Saturday, April 30, 2011

Public Forum Today!

Posted by NAMI East TN: Public Forum 1-3p today at Carolyn P. Brown University Center at UT Knoxville re: impact of the proposed 8.5% cuts to TennCare. Lots of people seem not to care if psychiatrists, therapists, social workers get cut by 8.5%, right up until they realize it will mean many of the most qualified will leave our area. TN already earns a "D" on the national report card for Mental Health Care.

Friday, April 29, 2011

This is a budget that needs reconsideration.

Haslam budget snips safety net
11:38 PM, Apr. 28, 2011|

Bill Haslam’s first budget proposal as governor is proceeding in the General Assembly, and it is noteworthy for how it would navigate the state through the loss of federal stimulus funds and a sluggish economic recovery.

But the governor’s plan has some serious flaws in how it treats Tennessee’s social safety net — looming gaps in essential services that simply do not have to be a part of Haslam’s “new normal’’ view of a leaner state government.

An analysis by a coalition including the Tennessee Health Care Campaign, Tennessee Justice Center, Tennessee Disability Coalition, National Alliance on Mental Illness-Tennessee and Tennesseans for Fair Taxation indicates that the governor’s current plan would cut vital services to vulnerable populations who fall under the Departments of Children’s Services, Health, Human Services, Intellectual and Developmental Disabilities and the TennCare Bureau of the Department of Finance and Administration.

Yes, the coalition acknowledges that the state must live within its means. But it also has found that millions are being kept in reserve funds that arguably should be spent now to maintain these services to children, the elderly and people with 
disabilities. Even worse, many more millions in federal matching funds will go to other states because social-service reserve dollars have been diverted to nonessential areas.

The coalition has identified a number of revenue sources that would not bust the budget, but consider the TennCare Reserve Fund alone. As of June 30, $260.6 million will sit untouched in this fund — while nearly $128 million in reductions in state money for TennCare programs will 
take effect the next day. Those include cuts originally planned by the Bredesen administration before federal stimulus money allowed a reprieve, but Gov. Haslam’s additional cuts would take a heavy toll on services ranging from birthing-method reimbursements to the money that pays for group-home nursing attendants and home health providers. Needless to say, health-care jobs, 
especially those on the lower end of the pay scale, will be lost in this scenario.

As the coalition notes, the TennCare 
Reserve Fund was established at a time when TennCare routinely ran over budget. Now that TennCare spending has been below budget for some years, why not use the money to keep the safety net viable? Furthermore, each dollar sitting in the 
reserve is worth only a dollar. If it were being spent on health and mental health, the federal government would match $2 to every $1. Instead, those millions will go to other states.

There are even more ways that the administration seems prepared to sit on funds that exceed state emergency needs. The state’s “rainy-day’’ fund will have a balance of $283.6 million by June 30. Gov. Haslam’s budget would increase the contribution to the fund — in addition to 
money resulting from better-than-expected state revenue collections this year.

Good business? Of course; and that is the very strength of Bill Haslam. His fiscal and executive skills are much of why voters put him in office. Some responsibilities of state government, however, do not easily fall within business precepts. The prospects for low birthweight babies in a state with a high infant-mortality rate, for example. The ability to control the cost of care of people with intellectual disabilities, for another.

It is in such cases that the state must step in, because the need for help is dire, and because there is no one else who can help. If the state guts intellectual-disability services to the extent that its patients end up at home, with families who cannot afford to care for them, on the streets or in 
the correctional system, the state not only has consigned these individuals to misery, 
it has cost taxpayers more money by shifting the burden to institutions that cost more to operate.

The time for deciding on the governor’s budget is nearly upon us. State Sen. Doug Overbey, R-Maryville and Rep. Mike Harrison, R-Rogersville, have wisely proposed an amendment to restore mental-health funding, but a broader review is needed. Gov. Haslam has shown himself to be a compassionate person through mission work in his church. He can extend that spirit by ensuring Tennessee’s most vulnerable people get the help they need — and still balance the budget.


Sunday, April 24, 2011

Good News for Knoxville! There is a Kathy Edwards our city: his name is Benjamin Wethington and his ministry is Agape Outreach Homes.

Click on the title of this article to see the Agape guys - the video says it all.

The Legacy of Agape Outreach Homes

Keeping the Faith

“I was hungry and you fed me, naked and you clothed me, sick and you visited me……What you have done for the least of these, you have done for Me.” She had read these words many times before, but this time they jumped off the page, and a calling was born. The story of Agape is Bobbye Wethington’s story. She liked to call this Scripture in Matthew 25 an “open –book test”, the answers to our final exam printed well in advance for all to read. And though we live in a time now bound by political correctness and cautious speech on matters of personal faith, Bobbye’s faith and Agape’s profound impact are undeniably linked. “Treat others the way you would want to be treated.” “Love never fails.” These were more than just Sunday- school notions to Bobbye. They are literally the foundation on which she built her ministry 25 years ago.

The Voice

Working as a disc-jockey at a local Christian radio station in the early 1980’s, Bobbye had already developed a reputation for her extraordinary compassion. Many times after work you could find her at the phone or electric company, paying an overdue bill for a stranger who had asked for prayer the night before on her call-in show. She ended each night with these words: “Jesus loves you, and so do I!” A novice at the technical side of the business, but a natural behind the microphone, Bobbye was taught to imagine that she was speaking to just one person. Broadcasting during the “graveyard shift”, she formed a unique bond with her listeners. A trucker, driving all night to make ends meet. A lonely widow simply unable to sleep. A housewife, up early to get the kids ready for school- each were drawn in by the caring voice on the other side of the radio. One night, a caller told her that he couldn’t usually listen to her whole show, because he worked mornings, but that he always set his alarm clock to go off right before the end of her show. “You’re the only one in my life that tells me that you love me, and you tell me everyday”, he said. In the Bible belt, a lot of people were saying “Jesus loves you”, but not many were following it with “and so do I!” We all see the hurt and suffering in the world but only a few are driven to action. Through experiences like these, Bobbye developed a passion for underdogs and lost causes.

The Crisis

The landmark emptying of many mental health hospitals in the 70’s, known as “deinstitutionalization”, created an epidemic of homelessness among the mentally ill community, and an unprecedented climate of fear and ignorance spread like wildfire through the affected cities, Knoxville among them. By 1980, according to many estimates, 85 percent of the homeless population was also suffering from a mental illness. The demand for housing, coupled with the lack of funding for it, birthed a system of care unlike the one before it. “Board and care homes” sprung up in many low-income areas, often housing sixteen people in one home. It should be offered that many of these facilities were operated by good people, doing the best they could to help whomever they could. All too often though, these homes were squalid and in disrepair, making the situation barely better than being homeless. The correlating absence of any substantial government oversight also made it easy for many of these owners to take financial advantage of their clients. When Bobbye set out to create a system of housing and support for the mentally ill, she faced widespread myths associated with those illnesses, and also sought ways to reshape public opinion about group homes and the quality of care they could provide. It was going to be the battle of her life.


