Sunday, November 28, 2010

If we can save the mentally ill, then why don't we?

Richard Antwine finally escaped the proverbial revolving door.
His exit came at the end of a noose, dangling from a bridge over a downtown Dallas freeway.
His death managed to stop a lot of traffic. I wonder if it will also make us stop and think about better ways to care for the mentally ill.
It's not like Antwine's mental problems were a secret. Our social services writer, Kim Horner, had interviewed him and featured his plight in front-page stories about the chronically homeless.
For years and years, he had bounced between the streets, psychiatric facilities and jail.
He told Kim that he often heard voices urging him to kill himself. And the voices apparently won out on Nov. 9.
His death is tragic. But it's also galling because Dallas County still doesn't use a proven method of helping people like Richard Antwine.
It's called Assisted Outpatient Treatment, and it is in use all over the country.
We have remarkable medicines to treat mental illnesses. But a problem often comes in getting people to take them.
Some people with mental illness simply cannot conceive that they have an illness or need medicine. Their illness robs them of self-awareness.
Other people may be coaxed into taking medicine, but as soon as the medicine makes them feel better, they stop taking it.
We don't want to lock all these people up in psychiatric institutions just to force them to take their meds. And we couldn't afford it if we did.
So we end up with many people like Antwine, mostly alternating between jail and homelessness, self-medicating with drugs and alcohol.
But Assisted Outpatient Treatment offers another option. No one is locked up. People are treated as outpatients. But they are "assisted" by a judge's order.
"It's the use of a court order that mandates a person to accept treatment," explained Brian Stettin. He is policy director for the Treatment Advocacy Center, which seeks more proactive treatment of mental illness.
There's a school of thought within the mental health world that people with mental illness ought to be completely free to make their own decisions – even to the point of living on the streets, ranting at imaginary voices.
"We just find that so profoundly sad," Stettin said. "It's so clear that the compassionate thing to do is help someone whose illness prevents them from making good choices on their own."
He said this isn't about punishing the mentally ill. It's about creating a court-ordered relationship between a patient and mental health providers. It obligates both patient and providers to be more diligent about treatment.
And it works. People tend to follow judges' orders. It's called "the black robe effect."
Studies show that court-ordered outpatient treatment reduces homelessness, crime, jail populations and psychiatric hospitalizations.
"Providing a little bit of outpatient care upfront is so much more cost effective," Stettin said.
So why isn't this being done in Dallas? It's a good question.
San Antonio has had it in place for several years. Work is under way to begin such a program in Austin. Houston has shown interest in learning more.
"My hope is that if we can get another couple of major counties to implement these changes, it will create a domino effect," Stettin said.
But there's no reason for Dallas to be the last domino.
How could Richard Antwine have expressed the need any clearer?

Monday, November 22, 2010

On chronic vs. holiday stress (for caregivers)

Recently my workplace hosted a lunch and learn on how to better handle holiday stress. I marveled at how situations that I would consider "no-brainers", i.e. certain food items selling out in the grocery store, could actually cause some people to stress out.  You just substitute spinach maria for that broccoli casserole, right?

If only it were as easy as substituting spinach for broccoli.  Those of us who deal with the chronic stress of caring for a loved one with severe and persistent mental illness know what I'm talking about. We never sweat the small stuff.  We've learned to choose battles. We let go A LOT. We listen-to-but-disregard well meaning advice.  We survive day to day.  We laugh in the face of holiday stress!

A strong support network is your greatest protection against stress. When you have trusted friends and family members you know you can count on, life’s pressures don’t seem as overwhelming. So spend time with the people you love and don’t let your responsibilities keep you from having a social life. If you don’t have any close relationships, or your relationships are the source of your stress, make it a priority to build stronger and more satisfying connections.

Check out this timely article with tips for helping out with the chronic stress we all are familiar with and deal with the best we can ~ ~ ~

Sunday, November 21, 2010

Want to be an Angel to someone?

Please consider the residents of Agape Outreach Homes this holiday season. Most of these men have been homeless or institutionalized most of their lives.  Agape needs funding to purchase gifts for these men and in need of sponsors. The cost for one man is $50 but any contribution will greatly help. Agape is a 501c(3) non-profit corporation. Any sponsorship will be given a letter of contribution for tax purposes. If you have any questions, please feel free to contact Agape.

