Friday, May 27, 2011

It's Terrible to Force Treatment On the Mentally Ill. But It's Worse Not to. | Mind Matters | Big Think


David Berreby on May 27, 2011, 12:59 PM
My mother had always been a suspicious and secretive person, but it wasn't until I was 14 that she really went nuts—with many of the same symptoms described in Rachel Aviv's piece in this week's New Yorker (available in full only to subscribers, unfortunately, but the summary is good and there's also this fine podcast available). My mother lived the kind of life Aviv describes so well: Early promise and achievement, check. Then a period of frustration and obscurity, check. Then the symptoms: Conviction of a vast conspiracy centered on the self, check. Mysterious lover who in reality was a passing acquaintance with no knowledge and no interest, check. Friendlessness and a tendency to drive away help, check. And, above all, the subject of Aviv's article: An absolute conviction that there was no need for psychiatrists, talk therapy, drugs or any other kind of treatment, because there's nothing wrong with me!
I have been through the wormhole of someone else's full-blown paranoia several times in my life (just lucky, I guess) and I was glad to see journalism touch on this central fact. Part of the reason crazy people are crazy is that they believe they're fine. In my mother's case, the helicopter overhead was there to spy on her, my teacher's idle chat about my day was part of a plot to spy on her and the phone rang because people were checking to see where she was—but as she'd always say, redfaced and roaring at the insulting thought, she was not crazy.
How often have I heard, from well-meaning people or from healthcare-system bullies, that there was plenty of help available, and it was just a matter of getting this or that paranoid to a psychiatrist. As if mental illness was like a having a bad cough or a bum knee. In fact, as Aviv reports, nearly half of people diagnosed with psychotic illnesses insist that they aren't mentally ill (and that number, of course, doesn't include people like my mother or her sister, who were never diagnosed at all).
Moreover, as I have learned from bitter experience, delusional people are very fond of their delusions. A paranoid person is a prince-in-exile, misunderstood and abused, but always the star: The fulcrum of a vast conspiracy, the target of top-flight surveillance tech, the object of some famous person's hidden love. Who'd want to trade that in for being a sorry, addled nobody in line for a paper cup full of meds? When a college acquaintance of mind ended up wearing a mental-hospital tag that read "10WA" (for 10th floor, Ward A) he told us visitors he was in the CIA's supersecret "Project IOWA." Many time in her life, my mother had to choose between friendship and delusion, work and delusion, me and delusion—and she always chose the self she loved best, the self at the center of the world's attention, her beloved delusional self. And a culture of absolute individual rights supported her.
Time was, family or friends or government could force such a person to get treatment, but since the 1970s concern for people's privacy and autonomy has eroded that power. Aviv's subject, Linda Bishop, was released from her final hospitalization with no place to live and without the knowledge of her family. Why? In order to qualify for housing assistance, she would have had to sign a form acknowledging that she had a disorder, and she refused. She also refused to let the hospital inform her daughter and sister, and, according to today's rules on patient privacy, her will had to prevail.
This is a pretty sorry state of affairs—as the psychiatrist Edwin Fuller Torrey points out in the piece, it is bizarre to speak of the freedom of people who are trapped in wholesale delusions. Torrey's organization, the Treatment Advocacy Center, lobbies for laws that would tip the balance away from protecting the right of the mentally ill to deny their afflictions. Many patients, ex-patients and their advocates oppose that move for many of the reasons that prompted the move away from forced treatment in the first place: Why should someone be forced to agree with a doctor's diagnosis? And how could we prevent this power being abused to force the merely strange and unpopular to conform?
What struck me in Aviv's skillful rendition of these debates was its individualistic orientation. Fuller Torrey argues that patients' suffering is greater when they're free to deny their condition. The psychoanalyst and law professor Elyn Saks,herself a schizophrenic, replies that the alleviation of suffering is no reason to violate an individual's rights—and that the suffering of forced treatment may be worse. Where, I wondered, are the rest of us? As framed in the piece, the subject of this debate is the mentally-ill person as social atom, floating in a social vacuum, with no need to consider the suffering or the rights of anyone else.
Missing from this conversation, as it often is in discussions of disability rights, is the effects of the mentally ill person on everyone around him—those who love him, do business with him, try to help him, fear him. In fact, mentally ill people cost the rest of us a lot. They cost us love, anxiety, fear, time and money.
Why doesn't that count? Surely the notion that anyone, sane or insane, has a limitless claim on the rest of us is morally questionable and practically ridiculous. Elyn Saks has written that society "should not be in the business of choosing selves" for individuals. Why not? Society does this to children for 20 years—it's called being raise and educated, a process in which the self that is entirely self-centered and wildly emotional is replaced by whatever the local child-raisers consider a polite young person. Society continues to choose selves for us, by means of convention and law, throughout our lives.
I hate paperwork, like to hold on to money, and enjoy lounging around naked in the sun. But society strongly pushes me to choose a self that files tax forms, pays what they say I owe, and declines to stroll naked to the park. By one light, this is an imposition on my absolute right to choose among possible selves. By another, it's simply the necessary business of connecting people to one another, and to community. When we suggest that mentally ill people should be exempt from such claims on them, we aren't claiming their rights are equal to those of typical people. Instead, we're saying their rights are superior. Whether the misery of treatment is worse than the misery of delusion for the individual could be debated. But when delusions aren't addressed, the misery of the rest of us isnever in doubt.
My mother died at 60. Her funeral was as friendless and strange as her life, with only me, her only child, and her sister in attendance. Her death saddened me, but I have never, in the decades since, ever wished that she was still alive. All in all, a sad, painful, broken life. But her right to immiserate other people was intact, inviolate, protected to the end.

