Saturday, October 30, 2010

Change mental health laws in Kentucky: Locking Down the Mentally Ill

From my Kentucky friend's blog: 
change mental heatlh laws in Kentucky: Locking Down the Mentally Ill: "click here to view Locking Down the Mentally Ill By James Ridgeway and Jean Casella"

Shooting Victim Demands to Know….

Ryan Mitchell was randomly shot and critically injured outside a Pocatello, Idaho, coffee house by in September.  The alleged shooter was a man with severe mental illness who had been stable and functioning in the community for years before budget cuts reduced his daily services, he stopped taking his medications and deteriorated into psychosis. 

One month after the shooting, Mitchell stood up at a public meeting in Pocatello and asked candidates at a public forum what they were going to do to reverse the budget cuts that led – and will lead to more – preventable tragedies like his shooting.

“My name’s Ryan Mitchell,” he said, in what the Idaho State Journal reported was an “electrifying moment.” 

“I recently was a victim to a random act of violence. I was the individual shot at Mocha Madness. This was a month ago as of yesterday. The fact of the matter is this was caused by recent budget cuts to our mental health program. My question is ... what are you going to do to fix it? Because it is an issue — and it is preventable.” 

Ryan is right: Preventable tragedies are just that - preventable. Coast to coast, mental health budgets are being slashed. Until lawmakers realize that the cost - human and otherwise - vastly outstrip the savings, there will be more. 

Friday, October 29, 2010

Improved Treatment Standards - Why do we need them?

During the 1960s and 1970s, state mental health laws governing treatment of severe mental illnesses, such as schizophrenia and manic-depression, for individuals who refused it underwent sweeping reform. Most notably, assisted treatment laws were changed to require a court finding of dangerousness before treatment could be provided to those incapable of recognizing their need for it. While well intentioned, efforts meant to protect people with mental illness resulted in many of the most severely ill going without needed treatment and, in too many cases, becoming homeless, incarcerated, suicidal, victimized or prone to violent episodes.
As the consequences of non-treatment continue to build, a new wave of reforms is under way in many states. States are abandoning dangerousness as the sole standard for assisted treatment.   Instead they are facilitating needed intervention before tragedy occurs.  These states are enacting and utilizing standards based on the need for treatment.
Another important reform happening in many states is to encourage the use of assisted outpatient treatment as a way to prevent repeated hospitalizations and other consequences of non-treatment.  When appropriate, assisted outpatient treatment fosters treatment compliance in the community through a court-ordered treatment plan. Not only does the court commit the patient to the treatment system, it also commits the treatment system to the patient.
Progressive assisted treatment laws must be crafted to reflect the significant advances that have been made in the last two decades in our understanding and ability to treat severe mental illnesses. We now know that these conditions are treatable biological brain diseases and not lifestyle choices, as was the prevailing thought four decades ago. Research shows that at least 40 percent of those diagnosed with schizophrenia and manic-depressive illness lack insight into their illness because of a biologically based symptom known as anosognosia. A person suffering from this symptom does not believe he or she is ill and is likely to refuse treatment reasoning, "Why should I take medication if there is nothing wrong with me?" Additionally, for those who previously refused treatment because of unpleasant or dangerous side-effects of medication, a much broader array of medications is now available so that possible adverse effects of treatment can be more effectively mitigated.

Thursday, October 21, 2010

Criminalizing Mental Illness - New Report

The National Alliance on Mental Illness (NAMI) has followed the lead of the Treatment Advocacy Center and National Sheriffs' Association in exposing the widespread and inhumane criminalization of mental illness in America.

NAMI on Oct. 20 reported the following and more from a review of federal and other data:
  • About two million people with serious mental illness are booked into local jails each year.
  • About 30% of female and 15 percent of male inmates in local jails have serious mental illness such as schizophrenia or bipolar disorder. Most are jailed for minor, non-violent offenses.
  • An estimated 70,000 prisoners suffer from psychosis on any given day.
  • About 50% of people with mental illness who have previously been in prison are rearrested and returned to prison not because they have committed new offenses, but because they have been able to comply with conditions of probation or parole—often because of mental illness.
Click here to read NAMI’s fact sheet on the criminalization of mental illness.
To see where your state ranks in criminalizing mental illness, click here to view "More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States."   

Independent studies show that participants in assisted outpatient treatment (AOT) experience a decrease in arrests and incarceration. Click here before midnight Friday, October 22, to let SAMSHA know you support making assisted outpatient treatment a mental health service priority.  


Budget Cuts + Hamstrung AOT = ?

Reposted from the T.A.C. Blog:

The recent stabbing of a college dean on campus in Kansas City illustrates the equation of adding mental health service cuts to a hamstrung assisted outpatient treatment (AOT) law.

Casey Brezik, 22, was diagnosed with paranoid schizophrenia in 2006 and resisted treatment, according to his biological father Raymond Florio. Missouri has cut its mental health budget $75 million since 2008. Officials at a clinic for the poor, uninsured and underinsured say the funding cuts are forcing them to turn away three-quarters of the people who call for help. A representative for ReDiscover told local media the stabbing incident illustrates the cost of cutting services to those who need them most.