“Not in my backyard.” It’s a sentiment so common that those in the mental health field have reduced it to an acronym. If Bobbye had chosen a rundown house in the inner city of Knoxville for the site of her facility, maybe there would have been less public outcry. Instead, she selected a ten-bedroom home in the historically middle class Fountain City area, sparking a bit of controversy. Soon after, the family sold their house in the suburbs of Powell, Tennessee, found a bank willing to loan her the money to get started, and went to work on the 90 year old house, which had been subdivided into three apartments by the previous owner. Once the work was completed in the winter of 1983, the State Licensure office and Fire Marshall inspections gave her the green light to begin taking in clients. Community support for the project left a lot to be desired, as expected. But neighborhood petitions and veiled threats eventually gave way to acceptance, and in many cases, respect. Many of these early antagonists are Agape’s strongest supporters today, owing mostly to Bobbye’s sheer will and determination. “They deserve a home in a nice neighborhood, too”, she would say. There was definitely something different about this woman.

The Legacy

Twenty-five years later, Agape is a leader in supportive housing for mentally ill men. We house and care for 31 clients in four separate facilities in the Fountain City area of Knoxville. The level of care and underlying philosophy of that care is a direct influence of our founder. Over the last two decades of her life, Bobbye worked tirelessly, not only for the success of her program, but for changes in mental health legislation at large and stricter oversight on supportive housing standards. She served on countless planning councils and committees in Nashville, which successfully lobbied for health insurance parity for the treatment of mental illnesses in the 1990’s. That Agape still stands today is a testament to the potential of a life given in service to others. Bobbye Wethington passed away in February of 2004, at the age of 62. Perhaps the most remarkable thing that can be said about her legacy is that she passed it on to her three children, Todd, Jonathan, and Benjamin. They were only boys when they began the journey that would change their family forever. She confidently obeyed her calling and raised her family among the “least of these”, offering them a unique perspective on life that cannot be overstated. Today, Bobbye’s son Benjamin serves as Executive Director of Agape Outreach Homes, Inc. Todd Wethington served as a Residential Assistant and Chairman of the Board of Directors for Agape until his untimely passing in June of 2000 at the age of thirty. Jonathan Wethington served as a Residential Assistant from 1997 to 2004. He and his wife Curry served alongside Benjamin as Co-Directors of the program from 2004-2006. They now reside in Mount Juliet, Tennessee where Jonathan serves on the pastoral staff in his church.

Saturday, April 23, 2011

Tennessee needs more folks who think like Kathy Edwards.

Edwards runs Leamington Lodge, a private rest home for people with mental illness. Many of the residents at the lodge also have drug addictions. "They go hand in hand," Edwards says of drugs and mental disorders, explaining that people with untreated mental illness often self-medicate with illicit drugs. They get hooked, then turn to crime to feed their addictions.

Read more:

Penny pinching Ilinois legislators may put people with mental illness at risk

Mental health advocates criticize Medicaid limits on anti-psychotic meds
April 14, 2011

The Illinois Medicaid agency recently cut costs by moving numerous medications, including several anti-psychotics, to a non-preferred list. Some mental health advocates are saying the agency’s action will come at a high price for people with chronic conditions such as bipolar disorder and schizophrenia.

The Illinois Department of Healthcare and Family Services, the state Medicaid agency, maintains a list of preferred and non-preferred prescription drugs for patients, with mostly generics left on the preferred list. Effective April 1, the agency re-categorized a number of medications, including several name brand atypical anti-psychotics, as non-preferred. That means doctors who want to prescribe them to patients on Medicaid will have to obtain prior authorization from the department first.

This may result in people with chronic mental disorders not getting the specific medication they need, said Mark Heyrman, a professor at the University of Chicago law school and the facilitator for the Mental Health Summit, a coalition of mental health advocates and providers. As a result of going untreated, they might end up hospitalized or in jail, he said.

“This is a real risk for people with mental illnesses,” he said.

The anti-psychotics removed from the preferred category include Abilify, Fazaclo, Invega ER, Seroquel and Seroquel XR, according to the list posted on the department’s website. All of these medications are used to treat schizophrenia. Abilify and Seroquel are also used to treat bipolar disorder, according to the National Center for Biotechnology Information.

Meryl Sosa, executive director of the Illinois Psychiatric Society, said she heard that the Illinois Department of Human Services expects Medicaid Managed Care to save $800 million during the next five years.

The Department of Healthcare and Family Services has a proposed budget of about $14.56 billion for the 2012 fiscal year, said Mike Claffey, a spokesman for the department. That’s compared to $18.5 billion for the current fiscal year. Funds for drugs make up about $2 billion of that amount, and atypical anti-psychotics account for approximately $200 million, he said.

Claffey said the average brand name anti-psychotic costs more than $200 per prescription, while the average generic medication costs less than $15.

If people currently being treated for serious mental conditions with brand name drugs switch to generic medications, the results could be devastating, Heyrman said.

Because the same medication may have a different impact depending on the individual, doctors use a trial and error method to find a drug that works with minimal negative side effects. Once they have found a drug that works, most practitioners wouldn’t recommend switching to another medication, he said.

In order to remedy that problem, the department is allowing people who are already on the drugs that have become non-preferred to stay on those medications as long as they have a diagnosis supporting that course of treatment, according to Claffey.

“The department is committed to ensuring continuity of care for patients currently on these medications, and for ensuring that patients have timely access to clinically-appropriate medications,” Claffey wrote in an email on behalf of the department. “We have safeguards in place to ensure that patient care is not disrupted.”

However, those safeguards won’t help patients who are newly diagnosed, or those who have been off medication for a while and need to start again, said Suzanne Andriukaitis, executive director of the National Alliance on Mental Illness of Greater Chicago.

In order to make prior authorization smoother for those people, the department usually reviews requests within two hours of receiving them, Claffey said.

They have also agreed to make prior authorization decisions concerning anti-psychotics available within 24 hours and to fax their determinations to doctors rather than mailing a response, Yohanna said. However, Andriukaitis expressed skepticism.

“In the past, it has taken sometimes five days,” she said. “If in fact they can turn those decisions around in 24 hours, I will be surprised. Even 24 hours is a long time.”

Doctors who write prescriptions for non-preferred drugs will have to remember to tell the patient not to go to the pharmacy for however long it takes to get approval, she said. If the doctor forgets, the patient may try to have the prescription filled and get turned down.

If that happens, the person might just decide to go without the medication, she said.

“I foresee a lot of stumbling blocks along the way with this new plan, lots of potential times when people could fall of the edge,” she said.

Other mental health advocates and doctors don’t see the department’s actions as problematic. Dr. Steve Weinstein is the medical director at Thresholds, an organization and support service on North Ravenswood Avenue that serves people with severe mental illnesses. He said he prescribes medications such as Seroquel on a regular basis, and he doesn’t think the recent changes to the preferred drug list will cause trouble for his patients, particularly because of the grandfathering provision.

