Monday, February 27, 2012

Oregon: A model for Tennessee

Prison Mental Health Unit Not Designed For Treatment
Chris Lehman OBP News | Feb. 23, 2012 10 p.m. | Updated: Feb. 24, 2012 3:31 p.m.

SALEM, Ore. – Oregon is putting the finishing touches on a gleaming new mental health hospital. The Salem facility replaces a crumbling 130-year-old building and is hailed as a new chapter in the state's troubled history of treating people judged guilty but insane. But there are far more mentally ill people in Oregon’s standard prisons. And the inmates with the most severe mental problems are housed in a ward designed for hardened criminals. That facility isn’t designed for treatment.

This story begins last fall, when I sat down for an interview with Max Williams, Director of the Oregon Department of Corrections.

Williams was stepping down after nearly eight years on the job. He spoke to me at length about improvements in the way the agency houses and treats mentally ill inmates.

Advocates for the mentally ill have long complained that Oregon’s prison system doesn’t provide adequate treatment. Williams says he made it a priority to improve services and beef up staffing. But he left me with this warning.

"I don't want you to think in any way, shape or form that we've solved the problem," he said. "What we've done is we've done a lot of work to make things better, but it continues to remain, I think, one of the great challenges."

So I decided to go see what life is like for mentally ill inmates at Oregon's largest and oldest prison -- The Oregon State Penitentiary in Salem. It took some time to arrange a visit. So in the meantime, I sought out Bob Joondeph, the director of Disability Rights Oregon.

He's toured the mental health wing at the state pen. He describes it as "dark" and "confined."

"It's a circular unit, two tiers of cells with metal mesh across the front of them, a guard tower in the middle, no light into that unit."

That cell block was built 20 years ago for an entirely different purpose.

"It was designed for very violent inmates that are being punished," Joondeph explains. "And it's now being used to house the people with the most severe mental health needs."

Joondeph says the conditions on the unit are so bad, it can exacerbate the mental health problems of the inmates there. He says that makes it less likely they’ll come out of prison ready to function in society.

I finally got the chance to visit myself. Prison officials wouldn't let me take along a microphone or a camera. But here’s the thing I noticed: when I talked to those officials afterwards, they used some of the same words to describe the unit that critic Bob Joondeph used.

"Dark. Crowded. We don't have treatment space, we don't have interview room space," says Jana Russell. She's head of Behavioral Health Services for the Oregon Department of Corrections.

She helped show me around one of the mental health units at the State Penitentiary. And she readily admits the facilities were not designed to house the mentally ill. During our tour we visited a narrow recreation area with a concrete floor. Eight feet wide. It’s one of the only ways for inmates there to get any natural light -- and that light comes through a barred window high above their line of sight.

On the wall was an odd metal frame. It had no discernible function and stuck out so far you'd need to watch out to avoid getting whacked in the head as you walked past. I asked Russell about it later. She said an accidental bump on the skull was the least of her concerns.

"That thing, that metal thing that was on the wall. That thing would cause me concern if I had an inmate who was suicidal," Russell says. "I wouldn't want to put him outside unsupervised, because you could hang yourself on that."

Just a fraction of the inmates diagnosed with mental illness are housed in the specialized wing -- only those with the most severe and persistent symptoms. Russell says despite what she calls a history of under-funding mental health services, staff on the unit are doing the best they can with the resources they have.

Gabriell Gitnes manages two of the mental health wings at the State Penitentiary. She says if she had been around when the building was designed…, "Well, I think everything would have been different."

For one thing, she says the current set-up doesn't have much, if any, therapeutic value. "When I think of the physical environment for the people that have to live here, I think the lack of outside space, the lack of grass, is huge."

Still, Jana Russell provides a reality check.

"This is not a hospital," she says. "We're not a state psychiatric facility. We are a prison."

And the prisoners here committed crimes, sometimes violent ones. Unlike patients at the Oregon State Hospital, these inmates were not judged to have committed their crime as a result of their illness. In some cases, the illness developed after they were incarcerated.

The state of Oregon is constitutionally required to treat mentally ill inmates to the same standards as they would get outside of prison. Mental health advocate Bob Joondeph say if the purpose of treatment is for people to get better, "This is the type of environment that does just the opposite.”

