Sunday, January 30, 2011

Ridicule Has No Place Where Severe Mental Illness Is Concerned

Sometimes you just gotta do the right thing, even if it means jumping into a cesspool of online commentors and swimming upstream.

I opened my Sunday paper this morning (the online version), to see a story about a naked man in Market Square who had thought snakes in his pants were causing his leg pain. Not only that, there was an accompanying mortifying videoclip of this poor soul that someone had made with a cameraphone.

At first I tried calling SEVERAL times and SEVERAL numbers at the Knoxville News Sentinel to voice my concern and disbelief. But no one answers the phone there on Sunday morning. So I did something I rarely do - I went to the comments section and submitted a request to remove the videoclip from the website.

http://www.knoxnews.com/news/2011/jan/29/naked-man-market-square-taken-hospital/?partner=popular

It is only when we speak up that we make a difference for someone. I hope that when this young man becomes stable again, there will be no trace of this videoclip or viewer comments to humiliate him. Recovery is tough enough without the ridicule.

What preceded the shooting in Tucson was a job that Loughner no longer held, a school that he no longer attended, a girlfriend who was no longer around, bizarre anger about the nation's allegedly lousy grammar skills and a reported fascination with the idea that George W. Bush and Dick Cheney planned the 9/11 attacks. Hollywood couldn't have written a script more in harmony with "A Dictionary of Symptoms."

OpEd in today's The Mercury, Pottstown, PA

"On any given day in the U.S., the number of people with severe mental illness in prisons is estimated to be three times higher than the number in hospitals, according to a new report from the Treatment Advocacy Center and the National Sheriffs' Association," reported Seena Fazel recently in The Wall Street Journal ("The Line Between Madness and Mayhem," Jan. 15-16).

"Interestingly," continued Fazel, "they found that Arizona and Nevada had the highest ratio of prisoners with mental illness, with 10 times more mentally ill people in jails and prisons than in hospitals."

Arizona has 5.9 psychiatric beds per 100,000 population, or one-tenth of the recommended level to meet public needs (only Nevada had a worse ratio), reports the Treatment Advocacy Center in Arlington, Va., a national organization seeking to eliminate barriers to the treatment of severe and persistent mental illnesses, such as schizophrenia and bipolar disorder.

An estimated 4.5 million people in the United States have either of those two illnesses, with reportedly 2.3 million and 2.2 million people, respectively, afflicted with bipolar disorder and schizophrenia.

On any given day, 40 percent of those people are going without treatment, i.e., 1.8 million, reports the National Advisory Mental Health Council.

In Arizona, there are more than 50,000 people with schizophrenia and a minimum of 25,000 are untreated, according to Dr. E. Fuller Torrey, a research psychiatrist specializing in schizophrenia and manic-depressive illnesses. He's executive director of the Stanley Medical Research Institute, and founder of the Treatment Advocacy Center.

This is where Jared Loughner comes in along with his reported behavior over the past year or so.

Schizophrenia is characterized by the following: a noticeable deterioration in the level of functioning in everyday life, a withdrawal from reality, illogical patterns of thinking, bizarre delusions, and social and/or occupational dysfunction.

What preceded the shooting in Tucson was a job that Loughner no longer held, a school that he no longer attended, a girlfriend who was no longer around, bizarre anger about the nation's allegedly lousy grammar skills and a reported fascination with the idea that George W. Bush and Dick Cheney planned the 9/11 attacks. Hollywood couldn't have written a script more in harmony with "A Dictionary of Symptoms."

"The proven link between untreated mental illness and violence is indisputable," asserts a statement from the Treatment Advocacy Center. Pointing to the aforementioned numbers in Arizona regarding people suffering from schizophrenia and the lack of psychiatric hospital beds, the center warns that "untreated mental illness is a public safety issue of significance in the state."

More broadly and explicitly, the center points to the consequences of nontreatment:

People with untreated psychiatric illness comprise one-third of the nation's 600,000 homeless population. "Eight percent used garbage cans as a primary food source," while "28 percent of homeless people with previous psychiatric hospitalizations obtained some food from garbage cans."

Approximately 1,000 homicides are committed each year by people with untreated schizophrenia and manic-depressive illness.

The suicide rate for schizophrenics is 10 to 13 times higher than in the general population.

"A 1998 MacArthur Foundation study found that people with serious brain disorders committed twice as many acts of violence immediately prior to their hospitalization, when they were not taking medication, compared with the post-hospitalization period when most of them were receiving assisted treatment," reports the Treatment Advocacy Center. "Important to note, the study showed a 50 percent reduction in the rate of violence among those treated for their illness."

Ralph R. Reiland is an associated professor of economics at Robert Morris University in Pittsburgh and a columnist for several Pennsylvania newspapers. He can be reached at rrreiland@aol.com

Tuesday, January 18, 2011

The mental-health 'system' that brought us the Tucson tragedy

Steve Luxenberg, The Washington Post
Tuesday, January 18, 2011;

Jared Lee Loughner didn't fall through the cracks, as the cliche goes. Nor did the mental health system "fail" him in the years before Jan. 8, when he fatally shot six people and wounded 13 others.

The mental health system performed much as we have designed it over the past 40 years, ever since the courts and state legislatures adopted "a danger to themselves or others" as the standard for taking action against those showing signs of a mental illness that might lead to violence.

But wait, you say. Loughner's behavior clearly showed he was a danger. Lynda Sorenson, his classmate at Pima Community College, wrote in her now-famous e-mails to a friend: "We have a mentally unstable person in the class who scares the living crap out of me. He is one of those whose picture you see on the news, after he has come to class with an automatic weapon."

So the cry has gone out: Why didn't anyone - family, neighbors, teachers, Loughner himself - take action? Why didn't the system intervene, treat him, lock him up if necessary?

Too little is still known, but this much can be said: Some people did see danger. Some people did act. But the "system" we have constructed - a patchwork of laws that vary by state - tolerates the odd, the strange, even the disruptive ravings of a Jared Loughner. This was a direct reaction to the days when behaving oddly or strangely, in the opinion of others, too often meant a long-term stay in an insane asylum of the kind that once dominated the country's mental health system. The system has yet to figure out the best way to deal with the tiny fraction among us who have a severe mental disorder and an apparent capacity for violence.

Ben McGahee, who taught the math class where Sorenson grew so nervous, made several complaints to college administrators. He told The Post, "They just said, 'Well, he hasn't taken any action to hurt anyone. He hasn't provoked anybody. He hasn't brought any weapons to class.' "

Perhaps Pima administrators should have acted sooner, but Loughner certainly did not slip through the college's cracks. Campus police reports document six complaints about Loughner between February and September 2010. At least three adminstrators met separately with Loughner before he was finally suspended - for posting a YouTube video accusing the school of genocide.

The overriding question in the reports was a legalistic one: Had he violated the school's code of conduct? If school officials wrestled with whether and how to refer him for a psychiatric evaluation, there's no evidence of that in the records released thus far. The mental health system can't fail someone it never sees.

In theory, Arizona's mental health law offers more leeway to intervene than other states. Almost anyone can ask a court to order a psychiatric evaluation, and judges can require treatment of anyone who is "a danger to self or to others, is persistently or acutely disabled or is gravely disabled," in the opinion of two physicians. But proving persistent or acute mental disability is difficult and less tested. In practice, danger is the standard that has permeated the consciousness of police and public institutions.

The college's Oct. 7, 2010, letter to Loughner presented a novel twist on that standard. To be reinstated, he would need to "obtain a mental health clearance indicating, in the opinion of a mental health professional, his presence at the College does not present a danger to himself or others." The college was putting the burden on Loughner, the student with impaired judgment, to get help.

The danger standard also has become embedded in Arizona's gun regulations, which prohibit anyone "who has been found to constitute a danger to himself or others" from owning a firearm, unless a court hears "clear and convincing evidence" that the person no longer suffers from the mental disorder.

Yet that law did not keep a gun out of Loughner's hands. Even if authorities had known of his suspension from school, it wouldn't have mattered. No court had "found" him to be a danger.

We have asked police, courts, mental health professionals - the system - to walk a fine line between the individual's right to liberty and the public's right to safety. Legislators and public officials need to determine whether the legal origins and applications of the "danger" standard are so restrictive they are inhibiting its common-sense use. We have good reasons to tolerate disconcerting behavior, but that doesn't require us to arm it with a Glock semiautomatic.

Loughner is awaiting trial, held without bail because a judge has now determined him to be a danger to others. Irony has no place in such tragedy.

Steve Luxenberg, an associate editor of The Post, researched the history of mental health treatment while writing his book, "Annie's Ghosts: A Journey Into a Family Secret."

From Inside the Empty Nest: A thought or two...

From Inside the Empty Nest: A thought or two...: "I have been stewing on this for a long, long time. But since the recent events in Arizona, it has brought it to the forefront of my mind aga..."

Monday, January 17, 2011

Living with a Mental Illness

CBS interviewing my friend, Lois, from Arizona. I so admire her courage, tenacity and unconditional love for her daughter. Lois is the definition of a tireless advocate.

But what if he wouldn't go voluntarily? What then?

TBI: Guthrie at Gateway Medical Center voluntarily
By JAKE LOWARY • The Leaf-Chronicle • January 13, 2011
The Tennessee Bureau of Investigation said today
that Clifford Guthrie has voluntarily gone to Gateway
Medical Center for a mental health evaluation.

According to Kristin Helm, spokesman for TBI,
agents came to Clarksville this morning and Guthrie
then went to GMC for the evaluation.

Guthrie told The Leaf-Chronicle on Wednesday that
he was planning to burn his car and garbage bins
at Public Square to make known that he was involved
in a "political and socioeconomic experiment"
against his will.

Austin Peay State University, where Guthrie was
formerly a student, issued a campus-wide warning
on Wednesday after Guthrie sent a letter claiming he
would commit "heinous, premeditated and anti-
American acts."

He has essentially been barred from campus,
according to APSU spokesman Bill Persinger.

Guthrie

Threat Sparks Caution at Austin Peay State University

If this sounds eerily familiar, it happened right here in Tennessee last week. Kudos to AP campus officials for taking action to keep everyone safe.

Man says he's part of 'socioeconomic, political' experiment

BY JAKE LOWARY • THE LEAF-CHRONICLE •
January 13, 2011

Austin Peay State University officials issued a
"campus alert" Wednesday night after receiving a
threatening letter from a former student.

Campus officials said the letter was written by Cliff
Richard Guthrie, who was enrolled at APSU for the
fall 2010 semester. Officials said Guthrie wrote: "...I
am forced to engage in a civil-civic action that will
be readily perceived as a crime that is heinous,
premeditated, racial, and anti-American."

In a rambling telephone interview with The Leaf-
Chronicle Wednesday night after the alert was
issued, Guthrie said he planned to burn his car and
garbage bins at Public Square in protest of being
involved in a "socioeconomic and political"
experiment that's unfolding in Clarksville.

The alert, which was distributed via text alert and e-
mail to the university community, said the
statements "are being taken seriously by APSU
officials and are considered to be threatening."

CPD spokesman Jim Knoll said he was unsure if or
how criminal charges would be pursued against
Guthrie because he threatened the APSU campus and
not any individual specifically.

Guthrie has been to CPD headquarters before to
complain about APSU, Knoll said.

Knoll was not exactly sure of the nature of Guthrie's
complaints, but said CPD is limited in its capacity to
help.

"What he was coming to us with was civil in nature,"
Knoll said.

Classes for the spring semester are scheduled to
open today at APSU.

The university issued Guthrie a criminal trespass
warning, essentially barring him from campus
property, and notified CPD, Montgomery County
Sheriff's Office, Tennessee Bureau of Investigation
and Fort Campbell Police about the communication.

The APSU alert included a photograph of Guthrie
and instructed students and staff to contact APSU
Public Safety at 221-7786 if he is seen at any
campus facility.

The Leaf-Chronicle obtained Guthrie's resume and
phone number from information he posted on the
newspaper's Facebook page. In the resume, Guthrie
identifies himself as a 33-year-old South American-
born man living in Clarksville.


In the phone interview, Guthrie said what he was
planning is not terrorism, but rather what he called
a "declaration" to make known the "experiment" he
feels he's involved in.

The experiment, he said, even confuses him, and
somehow relates to "creating a new world order."

"I'm concerned it's unfolding in Clarksville," he said.
"I realize it sounds like crazy mumbo jumbo ... It's
not that I'm crazy."

"I suspect it has something to do with a new world
order. It's just off my scale ... I have to know why I'm
included in it and what my purpose in it is."

Guthrie said the experiment is being coordinated
through the United Nations and is not specific to
Clarksville or even the U.S. His main reason for
concern is he feels the experiment includes "a
criminal result" and he does not want to be
associated with that.

Chat Transcript by Pete Earley - The Forum via USA Today

Great discussion today by Mr. Pete Early via USA Today.

A former reporter for The Washington Post, Pete Earley is the author of "Crazy: A Father's Search Through America's Mental Health Madness." His book tells two stories. It describes his attempts to help is college age son, Mike, after he becomes ill with bipolar disorder and is arrested. It also describes the year Earley spent inside the Miami Dade County Jail where he followed people with mental disorders into the community to see what sort of services they received. His book was one of two finalists for the Pulitzer Prize in 2007 and has won awards from Mental Health America and the National Alliance on Mental Illness. The American Psychiatric Association honored him as its Outstanding Patient Advocate of the Year in 2008.


Pete Earley's website
Pete Earley's USA TODAY column




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Comment from Pete Earley: Thanks for reading my column. I am eager to chat with you about parents and adult children with mental disorders. Let's get started.

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Prattville, AL: Blaming the parents for a son's actions is the easiest thing when people don't understand anything about mental illness or have any personal experience. It's a shame the public can make a bad situation even worse. The parents are grieving also. I bet, had they known his plans, they would have done anything in their power to prevent this tragedy. I can relate to your article and understand the frustrations and red tape when dealing with mental illness. I have also had to commit my father, who is bipolar, too many times to count and it's an emotional roller coaster and seems to be more difficult each time. Alabama really lacks the funds and resources to help the mentally ill and sometimes the help is too little too late. What has to be done in order to get better help for our mentally ill?
Pete Earley: Thanks for sharing your story. We are making progress, but it is slow. Many states now recognize that the dangerous criteria is simply inadequate. They are looking at whether someone is gravely ill, which is a better choice. We have to find a way to protect civil rights but also get people who are sick the help that they need. The second part of the answer is good community care. This is not a case of us not knowing how to help. It is a case of us not wanting to spend the money to provide the help that we know works. We also have made improvements in how the criminal justice system interacts with persons who are sick. We have CIT --Crisis Intervention Training programs to teach the police how to recognize mental illness. Also jail diversion programs to keep people out of jail.

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: As a parent myself, I can't buy your defense of the Loughners. If anyone should have realized how deeply troubled their son was, it should have been his parents. Also your statement that he did not live at home was incorrect according to all the reports I have heard. To have lived with this ticking time bomb for at least five years and done nothing to help him is unconscionable. Contrary to your assertion that they had no warning from the college, documentation has shown that the father was warned and advised to get help.
Pete Earley: You must remember that adult children are adults. As a parent, it is your job to protect and help your child, especially when a child becomes sick. But when they become adults, that gets rough, especially if the person has a mental disorder and does not want your help. There are many parents out there who have psychotic adult children in their home and can't force them into treatment and can't throw them out onto the streets. I also doubt the Loughners thought that their son was a mass murderer. I doubt you would view your son that way. I believe we must reserve judgment until we find out more about what they knew. But even then, please don't forget that adults cannot be forced under our system to seek mental help and some studies suggest that 40 to 50 percent of persons who are psychotic do not think they are sick and refuse to go into treatment.

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Spencer Virgina: On CNN yesterday, you spoke of befriending your son vs 'tough love.' Can you expand on this? My son has been undiagnosed for 18 years now because of the scenario you painted that he is calmed down when I get him in front of authorities. He battles rage. Most times his rage is directed at me. I too gave the ultimatum, and he moved out. He is headed for homelessness or jail. I would like points of contact but most important, how did you present this information to your son?
Pete Earley: I lied to get my son into treatment. I told authorities that he had threatened to kill me. This was after he was arrested breaking into a house to take a bubble bath. If I didn't lie, he would have gone to jail. My son has always resented that I lied. He had three more major breaks. I tried to work with him during those incidents and tried to understand what he was going through. It helps because we have better communication and are part of a team. But I still am worried when he starts becoming sick. This is why I recommend Advance Directives. The ill person signs a paper that gives his parent or trusted friend the ability to make decisions for him if he becomes psychotic. I write more about them on my web page at www.peteearley.com in my blog. Parents can become enablers, that is why people advise us to practice "tough love" but I have never found that to work well. What if tough love means your son is homeless or in jail? How can you use tough love if you are battling a brain disorder? Remember, these are sicknesses.

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Spencer, IN: Madman, crazy man, lunatic, deranged, nuts and creepy are some of the words used to describe Jared Loughner. I not only heard these judgments from friends, but from prominent federal employees reporting from the White House and influential media personalities. (On the Internet I read that he should have shot himself.) On one hand they claim Jared has a mental illness, yet on the other hand they use this disrespectful terminology! What other illness is addressed with such slang from high ranking officials? I feel Jared is a young man in great pain and confusion and deserves better. Suppose he does have a genetic predisposition for a neurological, brain or a mental disorder, that alone is challenging, but to live in a volatile political atmosphere, in my opinion, compounds the issue. Add on to this the normal stress of trying to understand oneself in a fast-paced global society, and this young man is bearing a lot of pain. Perhaps escaping reality is an outlet. I feel those in our society, especially those who have some emotional distance from the shooting, can become more educated, responsible and compassionate. Yes, it is a lot to ask, to open our hearts and minds and change our language, but that makes for a valid point and teachable moment. In so trying, one has the opportunity to empathize with the struggle Jared endures in trying to conform to our reality. I believe the media could have sent a message that such violent acts are unacceptable and Jared needs to take responsibility for his actions, yet speak of him with dignity and understanding of his illness. I feel it further impedes a person from seeking assistance when they fear they will be judged and insulted by society for doing so. My questions: Could you please give a scenario of how you would report the event to the public and do as I described in the above paragraph? I would like to write our public officials and ask them to “clean up their language”. What do you think is an effective way of saying this in a letter? Thank you!
Pete Earley: No, thank you for your excellent comment. What this man did was horrible. No one thinks otherwise. The question is did he do it deliberately or was he mentally ill? Being mentally ill does not excuse his actions, but it certainly should make a difference in how we look at him and the punishment that he receives. I have always felt that language is important and the use of the words that you mentioned are harmful and increase stigma against persons with mental disorders. The National Institutes of Mental Health says that one in five people will have a mental illness in any given year. That is a lot of people and many of them are afraid to speak out because we make fun of persons whose minds become confused. Would we make fun of someone who has cancer? No. Yet we make fun of persons with mental disorders. There should be no shame in having a mental disorder, only shame in us not doing something to help those who do. I blame ignorance and believe persons in high public jobs, as well as reporters, need to understand that the use of offensive language against persons with disorders is no more acceptable than terms that are racist and sexist.

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Oakland CA: Thank you for the opinion piece. Have you included the question of cost of treatment for mental illness? The drugs in use are among the most expensive, easily exhaust limits in prescription benefits. Hospitalization is enormously expensive. And for out-patient care, it is difficult to get psychiatrists to take difficult or complex cases.
Pete Earley: Sadly, we still do not have good medicines that can help with the symptoms of mental disorders. Most are not only expensive but also have side effects. My son has gained 50 pounds thanks to his antipsychotics. We also have a shortage of good psychiatrists. What we need to understand is that it requires more than medication to help someone with a mental illness. It also takes jobs -- so they can work. In many cases it takes housing -- so they can live independently. It also takes community acceptance so that they don't have to hide and live in shame. The good news is that many of these jobs and housing programs can actually save a community money while they help someone get better. They are more economic than building more jails and prisons. They are more effective than repeated trips to emergency rooms or stays in homeless shelters. I believe that actually helping a person get better will, in the long run, save a community money. When it comes to drugs. We need to find ways to help persons get medications without bankrupting families and persons who are ill. Right now, that is tough.

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Fairfax, Va. 22033: My husband and I met you at one of the mental health awareness meetings promoting your book. Our son Teddy is now 29 years old. Three years ago he was diagnosed with paranoid schizophrenia. He was evaluated by the Virginia State Mental Hospital and stayed for two months. He was released and six months later was admitted for two more months. Doctors said that he should just go home. Meds weren't really working and so we took him home and my husband and I agreed to not force meds on him. It was 1 1/2 years of hell. But I am here to say that he has stepped out of most of his schizophrenia and stepped into OCD. He refused to see a doctor. It is my assessment. He buys lots of shampoo, lots of colon cleanse and mouth wash etc. and takes an hour shower every day. We go to dinner with him and he walks across the street for his groceries and his cleaning products. Praise God he gets out. Because for 1 1/2 years he lived in his bedroom even on his birthday and Christmas. We have seen a miracle before our very eyes. I just wonder if the pot he was smoking masked the illness. Do you know of a group here in Fairfax that has a meeting for us to understand his illness better? Thank you and may God bless you and your son.
Pete Earley: The National Alliance on Mental Illness has a great chapter in Fairfax County. You can find it on the NAMI website and are welcome to join. It has a meeting next Monday night. Oftentimes, persons with mental disorders self medicate. They drink or use drugs to help ease the pain in their brains. The most common drug of choice is cigarettes. Studies show that 40% of all cigarettes bought in this country are bought by persons with severe mental disorders. Of course this hurts their health. If you have a loved one who has a serious drug or alcohol problem, then you might also have someone with a mental disorder. It takes a good doctor to diagnose and a good treatment team to help that person.

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Ft Myers, FL: If it is mental illness in the Tucson case, why are the "legal" authorities and general public trying so hard to disallow the insanity defense and further undermine the validity of insanity as a true and legal illness in the U.S.? Does retribution trump mental illness? Legal authorities and pundits claim there was intent with writings specific to the congresswoman and therefore regardless of illness, that trumps mental defense opportunity; similarly, if a mental patient willfully does not take medication, that may also be a claim of intent for any crime since supposedly the medication would prevent the crime. If mentally disabled patients cannot use the illness defense, then how can the public, legally or otherwise, believe that there are individuals who are "legally" mentally challenged? Can jurors be disqualified based on their feelings about mental illness; if yes, is that a violation of the Disabilities Act?
Pete Earley: Wow, what a powerful question. Thank you. I am not an attorney but I will try to answer your question based on my research. First let me suggest an article that was published by the New York Times about federal and state laws when it comes to insanity. http://www.nytimes.com/2011/01/15/us/15investigate.html?_r=1&emc=eta1 Does retribution trump mental illness? Absolutely. There are some 200 persons with severe mental illnesses currently on death rows in this country. Many of these persons have absolutely no idea what they have done. They have been sentenced to death because a court has ruled that they know the difference between right and wrong. That is the standard, not whether someone is mentally ill. Please look at a blog that I wrote about this concerning Kelsey Patterson. http://www.peteearley.com/2010/04/11/how-do-we-define-insanity/ Because we do not know what, if any, mental illness Jared Loughner might have, we can't predict what will be his fate. But I would wager that he will spend the rest of his life behind bars, either in a forensic hospital or prison, just as John Hinckley, the Unibomber and Andrea Yates. I like your question about the disabilities act but am afraid that I can't answer. Maybe someone else can.

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Scituate, MA.: I run a parent support group for parents of young adults; the young adults have a mental illness. What would you say is the main issue I should be educating the parents about in caring for their young adult who is ill and living with them?
Pete Earley: Parents need to find a way to keep communication open with their children but also understand that once they become adults, the parental control is going to diminish. That is why it is so important to get a child into treatment and help them understand the seriousness of their disorder early on so they can learn how to control the symptoms later when they are adults. One of the toughest lessons for me was that I couldn't simply swoop in and save my adult child. There were laws, rules, attorneys, doctors standing in my way. I also was ignorant. I had to learn about our mental-health system and our legal system. Family to Family is a great course taught by the National Alliance on Mental Illness that can help parents learn how to help their children. It helps both sides learn what is acceptable and what is not. Advance directives help. But I guess what is most important is trying to establish some ground rules about what will happen if someone becomes psychotic or stops taking their medication or engaging in treatment. A person with mental illness wants freedom. We all do. But when you have a serious mental impairment, that impairment is what keeps your from being free, not the persons who love you and want to help you. That is a tough lesson for people to understand. Parents should not be the enemy.

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Knoxville, TN: I am an intern at a system of care that works with high-risk youth 14-21. Are you familiar with this country-wide initiative to bring about change to the children and youth mental-health field? I am an advocate for expanding this philosophy to the adult system. I have family members who are suffering with misdiagnosed mental-health issues, and have experienced a loss of a family to a mentally-ill person with a gun. There must be many changes in the mental-health field in order to meet the needs of those it serves. Early identification and treatment are key in resolving these issues. I would like to hear your thoughts on what would make this system better.
Pete Earley: I am not aware of the system of care that you mention because most of my research and writing has been about adult children. This is because my son was an adult when he became sick and he was arrested. Therefore, I have spent most of my time advocating for the decriminalization of persons with mental illnesses. Getting help early is essential. The Va Tech shooter got help when he was in public schools before he turned 18. I think helping educate students and teachers about mental illness is essential. But have limited information about programs specifically aimed at young people. Sorry.

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Lexington, KY: Even with AOT laws in our state, it's been impossible for my husband and I to obtain timely and meaningful medical help for our son who sufferers with serious mental-health diagnoses. Without treatment and supports, he becomes abusive, delusional and sometimes threatens public officials to gain attention for delusional projects, which are a reality only in his mind. He does not take medications because he does not believe he is sick. Many times law enforcement professionals have indicated they can not report, refer or share information regarding my son's serious illness to mental-health agencies. They will state their job only allows them to arrest the person with an SMI. How can we advocate for law enforcement to share information with community mental health centers?
Pete Earley: Crisis Intervention Teams are a great solution when it comes to educating the public and law enforcement. Sadly, more police deal with persons with mental illnesses than psychiatrists. CIT is international now. Look for the Memphis Model. Remember that while privacy laws may stop the police from telling you information, you can always tell them what you know about your loved one's mental disorder.

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Kalamazoo, MI: Why say the shooting in Tuscan was because the man had a mental disorder versus him choosing to willfully commit this crime? Further, if it is so easy for us to draw this type of conclusion for this man, shouldn't we just say that anyone who commits a crime is mentally ill or has some type of psychiatric disorder?
Pete Earley: Not everyone who commits a crime has a severe mental disorder such as bipolar disorder and schizophrenia. The DMS, which defines mental disorders, separates brain disorders which are believed to be caused by malfunctions in the brain (the heart can get sick and so can the brain) vs. psychopathic behavior. There is a difference and the court and medical profession recognize this. Someone who is sick through no fault of their own is different from someone who is anti-social.

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Frederick, Maryland: Where can families go for help, a hotline of sorts, to stage an intervention for one of their mentally dusturbed adult family members? It's often like dealing with a child, the only difference is, by law, children are at the mercy of their parents or guardians. Adults must admit on their own that there is a problem. This doesn't typically happen.
Pete Earley: Contact the National Alliance on Mental Illness for advice or Mental Health America or DBPS, another support group. If you want to see what your state law is about involuntary commitment, try the Treatment Advocacy Center. Most communities have a mobile crisis response team that will come to your house and evaluate someone. Also, and this is important, find out if your police department has CIT trained officers. Look for help from what is called a peer-to-peer specialist who can help you.

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Thibodaux louisiana: What does an aging parent do to provide for disabled child after parent death when there is no other family?
Pete Earley: Again, contact NAMI and ask for help about this. There are legal steps that you can take to ensure that your loved one continues to get help after you are gone.

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Wilmington, N.C.: My son is in complete denial of his illness, schizophrinia. How can I get him to accept his illness and be compliant with taking meds? I am told a cognitive theripist may help. If so, how do I find a good one in this area?
Pete Earley: You might want to read a book by my friend, Xavier Amador called "I'm Not Sick, I Don't Need Your Help." It is one of the best at answering this question. I had a tough time with my own son. He finally came around but not after four major breaks and major run-ins with the law. If you can get a good case manager involved, that can be extremely helpful. Find out if your community has a peer-to-peer specialist. Peers are persons with mental disorders who talk to someone with a mental disorder. They are FANTASTIC and can help. It is like having a sponsor in AA. Forcing compliance is difficult. I sympathize. With my son, I never mention meds anymore. He knows how I feel, and badgering him doesn't help. Now I try to be his partner, as much as his parent. Sounds cliche but it is important. Good luck.

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Rome NY: My 23-year-old daughter seems to have two lives/personalities. One good life, caring, fun loving, hard working and involved with her family. Knows how to express herself in a normal manner. The side she tries to hide, domestic violence, constant/continual lies, finances, criminal friends, disappearing for long periods of time, yelling, screaming and cursing when we ask her a question about her secret life is taking its toll on our family. She will not seek professional care, since "we all have the problem" not her. She's living at home and enjoying the best of both worlds. Believe this is wrong, but don't want her to get worse into this dark world. This is the third time we've been through trying to improve her life. It does not seem to be working. Any advice is appreciated.
Pete Earley: This is a tough one. People told me to practice tough love. But I was unwilling to watch my son end up homeless or to shut him out. Again, you should join NAMI and try Family to Family. It is a course specially for this problem -- helping parents deal with adult children with mental disorders. Also groups such as NAMI and MHA can help you because other parents have been down this road. They can advise you. That is my best advice -- turn to other parents. You will discover that there are a lot of us out there.

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Bethlehem, PA: What can we do to get things changed. Elected officials don't take mental illness seriously.
Pete Earley: Perhaps now they will, but I also had great hopes for change after the Va. Tech massacre. It is paramount that we keep the pressure on our elected officials to fix our mental health system. The first big step is for persons, including parents, to come out in public and demand changes. We should not be ashamed that our loved ones got sick. Would we be embarrassed about cancer? We must educate the public and we need to tell our politicians that we vote and matter. I was told by a Va. governor that we have no clout because we have no votes and no PACS. This is why we must speak out after tragedies such as this and remind the public that people are suffering, a limited number of people who are sick are dangerous, and we are wasting human potential and millions in tax dollars on a system that is badly broken. President Bush's New Freedom Commission on Mental Illness found a "fractured" system that doesn't work. Funny, that mental health was not mentioned much during the great Obama health-care debates. That is a signal of how poorly we have communicated the need for better and effective care. The simple answer is to remind your politicians that this is a priority that matters.

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Clarksville, TN: How do you cope with a teenager (now 33) who started teaching the therapy and classes after 5 days into an in-house treatment facility (he was 17 at the time so we could send him) -- he was smarter, and still is, than everyone on the staff -- after a 7 year stint in a federal prison for selling drugs, he is now "presumed" normal as he has his own business and has completed a professional license that the general public would deem awesome (to go from down to the top) -- however, I know now that his problem is not drugs but he is narcissitic to the maximum(why didn't any of the mental health people we took him to realize this?) and he surrounds himself with people that constantly tell him how wonderful he is, including his new wife -- he is estranged from his whole family who have been used and abused to the maximum for 20 years and thought they were practicing "tough love" for many years.
Pete Earley: I'm sounding like a broken record here. My advice is NAMI's Family to Family. You may not be able to change a person, especially one with a narcissistic personality disorder. All you can do is change how you react to that person and limit the amount of hurt that he causes you. Good luck.

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Davenport, FL: I am grandmother who takes care of a grandchild after school and on holidays. He has been diagnosed with Asperger's syndrome. I've told his parents that when he gets upset he threatens to hurt himself or others. The parents tell me that's the only way he knows how to express himself; he is not able to just say, I'm angry and don't like what's happening right now. My question is: Who will take this seriously? What can I do? Thank you.
Pete Earley: I appreciate your question because it shows that there are many kinds of mental problems that can result in violence and danger, including the one that you mentioned. Autism is not considered a mental illness, nor is Downs Syndrome and yet persons with these issues also can become dangerous or difficult to control. It sounds as if you need to have a long talk with the parents and convince them that recognizing a problem does not mean criticism of their child. Best talk to an expert here who can offer helpful advice.

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Atlanta, GA: In retrospect, do you think your son showed signs of mental illness in adolescence, or during his earlier teenage years? If so, what were the symptoms and how did they differ from typical teenage behavior?
Pete Earley: I do not think that he showed obvious signs. He was very artistic and no easily influenced by his peers. He walked to his own drummer. But I thought that was a good thing. It wasn't until he was in college and under tremendous stress that his actions made us nervous. He stopped eating, complained that food didn't taste good, began drinking beer a lot which was out of character, and then progressively got worse. I remember his first psychiatrist telling us that if we were lucky our son was using drugs. If not, he had a mental disorder. I was stunned because I felt that drugs were worse. I was wrong. Many of the behaviors associated with adolescence also can be signs of impending mental disorders That is why it is so important to keep communication open and also be aware of what your child is doing. The fact that Jared Loughner had a shrine with a skull in the backyard would have given me pause. But that is me. Try to look for alcohol and drug abuse. Those are danger signs. Try to look for isolation. If all of the child's friends suddenly stop calling, that could be another signal. But, no, there were no clear signs until my son became obviously psychotic.

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Wilmington, N.C.: My son has been in three mental health hospitals and served three jail sentances all in the past eight months. He has been released after three days from facilities because of the 72 hour law. He entered into a mental health court program and since then has spent more time in jail than getting the help he needs! After months of home arrest with my husband and I, we are exhausted and frustrated with the system and the lack of help for the mentally ill in this state. The next move for my son is on the street unless we or someone can come up with a solution. We are parents that love and care for our son and have done everything in our power to help him. The system here has worked against our efforts to help him and it looks hopeless. I am told that the funds are being cut even more in this state and that only the worst cases are getting any attention at all. I feel very sorry for those parents in Arizona and I think people should look at the whole picture before making judgements.
Pete Earley: Amen, and thank you. USA TODAY got more than 300 comments about my article after it was posted online. Many showed a complete ignorance about mental health. But I received several dozen personal emails from other parents such as you. Believe me, what you are experiencing is much more typical than the public knows. That is why we must speak out, join NAMI and other support groups, and fight for reforms. As a parent, you have discovered what I have seen -- that we often are the enemy. If we want to force our children into treatment, mental health professionals often accuse us of trying dump our kids and problems on them. Civil rights lawyers fight us and accuse us of being overbearing and worse. If we don't fight to get them into the system, then we end up being accused of being bad parents, especially when something horrible happens. We are blamed for mental illnesses and bad parenting. It is frustrating. But have hope. And remember that while we suffer, it is our mentally ill loved ones who suffer even more, especially if they are delusional. My son had four major breakdowns and all of US went through hell. But now he is doing great. He took the first steps and we were ready when he finally was. He also had a tremendous case manager who is responsible for changing his life. She made the difference and I thank God for her every morning. There are programs out there that work. The key is getting the stars lined up -- finding a great program and getting your loved one into it and having him/her want to get better. I understand why some parents and loved ones give up. I do. But for your son's sake, I hope you can help him move forward.

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West Columbia, SC: Just read your article in today's USA TODAY. Bless you, and please continue your advocacy for mental illness.
Pete Earley: Thank you. But remember that I didn't have a choice. I would gladly go back to the days when I was largely ignorant about mental health and my son was well. But that is the past and thinking about going backward is counterproductive. I used to wish my son would be like he was. That was stupid. He is now a new, different and much changed person. He actually is a better person in many ways now that he has his symptoms under control. I am lucky because of that. He has grown with his illness despite all of the horrors that we endured. I am proud of him. He is a peer to peer specialist now helping others. But remember my son became ill. That is why I became an advocate. The people who work in the mental health system, oftentimes for little money or public rewards, are the real heroes here especially if they do not have a mentally ill loved ones. I salute them.

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Montana: Hi Mr. Earley. Thank you so much for the well-written and informative article. My cousin has been diagnosed with bi-polar disorder. I know his mother was kind, loving and attentive. His father is and was a hard working and honest man. The parents I am sure were not perfect, but most of us would have been quite happy with the both of them. They did not do anything to create my cousin's mental illness. It would be easy to blame his parents. "Easy" being the key word. I am so so sad for you, your family and your son. I know a little bit about how families take an emotional thrashing from society, when mental illness strikes. I have come to the conclusion that we are all like flowers, truly unique and individual. Some of us are dandelions which I have heard can be made into wonderful wine, though most of us use weed killer to remove them. Some may be like roses, with sharp thorns protruding. I don't believe there is such a thing as "normal." Only a persons learned ability to function within society, adhering to certain demanded social perameters. Recently a high school coach was found to have been targeting young teenage girls (grooming...) with sexting and photographs via cell phone. I had to ask myself, "Is this mental illness?" Truly deviant, but where do we draw the line with mental illness? I just do not know. I think that's the answer. We don't know "why," someone is mentally ill, so we take the easy road and blame the parents. I think the blaming is done because society demands blame be placed somewhere. I feel deeply sad for the parents of this young man. Thank you for stepping up to the plate on this issue. It is almost as if the public would burn the parents at the stake for being witches. Primitive thinking, and without compassion. That truly concerns me.
Pete Earley: The psychiatric manual that defines mental disorders is currently being written and updated. As you wrote determining what is an illness and what is something else is difficult. If we ever develop a blood test or some other medical way to determine that a person has bipolar disorder or schzophrenia or some other severe illness, then society might feel more compassion. But until we learn more about the brain, we are stuck with diagnoses that often are incomplete, difficult to determine and not too helpful. What is a mental illness? That is a question that we could spend hours and hours debating. As a loving parent, I can't tell you the medical answer. But I can tell you when my son is sick.

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prescott, az: From the news accounts that I've read, I'm assuming that Jared lived with his father. Dad was well aware of Jared's problems in school and the job market. If you are going to give someone shelter in your home, I think you need to have an awareness about what they are doing during with their time, especially if it is your child. Every parent knows that teens and older children are not inclined to freely share their feelings with parents, and will often tell them what they want to hear in order to keep them off their backs. But parents also know that what their kid tells them is not always the truth, especially in this case with Jared being tossed from school and losing jobs. I'll bet Dad was getting asked to provide some spending money in addition to a place to stay. I wonder what would have happened to Jared if Dad had confronted him after he was expelled from school instead of continuing to shelter him and unwittingly giving him a more comfortable environment and possibly the means to plan his attack. Maybe parents should be held accountable for their children's actions if they continue to shelter them past the age of majority. I have 4 sons. Two are still teens. They know that once they graduate high school, they have to move on. I still care, but they can't live at home anymore unless they are going to school full time. If that's the case, they must obey my rules of conduct and keep their grades up. Most kids want to get away from their parents influence as soon as they can, usually before they are prepared to do it sucessfully. So there are bound to be some bumps along the road to independence. But the parent needs to be aware of the child's behavior especially if the parent is still supporting the child. In Jared's case, with a possible personality disorder involved, it sounds like Dad reacted too late, which means he wasn't paying attention.
Pete Earley: In Jared's case, with a possible personality disorder involved, it sounds like Dad reacted too late, which means he wasn't paying attention. I don't think we know enough to draw many conclusions about the parents. We don't know what they were told. We don't know if they might have their own issues. We don't know if they tried and were blocked by our system or if they didn't care and ignored warning signs and being told that they needed to do something. Generally, I agree with what you have written. As a parent with two adults still living at home and seeking jobs and independence, I try to keep a close eye on them and their actions while still respecting their privacy. All of us have to decide what is tough love and what we can and do tolerate. But the point of my article remains the same: dealing with adults who have a mental illness is difficult and even parents who recognize that their loved one is sick often find their hands tied when it comes to forcing them to get help. Regardless of what we learn from the Loughner case, I hope we will recognize two things -- that we need to make our mental health system more accessible and that the role of parents with mentally ill children is much more complicated than many understand. We need to stop focusing on dangerousness as the only criteria for forcing someone into treatment and find a better way to protect civil liberties but also get people treatment when they need it. That is an important discussion that needs to take place. We need to begin adequately funding mental health services so there are no long delays. We need to fight stigma so that there is no shame in helping someone who becomes sick. We need to have a system where involuntary commitment is the last alternative and rarely used because people get help voluntarily. We also need a system that recognizes that if people are sick and don't realize it, that we need to help them rather than letting them roam our streets in pain and psychotic. We have failed to develop this system, in part, because there are no easy answers.

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Phoenix, AZ: As a parent of a mentally-ill adult, I feel tremendous compassion toward the family of this unfortunate person. We have been unable to get the care we want for my son because, at 20 years old, he is an adult and unless he permits it, we can't get info about his condition, and more importantly we can't give information about his progress to his doctors. Unless he was harming us or harming himself physically, no one would listen to us. In his situation (OCD/anxiety) he refuses all help, including all meds. So much is kept from us, we actually have no idea how he is really doing, even though we are all in the same home. I feel like an astronomer, watching planets from space and making guesses.
Pete Earley: You have expressed what all of us feel very poignantly. Just remember that while privacy laws may stop us from getting information from doctors and others, they do not keep us from providing information to doctors and others. When doctors have refused to tell me anything, I am polite and say, that is fine, but now you need to listen to me because if you don't and something happens to my son, I will come after you legally. I have even known of parents who have faxed statements to judges and hospitals. It is an uphill fight and sadly, the parents are often the ones left to pick up the pieces even when they are not included in the process. That's wrong and one of the changes that we need to make. Have you tried an advance directive?

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Comment from Pete Earley: Thank you for joining this discussion today. Sorry I couldn't get to all of your questions and comments. If there is any good that can come from the horrible shootings in Tucson, it will be that we as a society will look at our mental health system and begin debating and making changes that will improve it. I welcome your participating in that debate and your advocacy for change. Thank you

Sunday, January 16, 2011

Lawmakers call for hearings, help for the mentally ill after Giffords shooting - The Hill's Healthwatch

Good to finally hear, but a long time overdue.

Lawmakers call for hearings, help for the mentally ill after Giffords shooting - The Hill's Healthwatch

BEST RESOURCES ON MENTAL HEALTH FROM THE EXPERTS

If you know anyone (or know anyone who knows anyone) who may be suffering from a mental illness, please, seek out help.

The mental health experts who appeared on today's CNN broadcast of "State of the Union" have recommended a number of websites that contain a wealth of information.

All of them touted the National Alliance on Mental Illness (NAMI). They have a website and a toll-free helpline for anyone in need of counsel or information.
http://www.nami.org/
NAMI Information Helpline: 800-950-NAMI (6264)
It has local chapters in all states and specializes in offering families and persons with mental disorders help and advice. NAMI state, local and national phone numbers can be found here.

Dr. Fred Frese, Dr. Lisa Dixon and Pete Earley each recommended Mental Health America -- the oldest mental health advocacy group in America. You may visit their website to find a support group in your area.
nmha.org
Helpline: (800) 969-6642

Dr. Frese and Mr. Earley also touted the National Suicide Prevention Lifeline, which has a 24/7/365 toll-free number for anyone who's in trouble or knows someone who may be (1-800-273-TALK).
www.suicidepreventionlifeline.org

Dr. E. Fuller Torrey recommended The Treatment Advocacy Center.
http://www.treatmentadvocacycenter.org/
703-294-6001
Its website lists the state laws regarding mental health treatment standards. Click here for information on your state.

Dr. Lisa Dixon recommended the National Institute of Mental Health (NIMH)
www.nimh.nih.gov
She highlighted two NIMH research studies: RAISE Early Treatment Program and the Connection Program
raiseearlytreatmentprogram.org
www.connectionprogram.org

In addition to the above, Mr. Earley also provided us with an extensive list of advocacy groups, blogs and books that might be of interest to you:
Advocacy groups:
Bazelon Center for Mental Health Law (www.bazelon.org)
National Council for Community Behavioral Healthcare (www.thenationalcouncil.org)
Depression and Bipolar Support Alliance (DBSA) (www.dbsalliance.org)

Blogs:
McMan's Depression and Bipolar Web (www.mcmanweb.com)
Minds on the Edge (www.facebook.com/MindsOnTheEdge)

Books:
A Brilliant Madness: Living with Manic Depressive Illness by Patty Duke and Gloria Hochman
An Unquiet Mind: A memoir of Moods and Madness by Kay Redfield Jamison
I Am Not Sick, I Don't Need Help! by Dr. Xavier Amador with Anna-Lisa Johanson
Surviving Schizophrenia: A Manual for Families, Consumers and Providers by E. Fuller Torrey, M.D.
CRAZY: A Father's Search Through America's Mental Health Madness by Pete Earley
The Center Cannot Hold: My Journey Through Madness by Elyn Saks.

Tune in now to see interview with Dr. Fred Frese and author Pete Earley

http://www.cnn.com/CNN/Programs/state.of.the.union/

If you didn't catch it live, I'll post the link later. BEST discussion I've seen yet on the subject of the state of our mental health system. Five Stars!

Let's Lament Violence AND Untreated Mental Illness: Parents of mentally ill reflect on Arizona shooting

For those who have never experienced it, here is an excellent example of walking in our shoes.


Recognizing signs of mental illness 'difficult' for some

JEREMY OLSON Minneapolis Star Tribune
Sunday, January 16, 2011

Having a 36-year-old son who believes he is God has taken a toll on Sue Hanson.
If she calls police in Maple Grove, Minn., to take him to a hospital, her son might not believe that the officers or their bullets can hurt him. Left alone, he might wander away, believing he can make it to another planet.

"When you're God, you know, all things are possible," his mother lamented.

Parents such as Hanson and her husband have unique perspectives on the shootings in Tucson, Ariz. While they haven't endured the pain of having a child linked to a mass murder, they can relate to the tales of bizarre behaviors or his fixation with wild conspiracies.

They also have unique insight into the national question of the week: How could Jared Loughner's parents not have seen this coming?

If Loughner suffers from a severe mental disorder such as schizophrenia - and his reported behaviors hint he does - it wouldn't be strange for his parents to miss it, they said.

First is the matter of recognition.

"You don't want to believe it," said Hanson said, whose son is under civil commitment and lives in an assisted-living facility. "It's a difficult thing to get your head around if you haven't been exposed to mental illness - and most of us have not."

Hanson said her son's first "psychotic break" 16 years ago was obvious: He claimed he was Jesus.

For others, the signs weren't as clear. When Mindy Greiling's son started acting strangely several years ago, she suspected drug use. Mental illness seemed far-fetched - until she had to call police because her son, then 21, was wrecking her house.

Symptoms of mental disorders commonly emerge in the late teens or early 20s, particularly in men. Major life changes such as going to college or leaving home can trigger the disorders. While Loughner lived at home, others at this stage move away, making it harder for parents to detect.

Harder still is knowing when, as a parent, to intercede.

Dr. Michael Trangle, a psychiatrist for the HealthPartners Medical Group based in Bloomington, Minn., said parents need to set aside judgment. Instead, "talk to the kids. 'Something seems a little different. Tell me what's going on here.' Talk in a gentle, supportive way."

Mental health law poses another challenge. Children 18 or older have the right to decide whether to receive treatment - unlikely if they are delusional and don't believe anything is wrong. Parents aren't entitled to be informed of or involved in diagnosis or treatment.

Greiling's son was at the University of Montana, where a psychologist suspected schizophrenia. He couldn't share those findings with Greiling, who was shocked when her son returned home.

The next problem was obtaining mental health care. Greiling, like many parents, was advised to call police when her son was actively delusional. But when she called because her son was breaking things at her house, the police initially wouldn't take him to a hospital, saying he wasn't a danger to himself or others.

Greiling, a Minnesota Democratic-Farmer-Labor state representative, later promoted changes to state law so that substantial property damage, and not just bodily harm, could justify hospital confinement and civil commitment proceedings.

Mental illness itself, however, is not a good predictor of violent behavior, Trangle stressed. "There's much more corroboration (in the media) between mental illness and violence than truly exists in the world."

Greiling's son has stabilized and works as a janitor at Fort Snelling. She has sympathy for the parents of Loughner, who has been charged in the rampage in which U.S. Rep. Gabrielle Giffords, D-Ariz., was shot. Six people were killed.

It was a feeling Greiling expressed on Twitter the morning after the murders.

"Rep. Giffords' shooter sounds like another case of untreated schizophrenia," she wrote. "Let's lament violence AND untreated mental illness."

Saturday, January 15, 2011

Fear-Mongering?

http://swampland.blogs.time.com/2011/01/15/fear-mongering/

An excellent article that should be read in its entirety. Yes, there are critics out there of AOT, mostly consumers, who make the accusation of fear-mongering. But is it really? I agree with this writer. We can't afford not to fix our broken system.

We have lost our way when it comes to protecting ourselves from the violent mentally ill in this country, and protecting them from themselves -- not just violent schizophrenics, but also some who are depressed and bipolar.

Obviously, this does not mean the forcible commitment of all schizophrenics to mental hospitals. That would be unwise, immoral and impossible. It does, however, mean the following: that if someone starts acting like Jared Lee Loughner did at Pima Community College, we should have the right, as a society, to demand that he be submitted for a mental evaluation. If he is found to be potentially violent, he should be monitored and a course of treatment suggested. If he refuses to abide by this course of treatment, it should be made mandatory. One would hope that we'd finally find a way to overcome the crippling NIMBY objections and local some community treatment facilities in accessible places (to do this, by the way, would cost money--and higher taxes, no doubt--but if we want to consider ourselves a civilized society, we have no choice). In doing this, we should build in as many checks as possible--multiple evaluations, at the very least--to be sure that we're not acting peremptorily or vindictively.

Will this sort of redress prevent slaughters perpetrated by the violent mentally ill? Of course not. But it will reduce the threat--and it will benefit the vast majority of potentially dangerous people who are untreated now--although there's no way of knowing just how many slaughters we'll prevent. But it does seem to me that calling for a rebalance between the rights of the violent mentally ill and the safety of the society is not fear-mongering at all. It's an attempt to evaluate a difficult problem and find a solution that is more humane than the one we currently have.

On Chris Buice's op ed in today's KNS

Today I read an op ed in the Knoxville New Sentinel written by Chris Buice, pastor of the Tennessee Valley Unitarian Universalist Church where a shooting occurred two years ago by an individual with a long history of alleged UNTREATED mental illness.

Mr. Buice states "The man who committed this crime had a history of mental instability" then poses the question "How was someone with such a history able to buy a gun and unable to find treatment?"

My initial response would be that it was psychotic thinking, not political thinking affected the actions of Jared Loughner. These are two entirely separate issues, so let's not confuse them.

I highly suspect the same was true regarding Jim Adkisson, the TVUCC shooter but unfortunately, the media and others' focus on political vitriol and hate crimes at the time of that shooting distracted from the fact that he had a lengthy history of untreated mental illness that was never really addressed.

So "how was someone with such a history unable to find treatment?" The simple answer is he wasn't looking for treatment. He didn't think he was sick. It's a neurological syndrome called anosognosia. This is why it's on all of our shoulders to advocate for stronger treatment laws so they may receive treatment they desperately need, but do not acknowledge.

Mr. Buice is correct - words should heal, not harm. But along the same line, when dealing with the seriously mentally ill, treatment is critical to healing. Words alone do not cause or induce psychotic episodes. It's the absence of treatment.

A strongly worded Kendra's Law is the intervention Tennessee needs for our seriously mentally ill who do not recognize their illness and who refuse treatment.

Period. End of sentence. No words are even necessary, only treatment.

Friday, January 14, 2011

Never, ever criticize the parents until you've walked in their shoes

Don't Blame the Parents of Jared Loughner
By Pete Earley
USA TODAY

What's wrong with Jared Loughner's parents? Why didn't they do something? They must have known. Just look at the photograph of the Tucson shooting suspect. That grin. He's clearly nuts. They should have raised him better.

These are some of the comments I've heard and read on the Internet about Randy and Amy Loughner, whose son has been charged with shooting Rep. Gabrielle Giffords, D-Ariz., and 12 others, and killing six bystanders.

It's unlikely the Loughners' statement — that they "don't understand why this happened"— will soothe the criticism and anger aimed at them. But as the parent of an adult son with a severe mental illness who has been arrested, I can sympathize with the Loughners and testify that there are reasons why a parent can be caught off guard.

LIVE CHAT: Pete Earley will be online 1:30 p.m. ET Monday. Submit questions, comments at theforum.usatoday.com.
Many mental disorders, especially schizophrenia, emerge in late adolescence, when children often are rebelling and separating from their parents by pushing the limits to find their identities. Before my son's first breakdown, he told me that President Bush was behind the 9\11 attacks. He had also become obsessed with a female friend and talked endlessly about how they'd soon be married.

Signs aren't always obvious

Should either of those comments have caused me to think he had a mental disorder? Parents often suspect their adult children are abusing drugs or alcohol if they act strangely, not realizing that substance abuse can be an attempt at self-medicating and a warning sign of a possible mental disorder.

While it's obvious after a madness-fueled rampage that someone is dangerous, most people with mental illnesses are not violent and are more likely to be victims of crimes than to commit them. Few parents suspect their children are capable of mass murder.

Persons who are sick can also mask their illnesses. Judge Steven Leifman in Miami tells a story about parents who told him their adult son was severely ill, but when he appeared in court, he was polite, articulate and charming. Only when the defendant spotted his parents and became upset, claiming they were strangers spying on him, did Leifman get a glimpse into his confused thoughts.

But news reports said college officials warned the Loughners their son couldn't return to school until he had had a mental health evaluation. He was scaring other students. Obviously, that's a huge red flag — if it happened. Federal privacy laws limit how much information colleges can share with parents. Adult children are exactly that: adults. The first time my son and I visited a psychologist, my son turned his chair so that his back was facing the therapist and refused to speak. He didn't think he was sick.

Why don't parents call the police when their child refuses to cooperate? I did just that. They arrived and shot my son twice with a Taser when he tried to run away. He had not broken a law and to this day remains bitter toward me for calling them. I'm lucky. A friend's son was fatally shot by police.

Remember, having a mental illness is not illegal. Nor can anyone, even a parent, force another person into treatment arbitrarily. All states require a person be dangerous to himself or others. What makes Arizona's law more liberal is it also allows a person to be forced into treatment if he is "persistently or acutely disabled" or "gravely disabled." Would Loughner have met those criteria? I doubt it, based on my experience, given a police officer stopped him the morning of the shooting and let him go without noticing anything alarming about his behavior. Saying you are concerned about shrines with skulls in the backyard or strange writings is simply not enough in most courts.

Problems with committing someone

Even if parents get their children involuntarily committed, they often don't get help. Adults can refuse treatment, even when forced into hospitals. You also have to have somewhere to send them. A 2009 study by the National Alliance on Mental Illness found that Arizona's mental health services were grossly inadequate. The report was riddled with complaints such as, "When I first tried to get help after attempting suicide, I was told that I wasn't sick enough to qualify," and, "There is a six to eight week wait to see (a psychiatrist) as a new patient." Most states are plagued by long waiting lines because legislators have closed state hospitals and stripped treatment funds to balance budgets.

Perhaps the most hurtful comment leveled at parents is that they should have done a better job raising their child. Would you attack a parent's child-rearing skills if his son or daughter had cancer. Mental illnesses are just that: illnesses.

Blaming parents is easy, but before you throw that first stone, try walking in our shoes.

Pete Earley is the author of Crazy: A Father's Search Through America's Mental Health Madness and lives in Fairfax County, Va.

Wednesday, January 12, 2011

Missed Signals and a Troubled Mental Past

via PBS News - interview with Brian Stettin from the Treatment Advocacy Center

Deja Vu: The Tucson Tragedy and Knoxville, Tennessee

Knoxville News Sentinel editorial 1-12-11

The tragic mass shooting in Tucson, Ariz., on Saturday that left six dead, a congresswoman fighting for her life and 13 others wounded has sparked speculation over the motives of the suspect.

Jared Loughner, a 22-year-old college dropout, allegedly shot U.S. Rep. Gabrielle Giffords, U.S. District Judge John M. Roll and the others, including a 9-year-old girl, at a Giffords event at a strip mall.

Details of Loughner have emerged that paint a picture of a deeply disturbed individual who was forced out of community college because of concerns about his mental stability.

But there's an unavoidable political dimension to the tragedy as well. Some have placed part of the blame on the violent political rhetoric of the times.

While investigators haven't offered a conventional political motive to the crime, Pima County, Ariz., Sheriff Clarence Dupnik angrily denounced inflammatory political rhetoric at a press conference following the shooting. Dupnik's agency had custody of Loughner, and there had to have been something investigators learned in the early stages of the probe that led to his statement.

The possibility that inflammatory rhetoric might have played a role - as encouragement if not as primary motive - is deeply troubling and reminiscent of the 2008 shooting at Knoxville's Tennessee Valley Unitarian Universalist Church. At TVUUC, a troubled man who claimed to be spurred on my right-wing pundits killed two people in a rampage he wrote was aimed at liberals.

Political speech has always been full of hyperbole, but when partisans accuse opponents of being threats to America, unbalanced individuals might conflate rhetoric with reality.

The First Amendment is the foundation of our freedoms, and restrictions on political speech are anathema to a free society. But practitioners can honor the Constitution by voluntarily exercising restraint, even in spirited debates. Political rivals, be they supporters of health care reform or opponents of a nuclear weapons treaty with Russia, are not enemies of the republic but people engaged in policy disputes. Vilifying opponents dehumanizes them, which makes it easier to rationalize extreme actions against them.

While toning down heated rhetoric is a voluntary matter that could restore civility to public discourse, there are legislative steps states can take to help prevent future tragedies like those in Tucson and at TVUUC.

In Tennessee, there's a bill that in certain circumstances would allow family and associates of people with mental illnesses to get a court order forcing the disturbed individual to take medication and otherwise seek treatment. Modeled on a successful law in New York, the bill has never come up for a vote in Nashville and its primary Senate sponsor, Tim Burchett, now is Knox County mayor.

Lawmakers should revive the initiative. The law might not prevent every tragedy, but it can be used to get treatment for unbalanced people who otherwise might go over edge into violence, regardless of rhetoric. It's too late to prevent the carnage in Tucson, but we can and should take steps to prevent such crimes in Tennessee.

© 2011, Knoxville News Sentinel Co.

Tuesday, January 11, 2011

The Shooting's True Lesson

via DJ Jaffe, NY Post

Now that someone with mental illness has shot one of Washington's own, maybe Congress will start to pay attention to its abysmal failure to provide care for the most seriously mentally-ill Americans.

We'll see. Lawmakers took a brief lunge in that direction after mentally-ill John Hinckley shot Ronald Reagan in 1981, and an even smaller step in 1988 when Russel Weston, another mentally-ill man, entered the Capitol and shot two police officers. But most mentally-ill people are not violent -- and Congress seems content with ignoring those who are.

I fear legislators will react to Rep. Gabrielle Giffords' shooting by giving themselves added police protection -- that is, covering their own butts while leaving everyone else's exposed.

When you read Jared Loughner's rantings on YouTube, you're instantly transported back to the 1980s, when mentally-ill Ted Kaczynski -- the Unabomber -- started a 20-year career of sending bombs through the mail. He was caught only in 1995 -- after family members who read the Unabomber's 35,000-word psychotic manifesto, said, "That sounds like Ted," and told the police.

The family had tried to get help for Kaczynski before then -- but, like most families of people with serious mental illness, faced a Catch-22. They are powerless to do anything other than say, "Why don't you go to a doctor" until after the mentally ill person becomes dangerous.

Here's what Congress should do to save money, improve care and prevent violence:

1) Prioritize the seriously mentally ill. Federal mental-health dollars now go to an astonishing variety of social programs for the worried-well, with little left for the seriously ill. Congress should establish a federal definition of "serious mental illness" that covers no more than 5 percent of the population and require all programs that get federal mental-health funds to use at least 60 percent of those funds for the seriously mentally ill.

2) Eliminate the Substance Abuse and Mental Health Services Administration. This federal agency wastes its funds on everything but serious mental illness.

SAMHSA just e-mailed to alert me that its children's book, "Play Day in the Park," which "reinforces positive, healthy choices for children ages 3 to 4," is back in print. This, when seriously mentally-ill people are going homeless and untreated. But it's far worse; SAMHSA actually funded a conference in California where a speaker taught participants how to go off their antipsychotic medicines.

3) End or greatly restructure the Federal Protection and Advocacy for Mentally Ill Individuals Program (PAMII). The lawyers in this program occasionally do good work -- but more often, they defend the right of people with mental illness to go off treatment and be psychotic. They are the major impediment to reforming involuntary-treatment laws.

Congress should ban the use of any PAMII funds for lobbying against reform of involuntary-treatment laws or working to prevent family members from helping their loved ones, an especially big problem here in New York.

4) Provide seed money to states that want to make use of Involuntary Outpatient Commitment Laws. These laws allow courts to order someone with mental illness and a history of violence to stay in treatment if he wants to stay in the community. By cutting down on arrests, incarcerations and hospitalizations (not to mention dangerous), these laws save money and lives while helping the mentally ill live successfully in the community.

5) End the Institutions for Mental Disease Exclusion in Medicaid law. This prevents states from providing long-term care for people with mental illness.

If you need long-term care for a disease that resides in any organ other than the brain, Medicaid reimburses states for half the cost. But not if the disease is in the brain. So states lock the front door and open the back -- patients wind up in jail after committing some vile act only because they were left untreated.

There are mental-health groups that will oppose these changes -- they're feeding nicely off the status quo.

If there is any sanity needed, it's in how Washington addresses mental illness.

DJ Jaffe blogs on mental illness for Huffington Post and is the founder of Mental Illness Policy Org.

nykendraslaw@gmail.com

Monday, January 10, 2011

Looking Forward to 2011 - NIMH

http://www.nimh.nih.gov/about/director/2011/looking-forward-to-2011.shtml?WT.mc_id=rss

"There are mad men and mad women out there, and you just have to live your life"

I usually do not watch early morning TV shows but am snowed in this morning in chilly Knoxville, Tennessee. I was caught off guard by a statement just made by Hoda Kotb, Kathy Lee Gifford's partner, on this particular show.

She said, and I quote her directly,

"There are mad men and mad women out there, and you just have to live your life."

Are we, as a nation, really resigned to do this? Live our lives in the midst of the mad men and women out there? I assume she is referring to the seriously mentally ill, or perhaps she meant angry people in general. I don't really know what she meant by her ambiguous statement.

But sadly, I think this a sentiment expressed by many folks who do not/have not dealt with untreated mental illness on a personal basis.

They do not recognize there is hope.

They do not realize there is healing.

They do not understand that treatment is key to hope and healing..

This is why we need to share our stories.

This is why we need to kick awareness up a few notches.

This is why we must continue to advocate for stronger outpatient commitment laws.

After all, treatment is key.

Hoda almost had it right. There are mad men and mad women out there (although it is my preference to refer to them as having a serious and persistent mental illness). But some of us live our lives closer to them than others - and we need to be heard.

The Tragedy of Mental Illness

By Dr. Keith Ablow
Published January 09, 2011

The story of alleged gunman Jared Loughner’s murderous rampage, which took the lives of six innocent victims and critically wounded Arizona Rep. Gabrielle Giffords, will ultimately prove to be a story about how severe mental illness—including that linked to violence—routinely goes untreated.

By all accounts, Loughner was psychiactrically ill long before he shot anyone. He was described by a high school classmate as a drug user and loner whose thoughts made little sense. Ultimately, he dropped out. He apparently tried to complete a high school equivalency while enrolled in the Aztec Middle Community College, a program offered by Pima Community College that caters to those who have no high school diploma. He couldn’t finish up there, either. In fact, police were reportedly called to campus five separate times because Loughner was behaving erratically. A teacher has been quoted as saying that he worried frequently whether Loughner had a gun. Students say he was prone to nonsensical outbursts. He was sent home with the instructions that he not return until it could be proven that he was not a danger to himself or others.

I have no idea whether what should have happened at that point (or much earlier) actually did happen. If he seemed to be a danger to himself or others, Loughner should have been admitted to a locked psychiatric unit. There, a firm diagnosis of his condition should have been arrived at, and appropriate treatment rendered. This would likely have included psychotherapy and medication.

Only once Loughner seemed to be a threat to no one should he have been eligible for discharge, and then it may well have made sense that he be monitored in a cohesive outpatient psychiatry setting in which participating in counseling and/or taking medications was mandatory, with failure to do so resulting in another hospitalization.

If that had occurred (which I doubt) it is hard to imagine how Loughner’s case manager (who would have been appointed by the relevant department of mental health) would have missed his Internet ravings about how illiteracy, government conspiracy, “the rarest bird on earth, with no feathers,” and his “shot . . .” being “ready for aim,” would have escaped notice.

No, I would bet almost none of that happened, despite repeated and consistent evidence that would suggest Loughner may have been psychotic and having violent thoughts connected to his mental disorder. If that sounds a lot like the story of Seung-Hui Cho, the Virginia Polytechnic Institute shooter who killed 32 people, that’s because it is.

While polarized political parties may not be the best way to govern, I believe they will turn out to have absolutely nothing to do with Loughner turning into a killer. His murderousness will have nothing to do with the availability of firearms. His violence will be understood as a result of a severe, untreated or undertreated mental illness -- the kind that afflicts millions of young people in this country.

As a forensic psychiatrist who also has run community mental health centers, hospitals and clinics, I can tell you for sure, without any question, that the mental health care delivery system in this country is shoddy and shattered and without any hope at present of dealing effectively with sick individuals like Jared Loughner. There are slim resources and no strategy, whatsoever.

That’s the very, very worrisome story behind this tragedy.

Time to Speak Out, Not Hide

via Pete Earley's blog.

To speak out and tell your story (it can be anonymous), please contact me at aot4tn@gmail.com


As I write this, we still don’t know if Jared Loughner had been diagnosed with a mental disorder before his weekend shooting rampage. Loughner is the 22 year-old accused of wounding U.S. Rep. Gabrielle Giffords (D.-Ariz.) and killing a federal judge along with five others in Tuscon.

The Washington Post and New York Times both reported that officials at Pima Community College told Loughner and his parents in October that he would not be able to continue as a student until he obtained a clearance from a mental health professional that certified he was not a danger to himself or others.

That revelation certainly implies that Loughner was exhibiting symptoms of a mental disorder, but no one should automatically assume that.

Stories such as Loughner’s are upsetting to those of us who have loved ones with mental illnesses. That’s especially true if your loved one has tangled with the police while psychotic because you know how quickly an incident can turn violent.

If it turns out that Loughner did have a diagnosed mental disorder, I hope the National Alliance on Mental Illness (NAMI), Mental Health America (MHA), and other leading advocacy groups do not run for cover.

Instead, they should follow the example that NAMI Ohio set last week when Sheriff’s Deputy Suzanne Hopper, age 40, the mother of two children, was murdered by a man with a severe mental illness.

Deputy Hopper was fatally shot and Deputy Jermey Blum was wounded during a gun battle with Michael Ferryman, age 57, a man with a history of mental illness. The shoot- out happened outside Ferryman’s trailer in Springfield.

This was not the first time that Ferryman had shot at the police. He fired 16 times at other trailer park residents and the police in 2001 after an argument over fire wood. Fortunately, no one was harmed. Ferryman was arrested but was found ”not guilty by reason of insanity” at his trial. He spent a year in a state hospital before being released.

NAMI Ohio issued a press release as soon as it learned that Deputy Hopper had been murdered by Ferryman, who also was killed in the shootout.

As the state’s largest family and consumer mental health advocacy organization, the National Alliance on Mental Illness of Ohio (NAMI Ohio) is outraged at the tragic death of Deputy Suzanne Hopper. Law enforcement officers are the unsung heroes of our mental health system. Family members and consumers often feel that the mental health system has failed us. This is yet another example of how this system has failed. Suzanne Hopper, a highly decorated officer, wife, mother, and active member of her community has paid the ultimate price.

Our organization has screamed at the state leadership that these tragedies would occur if the mental health system did not adequately provide services, monitoring, and the oversight needed by certain individuals with serious and persistent mental illness. Our pleas were not only ignored but disregarded as an exaggeration. Today, we pray for Deputy Hopper and her family and Patrolman Jeremy Blum. We will never forget that Deputy Hopper gave her life in the line of duty. This tragedy will serve as a constant reminder to NAMI Ohio not to give up until the state has made needed changes.

Obviously, incidents such as the shootings of Deputies Hopper and Blum can increase stigma and fear. That’s why I believe we need to step forward immediately when they happen and put them into context. We need to remind the public that persons with mental disorders are more likely to be victims of crimes than to commit them. Having a mental illness does not make a person violent.

But we also need to acknowledge that persons, who are clearly sick, can harm others if they do not have access to meaningful community treatment services and their relatives are prevented by misguided laws from helping them get those services.

By issuing its press release, NAMI Ohio turned the spotlight where it should be – on our broken mental health care system and our need to revise our laws.

The murder of Deputy Suzanne Hopper is horrible. So were the murders of my friend, Fairfax County Detective Vicky Armel and of Fairfax Officer Mike Garbarino in 2006. They also were killed by a person suffering from untreated mental illness. The Virginia Tech massacre was equally as horrible.

The only way to stop these senseless killings is by calling attention to the need to fix our system. Being quiet and pretending nothing can or should be done should not be an acceptable option.

It’s time for advocates to speak out and demand reforms!

Death in the Headlines Again

via Treatment Advocacy Center - www.treatmentadvocacycenter.org

Ten years ago Monday, January 10, the shooting death of college student Laura Wilcox, 19, by a man with untreated mental illness made headlines in California and inspired passage of “Laura’s Law ” in California. The law authorizes court-ordered treatment for individuals with severe mental illness who meet specific legal criteria.

Over the weekend, a college-aged gunman with reported mental health issues made headlines when he opened fire on US Congresswoman Gabrielle Giffords and a crowd gathered around her in a Safeway parking lot in Tucson, allegedly killing six and wounding 19 others. The Congresswoman was shot through the head.

What links these headlines besides the bloodshed is official indifference and inaction. Ten years after Laura’s death, the law she inspired has been implemented in only 2 of California’s 58 counties. In the years leading up to the deaths in Tucson, Arizona distinguished itself as the second-worst state in the US for criminalizing mental illness and providing needed hospital beds. In this environment, more preventable tragedies are not a matter of "if," says Treatment Advocacy Center founder E. Fuller Torrey, MD, but "when."

Wherever you live, let your state and local leaders know it’s time to stem the tragedies and stop the headlines by passing and actively implementing treatment laws and standards that pre-empt stories like these.

Sunday, January 9, 2011

Gabrielle Giffords, Jared Loughner and Mental Illness

An exerpt from DJ Jaffe's latest op ed at the Huffington Post. Click on the link to read the entire posting.

Politicized Pundits and Politicians (PPPs) are on the air now analyzing the ramblings of Loughner, as if they are worthy of analysis. They are already starting to use him as a poster child for gun control or against the Tea Party, or for a Rodney King-style "can't we all be friends" approach to political civility.

But the PPPs are failing to address the reforms that could prevent these incidents.

What's needed is reform of our involuntary commitment and treatment laws.

Families face a deadly Catch-22. If their family member is so mentally ill they can't even recognize they are ill, they can't be helped until after they become "danger to self or others". Rather than preventing violence, the law in many states requires it. Families are the most frequent victims.

http://www.huffingtonpost.com/dj-jaffe/gabrielle-gifford-jared-l_b_806279.html?ref=tw

Responding to Treatment vs. Responding to Vitriol

I heard this quote yesterday, surprisingly from a sheriff in Arizona:

"When you look at unbalanced people, how they respond to the vitriol that comes out of certain mouths about tearing down the government. The anger, the hatred, the bigotry that goes on in this country is getting to be outrageous," said the sheriff. "And unfortunately, Arizona I think has become sort of the capital. We have become the mecca for prejudice and bigotry."

When asked by a reporter if Giffords being shot could have been motivated by "prejudice and bigotry," Dupnik responded, "All I can tell you is that there's reason to believe is that this individual may have a mental issue. And I think that people who are unbalanced are especially susceptible to vitriol."


Sheriff Dupnik needs to know the National Sheriff's Association believes the key to these preventable tragedies is getting the "unbalanced" to respond to treatment, not vitriol, through stronger AOT laws.

If Sheriff Dupnik believes Arizona is becoming the mecca for this type of behavior, then he needs to be the first to advocate for laws to keep Arizona communities safer.

Stronger assisted outpatient treatment laws could make all the difference.


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