We say the stabbing also reflects what happens when a state renders its assisted outpatient treatment law useless. Florio told the Kansas City Star that he and the young man’s mother had tried but been unable to get help for Brezik because their son “was an adult and was not willing to seek treatment.” Under Missouri’s AOT law, participants have to be “likely to comply” with a treatment order before being ordered into AOT. But AOT exists for people whose mental illness is so sick they can’t volunteer for treatment. Catch 22! Only the people who don’t need it can get it!

Add budget cuts to a disabled AOT law and what do you get? One preventable tragedy after another. Good going, Missouri.

Missouri governor was intended target of stabbing at MCC-Penn Valley

Posted:  09/20/2010 11:41 PM
The student accused of stabbing a college dean in the neck Tuesday in Kansas City actually wanted to stab Missouri Gov. Jay Nixon, according to sources close to the investigation.
In fact, Casey Brezik thought he had stabbed Nixon — until police told him otherwise while interrogating him Tuesday night, the sources said.
The news that he had wounded a college official, and that the official had survived, disappointed Brezik, the sources said.
The 22-year-old Raytown resident hatched his plan after learning that Nixon was to speak at Metropolitan Community College-Penn Valley at 10 a.m. Tuesday, the sources said. Brezik wore a bullet-resistant vest to class that morning. Nixon travels with Highway Patrol troopers.
Brezik did not have a particular beef with Nixon, the sources said, but wanted to harm him because he was a top government official.
Nixon arrived at Wheeler Downtown Airport shortly before  the 9:35 a.m. stabbing. He canceled his visit to the campus at 3201 Southwest Trafficway.
Nixon has been told about Brezik’s statements to police, a spokesman said Wednesday night. The spokesman declined to comment beyond that.
Diagnosed four years ago with paranoid schizophrenia, Brezik had been attending Penn Valley for only three weeks. Campus officials had not considered him a threat to harm anyone, said MCC Chancellor Mark James.
Brezik’s relatives have described him as an anarchist, and he ranted about various political topics on his Facebook page.
He is accused of stabbing the campus dean of instruction, Al Dimmit Jr., in the hallway outside the computer lab where a lectern had been set up for Nixon’s speech about high-speed Internet access projects. Brezik also allegedly nicked James in the chest with the knife as James wrestled with him.
In a news conference Wednesday at the college, Dimmitt’s son, Andrew, said his father was “recovering well,” and that he was “looking forward to returning as soon as he is able to Penn Valley.”
James told reporters at the same news conference that he would focus on “bulletproofing” the campus security plan, and improving student and staff emergency notification.
“I am determined to learn what we can from the situation,” said James, who came to MCC after a 30-year law enforcement career, including stints as a Missouri Highway Patrol trooper; a Bureau of Alcohol, Tobacco, Firearms and Explosives agent; and director of Missouri’s Department of Public Safety and Homeland Security.
After the stabbing, about 45 minutes passed before MCC electronically notified employees on all five campuses of what had happened. Because employees must opt in to get an emergency notification, not all 1,500 staff at Penn Valley got the word.
An electronic message did not go out to students until Wednesday morning, and then only to students who had signed up for notifications, James said. He said he was planning a campuswide discussion to learn where the notification system may have failed and to take suggestions.
MCC is looking to beef up its behavioral intervention team to help identify students who might pose a danger to themselves or others, James said.
He also thanked his staff for its “bravery and compassion,” during and after Tuesday’s incident.
When Brezik appeared Wednesday in Jackson County Circuit Court, onlookers could see an anarchist symbol tattooed on his right hand and a star, hammer and sickle tattooed on his left hand.
Brezik has battled mental illness for years, relatives said Wednesday. His biological father, Raymond Florio, said Brezik talked about “big brother watching” and harbored anti-government views.
Diagnosed with paranoid schizophrenia in 2006, Brezik spent time in at least four mental hospitals, according to court records filed by his mother in Greene County, Mo., in 2007.
His mother filed paperwork to become Brezik’s court-appointed guardian when he was 19 because he was “disabled and incapacitated.” The papers said Brezik had a history of “lack of personal hygiene, delusional thoughts, drug abuse, erratic behavior and homelessness.”
His mother requested that the case be dismissed on Sept. 19, 2007, two days after Brezik was sentenced to prison on a drug-possession conviction.
Florio said he and Brezik’s mother tried to get help for Brezik, but were limited because Brezik was an adult and was not willing to seek treatment. Florio said he thought the system let Brezik down.
“I’m not trying to downplay the situation,” Florio said. “It’s very serious and very grave. … It’s just really frustrating to see someone you care about go through this. … But what can you do until a situation of this proportion happens?”
Florio said he was glad Brezik’s options would be limited behind bars.
“Maybe now the help will be forced upon him,” Florio said.
Brezik’s demeanor Tuesday night in the Kansas City jail concerned police, who kept him in waist shackles and in a separate cell overnight.
On Wednesday morning, he wore a two-piece blue jail uniform and shackles as police led him into court for his first appearance to face four felony charges. Police brought him in separately from seven other inmates who had arraignments scheduled. The others sat in the front row while Brezik sat alone in the back row until the judge called his name.
The judge entered not guilty pleas for Brezik.
Brezik stared blankly and appeared dazed during much of the hearing. But he answered quickly and politely when the judge asked him questions.
At one point during the reading of the formal charges, Brezik lifted his finger as if he wanted to say something, but he did not.
The judge set Brezik’s next court appearance for Oct. 6.