On the Web:

Oregon Department of Corrections Behavioral Health Services:

Kudos to Scott Peters of South Dakota - We need his voice in Tennessee!

My Voice: The Argus Leader

The World Health Organization has long recognized that mental health forms the basis for all health. Indeed, mental health disorders account for four of the top 10 causes of disability in the U.S., and they are significant contributors to other leading causes of disability, such as cardiovascular disease. The cost of mental health disabilities in the U.S. exceeds $100 billion annually.

It is significant that the S.D. Health & Human Services Committee, on behalf of the Department of Social Services, introduced SB15 to reduce barriers to mental health treatment and to promote recovery from disabling mental and physical conditions. SB15 was a product of a lieutenant governor’s Behavioral Health Workgroup, consisting of mental health, chemical dependency, medical and legal professionals, consumer advocacy groups, legislative and state agency representatives.

Broadly, the primary outcome of SB15 is that mental health disorders can now be identified and treated earlier — as quickly and effectively as are other serious medical conditions. Upon recognizing the symptoms of a stroke or a heart attack, our loved ones and physicians would never knowingly postpone or fail to administer proven, effective treatment. Yet, in mental health care, for a brain disorder every bit as serious as a stroke, current law imposes roadblocks to effective care and treatment.

Here are a few examples of how SB15 aligns mental health care with other medical care:

A court-appointed guardian of an incapacitated person can generally seek medical treatment for that person’s physical illness, by “substitute informed consent.” In current mental health law, however, the guardian must have specific court authority to admit the person for treatment and the incapacitated person must also agree to that admission. This makes no sense, and SB15 removes those barriers to obtaining mental health care.

An agent, appointed by a person’s durable power of attorney, now will be able to admit that person for mental health care, under the terms of the power of attorney, just as any other medical care. If a person is committed for involuntary treatment, because the person has a severe mental illness and is a danger to self or others or chronically disabled by the illness, the mental illness board may now also assess whether the person is incapacitated for the purposes of making treatment decisions, and it may order effective treatment at the commitment hearing, instead of waiting for a separate court proceeding.

Under SB15, the Board might consider treatment for a co-occurring substance use disorder. Current research shows that a majority of people who have a severe mental illness also have a substance use disorder (perhaps over 65 percent). The two disorders together are often so intertwined that these patients cannot recover — unless both conditions are effectively treated together. SB15 now aligns the best practices for treatment and recovery from both mental illness and CD disorders in one process.

Finally, it is historically clear that severely mentally ill persons often fail to continue effective treatment after an inpatient stay.

SB15 allows the board to consider an outpatient commitment and a treatment order as a lesser restrictive alternative to continued inpatient treatment. It also allows treating physicians and outpatient program directors to seek assistance from law enforcement and the board to attempt voluntary compliance with a prescribed course of treatment. These provisions are designed to help with “revolving door” issues, to promote a continuum of care after inpatient treatment, and to avoid having to wait for intervention until the person is in such poor mental health that it takes an extended time for the person to again recover.

We now know, from functional MRIs and current research studies, that the sooner a person is effectively treated for a severe mental illness, the better chance that person has for a long-term recovery and the lesser chance for a long-term disability. This legislation helps individuals, communities, and treatment providers improve the overall, foundational health of South Dakota citizens. I commend the lieutenant governor for his focus on mainstreaming mental illness treatment, the Workgroup for developing this legislation, and the Department of Social Services for supporting it.

Written by
Scott Peters, co-chairman of the Minnehaha-Lincoln County Board of Mental Illness.

Sunday, February 26, 2012

Anguished mother of adult bipolar son speaks out

Jennifer Hoff, the mother of Matthew Hoff, 18, bipolar, talks about his recent "gone missing" period and being found by police, and society's problems in dealing with people like Matthew.

Saturday, February 25, 2012

Subject of restraining order offers glimpse into mental illness

Yet another compelling story in support of AOT:  share

Friday, February 24, 2012

LETTER: Psychiatric hospital closure needs to stop

"The fact that Alabama officials seem to believe they can avoid the costs associated with mental illness — by not treating the state’s most ill citizens — is astounding." Kristina Ragosta

Thursday, February 23, 2012

The Cycle that Never Seems to Quit

Transitioning to adulthood is especially difficult for our children with SPMI and turning 18 can trigger a never ending cycle of jail and hospitalizations. Becoming a legal adult overnight can cause some parents to lose a child, literally. 