Saturday, November 20, 2010

Corrections Cost Correction

Corrections Cost Correction

The Auburn Plainsman - A daily struggle life with paranoid schizophrenia

She walks through Haley Center like any other person, but as she passes fellow students, one question echoes in her mind, “Can they tell?”

A side effect of college life as a paranoid schizophrenic, this constant worry can make school difficult, but not impossible, according to April Dixon, freshman in animal science.

Dixon, diagnosed with paranoid schizophrenia in 1996, never thought college was a possibility, until she was accepted to Auburn last year.

“To be honest, I did not think I was going to get in,” Dixon said. “Even though I know I have this disease, people don’t understand it.”

The Mayo Clinic defines paranoid schizophrenia as “a chronic mental illness in which reality is interpreted abnormally.”

Symptoms can include confusion, auditory and visual hallucinations and suicidal actions.

Dixon said she often hears conversations in her head and experiences intense confusion.

“Sometimes you’ll be sitting in class, and even if you really know what’s happening, it will get you to a state where you think, ‘What’s really going on? What’s really real?’” Dixon said.

At the height of her illness, Dixon said she attempted suicide more than 20 times.

College can bring out the worst of the disease if you let it, Dixon said.

“Everybody is saying they’re stressed out,” Dixon said, “but this is a different level. It’s more intense than a regular person.

“But I just have to think that I’m stronger than this.”

Students have been respectful of her disease, even if they don’t understand it, Dixon said.

“The support of the Auburn community is something I’ve never experienced anywhere I’ve been,” Dixon said.

Professors have been accommodating without giving special attention, Dixon said.

“April comes to my office hours regularly to discuss assignments and ask questions,” said Kelly Kennington, assistant professor who teaches Dixon in World History I. “Any student has the ability to come speak with me about these types of issues.”

It is important for professors to understand students’ disabilities so they reach their full potential, Kennington said.

Students with mental problems should not be treated differently, said Doug Hankes, director of Student Counseling Services and licensed psychologist.

“It’s the same as if you were helping a friend with diabetes,” Hankes said. “What would you do? You would be a good friend, and this is the same thing.”

Once regulated on medication, individuals can lead normal, healthy lives, Hankes said.

Each day, Dixon takes 150 milligrams of Effexor, a long-acting drug to treat depression, and 60 milligrams of Abilify, which treats schizophrenia symptoms, but said she believes a positive mentality is more effective than medication.

“In a way, I think controlling it is more about personal motivation than medicines,” Dixon said. “They do help, but it’s not to the point where I want to be.”

Dixon said there are three main misconceptions about the disease she has observed.

“The No. 1 thing they think is that you’re crazy,” Dixon said. “The second thing is they’re scared of you. They think the voices are telling you to do something evil.

“The third thing people think is that you’re stupid. All my life, I thought I was.”

Being open about schizophrenia is the only way to change the stereotype, Dixon said.

“It’s going to take people that have the disease to come out and not be ashamed,” Dixon said. “Because of the disease, certain things are going to happen, but the thing I want people to know is that we’re just like everybody else.”

The Auburn Plainsman - A daily struggle life with paranoid schizophrenia

Tuesday, November 16, 2010

Leaders should reprioritize mental health in Missouri (ditto for Tennessee!)

October 28, 2010 | 6:04 p.m. CDT

In a forum held a few weeks ago for local candidates for the Missouri House of Representatives, mental health authorities pleaded with incumbents and candidates to consider the state of mental health programs in Missouri.

But were they really listening?

In a state that has less and less money to spend on programs, our state leaders seem to push mental health to the back of the policy pecking order year after year.

It’s not as if unworthy causes are hogging all of the attention. Funding for education and the state’s Medicaid program gobbles up more than half of Missouri’s $23 billion budget every year.