Wednesday, October 20, 2010

30 Minute Advocacy

People often ask the Treatment Advocacy Center how to change their state's mental illness treatment law or commitment standards. Every state is different. But we’ve discovered some tools that work no matter where you live. To help you make a difference in your state, we offer the following guide to “30-Minute Advocacy.” Click on any title below for details.

Know the laws in your state

Identify the deficiencies that need addressing in your state
Understand the facts
Write a letter to the editor
Write your lawmaker
Visit your lawmaker
Advocate for better use of the law
Be in the loop
Donate to the Treatment Advocacy Center
Know the laws in your state
To effectively advocate for intervention, it is essential to know the standards for intervention in your state or the state where the family member lives.
Click here for an overview of state laws and standards.
Use the US map to the left to navigate to your state’s page.  

Identify the deficiencies that need addressing in your state 
  • 44 states have assisted outpatient treatment (AOT) laws authorizing courts to order treatment for people with severe mental illness who are too sick to get treatment for themselves. If your state has such a law, is the law being used? Ask your local department of mental health or your state department of health and welfare.
  • 42 states are estimated to have fewer than the estimated bare minimum number of psychiatric hospital beds necessary to meet acute mental health needs. Click here to find out where your state ranks.
  • 25 states forbid civil commitment (inpatient and/or outpatient) until someone becomes dangerous. Use the state map at the top of the page to learn where your state stands on the dangerousness standard.
  • 6 states do not have court-assisted outpatient treatment laws authorizing court-ordered treatment for people too symptomatic to get treatment for themselves. These are Connecticut, Maryland, Massachusetts, Nevada, New Mexico, and Tennessee. If you live in one of these states, contact the Treatment Advocacy Center about how you can get involved advocating for change where you live.
  • 3 times as many people with severe mental illness are in jails and prisons than in hospitals. In some states, the ratio is close to 10:1. Click here find out where your state ranks.
Understand the facts

Assisted outpatient treatment works.
Knowing the facts about AOT’s effectiveness makes advocacy easier. Among the facts independent studies have documented for patients in AOT for six months or more: 
  • 77 percent fewer were hospitalized.
  • 85 percent fewer experienced homelessness.
  • 83 percent fewer were arrested.
  • 85 percent fewer were incarcerated.
  • 55 percent fewer experienced suicide attempts.
  • 48 percent fewer experienced drug abuse.
The consequences of non-treatment include homelessness, victimization, suicide, violence, arrest and incarceration. Learn more about Consequences of Non-treatment here. 
    Anosognosia is a medical condition. The majority of people with severe mental illness who are not receiving treatment have no awareness of their illness. The medical term for this condition is “anosognosia.” Learn more about anosognosia here.

    Severe mental illnesses are real diseases. Multiple studies confirm that schizophrenia and bipolar disorder are diseases of the brain in exactly the same sense that Parkinson's disease, Alzheimer's disease and multiple sclerosis are.
      Write a letter to the editor
      Letters to the editors of traditional and online media are a powerful way to draw attention to under-reported issues and to correct media errors. For tips on writing effective letters to the editor that will get printed, click here. Consider writing a letter when any of the following are reported in your local media:
      • A preventable tragedy in which the perpetrator or victim is publicly identified as suffering from an untreated severe mental illness (sample letter theme: “This tragedy could have been prevented if this state were using its assisted outpatient treatment law.”)
      • Governmental action with regard to the laws and commitment standards in your state (sample letter theme: “The Legislature should be faulted/praised for changing the state’s standard of what conditions warrant court intervention to get treatment for the severely mentally ill.”)
      • Any public issue related to severe mental illness (sample letter theme: “This state is jailing far more people with mental illness than it hospitalizes and turning a medical condition into a crime.”) 
      Write your lawmaker (state legislator or, in California, county supervisor)
      Even a handful of letters can have a tremendous impact on your state legislators and their decisions on whether to support treatment law reform. Click here for tips on writing effective letters to legislators. Don't know who your legislators are? Click here to find out.
      Visit your lawmaker
      If you live in or near your state capital, meeting with your legislator is the most effective way to explain the importance of treatment law reform. They personalize the issue and allow you to assess your legislator's position. Click here for tips on meeting with legislators.

