young waitress from Barley's. The TVUUC shootings. The Inskip Elementary School shootings. The Parkwest Hospital shootings. In every one of these tragic circumstances, the media hinted of family members desperate to intervene in a loved ones' untreated mental illness yet their hands were tied.

If only ...

Thursday, July 15, 2010

Kudos to Sen. Doug Overbey

Senator Doug Overbey has agreed to reintroduce an AOT bill in the 2011 session of the Tennessee Legislature.   Senator Overbey, a former State Representative, co-sponsored Senate Bill 1269 with Senator Tim Burchett in 2007 which was pretty much identical to New York's Kendra's Law.  Unfortunately the State of Tennessee Department of Mental Health opposed the bill so it was assigned to a Senate study subcommittee where it slowly died a quiet death.  Thank you, Senator Overbey, for your dedication to seeing that a Kendra's Law for Tennessee will soon again be on the radar of our State Legislature!

Wednesday, July 14, 2010

Op Ed, Knoxville News Sentinel 5-23-2010

Abdo Ibssa was not a monster. But the man who shot three staff members at Parkwest Hospital last month, killing one before taking his own life, lived in the grip of a monstrous disease. Severe mental illness made Mr. Ibssa believe that a doctor at Parkwest had implanted a tracking chip in his body, and propelled him to the hospital on a violent rampage.

How did we as a community allow this to happen? One might assume that Mr. Ibssa somehow slipped under the radar of an overburdened mental health care system. But the truth is even sadder.

Far from being under the radar, Mr. Ibssa was known to local authorities. According to news reports, Ibssa was accused of violently attacking a man last year, and earlier in 2010 was committed by his family to a Knoxville mental hospital. When he was deemed stable, he was released with a prescription for medication and (tragically) nothing more. After the shooting, police found the pills in his home, apparently un-utilized.

It is a pattern all too familiar to people like me, who struggle endlessly to keep a mentally ill family member out of harm's way. Our loved ones reject outpatient care, and the system does nothing to stop them until they do something to prove they are "dangerous to self and others," the standard for involuntary hospitalization.

Eventually they are released to repeat the heartbreaking cycle, unless of course their dangerous behavior included a violent crime. Then they get years of free mental health care in a prison cell.

The root of the problem is that many people with severe mental illness are incapable of recognizing that they are sick and in need of treatment. The clinical term is anosognosia, or lack of insight. In the minds of those who suffer from it, there is nothing wrong with them. When left on their own in the community, they stop taking medication.

While people with mental illness on the whole are no more violent than the general population, untreated severely mentally ill individuals are a different story. Studies show that untreated severe mental illness is among the most reliable predictors of future violence. And yet when an outpatient goes "off meds" in Tennessee, families and caregivers must stand by helplessly, knowing with certainty that dangerous behavior is around the corner, but legally powerless to prevent it.

In most states, a legal tool known as "assisted outpatient treatment" (AOT) is a potential solution. Under an AOT law, a mental health official or family member can seek a court order, requiring a severely mentally ill person to comply with treatment as a condition of remaining in the community. The purpose of the court order is not to punish the person if they should happen to stray off treatment. Quite the contrary. It is to ensure that the person's condition is constantly monitored, and to give authorities the legal right to help as soon as treatment non-compliance is detected.

These laws have been found to dramatically improve outcomes for patients. In New York, researchers have documented steep declines in rates of homelessness, hospitalization and incarceration.

Tennessee is one of only six states without some form of AOT on the books. In recent years, attempts by legislators to pass an AOT law have been stymied by the state Department of Mental Health, which has cited concern for the civil liberties of the mentally ill and the cost of comprehensive outpatient care.

The civil liberties objection is absurd to me, as it should be to anyone who has spent time in the company of an actively psychotic person. This condition is a living hell that no one would ever rationally choose for himself. These individuals are crying out for our help, even if their words and actions say the opposite.

The cost objection is incredibly short-sighted. Want to talk high cost? Look at what the state spends to hospitalize, prosecute and incarcerate people who we currently permit to become dangerous. The opportunity to spend a little up front to avoid these bills down the line should be seized by even the most hard-hearted fiscal conservative.

The time has come for Tennessee to leave the Dark Ages of mental health care and enact an AOT law. Some of us on the front lines of this issue have been saying so for years. But if the Parkwest tragedy doesn't wake up our legislators and mental health officials to this urgent need, I can't imagine what will.

*Click on the title of this post for the original article as printed in the Knoxville News Sentinel.