In the upcoming legislative session, state lawmakers — many of them expected to be newcomers to the Missouri General Assembly — will be forced to determine who gets what with a smaller pot of cash, and they will likely be preoccupied with finding ways to put unemployed Missourians back to work. Given this scenario, it would be hard to foresee any sharp increases in state support for mental health providers.
In terms of job cuts in state agencies, the Missouri Department of Mental Health has seen the biggest bloodletting since Gov. Jay Nixon took office last year, according to figures provided by Linda Luebbering, the state budget director. Of the roughly 2,500 jobs cut from Missouri state agencies, more than 850 came from the Department of Mental Health.

In the last three years, state funding appropriated for the Department of Mental Health has fallen more than $41 million, while the federal funding for the department increased more than $80 million within the same period, when accounting for temporary stimulus funds. In the 2010 legislative session, total approved funding for the department fell by more than $20 million, and in July Nixon withheld an additional $6 million to account for revenue shortfalls.

The cost of dealing with mental illness for all states combined is an estimated total of $200 billion, according to a study released in 2008 and funded by the National Institute of Mental Health.

Disorders ranging from depression, drug addiction and attention-deficit disorder to more complex psychological disorders, such as schizophrenia, can be classified as mental illnesses. Mental illness affects an estimated one in four Americans every year, according to the National Institute of Mental Health.
With the state cutting back on its contribution to mental health programs, greater strain is placed on local mental health authorities to provide services to this sector of the population, said Boone County Public Administrator Cathy Richards in an e-mail.

The Boone County public administrator, an elected position, is responsible for serving as a public guardian in a court of law for those who have a mental illness. Richards said 90 percent of her approximately 400 clients suffer from a mental illness.

“You see, mental illness just doesn’t go away because there isn’t money available,” Richards said. “What the public needs to understand is that there is a definite need in our community for greater, not fewer, mental health services. With mentally ill patients, little problems that are left untreated can quickly become major problems.”

For one, the schools in our communities must deal with a student population in which 16 to 22 percent of students are suspected of having a mental illness, said Lou Ann Tanner-Jones, a supervisor for the Columbia Public Schools Special Services Department.

Students could be suffering from internally manifested illnesses that affect an individual student’s performance in class, Tanner-Jones said, or externally manifested illnesses that affect classroom order. She said these students are faced with a “significant barrier” to learning.

“These kids sit in the class every day, but they’re not really there,” said Tanner-Jones at the candidate forum. “They’re just not connected.”

A reduction in state support to mental health programs, she said, passes the burden of providing services to these students onto the shoulders of local school district officials.

Missourians who have a mental illness have also become more of a concern for public safety officials.
At the forum, Columbia Police Captain Dianne Bernhad said dealing with citizens suffering from mental illness has become “one of the most important issues” for law enforcement.

The Columbia Police Department has worked with the Boone County Sheriff’s Department and the MU Police Department to provide officers with special training to help them recognize and deal with citizens who have a mental illness.

Bernhard said roughly 50 Columbia officers are given this training, which requires 40 hours of instruction.
In an e-mail, Bernhard stressed to me that citizens who have a mental illness are not inherently dangerous to police officers or other citizens, despite the public’s mindset.

“Yes, there are a few that are dangerous and those individuals need to be identified quickly and taken to treatment,” Bernhard said in the e-mail. “The consequences of not recognizing the difference could be tragic.” 

I do not envy the workload that awaits legislators, both veterans and newcomers, in the upcoming session. They are going to have to make tough choices about our state’s budget that are not going to make everyone happy.

But if legislators can emphasize the importance of sound mental health for all Missourians, and that it is an issue that cuts through so many more of the state’s concerns, they might be able to drum up the popular support they need to prioritize mental health issues for our state budget writers.

If funneling more revenue to mental health programs means new taxes — such as taxes on Internet sales transactions from out-of-state and an increased excise on tobacco, as some legislators have proposed — it will be a tough sell to Missourians. They are long known for an independent streak, in terms of political issues, and — like the residents of most states — they are feeling uncertain about the economy.
Richards said Missourians who suffer from mental illnesses “don’t make good poster children” for a political cause, like those who suffer from other disabilities, and that “no one stands up for the mentally ill.”
“Since no elected official that I know of strongly advocates for additional funding for mental health programs, funding is easily cut and mental health issues are easily swept under the carpet,” Richards said.
If this issue is seen by voters as a problem that causes strain in other policy areas, then constituents could get behind plans that have been politically risky in the past. They could argue that Missourians cannot perform at their best in school and at their jobs unless they are of sound mental health, and thus, it could be more difficult for Missourians to obtain and maintain work.