      Advocate for better use of the law

      If your state already has progressive commitment standards and assisted outpatient treatment provisions, advocate for consistent, effective implementation of them. To advocate:
      • Create or ask for a guide for family members to understand and use the new law to get treatment. Click to view samples of California's AB 1424, New York's Kendra's Law and/or California's Laura's Law.
      • Seek opportunities to speak to officials or organizations in a position to influence treatment for mental illness in your community, e.g., law enforcement agencies, district attorneys, judges and/or mental health providers or their professional groups.
      • Alert local media to misstatements about treatment laws and standards, families in crisis (providing they want to cooperate), how a better state law might have been used to avert a preventable tragedy and other issues of public interest. Most news organizations have a “submit a tip” function on their websites as well as functions for submitting letters to the editor, corrections, guest columns and other materials.  
      Be in the loop   
      • Share relevant local news stories in your community by emailing a link to the story at
      • Sign up for broadcast emails from the Treatment Advocacy Center about developments in mental health and its treatment.
      • Subscribe to our blog.
      Donate to the Treatment Advocacy Center
      The Treatment Advocacy Center does not accept funding from pharmaceutical companies or entities involved in the sale, marketing or distribution of such products. This makes private donations critical to fulfilling our mission of eliminating the barriers to the treatment of severe mental illness. To donate today, click here.

      Tuesday, October 19, 2010

      Consumer: ‘We are held accountable to take the medication’

      Reposting with permission from today's TAC blog:

      Christina Bruni is a librarian, writer and blogger. 

      She has also has been stable on medication for schizophrenia for 18 years. Chistina’s latest blog on Health Central speaks volumes about the power of treatment for severe mental illness and the value of assisted outpatient treatment.

      Those are messages we broadcast, too, but Christina’s message comes from the power of personal experience, and it minces no words. Bravo, Christina.

      Don’t miss Christina's blog at Health Central.

      Learn more about Christina’s inspiring personal story here. 

      Court-ordered outpatient treatment reduces recidivism | News | Behavioral Healthcare

      Court-ordered outpatient treatment reduces recidivism News Behavioral Healthcare

      Monday, October 18, 2010

      Where are the Cocoa Puffs?

      Here's a new blog recommendation that I think parents will especially relate to.  It's by Karen Winters Schwartz, author of Where are the Cocoa Puffs?

      Also, here are a couple of recommendations for her book.  (I know I will be making a trip to the bookstore tonight!)

      Where Are the Cocoa Puffs? is a coming of age story. It provides an authentic look at a teenager, her family and friends who struggle to come to terms with the onset of her mental illness and to find a balance between hope and acceptance. Read it for its own sake. Read it to learn. It speaks to many truths.
      Michael J. Fitzpatrick, MSW Executive Director
      NAMI National

      Where Are the Cocoa Puffs? Is an engaging family story of what happens when the 18-year-old daughter develops bipolar disorder. It is very well written and accurately reflects the effects of this disorder on all members of the family. Strongly recommended.
      E. Fuller Torrey, M.D.
      Executive Director
      The Stanley Medical Research Institute Author of: Surviving Manic Depression: A Manual on Bipolar Disorder for Patients, Families, and Providers

      Why change?

      Reposted from Change Mental Health Laws in KY's blog.

      Why change?

      Sunday, October 17, 2010

      Even Blogs need a Fall Break

      Just wanted to share with you these beautiful fall photos from a weekend visit to the Apple Harvest Festival in Waynesville & Maggie Valley, North Carolina.  Enjoy ~

      Saturday, October 16, 2010

      On Dedication ...

      I'm sitting in McDonald's in beautiful Waynesville, NC this afternoon.  The fall colors are more advanced here in the mountains of western North Carolina and I'm privileged to be right smack dab in the middle of all the autumnal activities going on in Haywood county.  I actually stopped here for directions because I'm having trouble finding their Apple Harvest Festival.  And, with complimentary WiFi, I was naturally compelled to surf the net while eating my quick lunch.

      I noticed this recent post from the Treatment Advocacy Center so am reposting with their permission.  Reminds me of the "it takes a village" quote.   Enjoy ...

      Margaret Mead was a groundbreaking cultural anthropologist and thinker. She was also the author of countless pithy and insightful quotations. 

      “Never doubt that a small group of dedicated people can make a difference – indeed, it’s the only thing that ever has” is among these pearls. This is a thought in which ALL of us working to eliminate barriers to treatment for severe mental illness can take encouragement and inspiration as we advocate for a population desperately in need of others willing to make a difference in their lives.

      Major Funding Commitment Helps Kendra's Law Succeed

      Just released:
      Psychiatric News October 15, 2010
      Volume 45 Number 20 Page 11
      © American Psychiatric Association

      Thursday, October 14, 2010

      New Study Confirms Effectiveness of Assisted Outpatient Treatment in Decreasing Arrest Rate of Psych

      Thanks to the Treatment Advocacy Center for this one.

      A new study published in Psychiatric Services* confirms the effectiveness of assisted outpatient treatment (AOT) in decreasing the arrest rate of individuals with serious psychiatric disorders. According to Dr. Allison Gilbert and the other authors of the study, the “odds of arrest in any given month for participants who were currently receiving AOT were nearly two-thirds lower” than those not receiving AOT.

