Wednesday, November 30, 2011

If Lakeshore Closes, It Won't Close Quietly

Employees, citizens voice concerns about closing of Lakeshore Mental Health Institute:

If Lakeshore Mental Health Institute closes, it won't close quietly.

"I will kick and scream all the way to the end," Knox County Commissioner Jeff Ownby told a group of about 150 people Wednesday evening at West High School.

Ownby, whose wife and sister-in-law are longtime Lakeshore employees, called the forum to let local elected officials "hear the concerns" of Lakeshore employees, family members of patients, advocates and "concerned citizens." About 10 other city, county and state elected officials attended, though only state Sen. Stacey Campfield and County Commissioner Amy Broyles spoke, both encouraging people to share concerns with Gov. Bill Haslam and Department of Mental Health Commissioner Douglas Varney.

Varney announced Nov. 11 that he wants to close the aging mental health institute by the end of the fiscal year, as part of a plan to outsource mental health care to private inpatient facilities and community-based programs. Under his proposal, Lakeshore would stop admitting patients next month.

But Ownby said he plans to ask Knox County Commission to approve a resolution requesting Varney allow two years to transition to the new plan, to "make sure this process is going to work." He also indicated a desire to look at purchasing the old Baptist Hospital of East Tennessee for retrofitting as a mental health facility and veterans hospital.

Most of those who spoke expressed doubt that other facilities would actually take the "difficult" patients who often end up at Lakeshore, that enough community-based programs exist to serve them, or that everyone can be served through those programs.

Employees expressed particular concern for longtime and "hard-to-place" residents, who might end up without services or be moved too far for family to visit. Several predicted a rise of mentally ill in the homeless and jailed populations if Lakeshore closes.

Some voiced anger that neither this nor a previous meeting was attended by Varney or representatives of the providers that would take Lakeshore's patients under his plan.

"Where are the officials from Peninsula, from Ridgeview? There's a lot of questions we need to ask," said longtime Lakeshore employee Victor Haynes, who added Varney "hasn't even toured our facility hasn't even come to talk to me on my shift hasn't even met my clients."

Local lawyer Alan Everett, whose brother spent three years at Lakeshore but now lives in the community with support, advocated Tennessee adopt "outpatient commitment" laws to compel people by court order to receive outpatient mental health care.

But family members spoke of the difficulty finding such services for mentally ill loved ones already, even as Lakeshore is one option. For some, it's the only option, they said.

Local musician/songwriter Marshal Sherles said his mentally ill brother was taken to Lakeshore "because he had nowhere else to go" and there received "a piece of his dignity that he had lost."

"My brother will never be 'normal' he cannot function in the community. We know that; he knows that," said Sherles, emphatically adding, "It is WRONG to close Lakeshore."

Tuesday, November 29, 2011

Georgia learned the hard way. Committee launches effort to address mental health needs.

If things like this weren’t so frustrating, they’d be funny.

Georgia’s Colquitt County reportedly decided a year or so ago that it couldn’t afford its mental health facility. So the powers that be closed it (“Committee launches effort to address mental health needs,” Moultrie Observer, Nov. 17). The facility had dispensed medications and provided counseling.

In no time at all, “individuals and agencies began noting that not having this facility was a severe detriment to those who did not have transportation” to other centers. As the kids would say – duh!

Then it was reported that both the emergency room at the regional medical center and the county jail were being impacted (duh!!). Oh, and “it was even suggested that some tragedies that occurred here might link to a lesser availability of services (DUH!).

So now a couple dozen leaders from community agencies and programs are meeting to discuss the issue and “lay groundwork to begin addressing the lack of a facility.” The chairman of the coalition “was pleasantly surprised at the large turnout for the first meeting, which he said suggests at many of the agencies involved are feeling the impact of not having a mental health facility here.”

Not to be irreverent or disrespectful but, really – DUH!!!!!

If even one county in one state has a “duh” moment about the impact of mental health treatment on the community, that's progress. What’s discouraging is that so many communities have to learn about the impact of not treating mental illness the hard way – and that so many individuals and families have to suffer while waiting for the moment to come.

Committee launches effort to address mental health needs

Source: www.treatmentadvocacycenter.org

Monday, November 28, 2011

Deinstitutionalization: A Psychiatric Titanic

This excerpt is drawn from Chapters 1, 3 and the Appendix of: Out of the Shadows: Confronting America's Mental Illness Crisis by E. Fuller Torrey, M.D. (New York: John Wiley & Sons, 1997).

http://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html

Deinstitutionalization is the name given to the policy of moving severely mentally ill people out of large state institutions and then closing part or all of those institutions; it has been a major contributing factor to the mental illness crisis. (The term also describes a similar process for mentally retarded people, but the focus of this book is exclusively on severe mental illnesses.)

Deinstitutionalization began in 1955 with the widespread introduction of chlorpromazine, commonly known as Thorazine, the first effective antipsychotic medication, and received a major impetus 10 years later with the enactment of federal Medicaid and Medicare. Deinstitutionalization has two parts: the moving of the severely mentally ill out of the state institutions, and the closing of part or all of those institutions. The former affects people who are already mentally ill. The latter affects those who become ill after the policy has gone into effect and for the indefinite future because hospital beds have been permanently eliminated.

The magnitude of deinstitutionalization of the severely mentally ill qualifies it as one of the largest social experiments in American history. In 1955, there were 558,239 severely mentally ill patients in the nation's public psychiatric hospitals. In 1994, this number had been reduced by 486,620 patients, to 71,619, as seen in Figure 1.2. It is important to note, however, that the census of 558,239 patients in public psychiatric hospitals in 1955 was in relationship to the nation's total population at the time, which was 164 million.

By 1994, the nation's population had increased to 260 million. If there had been the same proportion of patients per population in public mental hospitals in 1994 as there had been in 1955, the patients would have totaled 885,010. The true magnitude of deinstitutionalization, then, is the difference between 885,010 and 71,619. In effect, approximately 92 percent of the people who would have been living in public psychiatric hospitals in 1955 were not living there in 1994. Even allowing for the approximately 40,000 patients who occupied psychiatric beds in general hospitals or the approximately 10,000 patients who occupied psychiatric beds in community mental health centers (CMHCs) on any given day in 1994, that still means that approximately 763,391 severely mentally ill people (over three-quarters of a million) are living in the community today who would have been hospitalized 40 years ago. That number is more than the population of Baltimore or San Francisco.

Deinstitutionalization varied from state to state. In assessing these differences in census for public mental hospitals, it is not sufficient merely to subtract the 1994 number of patients from the 1955 number, because state populations shifted in the various states during those 40 years. In Iowa, West Virginia, and the District of Columbia, the total populations actually decreased during that period, whereas in California, Florida, and Arizona, the population increased dramatically; and in Nevada, it increased more than sevenfold, from 0.2 million to 1.5 million. The table in the Appendix takes these population changes into account and provides an effective deinstitutionalization rate for each state based on the number of patients hospitalized in 1994 subtracted from the number of patients that would have been expected to be hospitalized in 1994 based on that state's population. It assumes that the ratio of hospitalized patients to population would have remained constant over the 40 years.

Rhode Island, Massachusetts, New Hampshire, Vermont, West Virginia, Arkansas, Wisconsin, and California all have effective deinstitutionalization rates of over 95 percent. Rhode Island's rate is over 98 percent, meaning that for every 100 state residents in public mental hospitals in 1955, fewer than 2 patients are there today. On the other end of the curve, Nevada, Delaware, and the District of Columbia have effective deinstitutionalization rates below 80 percent.

Most of those who were deinstitutionalized from the nation's public psychiatric hospitals were severely mentally ill. Between 50 and 60 percent of them were diagnosed with schizophrenia. Another 10 to 15 percent were diagnosed with manic-depressive illness and severe depression. An additional 10 to 15 percent were diagnosed with organic brain diseases -- epilepsy, strokes, Alzheimer's disease, and brain damage secondary to trauma. The remaining individuals residing in public psychiatric hospitals had conditions such as mental retardation with psychosis, autism and other psychiatric disorders of childhood, and alcoholism and drug addiction with concurrent brain damage. The fact that most deinstitutionalized people suffer from various forms of brain dysfunction was not as well understood when the policy of deinstitutionalization got under way.

Thus deinstitutionalization has helped create the mental illness crisis by discharging people from public psychiatric hospitals without ensuring that they received the medication and rehabilitation services necessary for them to live successfully in the community. Deinstitutionalization further exacerbated the situation because, once the public psychiatric beds had been closed, they were not available for people who later became mentally ill, and this situation continues up to the present. Consequently, approximately 2.2 million severely mentally ill people do not receive any psychiatric treatment.

Deinstitutionalization was based on the principle that severe mental illness should be treated in the least restrictive setting. As further defined by President Jimmy Carter's Commission on Mental Health, this ideology rested on "the objective of maintaining the greatest degree of freedom, self-determination, autonomy, dignity, and integrity of body, mind, and spirit for the individual while he or she participates in treatment or receives services."8 This is a laudable goal and for many, perhaps for the majority of those who are deinstitutionalized, it has been at least partially realized.

For a substantial minority, however, deinstitutionalization has been a psychiatric Titanic. Their lives are virtually devoid of "dignity" or "integrity of body, mind, and spirit." "Self-determination" often means merely that the person has a choice of soup kitchens. The "least restrictive setting" frequently turns out to be a cardboard box, a jail cell, or a terror-filled existence plagued by both real and imaginary enemies.


· · ·


CHAPTER 3: JAILS AND PRISONS

Deinstitutionalization doesn't work. We just switched places. Instead of being in hospitals the people are in jail. The whole system is topsy-turvy and the last person served is the mentally ill person. -- Jail official, Ohio 1

Confining George Wooten in the Denver County Jail in May 1984 was another indicator of the growing mental illness crisis. The 32-year-old Wooten had been jailed over 100 times, including 28 times in the previous 2 years, for creating disturbances in the community. Wooten had been diagnosed with schizophrenia at age 17, and each time he used alcohol or sniffed glue or paint fumes, it exacerbated his schizophrenia and led to his disorderly behavior.