Reframe the issue in this way, and Missouri lawmakers could make the case that more funding is needed. In turn, they could stand up for a group of Missourians who truly need help.

Or they could maintain the status quo and continue to let the state’s contribution slip. Perhaps local governments, school districts and police departments will find a way to foot the bill themselves.
Richards seems willing to hold up her end of the bargain. She said it is the responsibility of governments to provide “necessary services to its people.”

“To provide little or no services to this group just means that the mentally ill will receive their services through some other venue, like in jails or emergency rooms,” Richards said. “These services are much more expensive than governmental funding and a completely ineffective way to manage the mentally ill.”

Andrew Denney is a senior at the Missouri School of Journalism and a political science major at MU. He is also a copy editor for the Missourian. He is set to graduate in December.

Hundreds Rally To Keep Dorothea Dix From Closing |

Hundreds Rally To Keep Dorothea Dix From Closing

An Op Ed Worth Reading

Exceptional Care, About to be Lost

I hope you will pause with me and think about the "least of these" who live and suffer among us. Certainly, by some standards, Phil Wiggins, my brother with schizophrenia, fell into this category.
Some of you may have followed Ruth Sheehan's columns in which she wrote so eloquently about Phil and his journey from 44 years in North Carolina state institutions into the community. If so, you know that the reformed mental health system was never adequately funded or properly implemented. As a consequence, the severely mentally ill have been relegated to prisons/jails and emergency rooms.
Statewide, patients wait on average 21/2 days for treatment, some for three weeks, some leaving without treatment, some shackled the entire time. And many of these ill, terrified people are young, because often severe mental illness strikes early in life.
The irony in all this is that neuroscience has made great strides in the 10 years since the reform was implemented. We now know that, much like cancer, if sufferers receive prompt and skilled treatment, the prognosis is better. Many go on to lead meaningful lives, even becoming productively employed. UNC's own Step and Oasis Clinics in Chapel Hill bear this out.
In the midst of all this chaos that is the state system, one hospital stands as a beacon of hope because of its ability to treat the sickest of the sick, the high acuity patients. One hospital remains the "go to" hospital for the others.
How does Dorothea Dix Hospital - which faces imminent closing - do this so well when the others fall short?
First, Dix is located in our most populated region, which matters on many levels. Dix attracts stellar staff. Most patients are able to visit with family and loved ones frequently. Dix has the nation's leading treatment mall, offering art, music, gardening, cooking, etc. Because Dix is situated in a dynamic metropolitan area, patients have access to museums, community events and job opportunities.
All of this helps because, as neuroscience tells us, the brain can be retrained, much the same way a stroke victim can recover function with skilled rehabilitation. And Dix does this retraining with less expenditure per patient than the other hospitals.
So, the legislature is closing the one hospital that does the best job for the least money - the only hospital that hasn't been placed on probation or cited for infractions.
I always thought North Carolinians had enough sense to have common sense. But if they don't, I will try to remember Phil's legacy: A person can endure lifelong suffering without becoming bitter. Phil remained sweet and innocent to the end.
Shortly before Phil's lung cancer diagnosis, he spent two months at Dix. His community supports had collapsed around him. At Dix, Phil found asylum and skilled, loving care. I was able to visit frequently because I lived nearby. Thankfully, he was returned to me for his final months.
But gentle soul that Phil was, he died a terrifying death in 2008, not because of cancer but because of schizophrenia. Knowing that he was dying, he was convinced that the oxygen and IV fluids were poisoning him and that I would not save him. The primary care hospital, with its rotating psychiatrists, was not equipped to deal with him. Phil spent his last days strapped to the bed, calmed only by my daughter singing lullabies.
How much longer will we inflict additional, unnecessary suffering on the "least of these"?
Maybe you are the one with the love or the power to stop the madness. If you doubt what I say, since I'm just a sister, visit Nami-Wake's website and read the letter from a Dix psychiatrist, Dr. James Wells, to the legislature. But act soon because Nov. 29 is the deadline. As Phil said on his last drive down that long winding road from Dix, "This world won't do." Surely it won't. But who will make it better?
Louise Jordan is on the board of Nami-Wake County(National Alliance on Mental Illness). Through Nami, she is working with the Center for Excellence at UNC to develop a group home employee skills training program.