Weinstein said he uses the prior authorization process five to 10 times per month and hasn’t had difficulties with it. Most of the time, all it takes is a five-minute phone call to get approval. For medications that require paperwork, he said he usually gets authorization within 24 hours.

Although he said delays in getting prior authorization may cause “small problems,” he doesn’t agree that people will end up in jail or hospitalized as a result.

“That’s unrealistic and dramatic,” Weinstein said.

Sosa agreed that the Medicaid agency’s actions won’t necessarily have disastrous results. She said that her organization, a district branch of the American Psychiatric Association, believes people should have access to all behavioral health medications. Still, she said she and other members of her organization understand that the department can’t ignore the financial crisis.

“They are in a situation where the state is making them cut costs,” she said. “I don’t think they’re trying to be mean. Hopefully the economic situation will improve, and then they’ll renegotiate it.”

Dr. Daniel Yohanna, an associate professor for the University of Chicago department of psychiatry and behavioral neuroscience, said he advised the agency concerning the alterations to the preferred drug list as a member of the Illinois State Medical Society Committee on Drugs and Therapeutics. The committee considered the changes at its March 9 meeting, with the state’s financial crisis spurring the changes, he said.

The agency needed to reduce costs as a result of the spending cap enacted as part of the income tax increase legislation in January, he said. According to the state’s official website, the cap limits the state’s spending growth to 2 percent annually for the next four years.

Claffey said they are making more changes to the preferred drug list, effective May 2. He said a provider notice regarding these changes will be sent out in the near future, and he will be able to provide more details at that time.

©2001 - 2010 Medill Reports - Chicago, Northwestern University.  A publication of the Medill School.

Tuesday, April 19, 2011

AZ Law Supports Those Who Seek Aid for Others - But It's Not Easy

Tim Steller Arizona Daily Star | Posted: Tuesday, April 19, 2011 12:00 am
Yes, the 18-year-old man acknowledged, he did turn off his mother's car while she was driving it.
"There was a dog running behind us - that's what I thought," he told a judge in a small Pima County courtroom on the fifth floor of UPH Hospital at Kino.
But no, he said, he is not mentally ill - "just a little bit hyper."
The judge, Court Commissioner K.C. Stanford, disagreed and cited a particularity of Arizona's law - people can be forced into treatment even if they aren't a danger to themselves or others. Stanford ordered him to be treated, against his will, for one year.
Arizona law gives extra leeway to people seeking to have someone evaluated and treated for serious mental illness. Every state allows for involuntary treatment of people who are a "danger to self or others," and about half the states do so for those found to be "gravely disabled," or unable to take care of their basic needs.
But Arizona law also permits involuntary treatment of those who are "persistently or acutely disabled" - that is, likely to suffer severe mental or physical harm because of impaired judgment caused by a mental-health condition. That provision puts Arizona in an elite group of states, said Brian Stettin, policy director at the Virginia-based Treatment Advocacy Center.
"Arizona has one of the best, most-progressive laws," Stettin said. In Arizona, he said, "You're focusing on the fact that the person is suffering as a result of their mental illness and their inability to seek treatment for it."
That can be helpful in cases like that of the 18-year-old man, whose mother filed a petition for him to be involuntarily treated for severe mental illness. The judge denied an argument by a Pima County attorney that he was a danger to himself or others but agreed that the young man is persistently or acutely disabled.
Still, the law is no panacea, because the system can be hard for laymen to negotiate, and the patients have the right to fight forced treatment, even if it would likely help them. Since January 2008, only about 54 percent of the petitions to have someone evaluated for serious mental illness have led to petitions for forced treatment.
Cadie McCarthy discovered this, painfully, in the last two months. Her son Eric had been living on the streets in San Francisco for months before calling home the afternoon of Jan. 8, hours after the mass shooting that wounded U.S. Rep. Gabrielle Giffords.
The son, 22, did not acknowledge hearing of the shooting, McCarthy said, but a week later he called again and said he wanted to come home. When he got here in mid-January, McCarthy said, he was like he has been since symptoms of mental illness began emerging at age 17 - angry, anxious, delusional and scared.
On Sunday, March 6, he came into his mother's room and asked her to "euthanize" him, she said.
"Something snapped in me and I decided I couldn't take care of him," she said. "I think he knew what he was doing that night. He wanted help."
McCarthy had her older son call 911, and sheriff's deputies took Eric to Northwest Medical Center on what is known as a prepetition - a legal request to have a person evaluated for severe mental illness.
That first night, McCarthy signed an affidavit that was to be attached to the prepetition, but there was no notary present. A hospital employee called the next day and said she would have to sign a new affidavit with the notary present. Several abortive efforts later, the affidavit was finally signed and notarized on Tuesday, March 8, McCarthy said.
"Just trying to find my way through it all has been difficult," she said.
Upon arriving at the hospital, Eric agreed to stay there voluntarily on the condition he didn't have to take medication, McCarthy said. Evaluators there concluded he was a danger to himself, and he was sent to Sonora Behavioral Health.
But after several days at Sonora, doctors there decided they would not support a petition for involuntary treatment, she said. Her information is limited, because her son is an adult and entitled to privacy under federal law.
But the decision left her wondering: "The fact that he wanted to kill himself wasn't enough?"
Professionals play a role in the petition process, even if it's initiated by a family member. In particular, social workers at Southern Arizona Mental Health Corp. often join first-responders when officers encounter someone who appears mentally disturbed.
They form the Mental Acute Crisis teams that police call in and which evaluate whether the person needs a mental-illness evaluation. Mental Health Corp. workers also check on people who are in nonemergency situations, to determine if they need evaluation.
After these "prepetitions" are filed, two psychiatrists and other medical workers have 72 hours to evaluate the patient. If they agree that the patient needs to be involuntarily treated, they file a request with the Pima County Attorney's Office, which files a formal petition to the court. These are heard in courtrooms such as the one in Kino hospital.
While Arizona's system gives some leeway to these professionals and the petitioners, it also gives the patient ways to fight forced evaluation and commitment. That, along with other circumstances, can lead to an allegedly mentally ill person avoiding treatment, said Paula Perrera, who heads the health-law unit at the County Attorney's Office.
"The mentally ill have as many rights as you and I," Perrera said.
However, she noted, when her office gets as far in the process as filing a petition for involuntary treatment, it is rare that it is turned down.
Mark Johnson often is the adversary to Perrera's attorneys in the fifth-floor courtroom. Johnson is one of the lawyers who regularly represent patients the county wants put into involuntary medical treatment.
On a recent Monday, Deputy County Attorney Dan Jurkowitz had a problem: He was supposed to call two psychiatrists to testify that another patient needed to be forced into treatment.
Both of them were out sick, so Johnson asked the judge, Court Commissioner Julia Connors, to dismiss the petition. Reluctantly, she did.
"Under the circumstances," she said, "I have no choice."
Contact reporter Tim Steller at 807-8427 or at

Why don't we help those with mental illness?

