Saturday, October 29, 2011

Should Involuntary Treatment for the Mentally Ill Be the Law?

An interesting piece in Time Magazine.,8599,2098044,00.html

Thursday, October 20, 2011

Why oppose public policy that makes so much sense?

Untreated severe mental illness and its negative consequences persist despite the existence of assisted outpatient treatment (AOT) laws in 44 states and progressive civil commitment standards in 26 states. In virtually every state, implementation of existing laws and standards is inconsistent at best and nonexistent at worst. Common obstacles to the use of existing laws and standards include: 


•    Incomplete or inconsistent understanding of how the laws and standards work
•    Inconsistent application by judges
•    Inadequate enforcement of court orders


•    Hospitals, physicians and mental health professionals who are unaware of the laws and/or don’t know how to use them
•    Identification mechanisms that would enable hospital emergency rooms, law enforcement and others to immediately recognize individuals under court-ordered outpatient treatment


•    Perceived or projected fiscal impacts on local government
•    Shortage of public personnel with knowledge or training in implementing the laws
•    Opposition by the mental health officials charged with implementing the laws and standards
•    Opposition from tax-funded protection and advocacy (P&A) groups


•    HIPAA/confidentiality obstacles
•    Absence of committed or informed family members to act as advocates
•    Perceived civil rights issues


Sunday, October 16, 2011

Hawaii on AOT: Voluntary treatment is always preferential. However, mental illness is a biologically-based disease that attacks the brain. As a result, MI renders many people incapable of voluntarily entering mental treatment because they are unable to make rational decisions or unaware that they are ill. When this occurs, they may require assisted treatment to protect their lives as wall as avoid tragic personal and society consequences.

1/21/11 - introduced
1/24/11 - passed 1st reading


     SECTION 1.  The legislature finds that the consequences of untreated mental illness are homelessness, criminalization, suicide, violence, victimization, lost productivity, permanently decreased medication responses, and the incalculable costs of unnecessary suffering.  Due to advances in mental health care in recent years, treatment is now available that can eliminate or substantially alleviate the symptoms of mental illness for most who suffer from it.
     When a diagnosis of any illness is made, most people seek medication, therapy, or helpful guidance back to regain health.  That takes rational thinking, which is often snatched away by mental illness.  When brain chemistry goes wrong, everything changes until that chemical balance is restored.  That is precisely why people with mental illness who are involved with potential criminal activity should be approached, processed, and managed in accordance with their illness.
     Voluntary treatment is always preferable.  However, mental illness is a biologically-based disease that attacks the brain.  As a result, mental illness renders many people incapable of voluntarily entering mental treatment because they are unable to make rational decisions or are unaware that they are ill.  When this occurs, people may require assisted treatment to protect their lives as well as avoid tragic personal and societal consequences.
     The causes of serious mental illness are still unknown, but the effects of serious mental illness remain devastating. People who are suffering from schizophrenia or bipolar disorder often become psychotic and separated from reality.  In this condition, they do not know what they are doing and can become part of a world that is totally different from reality.  As wrong and dangerous as their thoughts may be, those thoughts are true and compelling to them.  Active psychosis is not controllable until stabilization and orientation returns through medication and therapy.  One aspect of psychosis, by definition, is the inability of a person to grasp the harm that the person may be doing to that person's self or others.
     The purpose of this Act is to establish a legal framework for the provision of care to individuals who, due to the symptoms of severe mental illness, become ether dangerous or incapable of making informed medical decisions concerning their treatment.


The National Institute of Mental Illness (NIMH) in 2010 estimated that 7.7 million Americans suffer from schizophrenia and severe bipolar disorder - approximately 3.3% of the US population when combined. Of these, approximately 40% of the individuals with schizophrenia and 51% of those with bipolar are untreated in any given year.