It's Terrible to Force Treatment On the Mentally Ill. But It's Worse Not to. | Mind Matters | Big Think

Wednesday, May 25, 2011

When a CEO Knows Mental Illness First-Hand

From the Treatment Advocacy Center's blog

All of us who live and work with severe mental illness wish we could do more to raise awareness and eliminate barriers to treatment, but not many people have the capacity for changing the game that George Cope does.
Cope is president and CEO of Bell Canada and BCE, Inc. He is also the son of a mother with severe depression. On May 11, Bell Canada announced an unprecedented $10 million donation toward what will be the country’s largest psychiatric hospital – a Toronto redevelopment project that will transform an archaic facility into a “modern campus” that will be “the antithesis of the stereotypical hidden-away psychiatric hospital,” according to "Bell's $10-million donation hailed as mental-health game-changer" in the Globe and Mail.
More than $100 million has been raised for the Centre for Addiction and Mental Health since 2005 in what organizers call “the world’s largest fundraising campaign for mental health and addictions,” public health reporter Andre Picard wrote. Bell contributed $3.3 million to the campaign earlier this year with a national “Let’s Talk” day on which it donated a nickel for every call and text to community mental health groups. In September 2010, the company committed to investing $50 million in mental health causes over four years.
There's not much good news from the mental health front these days so the Canadian story is a welcome break. Bravo to Cope, Bell Canada and the other Canadian companies that are committing themselves to raising awareness, fighting stigma and improving treatment. Here’s hoping some of their fellow CEOs south of the border are taking note.

Strengthening laws, Enacting laws.

While New Yorkers are calling to strengthen assistant outpatient laws in their state, families in Tennessee are simply calling for an assisted outpatient treatment law.  As the author of this editorial states, the statistics show that this law is important and that it works.  Tennessee's proposed bill has been carefully fashioned to minimally impact the budget, providing us with a starting point.  We desperately need this law on Tennessee's books!

http://www.buffalonews.com/editorial-page/buffalo-news-editorials/article432893.ece

Monday, May 23, 2011

For families' sake, fix 'Kendra's Law' - NYPOST.com

New Yorkers are hoping to fix their law while families in Tennessee are left hanging onto the hope that legislators will soon pass a strong AOT law that will not ever need "fixing".

Thursday, May 19, 2011

Officers trained to help mentally ill people

Kudos to the City of Oak Ridge for providing CIT Training to Police Officers.

Planning for the East Tennessee CIT began in April 2010. That was before the fatal shooting of 48-year-old Eugene Rodney Harris. Harris, who reportedly had a history of mental health problems, was shot by Oak Ridge police officers after he allegedly threatened them with a large knife on Hillside Road last July.