According to a newspaper account, "Wooten says he likes jailers and the place. He calls it home. … Eight years ago, the officers might have taken Wooten to a community mental health center, a place that was supposed to help the chronically mentally ill. But now they don't bother. … Police have become cynical about the whole approach. They have learned that 'two hours later [those arrested] are back on the street … the circle of sending the person to a mental health center doesn't work.'"2


Removing the Mentally Ill from Jails

The odyssey of repeated incarceration for severely ill people like George Wooten was common in the United States in the early 1800s although many Americans found such practices inhumane and uncivilized. Their sentiments found organized expression in the Boston Prison Discipline Society, which was founded in 1825 by the Reverend Louis Dwight, a Yale graduate and Congregationalist minister. Shocked by what he saw when he began taking Bibles to inmates in jails, he established the society to publicly advocate improved prison and jail conditions in general and hospitals for mentally ill prisoners in particular. According to the medical historian, Gerald Grob, Dwight's "insistence that mentally ill persons belonged in hospitals aroused a responsive chord, especially since his investigations demonstrated that large numbers of such persons were confined in degrading circumstances."3

Dwight's actions led the Massachusetts legislature to appoint a committee in 1827 to investigate conditions in the state's jails. The committee's report, which was directed to the State General Court, included documentation that many "lunatics and persons furiously mad" were being confined, often in inhumane and degrading conditions. In one jail, a man had been kept for nine years. "He had a wreath of rags around his body and another round his neck. … He had no bed, chair or bench … a heap of filthy straw, like the nest of swine, was in the corner. … The wretched lunatic was indulging [in] some delusive expectations of being soon released from this wretched abode."4

The committee report concluded, "The situation of these wretched beings calls very loudly for some redress. They seem to have been considered as out of the protection of laws. Less attention is paid to their cleanliness and comfort than to the wild beasts in their cages, which are kept for show."5

Among the specific recommendations of the committee was that all mentally ill inmates of jails and prisons should be transferred to the Massachusetts General Hospital and that confinement of mentally ill persons in the state's jails should be made illegal. Three years later, the Massachusetts General Court "overwhelmingly approved a bill providing for the erection of a state lunatic hospital for 120 patients"; this opened in 1833 as the State Lunatic Asylum at Worcester. When the hospital opened, "more than half of the 164 patients received during that year came from jails, almshouses, and houses of correction [prisons]."6 One-third of these patients had been confined in these institutions for longer than 10 years.

Dorothea Dix, the most famous and successful psychiatric reformer in American history, picked up where Dwight had left off. In 1841, with the American asylum-building movement under way, Dix began a campaign that would focus national attention on the sad plight of the mentally ill in jails and prisons and would be directly responsible for the opening of at least 30 more state psychiatric hospitals.

At the time she began her crusade, Dix was a 39-year-old teacher who had been left a bequest by her grandmother, allowing her to give up teaching. Her father had been "shiftless, poverty stricken and irresponsible … fanatically religious, with a penchant for writing theological tracts in fits of 'inspiration,'"7 and her childhood had therefore been very difficult. Her father may in fact have been mentally ill, which would account in part for her zeal to improve conditions for such sufferers.

Dix's crusade began in early 1841, when she agreed to teach a Sunday school class at the East Cambridge Jail outside Boston. While there, she noticed not only that there were insane prisoners among the inmates, but also that the insane prisoners had no heat in their cells. When she inquired about this, she was told by the jailer that it was because "the insane need no heat." Horrified, Dix reported her findings to her friends and set out to investigate other jails in Massachusetts to ascertain whether similar conditions prevailed. Over the next year, she visited dozens of jails and almshouses and then presented a report to the state legislature. It rang of reform and set the tone for Dorothea Dix's future work:

I come to present the strong claims of suffering humanity. I come to place before the Legislature of Massachusetts the condition of the miserable, the desolate, the outcast. I come as the advocate of helpless, forgotten, insane and idiotic men and women … of beings wretched in our prisons, and more wretched in our Alms-Houses.
I proceed, Gentleman, briefly to call your attention to the state of Insane Persons confined within this Commonwealth, in cages, closets, cellars. stalls, pens: Chained, naked, beaten with rods, and lashed into obedience!8
After finishing her report in Massachusetts, Dix moved on to New Jersey, where she proceeded in the same fashion to visit jails and almshouses, then report to the state legislature and urge the building of public psychiatric hospitals in which insane persons could be treated humanely and receive treatment. By 1847, she had taken her crusade to many eastern states and visited 300 county jails, 18 prisons, and 500 almshouses. Her success in persuading state legislatures to build psychiatric hospitals was impressive, and she provided a major impetus to the reform movement.

The Reverend Louis Dwight and Dorothea Dix were remarkably successful in leading the effort to place mentally ill persons in public psychiatric hospitals rather than in jails and almshouses. By 1880, there were 75 public psychiatric hospitals in the United States for the total population of 50 million people. In 1880, the first complete census of "insane persons" in the United States was carried out. It was, in fact, a more complete census than has ever been carried out since and included letters to all physicians asking them to enumerate all "insane persons" in their community, a question about "insanity" on the census form that went to every household, and a canvassing of all hospitals, jails, and almshouses. A total of 91,959 "insane persons" were identified, of which 41,083 were living at home, 40,942 were in "hospitals and asylums for the insane," 9,302 were in almshouses, and only 397 were in jails. The total number of prisoners in all jails and prisons was 58,609, so that severely mentally ill inmates constituted only 0.7 percent of the population of jails and prisons.

That was the situation in 1880.9


Putting the Mentally Ill Back into Jails

The mentally ill began reappearing in America's jails and prisons in large numbers approximately 90 years after the 1880 census. In 1974 and 1975, for example, Glenn Swank and Darryl Winer assessed 545 inmates in the Denver County Jail and reported, "The number of psychotic persons encountered in the jail was striking, as was the number with a history of psychiatric hospitalization, particularly long-term (more than one month) or multiple hospitalizations. … Of the jail inmates with a history of long-term psychiatric hospitalization, many had been state mental hospital patients." They also noted a widespread belief among jail personnel "that there has been a marked increase in the number of severely mentally disturbed individuals entering the jail in recent years, but unfortunately there are no earlier data available for comparison. … The [jail] system seemed to have inherited responsibility for these persons by default rather than preference."10

A study of five California county jails carried out in 1975 by Arthur Bolton and Associates found that 6.7 percent of the inmates were severely mentally ill at the time of examination.11 Gary Whitmer's 1980 study of 500 mentally ill people who had been charged with crimes emphasized the causal relationship between the person's mental illness and his or her crime, and he cited examples such as a man who had "smashed the plate-glass window of a retail store because he saw a dinosaur jumping out at him"; a woman who refused to pay her restaurant bill because she believed that "she was the reincarnation of Jesus Christ"; a man who harassed two other men whom he believed to be "CIA agents who had kidnapped his benefactress"; and a woman with paranoid delusions who went up to a man on the street and "struck the victim in the right buttocks" with a hat pin.12At the time of their arrests, only 6 percent of the mentally ill studied by Whitmer were involved in any treatment program, leading him to conclude that the reforms brought about by deinstitutionalization had "forced a large number of those deinstitutionalized patients into the criminal justice system."

By the early 1980s, interest in the problem of the mentally ill in jails and prisons was growing, increasing as their numbers increased, and two methodologically sound studies of the problem were carried out. In Chicago, Linda Teplin, spurred by the observation that "mental health professionals speculate that the jails have become a repository for the severely mentally ill," interviewed 728 jail admissions using a structured psychiatric interview and found that 6.4 percent of them met diagnostic criteria for schizophrenia, mania, or major depression.13 In Philadelphia, Edward Guy and his colleagues interviewed 96 randomly selected admissions to the jail and reported that 4.6 percent had schizophrenia or manic-depressive illness, which they labeled as "an alarmingly high incidence of mental illness among inmates of a city jail."14

A more inclusive but methodologically less rigorous study of mentally ill people in the nation's jails was carried out in 1992 by the Public Citizen Health Research Group and the National Alliance for the Mentally Ill.15 Questionnaires were mailed to the directors of all 3,353 county and city jails in the United States asking them to estimate the percentage of inmates who on any given day "appeared to have a serious mental illness." This was further defined to include only inmates with schizophrenia or manic-depressive illness who were exhibiting symptoms such as auditory hallucinations, delusions, confused or illogical thinking, bizarre behavior, or marked mood swings. The jail directors were instructed not to include as mentally ill anyone who exhibited "suicidal thoughts or behavior" or "alcohol and drug abuse" unless the person also had other symptoms as previously described. No attempt was made to identify mentally ill inmates with more subtle symptoms of mental illness (e.g., an inmate with paranoid schizophrenia who did not discuss his delusional beliefs); the survey sought to count only those who were the most severely and overtly mentally ill.

Replies were received from 41 percent of the jails, which represented 62 percent of all jail inmates in the United States. Overall, the jail directors estimated that 7.2 percent of inmates appeared to have a serious mental illness, ranging from less than 3 percent in jails in Wyoming, Nevada, Idaho, and South Carolina to almost 11 percent in jails in Connecticut, Hawaii, and Colorado.