      The study was carried out in New York State, where AOT was implemented ten years ago as Kendra’s Law, named after Kendra Webdale, who was pushed to her death beneath a subway by a man with untreated schizophrenia. Kendra’s Law mandates treatment for the small percentage of individuals with schizophrenia or bipolar disorder who have a history of past dangerousness and of not taking their medication. It is of interest that in a recent state comparison of mentally ill individuals in jail,** New York State ranked among the states with the least number. It is likely that the use of Kendra’s Law has contributed to New York’s lower arrest record compared to other states.
      The number of mentally ill persons in jails and prisons has been increasing in recent years. Recent studies suggest that at least 16 percent of inmates of the nation’s jails and prisons have a serious psychiatric disorder, such as schizophrenia or bipolar disorder. Studies have also reported that more than 40 percent of all individuals with these disorders have been arrested at some time in their lives. Therefore, any treatment program that decreases the arrest rate is most welcome. The present study also confirms a previous study in North Carolina, where it was found that seriously mentally ill patients “with a prior history of multiple hospitalizations combined with prior arrests and/or violent behavior” had a reduction in arrests from 45 percent to 12 percent in one year while participating in AOT.***

      Although AOT is available in most states, it is being little used in most. One objection to it is that it uses a court order to compel outpatient treatment and is thus perceived as being coercive. The authors of the present study note, however, that “for those at high risk of criminal behavior, AOT may actually be a far less coercive alternative than cycling through the criminal justice system.”

      * Gilbert AR, Moser LL, Van Dorn RA et al., Reductions in arrest under assisted outpatient treatment in New York, Psychiatric Services 2010;61:996–999.
      **Torrey EF, Kennard AD, Eslinger D et al., More mentally ill persons are in jails and prisons than hospitals: a survey of the states (Arlington, Va.: Treatment Advocacy Center, May 10, 2010).

      ***Swanson J, Borum R, Swartz M et al., Can involuntary outpatient commitment reduce arrests among persons with severe mental illness? Criminal Justice and Behavior 2001;28:156–189.

      Controversial Law Improves Care for Serious Mental Illness

      Controversial Law Improves Care for Serious Mental Illness

      Advocates push for legislation for the severe & persistent mentally ill

      October 9, 2010
      KNOXVILLE, Tenn. (WVLT) - The first week in October is Mental Illness Awareness Week - a time when mental healthcare advocates take a deep look into issues involving mental disorders.
      One of the issues in the forefront is Assisted Outpatient Treatment or AOT, which is a court order for a patient to take their medication.
      Advocates such as Karen Easter say it's time to put the law on the books in Tennessee.
      "Like the Parkwest shooter who was so delusional and paranoid from not taking medication and starts to believe things that aren't true," Easter said.
      When Easter saw the bloody images of the random shooting at Parkwest Hospital last April - she had an eerie feeling she knew what was behind the rampage.
      "I wondered. I wondered if it was a person who was off medication."
      Easter, a Knoxville resident, supports a law that she and others say may have prevented this and other episodes of violence - like the one at Inskip Elementary School. She says AOT laws will allow family members or others to initiate a court order mandating a patient take their medication.
      Tennessee is one of only six states without such a law on the books, but some legislators hope to change that.
      "Currently our prisons and our jails are the leading treatment agency for those suffering mental illness," said State Sen. Doug Overbey - 8th District (R).
      Overbey is a cosponsor of a bill for AOT. Critics say it would be costly to enact and borders on a violation of one's civil rights. But Overbey says it's needed.
      "This is a way to keep citizens safe from folks who need to take medication and who pose a danger to themselves and the public at large."
      Easter says she hears from many families who'd like to see the bill pass and possibly put an end to some of the violence.
      "They are very sad preventable tragedies. All of these incidents."
      Sen. Overbey worked with former senator and current Knox County Mayor Tim Burchett on a pilot program for outpatient treatment, but it didn't get funding. Overbey says he's heartened to see programs like the one Sheriff J.J. Jones is proposing that creates safety centers for nonviolent offenders and those with mental illness.
      He and other senators plan to reintroduce AOT legislation in January.

      Wednesday, October 13, 2010

      Minds on the Edge

      The television program MINDS ON THE EDGE: Facing Mental Illness effectively illuminates challenging ethical issues as well as systemic flaws in program and policy design, service coordination, and resource allocation. These problems are contributing to a mental health system that is widely acknowledged to be broken. MINDS ON THE EDGE also provides a glimpse of innovative solutions that are currently being implemented across the country. These innovations, many shaped by the guidance and expertise of people with mental illness, offer promising solutions and hopeful direction to transform the mental health system.

      Check it out:

      Recent report from Duke University

      Controversial law improves care for serious mental illness.

      October 7, 2010

      Mounting evidence supports the benefits of New York State’s much-debated law authorizing court-ordered outpatient psychiatric treatment for people with serious mental illnesses, according to a series of newly published reports led by Duke University Medical Center researchers.

      Eleven years ago, the New York State legislature enacted the state’s first involuntary outpatient commitment statute, named “Kendra’s Law,” which was passed after a young woman, Kendra Webdale, was killed by a stranger with untreated schizophrenia.

      The law permits court-ordered, closely monitored outpatient treatment for people with serious mental disorders who consistently fail to take their medication and have a history of recurrent hospitalizations, arrest or violent behavior.

      Read more:

      Tuesday, October 12, 2010

      Pete Earley comments on Sam Cochran, Memphis Model's creator

      Mr. Pete Earley comments re: the creator of "the Memphis Model" in his latest blog entry.