Wednesday, November 10, 2010

Inmates With Mental Illness More Likely to Recidivate

As if it’s not bad enough that individuals with severe mental illness are over-represented in our prison populations and more likely to be behind bars than in a hospital, they’re also more likely to end up back in prison once they’re released, according to a new report from the California Department of Corrections and Rehabilitation.

A comparison of three-year recidivism rates found that 74-77% of inmates who were identified as needing mental health services were re-incarcerated compared with 66% of those who were not. Both figures are appalling, but the rate of recidivism for those with mental illness is still more evidence that mental illness is criminalized, not treated.

The full California report can be viewed or downloaded here. The section on mental health status begins on page 27. The Treatment Advocacy Center report on the criminalization of mental illness can be viewed or downloaded here. 

Monday, November 1, 2010

Media reporting family's plea for help receives criticism from consumer group - yet stands by their story

Reporting crime, mental health and the truth by John North

We write many stories that people wish we wouldn't. That goes with the territory on a beat that focuses on crime and punishment. Sometimes people complain about our work in online diatribes. Other times, they send a good, old fashioned letter-to-the-editor.

On Sunday an assistant professor at the University of Washington did just that, blasting a story Herald reporter Rikki King wrote about the young suspect in a Lynnwood armed robbery. The article explored the man's history of mental illness, and his family's grief over their inability to get him help. As they told us and court papers confirmed, there were repeated warnings from Joshua Rockwell's treatment providers that he could be dangerous when not taking his medications.

Now Rockwell is facing up to five years in prison, charged with armed robbery. As the story recounted, Suzanne Lankford's heart sank this summer when she saw a police surveillance photo from the holdup. The camera captured a look in her son's eyes that she said she's come to recognize as a sign that he is not taking his medication.

She asked King to share with readers the perspective of a mother trying to get help for an adult, mentally ill son whose life has spiraled into crime.

“We just wait to hear that he's arrested. And then we start all over again with the court system," Lankford said.

Jennifer Stuber apparently thinks we shouldn't have written the story. The Yale-trained Ph.D. focuses her academic attentions on the study of stigma and how it connects to public health. At the UW School of Social Work, she helps run a grant-funded project that aims to change journalism about mental health issues in the Northwest. She and others in her group monitor newspapers, websites and television broadcasts. When she sees something she doesn't like, she complains.

Stuber contends that the The Herald's article on Rockwell inaccurately portrays the role of mental illness in violent crime. The article, she asserts, plays into a broader societal narrative that scapegoats people wrestling with mental illness as being responsible for violence:

"The truth is we need to dig deeper as a society to understand the complexity underlying violent acts in order to enact meaningful policy responses to them. In the meantime, the inaccurate story journalists, policymakers and even family members insist on perpetuating that mental illnesses are a main cause of violent crimes comes with the horrific consequence of societal discrimination against all people living with mental illnesses and deters people from seeking treatment that is so important to recovery."

People in our newsroom have spent time with Stuber, talking with her about journalism and her concerns about the power of words. We are careful about what we write. That's why it is disappointing to see a highly educated person fail to read an article closely enough to understand what it actually reported. More troubling is Stuber's notion that the family members of mentally ill persons are somehow engaging in improper conduct when they share their truth, as happened here with Rockwell's family.

We've heard from other readers, including about a half-dozen people in the community who have faced similar struggles trying to help family members who have received a schizophrenia diagnosis. Beth Vavrousek of Marysville sent King this message.

"Thank you so much for your straightforward and compassionate article regarding how schizophrenia affects its victims and their families. I feel horrible for the couple that was robbed. How terrifying. This did not have to happen. This disease DOES turn our loved ones into people we, and they themselves, do not know. I speak from the experience of having two family members who suffer from schizophrenia. Getting them the help they need is nearly impossible in our system, until they harm themselves or others. It's an injustice to all. Again, thank you for your article."