Studies of inmates with psychiatric disorders in state prisons have also been carried out, and the results agree with the results from the studies done in jails. In general, jails keep prisoners sentenced for one year or less, whereas prisons keep prisoners with longer sentences. Ron Jemelka and his colleagues reported that many such studies "used a field survey approach in which one or more key administrators in each prison system was asked to respond to a series of questions about the mentally ill in their facilities. These surveys have suggested that 6 to 8 percent of state prison populations have a serious psychiatric illness," but for a variety of reasons "facility surveys are likely to substantially underestimate the number of mentally ill offenders."16

When prison inmates have been actually interviewed, a higher percentage have been found to be severely mentally ill. In 1980, Frank James and his associates reported findings from interviews of 246 prisoners in Oklahoma; 10 percent of them were found to be acutely and severely disturbed.17 In 1987, Henry Steadman and his colleagues published the results of interviews with 3,332 prison inmates in New York State; 8 percent of them were said to have "very substantial psychiatric and functional disabilities that clearly would warrant some type of mental health service."18

A 1988 study of 109 new admissions to the Washington State prison system, using a structured diagnostic interview, reported that 8.4 percent had schizophrenia, manic-depressive illness, or mania, while 1.9 percent more had schizophreniform disorder, and 10 percent met diagnostic criteria for depression.19 A similar study of 1,070 prison inmates in Michigan found that 6.6 percent had schizophrenia or manic-depressive illness and 5.1 percent had major depression.20 Considering all these studies, Jemelka et al. concluded that 10 to 15 percent of prisoners have a major thought disorder or mood disorder and "need the services usually associated with severe or chronic mental illness."21

Other studies have also been used to ascertain how frequently people with severe mental illnesses are put into jails and prisons. In 1991, a telephone survey was carried out of 1,401 randomly selected members of the National Alliance for the Mentally Ill, an advocacy and support group composed mostly of family members of persons with schizophrenia and manic-depressive illness. It was found that 40 percent of the mentally ill in this group had been arrested at some time in their lives and, at any given time, 1 percent of them were in jail or prison.22

Studies have also been done to ascertain arrest and incarceration rates for the homeless who are mentally ill. A 1985 study in Los Angeles of 232 people living in shelters and on the streets who had previously been psychiatrically hospitalized found that 76 percent of them had been arrested as adults.23 This is similar to the 74 percent previous arrest rate reported for severely mentally ill inmates examined in the Los Angeles County Jail.24 Such studies demonstrate a large overlap between mentally ill persons who are homeless and those who are in jail.

How many people with severe mental illnesses are in jails and prisons on any given day? If such illnesses are defined to include only schizophrenia, manic-depressive illness, and severe depression, then approximately 10 percent of all jail and prison inmates appear to meet these diagnostic criteria. The most recent data available in 1995 indicated there were 483,717 inmates in jails and 1,104,074 inmates in state and federal prisons in the United States, a total of 1,587,791 prisoners.25 If 10 percent of them are severely mentally ill, that would be approximately 159,000 people. It is also likely that the mentally ill often rotate back and forth between being homeless and being in jails or prisons. …


· · ·


The Imprisoned Mentally Ill and Deinstitutionalization

Between 1980 and 1995, the total number of individuals incarcerated in American jails and prisons increased from 501,886 to 1,587,791, an increase of 216 percent. During this time, the general population increased by only 16 percent.43 The vast majority of this increase has been fueled by changing demographics, more stringent mandatory sentencing laws, and the increasing availability of cocaine and other street drugs. Have the mentally ill, however, contributed more than their expected share to the increasing population of jails and prisons?

Several lines of evidence suggest the answer is yes. First, in 1939, Lionel Penrose, studying the relationship between mental disease and crime in European countries, showed that prison and psychiatric hospital populations were inversely correlated, As one rose, the other fell.44 This has become known as the balloon theory -- push in one part of a balloon and another part will bulge out. In 1991, George Palermo and his colleagues published an extensive analysis of the balloon theory utilizing data on U.S. mental hospitals, jails, and prisons for the 83 years between 1904 and 1987. They found the theory to be valid and concluded:

The number of the mentally ill in American jails and prisons supports the thesis of progressive transinstitutionalism. The authors believe that the statistical evidence derived from the national census data corroborates their clinical observation that jails have become a repository of pseudooffenders -- the mentally ill. Our opinion is that our results probably refIect the state of most United States jails.45

Observations by psychiatrists and by corrections officials also support a causal relationship between deinstitutionalization and the increasing number of former patients in jails and prisons. California was the first state to aggressively undertake deinstitutionalization, implementing the Lanterman-Petris-Short (LPS) Act in 1969, which made it much more difficult to involuntarily hospitalize, or keep in the hospital, persons who are mentally ill. In 1972, Marc Abramson, a psychiatrist in San Mateo County, published data showing that the number of mentally ill persons entering the criminal justice system doubled in the first year after the Lanterman-Petris-Short Act went into effect. Abramson said, "As a result of LPS, mentally disordered persons are being increasingly subjected to arrest and criminal prosecution."46 Abramson also coined the term "criminalization of mentally disordered behavior" and in a remarkably prophetic statement said, "If the mental health system is forced to release mentally disordered persons into the community prematurely, there will be an increase in pressure for use of the criminal justice system to reinstitutionalize them. Those who castigate institutional psychiatry for its present and past deficiencies may be quite ignorant of what occurs when mentally disordered patients are forced into the criminal justice system."

Similar observations were made throughout California in the years following implementation of the Lanterman-Petris-Short Act. A 1973 study in Santa Clara County indicated the jail population had risen 300 percent in the four years after the closing of Agnews State Psychiatric Hospital, located in the same county.47 In 1975, a study of five California jails by Arthur Bolton and Associates reported that the number of severely mentally ill prisoners had grown 300 percent over 10 years.48 In California's prisons, the number of mentally ill inmates also rose sharply in the 1970s. One prison psychiatrist summarized the situation:

We are literally drowning in patients, running around trying to put our fingers in the bursting dikes, while hundreds of men continue to deteriorate psychiatrically before our eyes into serious psychoses. … The crisis stems from recent changes in the mental health laws allowing more mentally sick patients to be shifted away from the mental health department into the department of corrections. … Many more men are being sent to prison who have serious mental problems.49
A second approach to assessing the relationship between deinstitutionalization and the increasing number of mentally ill people in jail prisons is to examine the reasons for incarceration. In the 1992 Public Citizen survey, investigators found that 29 percent of the jails sometimes incarcerate persons who have no charges against them but are merely waiting for psychiatric evaluation, the availability of a psychiatric hospital bed, or transportation to a psychiatric hospital. Such jailings are done under state laws permitting emergency detentions of individuals suspected of being mentally ill and are especially common in rural states such as Kentucky, Mississippi, Alaska, Montana, Wyoming, and New Mexico.

In Idaho, the incarceration of mentally ill persons who had broken no laws was standard practice until 1991, when the Idaho legislature made it illegal. Any persons requiring involuntary commitment were taken first to the local jail rather than to a hospital emergency room until they could be examined by a state-appointed psychologist. If the psychologist advised hospitalization, these people remained in jail until a psychiatric hospital bed became available. In 1990, Idaho state officials estimated that approximately 300 persons who had not been charged with any crime had been jailed that year for an average of five days each while awaiting psychiatric referral. This practice was true not only for the rural counties but also for Boise, the state capital, where the Ada County jail detained 85 persons without charges even though there were two private hospitals with psychiatric beds a few blocks from the jail. One of them had even been built with a federal Community Mental Health Center construction grant. In many states, especially those with poorly developed public psychiatric services, this practice continues. A sheriff in Florida observed, "I have had mentally ill inmates in paper gowns in holding cells for close observation for up to six weeks before we could find a hospital bed for them."

Most severely mentally ill people in jail are there because they have been charged with a misdemeanor. A 1983 study by Edwin Valdiserri and his associates reported that mentally ill jail inmates were "four times more likely to have been incarcerated for less serious charges such as disorderly conduct and threats" compared with nonmentally ill inmates.50 These inmates were 3 times more likely than those not mentally ill to have been charged with disorderly conduct, 5 times more likely to have been charged with trespassing, and 10 times more likely to have been charged with harassment. A more recent study at the Mental Health Unit of the King County Correctional Facility in Seattle found that 60 percent of the inmates had been jailed for misdemeanors and had been arrested on the average of six times in the previous three years.51 Similar findings have been reported from other parts of the United States. In Madison, Wisconsin, the most common charges brought against the mentally ill who end up in jail are "lewd and lascivious behavior (such as urinating on a street corner), defrauding an innkeeper (eating a meal, then not paying for it), disorderly conduct (such as being too loud), menacing panhandling, criminal damage to property, loitering or petty theft."52

In examining records of these arrests, researchers often find a direct relationship between the person's mental illness and the behavior that led to apprehension. For example, a woman with schizophrenia in New Mexico was arrested for assault when she entered a department store and began rearranging the shelves because of her delusion that she worked there; when asked to leave, she struck a store manager and a police officer. A man with schizophrenia in Pennsylvania who was behaving bizarrely on the street was arrested for assault after he struck a teenager who was making fun of him. People who suffer from paranoid schizophrenia, in particular, are likely to be arrested for assault because they may mistakenly believe someone is following them or trying to hurt them and will strike out at that person.

Theft may involve anything from cans of soda (an Oregon man with schizophrenia was arrested for "stealing pop bottles to turn in for refund") to a yacht (a Kentucky man with manic-depressive illness stole a yacht at a dock, then drove it around the lake until it ran out of gas). One of the most common forms of theft involves going to a restaurant and running out at the end of the meal because the person has no money, a practice commonly referred to as "dine and dash."

Police frequently use disorderly conduct charges to arrest a mentally ill person when no other charge is available. The mother of a son with schizophrenia in Texas said that her son was frequently arrested for "just wanting to talk to normal (his word) people in the malls or street. … He would follow them and just keep talking. … [He] would not go away when they asked him to and they were afraid. … His looks were very unkempt, which added to their fear." A man with manic-depressive illness in Washington State remembers being arrested for disorderly conduct because "I played music on my stereo too loud" and his neighbors complained. A man with schizophrenia in Illinois was arrested for throwing a television set out the window, probably because he believed it was talking to him.

Alcohol- and drug-related charges are also common because alcohol and drug use among this population frequently occurs as a secondary problem among the mentally ill (e.g., a woman with manic-depressive illness in Califomia was arrested for being drunk and disorderly on the street). There have been numerous arrests for driving while under the influence of alcohol or drugs; in some cases the person has not used either but, because of bizarre behavior, is assumed to have done so by the arresting officer.

Trespassing is another catchall charge police officers often use to remove mentally ill persons from the street. A man with schizophrenia and alcohol abuse in New Hampshire has been arrested 26 times, mostly on trespassing charges. A woman in Tennessee reported that her son with schizophrenia had been arrested and put in jail for holding a sign that says "Will Work For Food" and on another occasion for sleeping in a cemetery. In another scenario that frequently leads to arrest for trespassing, the mentally ill person has a delusion of owning a building; a man in Florida was arrested for refusing to leave a motel "that God had given him," and a man in Kansas entered a farmhouse and went to sleep because he believed he had won the farm as a prize from a cigarette company.

Local businesses often exert pressure on the police to get rid of "undesirables," including the mentally ill. This is especially true in tourist towns such as New Orleans, where the police have a well-known reputation for "cleaning the streets" by arresting all vagrants and homeless persons. A police official in Atlanta described how mentally ill homeless persons at the city's airport are routinely arrested, while a sheriff in South Carolina confided that "our problems usually stem from complaints from local business operators."

"Mercy bookings" by police who are trying to protect the mentally ill are also surprisingly common. This is especially true for women, who are easily victimized, even raped, on the streets. A sheriff in Arizona admitted that police officers "will find something to charge the person with and bring her to jail." A jail official in West Virginia, after describing how the local state psychiatric hospital routinely discharged severely disabled patients to the streets, said, "If the mental institutions will not hold them, I will."

In Madison, Wisconsin, police arrested a mentally ill woman who was yelling on the streets and charged her with disorderly conduct. According to a police department spokesperson, "People called us because they were afraid she'd be assaulted ... the woman was not exhibiting the dangerous behavior necessary for commitment to Mendota [State Hospital], she didn't want to go to a shelter and no one could force medication on her."53 So the police arrested and jailed her for her own protection.

A Los Angeles police captain sounded the same theme:

You arrest somebody for a crime because you know at least they'll be put in some kind of facility where they'll get food and shelter. You don't invent a crime, but it's a discretionary decision. You might not arrest everybody for it, but you know that way they'll be safe and fed.54
Another member of the Los Angeles police force described frequent arrests of severely mentally ill homeless persons:

[They are] suffering from malnutrition, with dirt-encrusted skin and hair or bleeding from open wounds. … It's really, really pitiful. … You get people who are hallucinating, who haven't eaten for days. It's a massive cleanup effort. They get shelter, food, you get them back on their medications. … It's crisis intervention.55
Sometimes "mercy bookings" are initiated by mentally ill persons themselves to get into jail for shelter or food; a man in Florida admitted, that "I would commit a crime near the police station and turn myself in. … Jail would take me in and put me to work cleaning floors."

The mentally ill also are sometimes jailed because their families find it is the most expedient means of getting the person into needed treatment. As the public psychiatric system in the United States has progressively deteriorated, it has become common practice to give priority for psychiatric service to persons with criminal charges pending against them. Thus, for a family seeking treatment for an family member, having the person arrested may be the most efficient way to accomplish their goal.

This method of getting treatment is also used in states in which psychiatric hospitals are only available for people who are a danger to themselves or others. In the Public Citizen survey of jails, numerous family members confided that either the police or mental health officials had encouraged them in pressing charges against their family members to access psychiatric care for them. In Massachusetts, the mother of a man with schizophrenia wrote:

In our state a patient cannot get into a state hospital, even if willing, without being dangerous to self or others. … Rather than wait for the patient to become so psychotic that disaster occurs, many families bring charges against a patient for making threats or damaging property. We have done this.

Similarly, in suburban Philadelphia, the parents of a severely ill young man who had no insight into his illness, who had refused treatment, and whom psychiatrists refused to commit involuntarily to a hospital because they claimed he was not a danger to himself or others, was finally hospitalized after his parents called the police. The parents obtained a court order barring him from their home and, when he violated the order, had him arrested. The judge, who had suggested to the parents that they use this mechanism to get treatment for their son, then offered the son a choice of staying in jail or going to the hospital.56 In these cases, jails become a transitional device to obtain psychiatric care from a failed treatment system.

The most direct approach for assessing the relationship between deinstitutionalization and the increasing number of mentally ill persons in jails and prisons is to ascertain how frequently former patients are arrested after discharge from psychiatric hospitals. Studies done prior to the beginning of deinstitutionalization did not find a higher arrest rate than for the general population. Virtually every study done since deinstitutionalization began has found the opposite.

Sunday, November 27, 2011

Pay Close Attention, Tennessee. There is an important lesson to be learned from Michigan. Let's not repeat their mistake!

Wayne County Sheriff Benny Napoleon spoke for most sheriffs when he said, during a community meeting earlier this year, that his jail had become his county's largest mental health care institution.

Over the last two decades, changes in state policy and big cuts in funding for community mental health care have pushed hundreds of thousands of mentally ill people into county jails and state prisons.

Between 1987 and 2003, Michigan closed three-quarters of its 16 state psychiatric hospitals, including Northville in suburban Detroit. The state now provides the sixth-lowest number of psychiatric beds per capita in the nation, reports the Treatment Advocacy Center.

"We closed too many (hospitals), too quickly," Mark Reinstein, president of the Mental Health Association in Michigan, told me this month. "It wasn't done in a planned, rational way."

Community mental health agencies -- which were supposed to take up the slack but never received the resources to do so -- face continuing budget cuts. The state has resumed warehousing its mentally ill -- this time behind bars.

A University of Michigan study last year found that more than 20% of the state's prisoners had severe mental disabilities -- and far more were mentally ill. The same study found that 65% of prisoners with several mental disabilities had received no treatment in the previous 12 months.

The problem is even worse in county jails, where psychiatric treatment is virtually nonexistent. In 1999, a Department of Community Health study -- conducted by Wayne State University -- of jails in Wayne, Kent and Clinton Counties found that more than half their populations were mentally ill and one-third were seriously afflicted, suffering from schizophrenia, bipolar and other psychotic disorders. If anything, the crisis has worsened since then.

Sometimes, the results are tragic. In 2006, I reported that Timothy Joe Souders, a mentally ill 21-year-old serving one to four years for stealing two paintball guns and threatening a police officer, had died of heat and thirst after spending four days strapped down in a hot isolation cell, naked and soaked in his own urine.

Since 2008, the state has slashed $50million from community mental health agencies, with Wayne County absorbing more than half of the cuts.

The annual budget for the nonprofit Detroit Central City Community Mental Health one of Detroit's largest community mental health agencies, plunged from $11.2 million in 2008 to $8million. President and CEO Irva Faber-Bermudez said the cuts have forced her agency to close an urgent care clinic and end an effective transitional housing program. Gov. Rick Snyder and the Legislature should reconsider these cuts if they really want to improve mental health care and remove mentally ill people from prisons and jails.

Treating one client in a community program costs about $10,000 a year, compared with $35,000 a year to house one prisoner. Detroit Central City's jail diversion and prisoner re-entry programs report recidivism rates of less than 10% -- at least four times lower than the overall state average.

Serving 4,600 people a year, Detroit Central City, headquartered at 10 Peterboro, reaches only half of those needing community mental health services. Statewide, more than 200,000 people a year use community mental health services, but experts say at least twice that many need them.

The return of hope
Homeless, Michael Squirewell, 56, came to Detroit Central City three years ago with nothing more than the clothes on his back. In the early 1980s, the former gang member had nearly $175,000 in cash.

Growing up in the Brewster Projects, Squirewell dropped out of school in the third grade. One of his friends on the northwest side was now famous writer Michael Eric Dyson, who cited Squirewell as a peer who "sought to protect me from some of the worst elements in our neighborhood."

Later, as a founding member of Young Boys Incorporated, Squirewell sold drugs and recruited other gang members -- some as young as 8 -- on Detroit's west side. He was stabbed and shot while witnessing nearly a dozen shootouts and murders.

By the mid-1980s, Squirewell had become his own best customer. Mentally ill and addicted to crack, he ducked into Dumpsters, hiding from the cops and getting high. "I didn't care about anything or anyone, even me," he said. "For a while, you get the cars, the girlfriends and the money. But a lot of pain and suffering go with it. It's not worth it."

By the time he got to Detroit Central City, Squirewell was broke and almost out of hope. The agency sent him to a transitional housing program for two months and helped him apply for Social Security benefits. It diagnosed his mental illness, put him on medication and taught him how to pay bills and cook meals. It gave him a new sense of hope and self-worth.

Today, in his two-bedroom apartment on East Jefferson, he looks out at Belle Isle and the Detroit River, instead of boarded homes and dope houses. He plans to marry Jackie Taylor, 47, of Detroit, next year. The two met at a state jobs program 13 years ago. "She walked this mile with me," he said.

Enrolled in a literacy program, Squirewell continues to work on his GED and mentors people going through the same struggles he did. "Detroit Central City saved my life," he told me. "I'm moving forward, and I'm not looking back."

Diagnosed in prison
Some clients don't reach Detroit Central City until after years of incarceration, said Norris Howard, manager of community re-entry.