      Sam Cochran is a familiar name because he is the retired police major who is  responsible for the development and spread of the Memphis Crisis Intervention Team model. In addition to being modest, Sam Cochren is a dogged and politically shrewd mental health advocate. Clearly his expertise is in bringing the mental health and law enforcement  communities together. But recently he has expanded CIT to be much more than a training program for law enforcement. Rather, CIT is changing the way that entire communities view mental health. He is now using what he has learned to spread CIT Internationally.  

      The Memphis Model: Program Benefits

      Since the CIT program began in Memphis, the citizens and the criminal justice system of Memphis have experienced significant benefits of the program. Some of the benefits of the program are listed below.
      • Crisis response is immediate
      • Arrests and use of force has decreased
      • Underserved consumers are identified by officers and provided with care
      • Patient violence and use of restraints in the ER has decreased
      • Officers are better trained and educated in verbal de-escalation techniques
      • Officer’s injuries during crisis events have declined
      • Officer recognition and appreciation by the community has increased
      • Less “victimless” crime arrests
      • Decrease in liability for health care issues in the jail
      • Cost savings

      Just out from Arch of Gen Psychiatry

      Effect of Mental Health Courts on Arrests and Jail Days
      A Multisite Study
      Henry J. Steadman, PhD; Allison Redlich, PhD; Lisa Callahan, PhD; Pamela Clark Robbins, BA; Roumen Vesselinov, PhD
      Arch Gen Psychiatry. Published online October 4, 2010. doi:10.1001/archgenpsychiatry.2010.134
      Context  Mental health courts are growing in popularity as a form of jail diversion for justice system–involved people with serious mental illness. This is the first prospective multisite study on mental health courts with treatment and control groups.
      Author Affiliations: Policy Research Associates Inc, Delmar (Drs Steadman and Callahan and Ms Robbins); School of Criminal Justice, University at Albany, Albany (Dr Redlich); and Department of Economics, Queens College, City University of New York (Dr Vesselinov), New York.
      Objectives  To determine if participation in a mental health court is associated with more favorable criminal justice outcomes than processing through the regular criminal court system and to identify defendants for whom mental health courts produce the most favorable criminal justice outcomes.
      Design  Longitudinal study.
      Setting  Four mental health courts in San Francisco County, CA, Santa Clara County, CA, Hennepin County (Minneapolis), MN, and Marion County (Indianapolis), IN.
      Participants  A total 447 persons in the mental health court (MHC) and 600 treatment-as-usual (TAU) controls.
      Intervention  Eighteen months of pre-entry and postentry data for 4 jurisdictions. All subjects were interviewed at baseline, and 70% were interviewed at 6 months. Objective outcome data were obtained on all subjects from Federal Bureau of Investigation arrest records, jails, prisons, and community treatment providers.
      Main Outcome Measures  Annualized rearrest rates, number of rearrests, and postentry incarceration days.
      Results  The MHC and TAU samples are similar on the major outcome measures in the pre-entry 18-month period. In the 18 months following treatment, defined as entry into mental health court, the MHC group has a lower annualized rearrest rate, fewer post–18-month arrests, and fewer post–18-month incarceration days than the TAU group. The MHC graduates had lower rearrest rates than participants whose participation was terminated both during MHC supervision and after supervision ended. Factors associated with better outcomes among the MHC participants include lower pre–18-month arrests and incarceration days, treatment at baseline, not using illegal substances, and a diagnosis of bipolar disorder rather than schizophrenia or depression.
      Conclusions  Mental health courts meet the public safety objectives of lowering posttreatment arrest rates and days of incarceration. Both clinical and criminal justice factors are associated with better public safety outcomes for MHC participants.

      Monday, October 11, 2010

      Johnson County seeks to keep mentally ill petty criminals out of jail -

      Johnson County seeks to keep mentally ill petty criminals out of jail -

      New Study Confirms Effectiveness of AOT in Decreasing Arrest Rates

      Assisted outpatient treatment (AOT) is effective in reducing the arrest rate for individuals with severe psychiatric disorders such as schizophrenia and bipolar disorder, according to a new study published last week in Psychiatric Services. And with fewer arrests, court-ordered treatment may result in fewer people with mental illness being jailed.
      “The odds of arrest in any given month for participants who were currently receiving (assisted outpatient treatment) were nearly two-thirds lower” than for similar individuals who had not yet entered such programs, according to the study of Kendra’s Law in New York. Treatment Advocacy Center Executive Director Jim Pavle noted that the results of the study provide further data that assisted outpatient treatment effectively reduces the criminalization of mental illness.” Forty-four states currently have AOT on the books. The exceptions are Connecticut, Maryland, Massachusetts, Nevada, New Mexico and Tennessee.
      In New York, AOT has been in use since 1999 and has been shown to result in a reduction of homelessness, hospitalizations, suicide attempts and drug abuse as well as arrest and incarceration. For additional details about the Psychiatric Services report, click here.