Wednesday, May 18, 2011

Advice For Those With a Loved One With Mental Illness - Dr. Lloyd Sederer

 My lecture had just ended when a carefully dressed woman asked me if I had a moment. I could see the distress and exhaustion in her eyes. Her name was Ellen, she said, and her 18-year-old son had become a constant source of worry and fear for the family--that he might do something terrible to himself, or might in one of his angry outbursts attack his sister, grandmother, father, or even Ellen herself. Tony had always been shy and awkward, she explained, but he had never had any behavior problems at school. When Tony turned 17, Ellen said, "...he began to change before my eyes. He became so hard to talk to, always wanting to be by himself, avoiding us and his friends. The school called to say he'd been absent a lot, and when he was there, he wasn't paying attention. I told him I was worried about him and thought he needed to see a doctor, and he said, 'I'm fine. Just leave me alone.' The family doctor said to give him time, but he's only getting worse."
Tony's mom was teeming with urgent questions: What should I do? How much time should I wait? What is the matter with him? Is he safe? Will he ever get well? And then there were the questions I thought she probably wouldn't even know to ask: what types of treatment exist, how to find them, and how to pay for them. How will she know that the treatment is right and working? And perhaps most important, what can she do to help him get the help he needs? All too frequently, people with a serious mental illness, like Tony, insist that they are fine and resist help, frustrating those closest to them. Not only does not getting treatment cause needless suffering, it can be associated with behaviors that are dangerous to the person himself, or to others.
I recall the wife of an attorney whose husband had become severely depressed after some business setbacks mid-career; the older, adult sister of a teenager whose weight had dropped from 120 to 90 pounds and who was constantly exercising and saying she was too fat; the spouse of an Army Reserve soldier back from his second tour in Iraq and drinking heavily, unable to sleep, plagued by nightmares and saying his family would be better off without him. Like Tony, the loved ones of these family members wanted no help. Their illnesses left them convinced that nothing was wrong, or feeling ashamed or hopeless, or all of the above.
More than 50 million Americans, youth and adults, are diagnosed each year with a mental illness like major depression, panic disorder, generalized anxiety disorder, PTSD, OCD, eating disorders, bipolar disorder, schizophrenia -- and alcohol and drug abuse, which frequently co-occurs with serious mental disorders. Their parents, spouses, siblings all worry about what to do to help them and what will happen next. While the most alarming instances of violence are truly rare -- usually the product of untreated mental illness and active drug and alcohol abuse -- they dominate our news. These are tragic illustrations of how not intervening early and effectively for problems that had broadcast themselves for quite some time can escalate into events that scar our national consciousness.
I have talked with thousands of family members like Ellen in my 35 years as a psychiatrist. Their pain and confusion is indelible in my mind. For them, and the millions of others who have a loved one with a mental illness, I can report good and bad news.
The good news is that improvement rates for serious mental illness like major depression and bipolar illness are as good as or better than those for chronic physical diseases like diabetes and heart disease -- provided the patient receives the right treatment consistently. The bad news is that an astonishing 80 percent of people in the U.S. -- tens of millions of people -- with treatable mental disorders do not receive proper diagnosis and effective treatment. One of the biggest challenges families face is often not the disease itself but the fight their family member will put up against getting any help.
Mothers like Ellen want and need to understand what has happened to their once happy child. Like other parents, spouses and siblings of anyone who suffers with depression, or an eating disorder, or PTSD -- mental conditions that are more common than any of us want to believe -- they are each trying to understand and help their loved one through the pain and dangers of their illness, and relieve the entire family of the burden these diseases create.
Every family (and friends and co-workers) with a member who has a mental illness encounters the same formidable problems. These families ask the same critical question, "What should I do"? I usually begin by saying four things:
Don't go it alone. Mental health problems, including addictions, are among the most common medical problems that exist! This means that many others, in your family and among your friends, have been down the same road you are on. Who can you confide in, trust, and ask to join you in thinking through the problems you face and the solutions you will need to find? Turn to your family doctor and trust your judgment; if necessary, don't accept a 'give it time' response.
If you know someone who has had a depression, addiction, traumatic disorder or other mental illness and is open about it (and, thankfully, more people are) ask for guidance; you may hear the good, the bad and the ugly but the more you learn the better. Turn to advocacy organizations like a local chapter of the National Alliance on Mental Illness (NAMI) or the Mental Health Association (MHA); they have help lines and may also provide referral information. Whatever you do, don't go it alone. You owe that to yourself and to your loved one. That lesson has been learned with every serious illness, including diabetes, heart disease, cancer, arthritic conditions, Alzheimer's and countless other conditions. Mental disorders are no different.
Don't get into fights with your loved one. This may be the hardest prescription of all. Faced with clear evidence of problems, your reason defied, and your worry and love driving you, you want to push harder, insist on your loved one facing the facts, doing something! That is the moment you need to take a deep breath and figure out how to control yourself.
Getting into a fight does not work. In fact, sometimes fighting will drive them more into their shell of denial and defeat. You need to ask yourself what is my loved one thinking or feeling and if you can't understand then how can I find out? You want to try to understand how their behavior may be serving them, in a way you don't yet comprehend. You also want to consider what leverage you have; for example, in addition to your love and concern, which is not quite working, what supports are you providing (like a cell phone, money, car, even a place to stay) that can be used to negotiate for what needs to be done.
In another Huffington Post article I introduced the concept of 'motivational enhancement', a process that helps a person see why they do what they do, why they might bother to change, and how to go about it. This is but one example of how to avoid a fight, and there are other techniques you can learn. Avoiding a fight is not the same thing as being disengaged; in fact, it is staying just as involved -- in a different way. But don't get into a fight. The battle is usually lost if you do.
Learn how to bend the mental health system to your needs. Mental health care in the U.S. is broken, as you have or soon will see. You will need to learn how to piece together its parts and make it work for your family. Because you are not alone there are others who can guide and coach you -- you can find them among other countless other affected families and in advocacy organizations. Like it or not, you will need to become a vocal spokesperson for what your loved one needs in a system that is fragmented, not organized to be accountable, not funded to incentivize effective care, and very uneven in its quality, despite good people trying to do the right thing. It may not be fair, or right, but health care in general -- not just the mental health system -- now demands informed and self-directed consumers and families.
Settle in for the siege and never give up. Few disorders, mental or physical, come and go in a short period of time. Most persist -- think of hypertension, heart disease, diabetes. The path of recovery is usually not immediate or continuous. The illness may go untreated, the treatment response may not be quick enough, services can be difficult to access and the quality of care may not be good enough. And through it all, your loved one may continue to resist getting help.
Your morale and determination will be tested. Never give up. My profession has learned again and again that at a certain point, often difficult to predict, a person's engagement in care and the course of illness shifts -- and a life is restored. When your loved one (and you) learns how best to manage their illness, and their overall wellness, then life will get back on track. I have seen so many people with serious mental disorders have full and gratifying lives. They may not be obvious in everyday life because fear of stigma has them quiet about their conditions; but I assure you they stand as terrific examples of people who have learned to live with their illness, and get the support they need to do so.
For all the Ellens, families and friends reading this post, start with these four guideposts. In future posts, I will discuss in more detail how to manage the mental health system and how to work with your loved one so they seek or continue to get the care they need.

..................

The opinions expressed herein are solely my own as a psychiatrist and public health advocate.
Dr. Sederer receives no support from any pharmaceutical or device company.
Visit Dr. Sederer's website questions you want answered, reviews and stories --- www.askdrlloyd.com

Prisoner with Mental Illness Locked in Solitary Filth in Private Jail

Prisoner with Mental Illness Locked in Solitary Filth in Private Jail

After a prison employee reported Mr. Horton's condition to the Metro Nashville Health Department, he was eventually moved to a special needs facility to receive mental health treatment. Later released, he now lives with his grandmother in Nashville. Yes, this occurred right here in Tennessee.

Monday, May 16, 2011

'Kendra's Law Directly Results in Reduced Crime and Violence'

reprinted from The Treatment Adovacy Center

A new, long-term study published in the May 2011 issue of Psychiatric Services reports dramatic benefits of assisted outpatient treatment (AOT) to its participants and society.

“Arrest Outcomes Associated with Outpatient Commitment in New York State” by Bruce G. Link, PhD, of Columbia University and four co-authors followed 183 patients at outpatient clinics in New York City, 86 of whom had participated in Kendra’s Law and 86 who had not.  The study found:
  • The population that never received AOT was twice as likely to be arrested as the group that did receive it.
  • Among those receiving AOT, the risk of any arrest was 2.66 greater before participation than after.
  • Among those receiving AOT, the risk of arrest for a violent offense was 8.61 times greater before participation in AOT than after.
“AOT, as implemented under Kendra’s Law in New York State, is a policy that substantially reduces the risk of arrest, including arrests for violent offenses among people with serious mental illnesses,” the authors wrote. “From the vantage point of a general public concerned with violence…, this is a very positive and straightforward outcome: Kendra’s Law directly results in reduced crime and violence.”

The authors said the reduced arrest rate “pushes us to consider a very beneficial trade-off in coercion, with a relatively small exposure under Kendra’s Law forestalling a substantially larger exposure delivered by arrest.”

An abstract of the article may be viewed at no charge online. Non-subscriber access to the full article in Psychiatric Services is available on a fee basis.

Jill Bolte Taylor's stroke of insight | Video on TED.com

Jill Bolte Taylor's stroke of insight | Video on TED.com

Nurse Legislator Advocates for Mental Health Bill | New York Nursing News

Nurse Legislator Advocates for Mental Health Bill | New York Nursing News

Saturday, May 14, 2011

4 STEPS TO FIX OUR BROKEN SYSTEM

Gov. Haslam restores money for TN Mental Health System

Unfortunately this link has disappeared: http://www.wbir.com/news/article/169683/2/Haslam-restores-money-for-TN-mental-health-system

Try this one:  http://tnreport.com/2011/05/18/more-revenues-means-more-spending/

NIMH · International Impact of Bipolar Disorder Highlights Need for Recognition and Better Treatment Availability

NIMH · International Impact of Bipolar Disorder Highlights Need for Recognition and Better Treatment Availability

NEGLECTED TO DEATH | Part 1: Once pride of Florida; now scenes of neglect - Neglected to Death - MiamiHerald.com

NEGLECTED TO DEATH | Part 1: Once pride of Florida; now scenes of neglect - Neglected to Death - MiamiHerald.com

The Loughner files: Pima College "not a mental health facility" - KGUN9 On Your Side, Tucson News, Weather & Sports

The Loughner files: Pima College "not a mental health facility" - KGUN9 On Your Side, Tucson News, Weather & Sports

Four Months Later: The Legacy of the Tucson Shooting

Four Months Later: The Legacy of the Tucson Shooting

Suit accuses Fla. disabled program of mistreatment - Florida Wires - MiamiHerald.com

Suit accuses Fla. disabled program of mistreatment - Florida Wires - MiamiHerald.com

During Mental Health Month, we need to focus on prisons

During Mental Health Month, we need to focus on prisons

Thursday, May 5, 2011

Kudos to Sheriff Ken Stolle, Virginia Beach


Sheriff Ken Stolle has offered the city $121,596 from the jail's reserve funds, enough to provide psychiatric medicine and therapy to about 450 poor people with mental-health and substance-abuse disorders served by a city program.
The offer was announced Tuesday night during City Council budget discussions. Last month, city officials sought to cut that amount from the Beach's mental health substance abuse program, saying they had to make "tough choices."
The council is likely to vote to accept the sheriff's offer at its meeting next week.
Mental health advocates and Stolle said the cuts could mean those not treated would wind up back in hospitals or jails.
Stolle said Wednesday that he understands the needs of individuals with mental-health issues because he served on the Health and Human Resources Subcommittee for 10 years when he was a state senator.
There are about 250 inmates in the city jail with mental illness who are not receiving proper treatment, and cutting treatment programs is not an option, he said.
"The money being cut would dramatically impact the people coming into my jail with mental illness," he said. "This is money well-spent, and it will decrease the money I'd spend housing them."
He said there was also an ethical element to his offer. "There's a responsibility for all of us in government to provide a safety net for the mentally ill," he said. "It helps me and them, so I think it's a win-win situation."
If the therapeutic and medication services were cut, some of those affected would've been placed on long waiting lists and others probably would not have received services at all. Some receive Medicaid, but many have no insurance.
The program is administered by the city's Department of Human Services, which could see its operating budget decrease by 1.9 percent, to $107.7 million, because of proposed budget cuts.
John W. Jones, executive director of the Virginia Sheriffs' Association in Richmond, said he hasn't heard of any other instances in the state where a sheriff used reserve funds to pay for proposed mental-health and substance-abuse cuts.
It's not surprising that Stolle is making an effort to address the mental-health problems in his jail because 16 percent of incarcerated people around the state need mental-health services, Jones said Wednesday. Also, jail and prison staff are not trained to handle inmates with mental-health issues, he said.
Kay Ashby, president of the Virginia Beach chapter of the National Alliance on Mental Illness, applauded Stolle's decision. "You wouldn't put a cancer patient in jail, would you?" Ashby said.
Aileen Kroll, legislative and policy counsel for the Treatment Advocacy Center in Arlington, said there is an increasing awareness of the consequences of not treating those with mental illness.
The nonprofit center advocates for mental illness research and treatment.
Bob Morin, the city's Human Services director, said the department was pleased that Stolle wanted to pay for the services. Morin said the department spends about $1.3 million each year treating inmates with severe mental health and substance abuse disorders in the city jail.
"It's a very exciting prospect to be able to work alongside of the Sheriff's Department and try to work with the folks in the jail who are having these mental illnesses and substance-abuse disorders," Morin said.
Jennifer Jiggetts, (757) 222-5150, jennifer.jiggetts@pilotonline.com