Sunday, April 17, 2011 12:00 am
Arizona Daily Star

It's the question every Tucsonan has asked since Jan. 8: Accused shooter Jared Lee Loughner showed so many signs of mental illness, but apparently didn't seek help and wasn't forced into treatment.

Why not?

Only he - and possibly his family - knows why he chose the path he did. But an Arizona Daily Star investigation reveals a system full of hurdles and contradictions that make help elusive for people with mental illness.

State law requires a residential-treatment system for those who need help, but supporters of the law have agreed it won't be enforced this year - and perhaps beyond - because of the state's budget woes.

Money problems also prompted the state to end case-management services and stop providing name-brand drugs to 28,000 lower-income Arizonans who don't qualify for Medicaid. The changes prompted a Sierra Vista woman - no longer able to get the medication that kept her illness at bay - to kill herself.

There are so few psychiatrists in the state that those reaching out for help often can't get an appointment for up to three months.

Arizona lets people petition to force others into mental-health treatment - even if they're not an immediate threat to themselves or others - but the law is largely unknown, difficult to navigate and results in compelling someone to get treatment only about half of the time.

Over all that is a shroud of stigma that only got darker when stories of Loughner's rants and writings - which experts say show signs of a disturbed mind - became public.

Even patients coping well with mental illness worried after the arrest that the public would see them as scary and dangerous. Actually, though, few people with mental illness are violent - and those who are typically hurt only themselves.

Today: Persistent stigma keeps many people from seeking help for mental illness.

Monday: A state law guarantees treatment, but a back-office budget deal means it's not being enforced. And the end of case management and brand-name-drug coverage left many marooned.

Tuesday: Forcing someone into treatment is possible but difficult. And a shortage of psychiatrists in Tucson means that even if you find a doctor who will see you, your first appointment might be months away.

Wednesday: Unless you're living in poverty, your insurance may not cover mental-health treatment.

Monday, April 18, 2011

Brother says sister might still be alive if she had received needed meds, case-manager help

AZ cuts left woman to struggle on own

Stephanie Innes Arizona Daily Star | Posted: Monday, April 18, 2011 12:00 am

On the morning of Jan. 8 - as Tucson was stunned by a mass shooting that killed six people and injured 13 - 40-year-old Monica Stefanov lay dying of an overdose inside a Sierra Vista home.

Her death followed a 30-year battle with serious mental illness - she'd been diagnosed with both bipolar and schizoaffective disorders.

People with mental illness tend to live shorter lives than those who don't - they are more likely to end up homeless and without health care, for one thing. They are also prone to killing themselves.

But Stefanov had more than mental illness working against her. She lived in Arizona, a state that jails or imprisons nine times more people with severe mental illness than it hospitalizes - the second-worst rate in the nation, says the nonprofit, Virginia-based Treatment Advocacy Center, which aims to improve treatment for mental illness.

A friend used a largely unknown Arizona law to force Stefanov into mental-health treatment, but she was released after five days.

What ultimately pushed Stefanov over the edge, her family says, was yet another cut to the state's behavioral health system. Last July, the state stopped funding case managers, therapeutic support and virtually all brand-name medication for the 28,000 seriously mentally ill Arizonans not enrolled in Medicaid. Stefanov didn't qualify for the health-care program for the state's poorest residents because her Social Security disability checks paid slightly more than the $10,830 per year general cap for a single person.

But the state still provided her services like group therapy, medication coverage and a case manager. Once those services stopped as part of massive state budget cuts, she was left alone with increasingly disturbing thoughts.

"I believe my sister would probably still be alive today if she'd gotten the service she'd needed," said Eric Harris, 31, Stefanov's younger brother. "July 1 came around and she had the carpet ripped out from under her. She suddenly had to do everything herself."

Since fiscal 2008 the state has cut 52 percent of its funding to non-Medicaid patients - a huge hit because so many people with mental illness, like Stefanov, earn too much from Social Security Disability to qualify for Medicaid, said Dr. Virgil Hancock, chief of psychiatry for Carondelet St. Joseph's and St. Mary's hospitals in Tucson.

Hancock said his two hospitals' emergency rooms are doing about 900 psychiatric consultations per month - an increase of about 25 percent from a year ago, he said. Many of the most severely mentally ill patients are in worse shape than their peers on Medicaid - who still have mental health services - because they have been sick for so long that they qualify for disability benefits from Social Security, pushing them a few dollars over the Medicaid eligibility cap.

"It's been horrific," Hancock said. "They ended up disenrolling the sickest patients in the system."


Diagnosed with bipolar disorder as a child, Stefanov's life had never been easy. While she could be a loving girl who adored animals, she had anger and hostility her family didn't understand. She once threw lit matches at her grandmother. She would get into fights, beating other children bloody.

"We didn't really talk about it. She was just crazy. You left it at that," said Harris, who heads a nonprofit agency in Sierra Vista that provides transportation to disabled and elderly people.

Stefanov grew up mostly in Tucson and dropped out of Catalina High School after several hospitalizations for psychiatric problems. She had a baby at age 16, which her parents raised.

At times in her life Stefanov kept her illness mostly under wraps. She worked for more than five years in tech support at America Online in Tucson. She also worked as a nursing assistant and a waitress, and was married twice.

But between her stable periods, she had bouts of self-medicating with drugs and would go through phases of heavy drinking. When she got older, she was diagnosed with schizoaffective disorder, which causes both mood problems and a loss of contact with reality.

In 2008 she tried to kill herself by overdosing on pills after she misplaced $100. She later told her family that losing the money showed she wasn't capable of anything.


By the spring of 2010, Stefanov was living with her two dogs in an apartment in Sierra Vista and attending computer and self-defense classes at Cochise College. Her family was hopeful that she was in a better place.

"She wasn't working, but she was functioning," Harris said. "She didn't rely on anyone for anything. She loved her dogs. She often would say she liked animals better than people. I think she felt the animals were more understanding."

On July 1, the state stopped covering the drug Invega, which had helped with Stefanov's psychoses. The drug has no generic version, so she went on a generic version of Risperidol.

Soon, she began developing conspiracy theories. She told her family that someone was following her wherever she went. She accused her neighbors of watching her and believed they were working with the FBI. She began calling the sheriff's department, reporting the presence of people who didn't exist.

After one of those calls, on Oct. 9, deputies arrested her for false reporting. She was released the same day and her family sent her to a friend's in Tucson, believing they shouldn't leave her alone. While shopping with her friend, Stefanov began ducking behind clothing racks, saying the people who had been following her in Sierra Vista were in the store, and that they were trying to get her.

Her friend filled out a petition to get Stefanov court-ordered treatment, and a judge ordered her into University Physicians Healthcare Hospital at Kino. When she was released after five days of treatment, she had no case manager to speak on her behalf, or to help her find a better medication.