Homelessness People with untreated psychiatric illnesses comprise one-third, or 200,000 people, of the estimated 600,000 homeless population. The quality of life for these individuals is abysmal. Many are victimized regularly. A recent study has found that 28 percent of homeless people with previous psychiatric hospitalizations obtained some food from garbage cans and 8 percent used garbage cans as a primary food source.
People with untreated serious brain disorders comprise approximately 16 percent of the total jail and prison inmate population, or nearly 300,000 individuals. These individuals are often incarcerated with misdemeanor charges but sometimes with felony charges as a result of behaviors caused by their psychotic thinking. People with untreated psychiatric illnesses spend twice as much time in jail as non-ill individuals and are more likely to commit suicide.
Episodes of Violence
There are approximately 1,600 homicides – among the estimated 16,000 total homicides in the U.S. – committed each year by people with untreated schizophrenia and bipolar disorder. According to a 1994 Department of Justice, Bureau of Justice Statistics Special Report, "Murder in Families," 4.3 percent of homicides committed in 1988 were by people with a history of untreated mental illness (study based on 20,860 murders nationwide). The Department of Justice report also found:
  • of spouses killed by spouse – 12.3 percent of defendants had a history of untreated mental illness;
  • of children killed by parent – 15.8 percent of defendants had a history of untreated mental illness;
  • of parents killed by children – 25.1 percent of defendants had a history of untreated mental illness; and
  • of siblings killed by sibling – 17.3 percent of defendants had a history of untreated mental illness.

Saturday, October 15, 2011

Disability Law & Advocacy Center of Tennessee - White Paper, June 2011

"The vast majority of persons with mental illness are able to live productive lives with no supports or services or with minimal assistance from mental health professionals. Even though mental illness is widespread in the population, the main burden of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 — who live with a severe and persistent mental illness." - Tennessee Disability Law & Advocacy Center

I agree wholeheartedly with this statement, yet I marvel at mental health consumers who advocate for the State to create more "peer support models" yet oppose funding to provide assisted outpatient treatment for the 6 percent with severe and persistent mental illness who need it the most.  Where is the peer support for these 6 percent?  Recovery for the folks with serious and persistent mental illness can not happen until treatment can happen.  An AOT law for Tennessee can make that treatment a reality.  Then, and only then - WITH TREATMENT - is recovery even possible.


Reprinted with permission from the Treatment Advocacy Center's Blog
The Treatment Advocacy Center is sometimes asked – or challenged about – why we talk about violence and untreated mental illness. The circumstances and aftermath of Kelly Thomas’s gruesome death illustrate a part of the answer.
Kelly Thomas was the 37-year-old homeless man with untreated schizophrenia who was brutally attacked by six Fullerton, California, police officers in July. He died five days later, after being taken off life support.
The unconscionable violence against Thomas was captured on video, which quickly hit the Internet, turned into headlines and broadcasts, and mobilized a horrified public. Since then, protestors have hit the streets by the hundreds. Two of the officers have been charged with crimes – murder and manslaughter – and investigations continue. 
Meanwhile, thousands of Facebook users have "liked" or joined groups calling on the Orange County Board of Supervisors to implement Laura’s Law – California’s assisted outpatient treatment (AOT) statute. AOT is a means of providing treatment to people too ill to seek it themselves before violence or homelessness or arrest or other consequences of non-treatment occur. After failing to enact the law in the decade since it was passed by the California legislature, the supervisors have called for a report from county mental health officials about how to implement it now.
That’s why we talk about violence and untreated mental illness. Because it takes lives – through suicide, homicide and victimization – and leaves countless families and bystanders wounded or bereaved. Because it leads to stigma. Because, sometimes, when enough people object or enough lawmakers care, it leads to change.
Ultimately, thousands of followers aren't “liking” or joining Justice 4 Kelly Thomas or Advocates for Laura's Law or Saturday Protest!!! on Facebook because the Treatment Advocacy Center told them there's a link between violence and untreated mental illness. They are doing it because they see the link for themselves and are saying: "Enough!"  Now Orange County supervisors – and, in an entirely unrelated episode, Mendocino County supervisors – at last may look at implementing the state law that itself was inspired when untreated mental illness led to the loss of three lives, including that of a teenager named Laura Wilcox. 
Reducing untreated mental illness reduces violence. Because of what happened to Kelly Thomas, more people see the value of making assisted outpatient treatment available to others with untreated severe mental illness. It's time for their elected officials to see it, too  – and to act.

Stabbing in Maryland Could be a ‘Teachable Moment’ (If Anyone Was in Class)

Reprinted with permission from the Treatment Advocacy Center's Blog
Antoinette Starks has a diagnosis of paranoid schizophrenia and a history of violence – two of the variables most likely to be present when an individual with severe mental illness commits a violent act.
Starks’s 2005 knifing attacks on shoppers in a Bethesda, Maryland, Nordstrom resulted in a verdict of not guilty by reason of insanity and her treatment in a forensic psychiatric facility (“Suspect, recently released from psychiatric facility, accused in stabbing at Md. Target,” Washington Post, Oct. 12).
Two months ago, Starks was released from the facility to a group home over the protests of prosecutors, who considered her dangerous to herself on others.
On Tuesday morning of this week, Sparks allegedly attacked a stranger without warning outside a suburban Maryland Target store, stabbing the victim multiple times with two double-blade weapons she made by taping knives together. Officers found her in a nearby parking lot and used a Taser to subdue her; the victim was hospitalized.
Attorney Kenneth Trombly, who represented one of the Nordstrom victims in a lawsuit against the retailer, said to the Post, “ ‘Was she monitored? Was she taking her medication?’ ”
We may never know. A state mental health official said confidentiality rules prevent discussing details.
What we do know is that Maryland is one of six states without an assisted outpatient treatment (AOT) law. The state has no form of court-ordered treatment in the community and few mental health courts that might order mental health treatment for individuals in the criminal justice system. “Conditional release” provisions used elsewhere to mandate treatment after release from psychiatric commitment exist but are rarely used.
In other states, episodes like the repeat stabbings by Sparks have become “teachable moments” that show lawmakers the need for better outpatient commitment laws. If history is a guide, Maryland’s legislators will miss the lesson. 

Thursday, October 13, 2011

Wednesday, October 12, 2011

Monday, October 10, 2011

Recovery is IDEALLY person-driven, but not always.

My father has late-onset paranoid schizophrenia and tried to commit suicide three times....
By Amanda LaPera
(NOTE: Amanda LaPera posted the following comment as both a consumer and family member in SAMHSA’s recent “Guiding Principles of Recovery” forum. It is republished on the Treatment Advocacy Center's website with her permission.)

While I think the idea behind most of the listed guiding principles is sound, I do take issue when it states that “Recovery is Person-Centered.” Instead I think it would be more appropriate to state that “ideally, recovery is person-centered” since that is not always possible. I apologize for the long response, but many people on this site have called people’s statements into question based on lack of evidence. There is a small but very important population being ignored throughout these various threads: those who are the most severely ill and lack the insight that they are indeed ill. This is not a made-up disease, or something cured by simple nutrition. Anosognosia is real.
Most of the comments I've read from "consumers" who have bipolar or schizophrenia and have lead normal lives or from those who equate assisted outpatient treatment (AOT) to torture don't understand that AOT does not apply to most people. Not all those who have a severe mental illness have anosognosia or a need for intervention. I am not here to represent any organization or to try to use propaganda to sway this discussion. I am trying to provide a more thorough understanding of the real issue. Please hear me out on this.
I am consumer who has successfully lived both medicated and not medicated during different points in my life. My mother has bipolar and has decided that she can't function without medication. (I completely agree with her - medication along with appropriate care from competent mental health care professionals is how she is able to take care of herself). My father has late-onset paranoid schizophrenia and tried to commit suicide three times, had three involuntary hospitalizations, has anosognosia, and has been homeless for the last 10 years where he's been taken advantage of, had his nose broken after being attacked, and was treated for frostbite from sleeping on the cold streets. My sister has severe anxiety/depression and, without her medication, I would worry for the safety of her and her children. My friend has bipolar and, without medication, was completely unable to work, leave her house, or function. And my son, who has something that nobody can correctly label yet, has been misdiagnosed over a dozen times by nearly 20 different mental healthcare doctors, mistreated with medications that caused ulcers, stunted growth, and then weight gain, and is currently doing much better without any medications.
Not everyone needs nor responds to medication. In fact, the medications of the 1970s and 1980s did my mom more harm than good. Finally, science has advanced enough to provide her with appropriate and effective medication. I can see all sides of this issue. The issue of anosognosia and the recognition that some of the most vulnerable people need others to help them to get treatment does not apply to all individuals who have bipolar or schizophrenia, only the most severe, like my father. It seems to be easy for many here to dismiss this idea as a family's desperation (yes, many families don't have enough information to help their loved ones effectively, and it is a very painful position to be in when you have to watch your loved one deteriorate), or an overzealous pharmaceutical industry (yes, there are definitely abuses there), or incorrect diagnosis (yes, we need more research dollars to be spent on understanding and "mapping" the human brain's chemical functions to eventually be able to provide reliable evidence of all mental illnesses), or even torture (yes, the psychiatric hospitals have committed many deplorable abuses in the name of medicine). But do these same individuals here not recognize that all human beings deserve the decency to be able to live healthy, productive lives, free from a severe disabling condition?
What about Andrew Goldstein and Kendra Webdale? What about Scottt Harlan Thorpe and Laura Wilcox? What about Jared Loughner and Rep. Gabrielle Giffords and the six who died? What about Seung-Hui Cho and the 32 people at Virginia Tech? What about Kelly Thomas and the police department? The list goes on and on. What do all of these tragedies have in common? A person who was severely mentally ill who was not being adequately treated and whose family knew there was a mental illness that needed to be treated.
I am not saying all violence is attributed to mental illness, nor am I claiming that all those with severe mental illness will become violent. Neither could be further from the truth. However, definition of recovery aside, how in good conscience could SAMHSA ignore these people in this discussion? While they make up a very small minority, we are still talking about human life and mental illnesses that must be addressed. Money will always be an issue, but it’s far less costly to provide sufficient care—be it inpatient or outpatient—than to sit by, pretend there isn’t a problem, and allow things to continue as they have been, with people being incarcerated or left to fend for themselves on the streets, which only results in more money being spent and more preventable tragedies.
Let’s look at the facts. According to SAMHSA, homelessness is frequently a mental health issue. Their National Mental Health Information Center lists the following statistics: over the course of 1996, 2.1 million adults were homeless; 39% of the homeless population in America report having a mental illness, and 20-25% meet the criteria for a severe mental illness. There are also several individual factors that may increase a person's risk for becoming homeless and remaining homeless for a longer period of time, one of which is an untreated mental illness that can cause individuals to become paranoid, anxious, or depressed, making it difficult or impossible to maintain employment, pay bills, or keep supportive social relationships. Homeless individuals with severe mental illness are twice as likely as other homeless people to be arrested or jailed. SAMHSA also reports: “Homelessness among people with serious mental illnesses can be prevented. Discharge planning that helps people who are leaving institutions to access housing, mental health, and other necessary community services can prevent homelessness during such transitions. Ideally, such planning begins upon entry into an institution, is ready to be implemented upon discharge, and involves consumer input. Providing short-term intensive support services immediately after discharge from hospitals, shelters, or jails has proven effective in further preventing recurrent homelessness during the transition back into the community.” And, according to the U.S. Department of Justice, Bureau of Justice Statistics’s study “Mental Health and Treatment of Inmates and Probationers” by Paula M. Ditton, BJS Statistician: “At midyear 1998 an estimated 283,800 offenders with mental illness were incarcerated in the Nation's prisons and jails.”
I don’t pretend to have the answer to everything, but I do know that we must recognize this subset of the population before they are incarcerated or homeless, and include them in this discussion.
Click on a link to read another story of Individuals and Families SPEAKING.
  • "The Monster's Mother" - My mentally ill son was sentenced to life without parole for murder, and I couldn’t shed a tear....
  • "Life Under a Cloud" - My journeys through psychosis were really just beginning....