      Saturday, October 9, 2010

      NAMI comments on the APA's draft revision of DSM V re: Anosognosia

      Anosognosia (unawareness of illness) is a neurological syndrome that leaves individuals unaware that they are sick. Studies suggest that approximately half of all individuals with schizophrenia have moderate or severe impairment in their awareness of illness. Anosognosia is distinguishable from denial of illness, which is something that most people experience to a greater or lesser extent. Anosognosia has a biological basis and is caused by damage to the brain, especially the right brain hemisphere. Awareness of illness often fluctuates over time, and can improve in many cases when individuals participate in treatment. However, Anosognosia has been described as the single biggest reason why individuals with schizophrenia (and, to a lesser extent, bipolar disorder) do not participate in treatment.1
      The DSM-IV-TR (Text Revision) includes a paragraph on anosognosia in the section describing associated descriptive features of Schizophrenia and Other Psychotic Disorders.
      “A majority of individuals with Schizophrenia have poor insight regarding the fact that they have a psychotic illness. Evidence suggests that poor insight is a manifestation of the illness itself rather than a coping strategy. It may be comparable to the lack of awareness of neurological deficits seen in stroke, termed anosognosia. This symptom predisposes the individual to noncompliance with treatment and has been found to be predictive of higher relapse rates, increased number of involuntary hospital admissions, poorer psychosocial functioning, and a poorer course of illness.”
      For reasons that are unclear, there are no references to anosognosia in the draft DSM-V.
      There is a growing body of evidence documenting that anosognosia is a prevalent characteristic among many people with schizophrenia and other psychotic disorders. Thus, it is critically important that assessment and treatment planning for individuals with these diagnoses take into consideration the potential for anosognosia and steps that can be taken to minimize harms that occur as a result of poor insight and non-participation in treatment. At the same time, as discussed in NAMI’s Grading the States 2009 report, it is important to recognize that there are many other factors that may contribute to reluctance to participate in treatment, including the side effects of medications, stigma associated with diagnosis and treatment, and past negative experiences with the mental health system. All of these factors should be taken into consideration in assessment and treatment planning.i

      NAMI’s Recommendation:

      The DSM-V section on “Schizophrenia and Other Psychotic Disorders” should retain the language on anosognosia that is currently contained in the DSM-IV-TR. Additionally, language should be added specifying that the existence of anosognosia should not be an automatic justification for coercive treatment. Finally, language should be added stating that while anosognosia should be considered in evaluating the symptoms and severity of schizophrenia and other serious mental illnesses and in treatment planning, it is important to recognize as well that there may be other reasons for reluctance to participate in treatment, including concerns about medication side effects, bad past experiences with the treatment system, fear of stigma, and other factors.

      i National Alliance on Mental Illness, “Grading the States 2009: A Report on America’s Health Care System for Adults with Serious Mental Illness,” March 2009, pp4-5,  

      Friday, October 8, 2010

      While Mr. Earley's Blog is down, I'll continue to feature his comments on this one.

      Pete Earley on Involuntary Commitment Laws.
      I have always argued that involuntary commitment laws that focus only on immediate danger are short-sighted. Nothing I read in the comments section has made me change my mind.
      As a society, we have endorsed the concept of involuntary commitment: rightly or wrongly. What this means is that this debate is not about whether or not involuntary commitment laws are a good or bad idea. That was decided decades ago and is well-established in the law. If we now want to re-open that debate, then let’s do it.
      But the real issue here is when the state should exercise its authority, not whether or not it has that authority.
      I believe focusing exclusively on dangerousness is short-sighted because I have seen examples of persons who have suffered and have died because no one could intervene to help them. Most states have recognized this fault and have added clauses that allow judges to consider whether a person is incapable of taking care of him/herself or may be gravely disabled. I think those are reasonable approaches.
      Trying to find better language does not automatically mean that a person is in favor of stripping away civil rights. It means that he is seeking a better alternative.
      I also have said that I have no idea how to resolve this issue. Involuntary commitment is not something that should ever be treated lightly.
      Which is why I have repeatedly raised the issue of what is an acceptable standard? Can we craft a better system than our current one? I think we should. And I do not think that raising these questions makes me an enemy. Instead, I believe consumers should want to be involved in such a discussion since, as many commentators point out, they have the most to lose. Rather than attacking me for questioning our current standards and criticizing the “dangerous” clause, I would welcome ideas that either explain why our current system is the best possible or how we can approve it. 

      Wednesday, October 6, 2010

      Pete Earley on AOT. I agree.