"All these individuals have the same characteristic situation - many have been very ill, have recovered to some extent with the help of medication and support and in one fell swoop it was taken away," said H. Clarke Romans executive director of the National Alliance on Mental Illness/Southern Arizona. "There are lots of people like Monica who are marginalized and could easily fall off that edge."


After her release from UPH, Stefanov's condition worsened. On the Saturday after Thanksgiving, she crawled through a neighbors' dog door and held the neighbor up against a wall, threatening to kill her. She demanded to know the location of listening devices she believed had been planted in her apartment. She was arrested and sat in the Cochise County Jail until Jan. 5, when a judge ordered her to outpatient mental health treatment.

Evicted from her apartment and staying with her brother, Stefanov ended up in the emergency room after drinking an entire bottle of Nyquil to treat an upper respiratory illness.

She told doctors she had AIDS, and said they were lying when they told her she was fine to go home.

Angry, she stayed in bed most of the day Friday and on Saturday, Jan. 8, Harris asked another sister to watch Stefanov while he went to his parents' house with his wife.

About 30 minutes after he left - around 9:30 a.m. - his sister called to say Stefanov wasn't breathing. The Medical Examiner's report said she had Nyquil, Benadryl and a high amount of amphetamines in her system when she died.

"I was sitting in the ER and I got a text message about everything going on in Tucson," Harris said. "But it was hard for me to think about anything but my sister."

Contact reporter Stephanie Innes at or 573-4134.

Sunday, April 17, 2011

Five Seconds in April: The Parkwest Shooting One Year Later

Matt Lakin of the Knoxville News Sentinel poignantly reviews the Parkwest Hospital shooting on its one year anniversary and raises awareness about Tennessee's pending AOT law,  first introduced in the legislature in 2007 and recently tabled in favor of a one year study to determine it's implications.   But can Tennessee really afford to wait one more year for a law that could prevent such tragedies?  

Kin sought mental care for Parkwest shooter Abdo Ibssa, but he resisted

By Matt Lakin
Sunday, April 17, 2011
He prayed every day and talked to angels before breakfast.
He cursed strangers and thought he carried a government-issued computer chip that tracked his every step.
He wouldn't see a doctor. He wouldn't take medicine.
Abdo Ibssa still didn't qualify for commitment to a mental institution under Tennessee law. His longest stay in psychiatric care added up to just 72 hours.
Tuesday marks one year since Ibssa - a former X-ray technician and aspiring doctor - opened fire with a stolen gun in a doorway at Parkwest Medical Center. He killed a woman he'd never met, wounded two others and missed one man, then put the gun to his head and pulled the trigger.
He would have turned 39 the next day. Knoxville Police Department investigators searching his apartment found a bottle of antipsychotic medication, never opened.
"All this could have been avoided, to tell the truth," said his older brother, Mohammed Ibssa. "I told (authorities): 'He's going to be dangerous. There's no way within 72 hours he's going to get well.' Of course he's a grown person, but a grown person with mental illness is like a child. They need to change the system."
A year later, the system's the same. State law requires that the mentally ill pose an "imminent danger" to themselves or others in order to be committed to a hospital against their will. Mental health advocates say that's a danger almost impossible to prove until too late.
Forty-four states allow outpatient commitment, which lets mentally ill patients remain free only if they comply with monitored treatment - but not Tennessee. Efforts to pass a law providing for such treatment have stalled for the past five years.
"This law could save lives, and it absolutely would have prevented this," said Karen Easter, an advocate for improved treatment who's dealt with mental illness in her family. "We've had more than our fair share of these incidents in Knoxville, and this is one of the most prime cases I can think of where outpatient commitment would have helped."
Ibssa's family says the system failed not just him but everyone - from hospital workers Nancy Chancellor and Ariane Guerin, who survived the shooting but still suffer from their injuries, to Rachel Wattenbarger, who died that day. Treatment advocates say it's just a matter of time before the system fails again.
"Abdo was not a violent person," the brother said. "He never mentioned violence. It's shocking for us. It's shocking for the people who lose loved ones. There's no time frame for someone capable of doing this kind of damage to society. It can happen at any time."

From clinicals to corner store
Abdo Ibssa grew up in the village of Haramaya in eastern Ethiopia and in 1991 immigrated to the U.S., where he became a naturalized citizen. He graduated from Emory University in Atlanta in 1999 with an associate degree in radiology.
Jobs at hospitals around the country followed, working through a medical temporary service as an X-ray technician in Minneapolis, Allentown, Pa., and at the University of Tennessee Medical Center in Knoxville. While in Knoxville, Ibssa checked into Parkwest Medical Center in 2001 for a routine appendectomy.
He found a full-time hospital job in Atlanta the following year and moved in with girlfriend Firee Jawhar, a pharmacist. She gave birth to a son, Sorren, in September 2005.
"He was an A student, the youngest in the family," the brother said. "He had never been in trouble. He had a beautiful house, a beautiful kid."
Soon after the son's birth, the relationship fell apart. Jawhar won't talk about what happened or why. She swore in a child-support lawsuit that Ibssa moved out when the boy was 9 months old in July 2006.
"He has not visited or helped the child since," Jawhar wrote.
Ibssa left his job as a CT scan technologist at Decatur Medical Center the same month, according to a resume he posted online. He later enrolled at St. James School of Medicine in Bonaire, part of the Dutch Antilles in the Caribbean.
"He dreamed of helping poor people in Ethiopia," the brother said.
Photos from the school's white-coat ceremony in 2008 show a smiling Ibssa, proudly posing amid palm fronds with family and friends. But notes found by police in his apartment after the shooting suggest the breakup never left his thoughts - and became the focus of an obsession and paranoia that lasted the rest of his life.
"Had a bitter divorce with my XGF while I was in the Caribbean," he wrote. "We had exchanged violent emails back and forth. ... She threatened me that I didn't know who I was messing with and you need to be careful."
Ibssa never finished his medical education with the clinical rotations necessary to become a doctor. School records list his status as "inactive." He later told a judge he leftbecause of "personal problems" and owed the school $80,000.
Ibssa ultimately returned to Knoxville, where he'd worked years before. He bought Al's Market, a convenience store at the corner of University and Fifth avenues in Mechanicsville, and opened for business in fall 2008.
"He said he was not able to concentrate on his education," the brother said. "The economy was so bad, he couldn't find a job. He had a small amount of money, so he bought a small business. Knoxville was close to Atlanta. His son was in Atlanta. The price was OK. He just wanted to be close."

'They're always after me'
Ibssa returned to the U.S. at the height of the 2008 presidential campaign. He kept handwritten logs of business at the market - and used the same logs as an informal diary.
The notes indicate a new fixation, this time on then-Democratic presidential candidate Barack Obama. Ibssa - an East African immigrant and lifelong Muslim who read the Quran daily - apparently identified with Obama and the unproven rumors of African birth and Islamic allegiance that still surround the president.
At the same time, Ibssa became convinced someone had stolen his identity online.
"Someone else hacked my email and profiles," he wrote. "Ended up somehow on TV and presidential (campaign). ... Muslim terrorist, socialist, witch doctor. ... I emailed the Obama watch dog to watch out that I think they are attacking you with my character (need all emails from Google). ... Then I got put on terrorist list and watchout list because of that email I sent the Obama campaign."
He worried in vain. Investigators checking Ibssa's background after the shooting found no sign federal authorities knew - or cared - he even existed.
"We checked with the Joint Terrorism Task Force," said KPD Sgt. Ryan Flores, who led the Parkwest shooting investigation. "He was not on any kind of terrorist list. That was just another thing in his head."
The paranoia grew each day. Business at the store proved slow. Ibssa, still in debt from his time in medical school, filed no income tax returns in 2008 or 2009.
He complained to family members that he felt tired and ill, that people watched him everywhere he went. He saw spies in every crowd and tasted poison in his food. He thought he saw himself on television and heard people talk about him on the radio.
"That type of business takes a lot of time and energy, and he's not a very business-minded person," the brother said. "He would always tell us: 'The media are after me. Somebody put medication in my coffee. I don't feel so good. You think I'm crazy, but it's true. They're always after me.' Every day he went straight from home to the store and back. He never went anywhere else."
Ibssa spent his spare time studying the Quran, reading books on espionage and government surveillance, listening to music online, and surfing the Web for news stories on Africa and terrorism. A speeding ticket proved police had tailed him. Static on the phone showed the CIA was listening.
"Control every aspect of human life," one notebook entry reads. "That what they are doing. There gone be a revolt."

Random acts
Customers at the store noticed Ibssa acting strangely. He argued with employees. He called E-911 to complain about loiterers in front of the store, then accused police of harassing his customers.
"My coworkers looking at me funny," he wrote. "What is wrong with this guy kind of look. Oh I wish they knew what is going on LOL!"
Jalal Boudarga still wonders what was going on when Ibssa attacked him outside the CVS on Magnolia Avenue the afternoon of May 11, 2009. He carries seven screws in his foot as a reminder of the day he parked beside Ibssa at the drugstore.
"There was another guy from my country right there in the store with me," said Boudarga, a Moroccan native. "We were talking in our language, but we weren't talking about him. I didn't know him. I'd never seen him before.
"I got in my car and started backing out. Just because of the fact that I turned and looked at him then, he jumped in his car, pulled out and stopped it behind me. I got out, and without saying anything, he punched me in the face. I fell against the car and broke the mirror. I had to defend myself. My foot got caught in the asphalt, I fell and it broke. I called the police, but they didn't even arrest him."
Ibssa left before officers arrived. When police questioned him later, he insisted he heard Boudarga laughing at him and calling him names in Arabic.
A store security camera recorded part of the fight, but not enough for police to file charges.
"It was unclear who started the confrontation and what really occurred," KPD Officer Andrew Gyorfi wrote in a report.
Boudarga sued Ibssa in January 2010 for $300,000. Ibssa never filed a response, and the case never went before a judge.
"I couldn't figure out what it was about until (the shooting at) Parkwest happened," Boudarga said. "That explained it. I just thank God he didn't have a gun that day. He probably would have killed me."

Angels, demons and microchips
By the start of 2010, Ibssa began talking about microchips. He believed the government had found a way to track him wherever he went with a chip installed somewhere in his body.
First he accused his ex-girlfriend. Then he settled on a target closer to home.
"He had the surgery (at Parkwest) in 2001," the brother said. "He thought it happened then. I told him: 'No. No one can implant chips in you.' So now I'm always against him. When I call, he hangs up the phone."
Sometime in February 2010, Ibssa went looking for a doctor, demanding someone X-ray him and find the tracking chip. The response sent him into a rage.
"He screamed at the doctor, and the doctor called the police," the brother said. "They handcuffed him and took him to Lakeshore (Mental Health Institute). They kept him 72 hours and let him go. We found out later when he told us about the medication he'd been given. He never took it. He said, 'I'm not crazy.' "
Police said they couldn't verify that story but don't doubt it. Officers regularly respond to mental health calls without writing reports, even if someone's taken into custody for evaluation. Investigators found a bottle of Haloperidol, a drug typically prescribed for schizophrenia, in Ibssa's apartment after the shooting - and no sign he'd taken a single pill.
"I never met the man, but based on the documentation I found on him, the story seems pretty consistent," said Flores, the KPD investigator. "There's no offense report that documents it, and when it comes to getting mental health records, it's a feat for us, even with a court order."
Family members hit the same wall.
"We called Lakeshore," the brother said. "They wouldn't even talk to us. I called the mobile crisis center (at the University of Tennessee). I asked them, 'What do we need to do?' They said the only thing they can do is treatment if he accepts it. Otherwise, they told us to take him to the nearest clinic, but the maximum stay was only 72 hours. We told them he needed more than that. They said we had to go through the courts. He wouldn't take our help. He said he didn't want to be a burden."

Burdens and barriers
Advocates for treatment call the family's story familiar. For loved ones of the mentally ill, Tennessee's laws can prove to be a maze of doubletalk and dead ends. Meanwhile, a delusional relative refuses all offers of help.
"It's not just denial," said Brian Stettin, policy director for the Treatment Advocacy Center in Arlington, Va., which pushes for improved access to mental health treatment nationwide. "There's something going on in that person's brain where they are incapable of seeing their illness at all. These individuals have a tendency to wind up in an endless cycle of bouncing between hospitals and jails while the family stands by helpless."
Easter, the mental health advocate, knows the feeling. She's seen the problem firsthand.
"Unless you've been touched by it, I don't think you can truly understand it," she said. "You call everyone for help. But until something (violent) actually happens, they won't come to you. The most they'll do is tell you to bring that person to the emergency room. Have you ever tried to get a psychotic person into a car to get them to an emergency room against their will?"
Sometimes the family member commits a crime serious enough to earn jail time and treatment behind bars. Sometimes help never comes in time.
David Rudd spent about a decade in and out of jails and hospitals before he pulled a stolen gun and fired into a crowded Hooters restaurant in West Knoxville the morning of Dec. 29, 2007. The gunshots wounded an assistant manager and killed Stacey Sherman, a 35-year-old father of eight children, who'd stopped at the restaurant on his way through Knoxville from Michigan.
Rudd, 25, died the next day, shot by police after he pointed the gun at officers.
The case drew attention to a bill filed by then-state Sen. Tim Burchett, now Knox County mayor, that would have allowed outpatient commitment of the mentally ill. Under the process, family members could petition a judge to order monitored treatment of a loved one. The bill failed to pass after the state Department of Mental Health placed a $17 million price tag on its implementation - an estimate advocates still dispute.
"Everybody said they didn't see the need in it when we introduced it in 2006, and then the Hooters shooting happened," Burchett said. "It was purely the money that killed it. I still think it's very doable, and Parkwest is a perfect example of another tragedy that could have been prevented if family members could have gotten involved. ... But people have short memories. They want their pizzas in 30 minutes or less, and that's about how long they care about this kind of issue."
State Sen. Doug Overbey, R-Maryville, continues to push for the bill but says it won't see daylight this year. The Department of Mental Health has asked for a year to study how 44 other states have instituted similar measures and look for any cost-saving steps.
"We have a new (governor's) administration and a new (mental health) commissioner, so I think we need to give them time to do the study," Overbey said. "We need to heed the lessons of the past and try to learn from them so these tragic situations are not in vain."

The last call
Ibssa's family, scattered across the South, gave up on trying to help him through the legal system.
"His problem became so severe," the brother said. "We started worrying and discussing what to do. I told my brothers, 'He has to be close to us.' In March, we went to visit him. I came from Atlanta. One brother came from Dallas, one from Florida. We spent two nights with him to see how he was doing."
What they found discouraged them further. Ibssa still refused all help. He refused to take any medication.
"We tried to get him to give up his business," the brother said. "He said: 'What am I going to do? I'll be homeless.' We talked to his neighbors. We said, 'Please, call 911 if he does anything.' I was calling him on a daily basis. Sometimes he'd pick up the phone when we called, sometimes he wouldn't."
April 2010 brought sunshine and warmer weather but no change.
"I always told him to pray," the brother said. "He told me two or three days before (the shooting): 'I got up early, and I could see angels in my apartment. They came and talked to me.' I told him it was because he was trying to be a righteous person."
The brother made the final phone call April 19 at noon. He got no answer.
"So I called the store," the brother said. "I talked to a lady. She said: 'He's outside. I'm a new employee.' He hired her that day. She got him to the phone. He didn't even talk to me for a second. He said: 'I'm doing fine. I can't talk to you, I've got to go.' "
Ibssa went home to his apartment at Kingston Pointe in West Knoxville. Just before 4 p.m., he picked up the phone, called Red Star Taxi, and asked for a cab to Parkwest.
Matt Lakin may be reached at 865-342-6306.

Friday, April 15, 2011

With circumstances forcing mental health systems to do more with less, assisted outpatient treatment is a critical form of “smarter spending”

(Adapted and reprinted from TAC's Catalyst - Winter 2011)

Crisis and Opportunity

The darkening fiscal picture for state governments nationwide is clearly raising new barriers to treatment for those with severe mental illness. Psychiatric beds – already at historic lows – are being reduced further. Entire hospitals are being closed or threatened with closure. Emergency-room holds for people with acute symptoms are ballooning into days and even weeks in the absence of open inpatient beds. Prescription-drug coverage for low-income patients is being eliminated – slashing the lifeline to sanity and functionality for thousands of people.In such a fiscal environment, it is more imperative than ever for mental health systems to include AOT in their approach to community-based care. This need stems from two simple facts:
  • Assisted outpatient treatment vastly improves treatment outcomes for its target population, which leads to savings in the avoidance of the costly consequences of non-treatmet e.g., a recent independent study of New York’s AOT program found that, for the program’s high-risk population, AOT cut both the likelihood of being arrested and the likelihood of hospital admission by about half.
  • Without assisted outpatient treatment, a sizable portion of any amount spent on community-based services goes to waste because some of the intended recipients are not capable of accessing those services at all.

Budget freefalls and budget cuts

Virtually all states are required by law to balance their operating budgets annually or biannually. As a result, unlike the federal government, states cannot maintain services during an economic downturn by running a deficit. State government revenues have been in a freefall because of falling tax revenues and pension fund investment losses, according to the Census Bureau. Revenues available for states to fund programs, including mental health care, plunged almost 31% between fiscal 2008 and 2009; dismal economic projections and the scheduled expiration of federal assistance to state Medicaid programs in June may lead to even deeper cuts in fiscal year 2012 budgets.

In this environment, every public program funded directly by states is subject to possible reduction. Already, budget cuts have impacted all major areas of state services in at least 46 states plus the District of Columbia since 2008, according to The Center on Budget and Policy Priorities. Health care – the category that includes mental health treatment – has been reduced in 31 states.

What You Can Do

The impact of mental health budget cuts can be mitigated by maximizing the use of existing mental health services by those in the most dire need, and that is precisely why assisted outpatient treatment must be part of the current fiscal debates. AOT remains unauthorized in six states and is grossly under-used in nearly all of the 44 states and the District of Columbia, where it has been signed into law. With circumstances forcing mental health systems to do more with less, advocates everywhere must make the case that assisted outpatient treatment is a critical form of “smarter spending.”

Tuesday, April 12, 2011

Francis Scott (Scotty) Zingheim Obituary

Scotty was the son of my friends and fellow advocates, Frank and Ann Zingheim of Crossville.  Their son's preventable death last week not only serves as a tragic reminder that we absolutely need to change mental health laws in Tennessee, but it strongly reinforces that  legislators need to listen to families and become unwavering and dedicated advocates themselves.  Condolences to the Zingheim family.

ZINGHEIM, Francis Scott (Scotty)Age 48. Scotty died on March 31, 2011 due to suicide. He suffered from Paranoid Schizophrenia with the onset of symptoms in his early 20s. Even while battling chronic mental illness, Scott found pleasure through Chess. He won the Illinois Junior Chess Championship at 17 and recently won the Cumberland County Chess Championship. Scotty reached a Grandmaster rating and was currently rated a Senior Master. His rating is even more impressive given how few competitions he entered. Some of his games are published for Chess enthusiast to study. Scotty also received a Swimming Scholarship to college; and as a lifeguard he saved a youngster's life. Scotty is survived by his parents, Frank and Ann and his sister, Casey. Our family's sadness is compounded by the lack of effective, vital mental health treatment. The state's TennCare cuts caused Scotty's ineligibility for the Helen Ross McNabb PACT (Program of Assertive Community Treatment) program which successfully kept Scotty, and others, out of the mental hospital for years. Without accessible and affordable Case Management treatment and prevention services, families like ours will continue to suffer tragic outcomes. Donations and/or support for effective mental illness advocacy may be made to The National Alliance on Mental Illness at: or NAMI Tennessee, 1101 Kermit Drive, Suite 605, Nashville, TN 37217.

Francis Scott (Scotty) ZINGHEIM Obituary: View Francis ZINGHEIM's Obituary by The Tennessean

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Families Use Son's Obituary to Send Message

Scott Zingheim was diagnosed as a Paranoid Schizophrenic when he was 15-years-old. He committed suicide on March 31.

Crossville, Tenn. - A Cumberland County family blames the state's healthcare system for the death of their son.

Frank and Ann Zingheim's 48-year-old son, Scott, committed suicide on March 31st.

On Sunday, his obituary appeared in The Tennessean, with a tribute to his life, and also a message for state lawmakers.

"No one listens, no one listens," said Frank Zingheim. "There are major cuts being made in Nashville right now."

Scott Zingheim was diagnosed as a Paranoid Schizophrenic when he was 15-years-old. His parents say he was in and out of hospitals for most of his life, until one program was finally able to make a difference.

Through TennCare, Scott was able to take part in PACT, or the Program of Assertive Community treatment. The Zingheims say it changed his life and taught him how to cope with his mental illness.

"For the first time in years, he was hospital free," said Frank. "He didn't go to the hospital because they monitored and took care of it."

But in 2005, cuts to TennCare made Scott ineligible for the PACT program.

"He was deemed ineligible they said, because he had Medicare, and you can't have TennCare and Medicare," said Ann Zingheim. "If he'd just had TennCare, he would've been kept on."

From that point on, the Zingheims say it was all downhill. They believe their son committed suicide because the system failed him.

"I mean, that's the point," said Frank. "Stuff like this has real implications."

The Zingheims detail their concerns in Scott's obituary, and hope it will catch the attention of state leaders making decisions about budget cuts.

"Make the system whole again, for those folks who desperately need it," said Frank.

A spokesperson for TennCare tells News Channel 5 those cuts that came in 2005 and 2006 were part of a massive reform to TennCare that was needed because the program's budget was growing exponentially.

She says it was a tough time for everyone involved, and some very difficult decisions had to be made.

The Zingheims tried to print Scott's obituary in several other newspapers across the state, but they were turned down.

When The Tennessean accepted it, the couple purposely chose to print it in Sunday's paper, in hopes of reaching the most readers possible.

Tenncare, meanwhile, could face some deep cuts once again in this year's budget. This time though, the economic downturn is to blame.

Frank and Ann hope their son's story will prompt lawmakers to reconsider.

"In this wonderful country, we should take care of the people that really need to be taken care of," said Ann.

By: Heather Graf

Monday, April 11, 2011

Saturday, April 9, 2011

California & Tennessee - not so different.

Corinna Craddock is an editor and regular contributor to Stay At Home Mom for the San Diego online Examiner.

Although she refers to preventable tragedies in California, they all have striking correlations to several that have occurred right here in Knoxville.

We are approaching the one year anniversary next week of the most recent of these, the Parkwest Hospital shootings.

A bill has been introduced in our state legislature that would provide for court ordered assisted outpatient treatment.

This important piece of legislation could potentially help people with severe and persistent untreated mental illness, like Mr. Ibssa, receive treatment they so desperately need.

The question for both California and Tennessee is, can we make this happen - or do we wait until the next tragedy occurs due to our refusal to acknowledge the plight of the mentally ill in our community?

Wednesday, April 6, 2011

Tennessee: One of Six Without

Tennessee, like every state, has its own laws that establish criteria for determining when court-ordered intervention is appropriate for individuals with severe mental illness who need treatment but are too ill to seek it voluntarily. 

Tennessee is one of only six states that do not allow court-ordered treatment in the community, often called "assisted outpatient treatment (AOT)" or "outpatient commitment."
  • Tennessee laws apply to someone who needs treatment but is unable to seek it voluntarily. 
  • The state's mental health laws outline what steps must be followed and what standards must be met before someone can be ordered into treatment in the hospital.   
  • Tennessee still uses a civil commitment standard based primarily on a person’s likelihood of being dangerous instead of using a more progressive “need for treatment” standard as in many states.
To get court-ordered treatment for a loved one:
  • For inpatient care, there must be a substantial likelihood of serious harm, which includes the individual's inability to avoid severe impairment or injury from specific risks or the individual placing others in reasonable fear of serious physical harm.
  • For court-ordered outpatient care, the only available legal mechanism is the conditional discharge of a person transitioning out of an involuntary hospital commitment. Outpatient commitment is not available for individuals currently in the community, nor for those ready for discharge from a voluntary hospitalization.

Tennessee Assisted Outpatient Treatment Legislation

On February 11, 2011, State Senator Doug Overbey (R-Maryville) and State Rep. Debra Maggart (R-Hendersonville) introduced SB 608/ HB 683, a bill authorizing court-ordered outpatient treatment for certain high-risk individuals with severe mental illness. If enacted, this legislation will bring a much-needed dose of common sense and compassion to mental health care in Tennessee and help its target population to steer clear of hospitals, jail, prison and the streets. Keep checking this page for updates on the status of the bill, and what you can do to help it pass.

Monday, April 4, 2011

Louisiana Makes It Easier for Someone with a Severe Mental Illness To Receive Treatment with Nicola's Law

nicolaFollowing the tragic death of a pregnant police officer, Governor Bobby Jindal signed a progressive treatment law on June 21, 2008. The law, which unanimously passed both houses of the state legislature, took effect on August 15 of the same year. “Nicola’s Law” was proposed after the slaying of 24-year-old New Orleans police officer Nicola Cotton as she attempted to arrest a rape suspect who had been in and out of mental institutions his adult life. Cotton was overpowered by the suspect and shot with her own gun. She was eight weeks pregnant at the time of her death. The man was not in treatment or taking his medication at the time of the tragedy, according to his sister.
Nicola’s Law provides a flexible standard for targeting care at those most at risk of harm because of untreated severe mental illnesses. The law was projected to result in about 170 people in Louisiana receiving treatment each year. 


Louisiana, like every state, has its own laws that establish criteria for determining when court-ordered intervention is appropriate for individuals with severe mental illness who need treatment but are too ill to seek it voluntarily. In Louisiana:

State law authorizes both inpatient (hospital) and outpatient (community) civil commitment.

Treatment in the community - which the Treatment Advocacy Center terms “assisted outpatient treatment (AOT)” - is known as "involuntary outpatient treatment."

Louisiana is one of the 27 states whose treatment standard is based on a person’s “need for treatment” rather than only the person’s likelihood of being dangerous to self or others.

For inpatient care, a person must be a (1) danger to self/others or (2) unable to provide for basic physical needs, such as essential food, clothing, medical care and shelter, and unable to survive safely in freedom or guard against serious harm.

For outpatient care, a person must meet all of the following criteria:

(1) be unlikely to survive safely in community without supervision;

(2) have a history of noncompliance that includes two hospitalizations in previous 36 months or have acted/threatened/attempted violence to self or others in 48 months immediately preceding filing of the petition;

(3) be unlikely to voluntarily participate in treatment;

(4) be in need of treatment in order to prevent relapse or deterioration likely to result in patient becoming a harm to self/others; and

(5) be likely to benefit from treatment.

    Sunday, April 3, 2011

    Two Years Later and Nothing Has Changed

    I thought I'd revisit this series by JJ Stambaugh that ran March 2009 in Knoxville News Sentinel.

    At that time, Tennessee was one of 8 states without assisted outpatient treatment laws.

    Now, over two years later, Tennessee still lags behind as one of only 6  states without AOT laws on the books.

    The good news is we currently have an AOT bill proposed by Sen. Overbey, awaiting review by a Senate Subcommittee.

    NOW is the time for our Legislature to take action or Tennessee may very well soon become one of 50 without.