Jerry Zillner of Detroit didn't know he was mentally ill until after he started serving a 13- to 50-year sentence for second-degree murder, a crime he committed in early 1986, when he was 19, after a neighborhood man assaulted his mother and sister on Detroit's east side. He was diagnosed in prison with paranoid schizophrenia and bipolar disorder. Zillner, 44, was paroled on April 5, after serving more than 26 years in prison.

Before prison, Zillner worked as a disc jockey, mainly at after-hour parties. He dropped out of Southeastern High School in the 10th grade.

"I always knew something was wrong, but I didn't find out I had a chemical imbalance until I went to prison," he told me. "When I got upset, I was like Dr. Bruce Banner (the mild-mannered comic-book physicist who involuntarily turns into the raging Hulk). I had racing, manic thoughts. I could go from 1 to 1,000 in moments."

After sentencing Zillner, Judge George Crockett III ordered a psychiatric evaluation. Zillner spent seven months in a prison forensic unit.

In prison, Zillner earned a GED but was sometimes out of control. Following a beef in 1994, he stabbed an inmate multiple times with a homemade shank. (The inmate survived.)

Zillner started taking psychotropic medications to even his thoughts and moods. He joined the Nation of Islam. His newfound faith gave him strength but also forced him to look at himself. He knew he was lucky to get a second chance.

"I can never use (mental illness) as a crutch or excuse," Zillner told me. "It doesn't lessen my responsibility as a man. I deserved that punishment. I'm just thankful I'm still alive."

On parole, Zillner came to Detroit Central City to get a monthly injection of Prolixin, an antipsychotic drug. He also found other ways to help himself. Now he spends two to three hours a day at Detroit Central City, attending group meetings and counseling sessions and talking to peer specialists -- mentally ill people who serve as mentors.

Detroit Central City helped him settle at Cass Community Social Services. At home, Zillner exercises, reads and meditates. At 6-feet-4 and 185 pounds, he's slim and cut. He has lined up a job as a sanitation worker or, as he puts it, "garbage man," and continues to work with the Nation of Islam.

Without Detroit Central City, Zillner said he would probably be back in prison. "This place helped me become stable," he said. "I have a support system. I'm doing well, and I'm about to do better."

Cries for help
Pattie Charleston, a certified peer support specialist at Detroit Central City, has spent most of the last six years helping other mentally ill people avoid the criminal justice system and get the community treatment they need.

"Every day when I come in, I see me," said Charleston, 50, who spent a total of 24 years locked up for various offenses, including check fraud, larceny, prostitution and drugs.

A manic-depressive, Charleston became a Central City client in 2003, after decades of mental illness, severe depression, incarceration and substance abuse. She started drinking at 11. By 19, she was using crack. She tried to commit suicide by slitting her wrists, overdosing on pain killers, and hanging herself.

"It was really a cry for help," she said. "I couldn't understand why my life was such a roller coaster. Even when I was off drugs, this cloud would come out of nowhere."

After Detroit Central City diagnosed her mental illness, she had to confront the stigma. "You're labeled as crazy," she said. "I felt that if I had a mental illness, my life was going to be limited."

Charleston worked with a treatment team and learned how to manage stress and mental illness. Her therapist helped her cope with the pain and trauma of childhood molestation.

Impressed with her progress, the agency hired Charleston two years later. She later became a certified peer support specialist, working as a mentor and role model.

This year, her work with jail diversion became even more personal. She visits her 19-year-old son, William Rhymes, in the Wayne County Jail, where he awaits trial for armed robbery. Charleston believes her son is -- like her -- bipolar, but he hasn't been diagnosed or treated. He attempted suicide in 2008, according to court records.

Last month, I went with Charleston to visit her son in jail. No chairs were available for visitors, who had to practically shout through small glass partitions.

Rhymes told me he asked to speak to a psychologist a week earlier but had heard nothing. "I feel overwhelmed," he said. Charleston works with a social worker, trying to make sure the court evaluates her son's mental illness.

As she left the jail, Charleston placed her hand on the glass, where her son placed his, and held it there. "He's slipping through the cracks," she said as we walked away. "I don't want them to count him out."

JEFF GERRITT is a Free Press editorial writer. Contact him: gerritt@freepress.com or 313-222-6585 Detroit Free Press

Wednesday, November 23, 2011

DMH opposition to bill does disservice to those struggling

Donald Rudolph, 18, was arrainged on three counts of murder Nov. 14 in Quincy District Court.

OFFICIALS OF the Department of Mental Health have opposed a bill proposed by state Representative Kay Khan “that would allow judges to order those with severe mental illnesses to undergo regular treatment at outpatient facilities near their homes’’ (“Parents of troubled adults face dilemmas,’’ Page A1, Nov. 19). One reason they give is that it would limit the civil rights of the mentally ill. This is a common argument - though mentally ill, people still have a right to their autonomy.

But autonomy without reason is not autonomy. Autonomy without reason is mental slavery and bondage to unreality. Do those DMH officials believe that remaining in a mental prison filled with torment is a form of freedom, or that the isolation engendered by such so-called autonomy is a true manifestation of freedom?
Khan, a Newton Democrat and a psychiatric nurse, is to be lauded and supported in her effort to bring true freedom to the mentally ill. She places before us a choice we must make for the sake of our own humanity and the human rights of those challenged by mental illness.

Davin Wolok
Brookline

Source: The Boston Globe 11/23/11

Note: We have a very similar situation here in Tennessee. TDMH asked to "study" Senate Bill 0608 (AOT) and has deemed it a financial impossibility. Ironic since the bill was specifically written NOT to impact the budget, i.e. no new services or programs whatsoever created by the bill, only mandated treatment of existing services - a definite disservice to those struggling.

State could do more to ensure that people get treatment

Letter in today's Boston Globe. Tennessee could do more as well.

TWO RECENT reports of young men with serious mental illness murdering family members are a chilling reminder of the most dire consequence faced by families struggling to provide care for, or even maintain a relationship with, a loved one suffering from severe mental illness (“Parents of troubled adults face dilemmas,’’ Page A1, Nov. 19).

In Massachusetts, our system of care, despite its strengths, is often unable to address the needs of those who do not pursue treatment voluntarily.

In particular, Massachusetts, unlike most other states, does not allow for the option of court-required outpatient treatment, which can be invaluable for the small number of patients who show evidence of danger to themselves or others when off medications.


The majority of those with whom psychiatrists work are involved in guiding their own treatment. We strive to collaborate not only to reduce symptoms but to improve quality of life and work toward recovery.

However, we must do a better job of reaching out to individuals who need our services and of providing support to their desperate families. In cases where there is a clear history of violence toward others, endangerment of their own safety, or severe incapacity to care for themselves, ensuring that such individuals receive treatment is a matter of life and death.

Dr. Donald B. Condie

President

Dr. Marie H. Hobart

Immediate past president

Massachusetts Psychiatric Society Wellesley

Tuesday, November 22, 2011

SINCE 2009 - NATIONAL SHERIFFS’ ASSOCIATION SUPPORTS THE MISSION OF THE TREATMENT ADVOCACY CENTER

WHEREAS, the National Sheriffs’ Association (NSA) and its NSI, Education and Training Committee have again reviewed the mission of the Treatment Advocacy Center (TAC), a non-profit organization in Arlington, VA; and

WHEREAS, NSA has actively partnered with TAC in the development of protocols and models dealing with officer interaction with those with mental illnesses to insure officer safety and the safe and ethical treatment of those individuals; and

WHEREAS, the mission of TAC is to eliminate barriers to treatment for Americans who suffer from, but are not being treated for, severe mental illness; and

WHEREAS, over 40% of individuals who suffer from severe mental illness are not being treated at any given time; and

WHEREAS, one of the most serious consequences of failing to treat severe mental illnesses is there are more than twice as mentally ill individuals in jails than any other facility, for longer periods of time that other incarcerated individuals, and more than one million people are admitted, with severe mental illnesses, to jails; and

WHEREAS, the consequences of non-treatment, including incarceration, suicide, homelessness, victimization and violence, can be prevented by having laws based on a “need for treatment” standard instead of a “dangerous” standard for those who refuse treatment; and

WHEREAS, some states, such as Florida, have enacted tougher laws allowing court-ordered treatment in the community for individuals in need of treatment; and now

RESOLVED, that the National Sheriffs’ Association does hereby: supports the enactment of a “need for treatment” laws and laws that allow for court-ordered treatment for those who refuse it.

Adopted by NSA’s Board of Directors in Washington, DC on January 31, 2009

NEW Study: Homicide Rate Correlates with Civil Commitment Laws

THE LESS RESTRICTIVE THE CRITERIA, THE LOWER THE HOMICIDE RATE

A new study from the University of California reports that broader civil commitment criteria for involuntary treatment of mental illness correlate with a lower homicide rate.

In “Civil commitment law, mental health services, and US homicide rates,” researcher Steven P. Segal of the University of California, Berkeley, examines the impact of civil commitment statues based solely upon dangerousness criteria on homicide rates and concludes:

“(T)he results show the importance and potentially preventative utility of broader (involuntary civil commitment) criteria, increased psychiatric inpatient-bed access, and better performing mental health systems as factors in how many people die of homicide each year. “

Upon review of the research, Dr. E. Fuller Torrey said, “Predictably, Segal found that social and demographic factors such as poverty, being a young male or substance abuse have the strongest correlation with homicide. The real news here is that, not far behind, three mental health factors – narrow civil commitment laws, lack of psychiatric beds and poor mental health systems – were also significant predictors."

A international authority on mental illness and violence, Dr. Torrey said that "this means we can decrease homicides by using broader commitment criteria such as assisted outpatient treatment (AOT), providing an adequate supply of psychiatric beds and improving the mental health system.” Of these three factors, Segal found that civil commitment criteria limited to "dangerousness" were most predictive of higher himicide rates.

Segal is a member of the Mental Health and Social Welfare Research Group and the Mack Center on Mental Health and Social Conflict at the University of California Berkeley. Among his findings:

The association of violent behavior and schizophrenia “has been established.”
Socio-economic, demographic and other social factors account for 25% of the difference in homicide rates between states.
Mental health factors account for 17% of the differences.
Using narrow “dangerousness” standards for civil commitment instead of broader ones seems to have the paradoxical effect of feeding stigma by contributing to mental illness-related violence.

Segal’s report is in press from Social Psychiatry and Psychiatric Epidemiology (Nov. 10, 2011) and temporarily available online. Because it validates arguments the Treatment Advocacy Center makes in favor of reforming and implementing civil commitment laws – and refutes arguments made against them – the study is a valuable resource for lawmakers and advocates for treatment law reform.

Source: www.treatmentadvocacycenter.org

Problems at Perkins will continue until Maryland broadens access to treatment for the severely mentally ill

Problems at Perkins will continue until Maryland broadens access to treatment for the severely mentally ill

Monday, November 21, 2011

LAPD officers shoot, injure mentally-ill woman | abc7.com

LAPD officers shoot, injure mentally-ill woman | abc7.com

Mental health commissioner defends plan to close Lakeshore - Kingsport Times-News

Over the weekend, Commissioner Varney justified to his hometown newspaper that by closing Lakeshore, seriously mentally ill citizens of the Tri-Cities will no longer need to be "handcuffed and hauled to Knoxville".

But in an interview with WBIR earlier this week, the Governor asked the Commissioner point-blank what would become of those at Lakeshore who were seriously ill and the Commissioner reassured him:

"If they transport 100, maybe one of these would fall under that category. Based over 35 years experience it's really a very rare occurence that they are at that particular point".

So which is it?

Dangerous to the point of requiring handcuffs and hauling off?
OR
A very rare occurence?

I believe the answer lies somewhere in the middle.

Assisted Outpatient Treatment would help prevent the need to "handcuff and haul off" as well as prevent those "rare occurrences", if indeed they are rare.

Mental health commissioner defends plan to close Lakeshore - Kingsport Times-News

http://www.wbir.com/news/article/191301/2/Governor-has-questions-about-proposed-closure-of-Lakeshore

Orange County, CA may finally adopt mental illness law following homeless man's death

"If we didn’t have assisted outpatient treatment, the only way you can really intervene with seriously mentally ill people who refuse treatment is to wait until something horrible happens," says Michael Heggarty, Nevada County's behavioral health director, "and then you can use involuntarily hospitalization or incarceration. But that’s a terrible outcome to have to wait for."

What’s more, says Heggarty, for every dollar spent on Laura’s Law, Nevada County saves $1.81 because fewer people end up in jail or in a mental hospital. Still, Heggarty says he was skeptical about the need.

"Part of my ignorance at the time was not really understanding fully the number of people that are seriously mentally ill," Heggarty says, "and because of their mental illness ... refuse to be in treatment because they don’t consider themselves to be sick."

http://www.scpr.org/news/2011/11/21/29976/oc-may-adopt-mental-illness-law-following-homeless/

White House Shooting Suspect’s Path to Extremism

“He really did fly under the radar,” said Joelyn Hansen, a spokeswoman for the Idaho Falls Police Department.

Now the entire town knows who he is.

http://www.nytimes.com/2011/11/21/us/oscar-ortega-white-house-shooting-suspect-struggled-with-mental-illness.html

White House Shooter Called a 'Textbook Case' of Schizophrenia - National - The Atlantic Wire

White House Shooter Called a 'Textbook Case' of Schizophrenia - National - The Atlantic Wire

KNS Reader Comment #5 re: No More Lakeshore

The closing of Lakeshore will undoubtedly result in more homelessness, crime, and probably death (seeing as how they have proposed a January vacate date - releasing 80 mental health patients in the dead of winter is not smart).

In our county (more specifically our city) the mental health laws make it next to impossible for very sick people to get the services they need. Deinstitutionalization should have taught us something.

If the closing of Lakeshore is what it will take for our government to realize that mental health laws need change then there may be some good that comes out of it - unfortunately it will be at the expense of our community and more importantly the individuals who desperately need places like Lakeshore.

Sunday, November 20, 2011

KNS Reader Comment #4 re: No More Lakeshore

And what does Varney suggest we do with those patients who Peninsula will invariably decide cannot be treated at their facility?

He says that there will be a short list of reasons that Peninsula can give to refuse an admission. What happens to those who they refuse?

Will they just end up living at the ER until they are stabilized?

If there is a psychotic patient tearing up the ER--throwing things, requiring 4 point restraints, requiring a 24/7 one to one sitter, where will he/or she go?

That's been the beauty of Lakeshore for all these years. They were THE LAST HOPE for so many. They were a place for a patient to go when no other facility would accept them.

A patient could have a history a mile long--one that shows constant non-compliance, serious addiction issues, and severe and persistent mental illness. And Lakeshore had to accept them because no other facility would be willing to accept the patient.

What does Varney suggest will happen with these patients?

They're not going to go away. They're always going to be with us.

KNS Reader Comment #3 re: No More Lakeshore

Mental health treatment is all but non-existent these days. Everything is done on an outpatient basis and that is basically handing someone a band-aid (pills) and saying "Here ya go, do the best you can with this." For these people who are supporting this closure, I hope they never have to deal with caring for a loved one who suffers from mental illness. I have dealt with it for a good part of my life and it gets harder every day. It becomes a never ending cycle of calling the Doctor and changing dosage of meds hoping that will treat the problem. Most of the time it doesn't. Even if the person gets admitted to a psychiatric hospital, they are lucky to be there for 3 days and that isn't nearly long enough to get the help they need. I don't know what the solution is, but I am fairly certain that closing more facilities isn't the answer.

KNS Reader Comment #2 re: No More Lakeshore

I wonder how Peninsula is going to bring in the "hard core", long-term mentally ill population into their more "well-heeled", private pay population.

Do you honestly think that a homeless schizophrenic who has lice and other hygiene issues is going to be treated along side an upscale Farragut, mother of 3?

Peninsula has been able to refuse these types of people in the past. I just don't think they're going to risk losing their higher revenue, privately insured clientele for a few dollars from the state.

Furthermore, have you ever tried to get to Peninsula? If you live in East Knoxville and rely on public transportation, there's no way you're going to be able to participate in your family member's care if he/she is sent to Peninsula.

This whole idea is half-baked. It's like when Pharaoh told the Israelites, "from now on you're going to have to make bricks using your own straw!"

It makes it harder on everybody involved. I don't see winners in this situation.

Varney says that we can't build a new facility. Well, I'm sure we could rent something. There are plenty of vacant facilities that could be ready to go.

I just don't believe this guy has thought this thing through. It's one thing to sit in Nashville and play "what if" games. It's something else entirely to speak to people who have been working on the front-line--people who know what works and what doesn't.

More KNS Reader Comments on Proposed Lakeshore Closing - #1

As a person who is trained as a mental health professional I have huge problems with what Mr. Varney is proposing. While I very firmly believe in treating clients in the least restrictive environment, there are some folks that Lakeshore is the least restrictive environment. It is the best and safest setting for them. There is a considerable lack of available "beds" for in-patient psych treatment and the lack of available beds and treatment facilities continues to get worse. Yes, at one time far too many folks were being placed in mental health facilities, that did not belong their. Now, cutting psychiatric facilities is politically expedient as people with psychiatric issues generally are not voters.

In the end, all that will happen is those people that should have received proper and caring treatment at Lakeshore, will end out on the streets and often in the prison system, at a much greater cost. This "decision" is fool hardy and short-term thinking with potentially deadly results for some of these folks.

Trying to shove this off on the private sector is a sad joke. I can assure you the insurance companies do not care. I hold a Master's in Mental Health Counseling. I stopped practicing when the insurers started telling me I could solve all the serious issues for those with profound psychiatric problems in 5 or 10 sessions. It did not matter how seriously "troubled" these folks were, that was all the insurers would cover, and they would not consider anything more. It was not a mental health professional at the insurer that made those decisions, which is why I no longer practice. People were and are dying because of these short-sighted decisions. The State is only fooling themselves.

While Mr. Varney claims to have had extensive experience, he has been the CEO of a community mental health agency for a very long time. According to the "official" biography on him, he no longer holds a license to practice. He has a master's degree in Psychology from East Tennessee State and was formerly licensed as a psychological examiner, marriage and family counselor and professional counselor. Mr. Varney clearly has little or no direct experience with in-patient mental health treatment. It also is evident he has not seen out-patient clients, as a therapist, in some considerable time. It appears Mr. Varney is making decisions about Lakeshore that are not in the best interests if the patients, but rather are politically expedient. That needs to be stopped, and now!

Actions such as what Mr. Varney is trying to pull have been tried in other states, and for the most part have not gone well. While the local private supplier of in-patient mental health services are very good, they are often at capacity now, and yes they can and do cherry pick. The first question is always what insurance does the person have. I understand, as the costs for treatment can be very high, and they can only provide so much in pro bono services
.

Source: Knoxville News Sentinel - reader comments

Short-sighted budget cuts hurt us all

If this sounds familiar it's because short-sighted budget cuts are happening in Tennessee too.

From the blog of Mr. Pete Early:

Ohio once was a state that provided good mental health services. It was a leader in evidence-based, community recovery programs. It was a model when it came to implementing Crisis Intervention Teams, Mental Health Courts, and jail diversion programs.
Tragically, short-sighted budget cuts and poor leadership has caused Ohio to slip from being a leader to becoming a failure.
In a recent front page story headlined: “Illusion of Treatment,” Columbus Dispatch reporters Alan Johnson and Catherine Candisky warned that Ohio’s system is “on the verge of collapse.”
Thousands have been slashed from the mental-health-care rolls. Others might have to wait months to see a psychiatrist. State funding for mental-health services has been decimated…hundreds of small group homes for the mentally ill have closed.
Prisons, nursing facilities and homeless shelters are the new homes for thousands of mentally ill Ohioans…“Our state leaders have washed their hands of Ohioans who are suffering from mental illness,” said Terry Russell, a veteran of 37 years at the local and state level in Ohio’s mental-health system. “If we are to be judged by how we treat the sickest in our society, we should all be ashamed.”
Like other states, Ohio faces huge deficients – an $8 billion budget shortfall. The governor and legislature have reacted by slashing some $100 million in the past three years from community mental health care services.
Ohio is not alone in making drastic cuts in mental health care budgets. I returned last week from Texas which is poised to cut services. Virginia may soon close two much-needed hospitals. Pick a state and you will hear the same lament. Cuts must be made and mental health services are an easy target.
While I understand the need for belt-tightening, cuts to mental health services actually cost a state money rather than saving it funds.
How is that possible?
Because serious mental disorders don’t disappear just because you stop paying to treat them. Like stepping on a balloon, the costs associated with mental illnesses simply shift over and increase costs in areas, such as jails and prisons.
The Perryman Group, a Texas-based economic research and analysis company, was asked in 2009 to study the Texas mental health service. What it found should be required reading by every governor and state legislator in our nation.
The group looked at the cost to Texas for medication, hospitalizations, clinic visits and emergency rooms visits by persons with mental disorders. Economists also factored in what they called “spill over” costs, such as lost earning potential, lost tax revenues, the costs of jails and prisons, the impact of alcohol and drug abuse in a community, and costs due to homelessness.
What it concluded was that “savings generally exceed the cost of providing mental health and substance abuse treatment in a state.”
The authors found that providing treatment for alcohol and substance abuse would give the state a return on investment of $2.26 for every $1 that was spent. Jail diversion, which enables persons with mental disorders to get treatment rather than being locked-up, averaged a return to the state of $2.70 per every $1 that it spent.
The most interesting statistic was a projection about cuts that Texas has made during the last decade. If the state had stuck with the budget that it had in 2000 for mental health and substance abuse services, rather than butchering those funds — Texas would be earning a 170% return on its money or netting $32.76 today for every dollar that it spent.
Instead, reducing services resulted in Texas losing productivity, losing jobs, and losing tax revenues. At the same time, Texas has seen an increase in state costs for jails, an increase in suicides, increases in drug and alcohol addiction, and an increase in homelessness.
After crunching the numbers, the Perryman group concluded that cutting the mental health services in Texas actually had contributed to the budget deficit that the state now faces, rather than helping reduce it!
None of this surprises me because I have witnessed it on a personal level. When my son, Mike, was psychotic, he was arrested. He ended-up in costly emergency rooms. He was hospitalized.
Thankfully, a case manager in a jail diversion program took charge of his case. She got him into an apartment, into treatment, and eventually got him a job. Today, he is paying taxes and is in recovery.
Not everyone is as fortunate as my son, but I have seen people recover who once would have been considered “unrestorable” and locked in back hospital wards.
We must stop paying more and more each year for bigger jails, more prisons, endless hospital emergency visits and overnight stays in traditional homeless shelters. We need to use our sparse tax dollars to pay for evidence based programs that actually help people recover.
Please tell your state politicians about the Perryman report. Please tell them that recovery is possible. It is not only the moral thing to do, but now we know it is the financially smart thing to do.

Friday, November 18, 2011

Lawmakers voice concern over proposed mental hospital closure

Lawmakers voice concern over proposed mental hospital closure

State urged to keep open Tinley Park Mental Health Center - Joilet Herald News

“We’re not solving the problems of the state on the backs of those who need our help,” Walsh said.

Henry Felts, of the Illinois Nurses Association, fears that many people who would’ve been treated at Tinley Park “will become homeless ... pushing a shopping cart with all their belongings and living in cardboard boxes under an overpass.”

That sentiment was echoed by Christopher Skene, of the Chicago-based Mental Health Summit, who said the center handled 18 percent of the patients at state mental health centers last year. He wondered where those people would get the care they need.

“You tell them they’re out of luck? That’s not right morally or fiscally. We’re not talking about setting a broken bone here. We’re talking about people who are incapable of caring for themselves,” Skene said.


State urged to keep open Tinley Park Mental Health Center - Joilet Herald News

Thursday, November 17, 2011

Wednesday, November 16, 2011

Was White House Shooter Another 'White House Case"?

Oscar Ramiro Ortega-Hernandez, a 21-year-old man police say suffers from mental illness, has been apprehended in connection with semiautomatic gunfire aimed at the White House on Nov. 11.

Police believe Ortega-Hernandez is mentally ill. "He has an extensive record, ranging from domestic violence to drug charges," ABC news reported. "Sources say a police investigation uncovered evidence suggesting Ortega-Hernandez has a fixation on the White House.”

Fortunately, no one was hurt.

Unfortunately, until states start addressing the needs of individuals with severe mental illness - and using the laws that allow for treatment rather than jail - we will only see more and more of these incidents.

If convicted, Hernandez is likely to join the thousands of other individuals with untreated mental illness in our jails and prisons. If not convicted, he could end up at Washington DC’s St. Elizabeths Hospital, where so many people have been admitted after showing up at the home of the President in the grip of severe mental illness that they’re known by staff as "White House cases."

Source: Treatment Advocacy Center

Proposed Lakeshore Closing: A Mental Health Professional's Perspective

As a person who is trained as a mental health professional I have huge problems with what Mr. Varney is proposing. While I very firmly believe in treating clients in the least restrictive environment, there are some folks that Lakeshore is the least restrictive environment. It is the best and safest setting for them. There is a dearth of available "beds" for in-patient psych treatment and the lack of available beds and treatment facilities continues to get worse. Yes, at one time far too many folks were being placed in mental health facilities, that did not belong there. Now, cutting psychiatric facilities is politically expedient as people with psychiatric issues generally are not voters.

In the end, all that will happen is those people that should have received proper and caring treatment at Lakeshore, will end out on the streets and often in the prison system, at a much greater cost.

Trying to shove this off on the private sector is a sad joke. I can assure you the insurance companies do not care. I hold a Master's in Mental Health Counseling. I stopped practicing when the insurers started telling me I could solve all the serious issues for those with profound psychiatric problems in 5 or 10 sessions. It did not matter how seriously "troubled" these folks were, that was all the insurers would cover, and they would not consider anything more. It was not a mental health professional at the insurer that made those decisions, which is why I no longer practice. People were and are dying because of these short-sighted decisions. The State is only fooling themselves.

Source: KNS reader comments

Proposed Lakeshore Closing: A Friend's Perspective

I can speak from experience regarding the availability of "community hospital reources" for a friend who was having an acute episode of what was later determined to be the initial onset of paranoid schizophrenia. It's utter fiction for Varney to suggest closing the only full service state psychiatric service in this area is at all an option. He was well insured, which was the only reason I eventually found him a bed after being turned away at the first 2 stops for a lack of beds. I asked several people at each hospital that turned him away if they were especially busy. Each time they stated no, we rarely have enough beds for psychiatric treatment - you'll be lucky to find him one at all and had it been a weekend I wouldn't have been able to find one anywhere. Every hospital was willing to treat him - but there are so few beds for in patient care it just wasn't an option. There simply aren't enough resources to consider this. In addition, there will always be cases where long term housing is required.

Source: KNS reader comments

Proposed Lakeshore Closing: A Parent's Perspective

From one with a mentally ill adult child, closing Lakeshore is the biggest mistake they can make. The other facilities in the area do not keep them for more than 2-3 days. My adult child is non-compliant with meds. This has been the routine for 15 years. On then off. Penisula has never kept my child for more than 3 days. Lakeshore has been the only one who will keep my child and stabilize. My adult child needs more than Lakeshore can offer as well however that will never happen but Lakeshore is the only saving grace left that can help. More needs to be done on Mental Health laws. Parents have no recourse for an adult child who is mentally ill yet they themselves cannot function in society without help. Parents are left to pray that they don't get "that call" in the middle of the night. Wake up, we need help not more closings and defunding. Defund the big bonuses and salaries and put more towards mental illness assistance and treatment.

Source: KNS reader comments

More on Morals ...

Another excellent post from the Knoxville News Sentinel article today:
-------------
So it's "morally right" not to have a place to house your mentally ill, especially the chronic mentally ill?

It's "morally right" to send them halfway across the state for treatment, or just let them wander around in the streets, where they make up a disproportionate percentage of the chronically homeless?

It's "morally right" to put them in jail, where a lot wind up because of petty crimes they commit?

It's "morally right" to expect someone who has a chronic mental illness to find their own help in what passes for "community mental health centers," which are chronically underfunded and understaffed and may be difficult to get to, and still don't give them a roof over their heads if they need one?

And it's "morally right" to throw hundreds of people out of jobs?

Just one question for you, Mr Varney.....WHERE did you learn your morals?

Source: KNS reader comments

...
Enhanced by Zemanta

If closing Lakeshore is "morally right", the moral compass is broken.

I'm posting another reader comment from this morning's Knoxville News Sentinel. Please, now is the time to contact these legislators!

State Rep Joe Armstrong: 615 741-0768
State Rep Harry Tindell: 615 741-2031
State Rep Harry Brooks: 615 741-6879

-------------------
So Varney thinks that it's "morally" the right option to close Lakeshore?

Where does he think these patients are going to go? McNabb? Cherokee? It takes 3 to 4 months to be seen by either one of these out-patient programs.

And the follow-up rate at an out-patient program is much lower (and therefore much less cost effective) than treating someone at an inpatient program.

Look, over the decades, the State of TN has slowly closed the doors at Lakeshore--trying to make everyone believe that it's saving money. They've also tried to "spin" their decision by saying that it's more humane to treat people from a community program than to have them housed in an institution.

But the truth is that many of the long-term, persistently mentally ill patients have ended up in senior/disabled housing, jail, and the streets.

They have not flocked to the mental health centers as predicted. They have floundered and failed in the community.

Varney wants us to believe that he knows better than what scientists and researchers have had to say about deinstitutionalization. He wants us to trust his "gut instinct" on this.

I'm not buying it.

His decision is to lower costs without regards to the impact it will have on individuals and communities. He gets paid very, very well to make these decisions.

He should be ashamed of his decision AND his attempt to make folks believe that it was based on anything other than the bottom line.

I don't know if he's still a licensed Psychological Examiner or not, but if he has any professional ethics, his board should be notified immediately so that they can evaluate his actions and impose disciplinary measures.

Monday, November 14, 2011

An internal review of conditions inside North Carolina's Central Prison found that inmates with serious mental illnesses were neglected by staff and locked away in fetid cells.

An internal review of conditions inside North Carolina's Central Prison found that inmates with serious mental illnesses were neglected by staff and locked away in fetid cells.

A 2011 report says that neglect, which included the failure to properly track anti-psychotic medications, may have contributed to the death of at least one inmate. The report was obtained by The Associated Press through a public records request.

Jennie Lancaster is the chief operating officer for the N.C. Department of Correction. She says living conditions for inmates will improve when the state this month opens a new $155 million health care complex at Central.

No prison staff were fired or disciplined following the internal review, which was performed last spring by two prison system nurses.

"The system is just becoming choked. We have more people in need than we have capacity for. Our jails are becoming de facto mental health institutions."

Should inmates get health care behind bars, it's far from guaranteed they'll continue getting better in the outside world. Each inmate gets two bus tokens upon their exit, and if they're on medications, an average of 14 days of supply left. Then it's up to them to continue treatment — if they can afford it.

"They're often stable here," Payne said. "But when they're released, they stop taking medication, and that's when the incidents occur."

Incarceration is meant to be a deterrent. But the Kitsap County jail provides for some inmates the only access to health care they ever get. Some county residents literally come and go from the jail and the outside world, medicating and then destabilizing, over and over again.

"We're in this constant cycle," Payne said.


Sound familiar?

Unfortunately, this is a harbinger of things to come for us locally as we (1) close our state mental institution here in Knoxville and (2)continue to stall passage of assisted outpatient treatment laws in our state legislature.

- Are our communities currently equipped to handle this type of capacity? No.

- Must those "on the wait list" for services decompensate to the point of having to receive their treatment in the Knox County Jail before their scheduled appointment time? Highly probable.

- If Lakeshore is ultimately closed would an AOT law help this situation? ABSOLUTELY!

Those with severe and persistent mental illness would receive court ordered treatment before having to commit a crime to get it. And misdemeanor, petty crimes are inevitably committed by these seriously ill folks as proven by our current county jail population.

Until then, the future is not looking bright for those with serious mental illness in Tennessee and their families.

Enhanced by Zemanta

Tall Pall: A compelling personal account told by his sister that illustrates what his life was like after the closings of state hospitals

PsychiatryOnline | Psychiatric Services | Personal Accounts: Tall Paul

Sunday, November 13, 2011

Paul's Legacy Project

I received a response from Ilene Flannery Wells, Founder of Paul's Legacy Project. She raised my awareness about the Medicaid law, Institutes for Mental Disease Exclusion, that help explain recently announced plans to close Lakeshore Mental Health Institute here in Knoxville.

Most people do not know that unlike other Medicaid eligible adults with a chronic illness in their heart, liver, kidneys, or lungs who need long-term in-patient nursing care, people who are Medicaid eligible and have a mental illness are not covered for long-term in-patient care in a state hospital. It is due to an archaic Medicaid law called the Institutes for Mental Diseases (IMD) Exclusion. It is federally sanctioned discrimination and forces the states to pay for 100% of the costs. So, what do the states do? That's right, they have released even the sickest of the sick, who cannot manage in the community. State hospitals are closing left and right. Please read more about this law here: www.paulslegacyproject.org


Paul's Legacy Project's mission is to advocate for equal access to long-term in-patient treatments for people with severe mental illness, because mental illness is a medical illness.

Thanks, Ilene!

Saturday, November 12, 2011

Our scientists and researchers tell us what is needed to treat people with mental illness. Yet our state commissioners and others go with their "gut instincts" and close programs -- leaving thousands without the help that they need.

Another opinion from the KNS readership:

So, we're going to have 155 beds to serve the 500,000+ Knoxville/Knox County residents (plus surrounding counties). Do the math...

Our scientists and researchers tell us what is needed to treat people with mental illness. Yet our state commissioners and others go with their "gut instincts" and close programs--leaving thousands without the help that they need.

Although the treatment folks received in the early days of Lakeshore was somewhat primitive, at least they recognized that the severely and persistently mentally ill needed housing.

Today we kick these people to the curb; saying that "the community" can deal with the problem.

Unfortunately, the community's response is to allow people to go untreated--they become homeless, they become unable to work, unable to parent, unable to excel in school...

It currently takes 2 to 3 months for someone to be seen at our community mental health centers (Cherokee and Helen Ross McNabb).

Can you imagine telling a woman with breast cancer, "You'll need to wait 2 months to be seen and treated."

This an awful decision--one of many that The Tennessee Department of Mental Health has made over the decades.

Shame on the commissioner!

It is inhumane to treat people this way!

Closing Lakeshore: another angle.

I've been following the comments on the Knoxville News Sentinel story. Not surprisingly, there are many comments from advocates of the seriously mentally ill who "get it" - they understand the negative implications and oppose the closing. I've posted several of these together in a previous posts but now will be posting selected comments as separate posts. KNS readers, keep those comments coming!

----------------------------
Another angle to consider: I was told by someone who should know that the proposed alternatives frequently blacklist patients and refuse to treat them. Their only recourse is Lakeshore.

So the state will wash their hands of these people, and they'll wind up a local problem in our jails.

Which I believe was a big complaint by the sheriff not that long ago - that jails were being filled with the mentally ill where he was spending both budget and resources on them. The governor was well aware of that, since he was mayor here then.

So not only is this wrong in terms of treatment of fellow human beings in true need, the state just dumped their responsibility on the counties. We will still get to pay, but the ill won't receive care.

Enjoy that park. You'll be paying for it, and so will they.

State to Close Lakeshore Mental Health Institute & outsource to for-profit, private entities? Short sighted, bad decision according to several KNS commenters.

Comments from the Knoxville News Sentinel re: plans to close Lakeshore:

So, we're going to have 155 beds to serve the 500,000+ Knoxville/Knox County residents (plus surrounding counties). Do the math ...

Our scientists and researchers tell us what is needed to treat people with mental illness. Yet our state commissioners and others go with their "gut instincts" and close programs--leaving thousands without the help that they need.

Although the treatment folks received in the early days of Lakeshore was somewhat primitive, at least they recognized that the severely and persistently mentally ill needed housing.

Today we kick these people to the curb; saying that "the community" can deal with the problem.

Unfortunately, the community's response is to allow people to go untreated--they become homeless, they become unable to work, unable to parent, unable to excel in school...

It currently takes 2 to 3 months for someone to be seen at our community mental health centers (Cherokee and Helen Ross McNabb).

Can you imagine telling a woman with breast cancer, "You'll need to wait 2 months to be seen and treated."

This an awful decision--one of many that The Tennessee Department of Mental Health has made over the decades.

Shame on the commissioner! It is inhumane to treat people this way!

----------------

And as far as these patients going to these other three facilities, there is a reason that Lakeshore is still open. These other hospitals are going to have to get the capacity/ability to handle the immediate crisis situations and not just the type of patients they are handling now.

----------------

Instead of closing Lakeshore and outsourcing to for-profit companies, we should be expanding Lakeshore's facilities, and moving more of Tennessee's mental health care to state facilities.

----------------

Really sad for all the people who go there for treatment. They seem to lose one lifeline after another, and as you can read in most of the other comments above, people are pretty merciless toward the less fortunate as long as they get "a pretty park" or sports complex or whatever.

The grounds are certainly pretty, there's already a park there for those so inclined, but the hospital itself, while far from luxurious, does good work. Better, in fact, than some of the touted substitutes.

Shameful.

----------------

Bad decision I do believe ...... and what happens if all the employees start seeking and finding employment long before that June deadline? Where does this leave the residents?

Closing of state facilities is one of the major factors that lead to the increase in homeless population!

----------------

One of the significant causes of homelessness is the downsizing, and now apparently elimination, of state mental hospitals, with hollow promises to instead provide for mental health services "out in the community." It's not a coincidence that the decrease in mental hospital beds occurred at the same time as an increase of mentally ill people on the streets. Mental illness doesn't just go away when you try to ignore it. This represents an infuriatingly short-sighted effort to cut costs.

----------------

How could this be considered as an option in a time when people are facing financial desperation, home foreclosures, unemployment, all causing great mental issues? In the real world, where the middle/lower class income live, there is no private, or community support for people who suffer mental illness! Wish it were that everyone had the quality health care that Governor Haslam and his family enjoys.

----------------

Another angle to consider: I was told by someone who should know that the proposed alternatives frequently blacklist patients and refuse to treat them. Their only recourse is Lakeshore.

So the state will wash their hands of these people, and they'll wind up a local problem in our jails.

Which I believe was a big complaint by the sheriff not that long ago - that jails were being filled with the mentally ill where he was spending both budget and resources on them. The governor was well aware of that, since he was mayor here then.

So not only is this wrong in terms of treatment of fellow human beings in true need, the state just dumped their responsibility on the counties. We will still get to pay, but the ill won't receive care.

Enjoy that park. You'll be paying for it, and so will they.