      Forcing someone to accept treatment should always be a last resort and forced medication, in particular, should only be done in critical situations, under careful review and after a number of safeguards have been met. But sometimes a civil society has no choice but to intervene when someone is mentally incapacitated. Leaving them psychotic and abandoned  delusional in our streets and in jail is not humane.
      That is what I always have said. 
      I believe the number of persons who are forced to go into treatment would be a much smaller number if we had better mental health services.
      This is why I have always argued that good mental health involves having access to good medical care for the entire body, as well as housing, jobs, addiction counseling, transportation, and being accepted as an important and valuable member of society. In recent years, I have especially become an advocate for Housing First.
      I have always believed in listening to consumers. That is why I have a clause in my speaking contract that says I do not appear on discussion panels that do not include consumers.
      I might not have written my book if - when I took my son to an emergency room - we had been greeted by a peer-to-peer specialist or mental health counselors who had been trained in more compassionate ways to help my son rather than being greeted by an emergency room doctor who was busy with other cases and advised me to wait until my son became dangerous and hurt himself or someone else before bringing him back.
      In the past several years, I have visited more than a 100 mental health programs and I now know that there are many ways to better handle the situation that we encountered. What frustrates me is that many of these  methods are not available nationwide.
      In a perfect world, no one would ever have to be forced to accept any kind of treatment against his/her will, but this is not a perfect world and people do end up with mental problems that disrupt and threaten their lives.
      I am haunted by the man in Miami who believed a devil was inside his body so he chewed a hole in his wrist to let that devil escape. What do we do about him? Leave him to end his life, bleeding and delusional?
      What do we do about the fellow sleeping under the bridge in Georgetown who once was a lawyer but now does not know what day it is or what year it is? Why do we assume he does not want our help and leave him under that bridge?
      What do we do about Freddie Gilbert, a man in the Miami Dade jail who couldn’t speak because he was so disoriented. Do we leave him naked and speechless in that cell?
      If a person ends up in homeless and unable to care for himself or in jail, then society is in charge of caring for him. Does this change the equation?
      Does it make us more responsible for him?
      These are tough issue worthy of honest debate.
      Where does this leave us?
      It leaves me feeling unsatisfied and frustrated.
      I am a parent and I freely admit that shapes my viewpoint. I learned long ago as a parent that I can not control my son or force him to do what I want. Nor should I. Instead, I support him, talk to him, stand by his side and advocate for him. Most of all, I listen to him. This is why I have asked him to prepare an advance directive so that I know what he wants if something happens. As a parent, I feel that working with him is exactly what I should be doing.   
      But I also will not abandon him. If he begins hearing voices, taking his clothes off because he thinks that makes him invisible, and talks about killing himself, I will become his advocate and do what I can and what is necessary to keep him from becoming homeless, incarcerated or killing himself.
      If you are a parent, you understand.
      What makes me angry is that we do not have an unlimited range of services that can be tailored to his needs. Instead, we are forced to chose the best of the worst. And that is what we should be discussing. Why are there not better programs, better treatments, more alternatives.
      All of us deserve better.
      Do my son and I agree on everything. Absolutely not. In these debates, we have chosen to disagree and to defend our different viewpoints — but also have promised to respect each other.
      I imagine that would be a good position for all of us when it comes to these issues. Listen, respect, and try to find some common ground and more reasonable solutions.

      Tuesday, October 5, 2010

      Pete Earley responds to critics

      Here is Mr. Pete Earley's latest blog entry along with an excerpt that I, myself, can identify with of late: 

      "I was taught that when you didn’t have any merit to your argument, you attacked the person who disagrees with you. That is a tactic that I have always tried to avoid and I tend to dismiss comments made by people who engage in that sort of behavior." 

      Well, if dismiss and ignore mean the same thing, then Pete and I are on the same wave length!

      Unfortunately, Mr. Earley had to close his blog comments tonight due to abusive and inappropriate posts from a few who disagreed with his take on the 2010 Alternatives Conference. 

      On a similar note, I am incredulous at bloggers/commenters who name someone in their speculative assumptions and repeatedly make false and misleading statements against them.  Honestly.  Do they not realize they could soon find themselves facing a libel suit?

      Mr. Earley's full blog entry may be read here:

      NAMI Statement on Treatment Advocacy Center (TAC) Hospital Report

      Two reports, one conclusion.

      More hospital beds are needed in our great country for those with severe and persistent mental illness!

      So why isn't it happening?

      Monday, October 4, 2010

      It's All in Knowing How to Get Help

      Resource item to bookmark new to the TAC Website:

      Knowing How to Get Help
      Lois Damron of Georgia knows the power of knowledge. Lois has a son who was incarcerated for severe mental illness for two years with no medication. Thirty-five days before his release, he was finally given treatment.

      Lois was desperate for her son to stay in treatment after his release and called Treatment Advocacy Center advocate Aileen Kroll for advice. With the specific information about assisted outpatient treatment (AOT) and getting a power of attorney that Aileen provided, Lois succeeded in getting court-ordered treatment assistance for her son.

      Lois reports that her son is now at a halfway house, stable on medication and attending classes. She calls Aileen her “angel” for the information Aileen provided and nominated our advocate for Georgia for our Torrey Advocacy Commendation.

      We know countless other family members need specific information when loved ones are in crisis or need help but are too sick to volunteer for it. To make available the kinds of information Aileen was able to provide Lois Damron, the TAC has just launched a new "Get Help" section on their website (just click on title of this article to go there).

      If you have a loved one with severe mental illness or if you know someone who does, bookmark the section, print out the crisis guidelines attached to it.

      Saturday, October 2, 2010

      People with mental illness shunned by Alternatives 2010 Conference in Anaheim

      The seriously mentally ill need a voice too.  It's not an "alternative" to simply ignore them.  DJ Jaffe comments in the Huffington Post: