Friday, July 29, 2011

Psych Patients Twice as Likely to be Rearrested in the US

A study published in the current issue of Schizophrenia Bulletin reports that patients with psychosis who are arrested once are twice as likely to be arrested a second time in the United States compared to other countries.
The authors, Drs. Seena Fazel and Rongqin Yu at the University of Oxford, examined 27 studies of repeat psychiatric offenders. Nine of the 27 studies were done in the United States, 7 in the United Kingdom, 4 in Canada, and 1 each in Japan, Sweden, France, Italy, Germany, Belgium, and Brazil. ("Psychotic disorders and repeat offending: Systematic review and meta-analysis," December 2009).
The risk of re-offending was calculated as an odds ratio (the probability of a certain event is the same for two groups). For the studies done in the United States, the odds ratio was 1.6, whereas for studies done in the other countries, the odds ratio was 0.8 - just half as much. The study coincidentally affirms the findings of a recent investigation by the Palm Beach Post of re-arrest among defendants acquitted for reason of insanity in Palm Beach County, Florida. ("Not guilty and insane: Local defendants are getting out, rearrested," July 10)
The higher risk of re-offending for patients with psychosis in the United States is most likely a consequence of our poorer psychiatric follow-up services for mentally ill individuals who have been in jail or prison, according toDr. E. Fuller Torrey, a co-author of our 2010 study of mental illness in jails and prisons. "This study thus confirms what has been known anecdotally—that almost every Western country now provides better psychiatric outpatient and follow-up services for individuals with severe mental illness compared to the United States."

Sometimes It's Hard to be a Mother - personally speaking

Thank you, Doris, for voicing the opinion of many other moms.  Advocacy is hard enough without fighting more stigma.  If only they could wear our shoes for a day ...

Tuesday, July 26, 2011

On treating the root.

It always helps to get to the root of a problem; untreated mental illnesses is no different. Sadly, self-medicating with drugs and alcohol always clouds this issue and exactly the reason we need to work even harder to raise awareness.

From the Treatment Advocacy Center's blog:
The death of talented singer-songwriter Amy Winehouse at the age of 27 appears to have been a direct result of her well-known substance addiction. The fact that she apparently suffered from bipolar disorder as well has essentially been a footnote.
For those of us who live or work with untreated severe mental illness, the presence of bipolar is far from incidental. We know how often the condition is associated with substance abuse problems. When Winehouse told an interviewer, “I do drink a lot; I think it’s symptomatic of my depression; I’m a manic depressive” (the name that has largely replaced manic depression in the US), we nodded our heads. Lack of treatment is tragically common - currently affecting an estimated 3.3 million people in this country, many of them self-medicating with alcohol or drugs.   
Also common is opposition to laws and standards that would make it easier to get treatment for these millions even when they are too ill to seek it. Foes say that money, not treatment, is the game-changer. “People with mental illness don’t need involuntary treatment,” the trope goes, “they just need more community services that they’d get if there was enough money.”
News reports put Winehouse’s estate at $15-$20 million. What a heartbreaking irony that her biggest hit, “Rehab,” made millions of those dollars but what might have saved her life was the treatment the song chronicled rejecting. 
For other commentary on Amy Winehouse’s death: 
  • Celebrity Russell Brand. “Whether this tragedy was preventable or not is now irrelevant. It is not preventable today.”
  • Mental health blogger Mark Vasey, “Amy Winehouse dies after struggling with bipolar disorder and drug addiction.”  

Thursday, July 21, 2011

Many updated research reports and backgrounders on mental illness topics now linked from a single source.

Talk about a wealth of information - all the links are right here.  Thank you, Treatment Advocacy Center!


Reports and Studies

Threats to Radio and Television Station Personnel in the United States by Individuals with Severe Mental Illnesses (1999)

Even privately insured have hard time getting psychiatric care in Massachusetts: Harvard study

"People with mental health problems often can't advocate for themselves – especially in a crisis," said lead author Dr. J. Wesley Boyd, an attending psychiatrist at the Harvard-affiliated Cambridge Health Alliance. "Health insurers know this and yet, thanks to their restrictive provider networks and their low reimbursement rates for psychiatric services, they've created a situation where a patient with a potentially life-threatening disorder, such as the severe depression portrayed in our callers' scenario, is essentially abandoned at a time of great need."

Read on ...
Even privately insured have hard time getting psychiatric care in Massachusetts: Harvard study
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On Mental Illness: Getting Through a Mental "Cold". Category: Columns from The Berkeley Daily Planet

An interesting perspective from someone "well-medicated" yet dealing with the never ending challenge of living with a severe and persistent mental illness.

On Mental Illness: Getting Through a Mental "Cold". Category: Columns from The Berkeley Daily Planet

Wednesday, July 20, 2011

Prison issue: Lack of care for people with mental illness -

Prison issue: Lack of care for people with mental illness -


Airing Friday, July 22, 10 pm on ABC
“20/20” reports on the challenges facing families whose young children are suffering with severe mental illness.  ABC News correspondent Jay Schadler shares the stories of three girls in California: seven-year-old Jani Schofield, a beautiful blonde child who loves to swim and play, but has been diagnosed with schizophrenia -- her hallucinations command her to act dangerously and violently, like jumping off a high building or hurting her baby brother; Rebecca Stancil, a precocious nine-year-old who has already tried to commit suicide; and Brenna Wohlenberg, a 13-year-old who loves to play with her dogs but fears she will hurt them or her little sisters because of her psychotic behavior, some of which is caught on tape.   “20/20” spent time inside the homes of these children to see what life is like for the girls.  Their families kept video diaries showing the daily struggles, breakdowns, and the overwhelming strain on both personal relationships and finances.
“20/20” turns its attention to this disorder that is often misunderstood, and misdiagnosed, and reports on the treatments and new medical understanding of this frightening mental disorder. “20/20” airs FRIDAY, JULY 22 (10:00 – 11:00 p.m., ET) on the ABC Television Network. (OAD: 3/12/10)
“20/20” is anchored by Elizabeth Vargas and Chris Cuomo. David Sloan is executive producer.


Ultra Short Psychiatric Hospitalization and Bloodshed

In the 1970s, a “short” hospitalization for psychiatric crisis was 21-28 days; “long” was 90-120 days, a February 2011 article in Psychiatric Services reported. Today, the average hospital stay for a patient in acute psychiatric crisis is 5-6 days - an "ultra-short" stay in medical talk. Being an average, that means that for every patient hospitalized 10 days, there's one who's an inpatient for a day or less.

One of our daily activities at the Treatment Advocacy Center is monitoring news reports involving severe mental illness, and not a day goes by without evidence that this treatment model is producing horrific results. Here are just three of the stories our searches turned up in the last few days. 

From Hawaii – “Judge says lack of care led to killing of woman” (July 19) – “A state judge suggested Monday that the fatal beating of an 85-year-old Aiea Heights woman by her 49-year-old grandson could have been avoided if hospital officials, the man's family and his treating physician did what they were supposed to do.” 

From New York – “Mom charges hospital should not have let suicidal son go in new lawsuit" (July 19) – “The grieving mother of a mentally ill Bronx man who killed himself in 2009 is suing Montefiore Medical Center for letting him leave the hospital's psychiatric unit despite signs he was suicidal.”
From Ohio – “Police: Man had mental evaluation before killing niece: Lanny Stoinoff Charged with aggravated murder of 4-week old” (July 12) – “The male caller told the operator that Stoinoff was not armed, but said, 'He had some mental issues and he was committed like for seven days and they released him, and he moved out of his house. He was living over here.' " His father told officers Stoinoff had stopped taking his medications.

As state governments continue reducing beds and closing hospitals (see Tuesday's blog from New Jersey for just one example) - we will only see more stories like these. Perhaps lawmakers should monitor preventable tragedies the way we do so they can start counting the loss of human life in their budget calculations.

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Sunday, July 17, 2011

Civil Commitment Laws - Up to date Statutory Language

The fourth and final new or updated legal resource developed in conjunction with our Psychiatric Crisis Resource Kit is "State Standards for Assisted Treatment – Civil Commitment Criteria for Psychiatric Inpatient or Outpatient Intervention by State."

Unlike the civil commitment charts, which contain summaries and excerpts of state laws, this document provides a central source of the statutory language in which each state establishes its civil commitment laws and standards. ”State Standards for Assisted Treatment” was updated in conjunction with our new Psychiatric Crisis Resource Kit, a 2010 Torrey Action Fund project providing tools and information for responding to – and helping others respond to – mental health emergencies. The kit was introduced at NAMI 2011 in Chicago and is published here on our website.

The three charts developed or updated in association with the project are: 
"Assisted Psychiatric Treatment: Inpatient and Outpatient Standards by State" - essential information about laws governing court-ordered hospitalization (inpatient) and community treatment (often called "assisted outpatient treatment" or "AOT") 
"Emergency Hospitalization for Evaluation: Assisted Psychiatric Treatment Standards by State" - essential information about criteria for emergency hospitalization for psychiatric evaluation (also called "hold," "pick-up," "detention," "provisional hospitalization," "72-hour emergency admission" or other) 

"Initiating Court-Ordered Assisted Treatment: Inpatient, Outpatient and Emergency Hospitalization Standards by State"- essential information about who may initiate proceedings leading to court-ordered treatment for an individual with symptoms of severe mental illness

    In Minnesota it's Official: Severe Mental Illness Isn't Medical

    At a time when state budgets everywhere are being balanced on the backs of people with mental illness, the state of Minnesota managed to forget this population altogether.
    Yes, for two weeks after state government shut down, a district court judge who ruled that “basic care and medical services” would continue to be funded during the shutdown didn't see fit to include psychiatric treatment in that class. As a result, 135 state mental health workers who dispense psychiatric medications, respond to mental health emergencies and operate crisis facilities were laid off, and untold numbers of vulnerable patients received reduced or no services. One crisis mental health facility was closed, 24-hour service at another was curtailed, transportation to a crisis bed facility in St. Cloud ended, and all manner of other havoc to the safety net for the state’s most vulnerable residents was wrought.
    We’d like to think this was merely an inadvertent oversight, but it looks more like action revealing attitude. Several mental health providers requested funding from the official appointed to make recommendations but didn't get a response until after Minnesota public radio broadcast a story about the situation (“Shutdown forces mental health crisis programs to cut services,"July 13). The next day came news that "mental health grants" would continue to be funded during the shutdown because "a coverage gap would affect (the) health" of  individuals with "serious and persistent mental illness." As kids like to say, "Well - duh!"
    Gov. Mark Dayton (D) and Republican legislative leaders reportedly have reached a budget deal that will enable the state to re-open for business completely “within days.” That does not get officials off the hook for leaving people with a serious medical condition without medical care for half a month. Left unchallenged, the attitudes that led to this "oversight" are likely to continue producing actions that endanger Minnesotans with mental illness.

    Wednesday, July 13, 2011

    On the Non-Medication of Jared Lee Loughner - A Choice Between Horribles - Business Wire -

    ARLINGTON, Va. -- The 9th Circuit Court of Appeals ruling that accused killer Jared Lee Loughner cannot be involuntarily medicated for his symptoms of psychosis dramatically illustrates why people with severe mental illness do not belong in the criminal justice system.

    On the one hand, we have a federal prosecuting attorney who wants Loughner to be medicated so the government may bring him to trial and debunk a likely insanity defense. The prosecution’s goal is to improve Loughner’s mental state sufficiently to try, convict and potentially sentence him to death.

    On the other hand, we have a defense attorney objecting to the only means by which the illness that appears to have produced the calamitous events of January 8 might be brought under control.
    “Either of these approaches leads to an awful result and fails to address the root cause of the Tucson tragedy,” said James Pavle, executive director of the Treatment Advocacy Center in Arlington, Virginia. “The root cause was untreated severe mental illness, compounded by the failure of the college he attended or anyone else who observed his disturbed state of mind to seek help for him under Arizona’s progressive involuntary treatment laws and standards. As long as we ignore people who suffer from untreated mental illness until after crimes are committed, we will continue to be faced with choosing between horribles.”

    The Treatment Advocacy Center is a national nonprofit that focuses on eliminating barriers to the treatment of severe mental illness.

    Read more:

    Tuesday, July 12, 2011

    Stopping the Revolving Door - A Civil Approach to Treating Severe Mental Illness

    A heartbreaking and hopeful documentary about how court-ordered treatment saves lives and families.

    Sunday, July 10, 2011

    Psychiatric Crisis Resource Kit

    The Psychiatric Crisis Resource Kit is a collection of tools and information for responding to - and helping others respond to - mental illness emergencies. The Kit will be introduced at the 2011 NAMI Convention in Chicago (July 6-9). All components will be available here and on CD-ROM after the conference. They will include:

    What to do in a Psychiatric Crisis” – a writable brochure tool that community organizations and agencies can use to quickly and economically create a local resource guide for use by families and caregivers in psychiatric emergencies 

    Illustrated step-by-step instructions to completing the writable brochure 

    NEW "State Standards Charts for Assisted Treatment - Civil Commitment Criteria and Initiation Procedures" (June 2011) - state-by-state information about the laws and criteria that establish court-ordered inpatient and outpatient treatment practices, emergency hospitalization for psychiatric evaluation and who can initiate a petition for court-ordered treatment 

    HELP sheets with practical strategies for responding to four specific crises scenarios 

    Crisis vocabulary - key terms defined 

    HIPAA at a glance - a chart of the rules and exceptions

    If you have questions, suggestions, problems or wish to request a copy of the CD version of this information, please email us at

    Who can initiate involuntary treatment?

    Because knowing how to get emergency treatment for someone in psychiatric crisis can be a life-or-death matter, the Treatment Advocacy Center has developed a unique resource for families, caregivers, medical providers and others who find themselves handling a mental health emergency. 
    "Initiating Court-Ordered Assisted Treatment: Inpatient, Outpatient and Emergency Hospitalization Standards by State” provides essential information about who can seek court-ordered intervention in a mental health emergency - and how.
    When Jared Lee Loughner shot 19 people in Phoenix earlier this year, killing six, a great deal of misinformation followed about whether and how the tragedy could have been averted. The fact is that every state has laws and procedures for getting individuals with symptoms of severe mental illness into treatment when they are unable or unwilling to seek help voluntarily. Knowing these laws and procedures is critical when a mental health emergency occurs.
    At this week’s NAMI 2011 conference in Chicago, we are introducing our new Psychiatric Crisis Resource Kit: tools and information for responding to – and helping others respond to – psychiatric crisis. "Initiating Court-Ordered Assisted Treatment" was developed  in conjunction with our new Psychiatric Crisis Resource Kit, a 2010 Torrey Action Fund project providing tools and information for responding to – and helping others respond to – mental health emergencies. The kit was introduced at NAMI 2011 in Chicago and is published here on our website.
    Another helpful resource developed in conjunction with the project is "Emergency Hospitalization for Evaluation: Assisted Psychiatric Treatment Standards by State."

    Monday, July 4, 2011

    One Year Anniversary of the Blog

    This month marks the one year anniversary of "It's Time to Change Tennessee's Mental Health Laws".

    My desire this past year has been to raise awareness of the plight of the seriously mentally ill in Tennessee.  Many are spending time in our jails and prisons where they do not belong.  Timely treatment could restore many of these individuals to functional lives, reuniting them with their families.

    Today I'd like to thank all of you for your time and consideration to read my blog.  I hope your awareness has been raised :) and I invite you to correspond with me.  Are there any topics you want to see discussed more in depth?  Would anyone be willing to write their personal story (anonymous, if preferred) to be posted to the blog?

    I welcome any constructive comments and look forward to keeping this blog active until mandatory assisted outpatient treatment laws are alive and well in Tennessee.

    Happy 4th, everyone!


    Helpful hints about what to do in a crisis, and a Post editorial ~ from the blog of Mr. Pete Earley

    If you have never read Mr. Earley's blog, it is definitely deserving of a bookmark at the top of your "must-read-everyday" list.
    A new Psychiatric Crisis Resource Kit that can help families if someone they love develops a mental disorder is scheduled to be unveiled this week in Chicago at the national convention of the National Alliance on Mental Illness. It’s been developed by the Treatment Advocacy Center.    
    Of course, the first thing that comes to mind whenever someone mentions TAC  is its aggressive and relentless campaign to promote Assisted Outpatient Treatment laws. But whether you support AOT laws or oppose them really doesn’t matter. All of us with loved ones who have a mental disorder need to be prepared and from what I have seen so far, TAC has done a real service by putting together a mental health first aid kit.
    When my son first became ill, I was completely at a loss about what to do. And based on the emails and letters that I receive weekly, other parents, families and friends find themselves in the same situation.
    For instance, the kit recommends that families compile a list of telephone numbers for key people, agencies and organizations that should be contacted if there is an emergency. While that sounds like a no-brainer, how many of us have the telephone number of a mobile crisis team, a psychiatric case manager, or anAssertive Community Treatment (PACT or ACT team) handy? Do you know the emergency numbers for your community mental health provider? How about your local suicide hotline? Do you know if your community has a Crisis Intervention Teamand, if so, how to contact it. What’s the number of a public defender who knows mental health laws? Or a private attorney? Is there a mental health court in your jurisdiction and, if  there is, do you know what sort of cases it will hear?
    How about the telephone numbers for homeless shelters, a clubhouse or a peer to peer specialist? How about a contact at your local NAMI or Mental Health America?
    The kit recommends that you have a complete psychiatric and medical history on hand during a crisis. Has your loved one filled out an advance directive? Do you know what medications your family member does and doesn’t want to take and why?
    The kit spells out exactly what sort of medication information you might need, including such simple things as the age of your loved one when they were first diagnosed, any medications that have or have not helped in the past, dates and locations of previous hospitalizations, a list of current medications.
    Of course, TAC also has included each state’s standards for involuntary civil commitment and information about AOT laws.  But there is also information about HIPPA laws and how to deal with doctors who don’t think they need to listen to parents or family members.
    It’s important for all of us who have a loved one with a mental disorder to have thought about what to do if there is a crisis. Have you talked over an emergency action plan with the family member who has a mental disorder when he/she has the symptoms of his/her illness under control so that you can make sure that their wishes, when possible, can be carried out?
    As I looked through a preview of the TAC kit, I realized that I had not done many of the common sense steps that I’ve just listed. Yes, I carry the name of my son’s case manager, psychiatrist and emergency numbers for CIT, a mobile crisis response team, and the local community mental health treatment center in my billfold.
    But I’ve not got a folder with other vital information in it, including a signed advance directive or history of my son’s previous hospitalizations and medications.
    Again, even if you are against AOT, it strikes me that this kit would be extremely valuable for family members and consumers to obtain. In addition to making the kits available in Chicago, you can get information about them by visiting the TACwebpage.
    One item that caught my eye when I read about the kit is called IN A CRISIS GENERAL GUIDELINES.  I’m reprinting it exactly as TAC has listed it on its website and in its publication, The Catalyst,  because I wish that I would have had this list the first time that my son became ill.
    Here is what TAC recommends.
    IN ANY CRISIS: Your goal in an emergency is to stabilize the situation and get the person to professional help as quickly as possible.  
    • Do not try to manage the situation alone – Sometimes just having another party present or on the phone with your loved one will defuse a situation.
    • Start at the top of your Emergency Contacts list and work your way down – If it is an evening or weekend and you cannot reach providers or agencies, call the most appropriate hot-line.
    • Speak to your loved one in a calm, quiet voice – If it seems he/she isn’t listening or can’t hear you, it is possible that auditory hallucinations (“voices”) may be interfering. Don’t shout; raising your voice won’t help and may escalate tensions.
    • Keep instructions and explanations simple and clear – Say, “We’re going to the car now,” not, “After we get in the car, we’ll drive to your doctor’s office so she can examine you.”
    • Respond to delusions by talking about the person’s feelings, not about the delusions – Say, “This must be frightening,” not “You shouldn’t be frightened – nobody’s going to hurt you.”  
    • Don’t stare – Direct eye contact may be perceived as confrontational or threatening.
    • Don’t touch unless absolutely necessary – Touch may be perceived as a threat and trigger a violent reaction.
    • Don’t stand over the person – If the person is seated, seat yourself to avoid being perceived as trying to control or intimidate. 
    • Don’t give multiple choices or ask multi-part questions – Choices will increase confusion. Say, “Would you like me to call your psychiatrist?” not “Would you rather I called your psychiatrist or your therapist?”
    • Don’t threaten or criticize – Acute mental illness is a medical emergency. Suggesting that the person has chosen to be in this condition won’t help and may escalate tension.
    • Don’t argue with others on the scene – Conduct all discussion of the situation quietly and out of the person’s hearing. 
    • Don’t whisper, joke or laugh – This may increase agitation and/or trigger paranoia. 
    Please distribute these helpful hints to folks who you think might benefit. You might also suggest that they read my friend, Dr. Xavier Amador’s book, I’m Not Sick, I Don’t Need Your Help which I turned to for advice when my son became ill. It stressed many of the same points.
    Two weeks ago, I reported on this blog that the Fairfax County Police Department had fired the police officer who fatally shot David Masters in November 2009 while he was sitting in his truck at a stop light. He was being pursued because he had taken flowers from a local business. He also had a history of mental illness.
    Eight days after my blog appeared, Tom Jackman at The Washington Post confirmed that the police had fired the officer. Jackman identified him as David Scott Ziants, age 28.
    Jackman reported:
    No civil suit has been filed in the Masters case, but David Masters’s sister and brother-in-law have filed notice of intent to sue. David Masters, 52, named his ex-wife and stepdaughter as executors of his estate, but under Virginia law only family members are entitled to recover damages in a wrongful death case. Ziants declined comment Tuesday when a reporter knocked on the door of his Prince William County home.
    The Post followed up that story on Saturday with an editorial that criticized the Fairfax Police Department for taking so long to investigate the case. One specific criticism that the newspaper lodged was that more information about the shooting had been released by the Fairfax County Commonwealth Attorney than by the police.
    “Tellingly, most of the details about the case were disclosed by the chief prosecutor in Fairfax, Raymond F. Morrogh, not by police.”
    While I appreciate the editorial, I was surprised that the Post seemed to be praising Morrogh. Yes, he did act more swiftly than the police and he did reveal more information, but his explanation for why he had decided to not purse any criminal charges — even a minor offense — against the officer struck many in the mental health community as being pusillanimous.  It didn’t help when Morrogh made this comment to reporter Jackman:
     ”Unfortunately, we had a mentally ill man who was behaving bizarrely,” Morrogh said. “His family indicated he was behaving under delusions, that he might feel he was under attack if approached by the police. I think that’s the explanation for his actions.”
    That comment implied that Masters, somehow, was to blame for his own death.
    The editorial also pointed out that despite lip service, little has been done by Fairfax officials to implement a citizens backed police review board.
    I’m just thankful that Fairfax County has now formalized its Crisis Intervention Training program for police.
    Hopefully, with better training, there will be fewer of these preventable tragedies.