Assisted Outpatient Treatment (AOT) could bridge this gap, but - unfortunately - it looks like it will take a change at our State's highest administrative level for this to ever happen in the Tennessee.

Doug Varney, Gov. Haslam's appointed Commissioner of Mental Health, is adamantly against any type of mandatory treatment for people with untreated serious and persistent mental illness - even though it is a well known fact that Tennessee is only one of 6 states in our entire country without AOT laws on the books.  

It's stories like this that reinforces the need for families to be able to intervene for their loved ones: 


A mentally ill Orange County teen who had been missing since his release from jail  this month has been located, after he was arrested by Santa Ana police, his family said.
Matthew Hoff's family posted on the Facebook page "Matthew We Miss You Please Come Home"that the missing teen had been arrested Tuesday by Santa Ana police.
"Matthew is OK!" the post said.
"It is great news and we will be able to sleep tonight knowing our son is safe. BUT ... it's just the beginning again with this CYCLE that does not quit."
Hoff, 18, was apparently arrested on suspicion of having narcotics, his family wrote in a Facebook post, and later confirmed by email.
His family and authorities have been searching for him since he was released from a 60-day jail stay at 4 a.m. on Feb. 7.
His mother told The Times that Hoff had been in custodial treatment for severe mental illness for most of his adolescence, but had to leave the system when he turned 18. During the two-month jail term for taking things from a neighbor's car, his family said, he went off of his medication.

Monday, February 20, 2012

The Storms

There are so many dangers when a person is mentally ill and homeless, but one of the worst is to be exposed to the elements during all seasons. I have not heard anything or seen anything written about this danger, but it is very real.

valerie-foxDuring my homelessness, one of the most wretched experiences was the cold, wet windy days of winter. Never having proper shoes, I would be exposed to slush, biting cold, and some days numbness in my feet. I was lucky to pretty much always have a warm coat, but shoes were tricky for me. Not many were comfortable for me so I resorted to wearing comfortable sandals in the winter and summer. You can imagine walking through a winter storm with only sandals on my feet; yet that is what I did. I remember being afraid I would get frostbite, but then my voices would tell me I would be alright. And I continued living homeless.

To cope with the very bad weather of winter, I would utilize the Morristown Library on many a day of rain or snow or sleet. This is the same library that was sued by another homeless person. I was never made to feel as an outcast. I would sit through a storm; or if I could find a quiet place, I would close my eyes for a time – not sleep but rest. No one gave me a hard time. I was never asked to leave, and I was afforded a few hours of warmth and safety.

After realizing the winter in Morristown would be very difficult, I gravitated to New York where I knew I could find shelter in terminals; and this is primarily where I spent the winter. I remember one of the reasons I decided to seek shelter in a long-term care facility was because I knew I could not face another winter living the way I was.

To close, I will say I never did get frostbite. However, my feet remain very sensitive; and I have to be very careful about shoes I choose. It is many years after homelessness, and my body is healthy. I am very thankful to a higher power for seeing me through that time and allowing me to live a good life in mental health.  


(a person in recovery)
Reprinted with permission of Valerie Fox
Click here to email Valerie Fox.
For more about the role of libraries as shelter for homeless individuals with mental illness, see Unintended Shelters.

Wednesday, February 15, 2012

A Neglect of Mental Illness

By letting mental afflictions go untreated, we consign millions of Americans to misery and put a drag on our economy.  Great article just published in Scientific American:

Thursday, February 9, 2012

There is a great need for treatment on the streets of Knoxville

I spent another Wednesday evening under the I-40 bridge yesterday.  Had a long conversation with a Knox County Sheriff's deputy there about the obvious number of people exhibiting signs of untreated serious mental illness.  He agreed.  The need for treatment is OVERWHELMINGLY great on the streets of Knoxville.  It's there every day and every night, not just on  Wednesdays, under the I-40 bridge in the heart of downtown Knoxville.  We can't continue to diminish services to these people under the pretense of "doing more".  Community services will not "do more" unless the services are actually provided to them.  I think that if the powers who have determined Lakeshore's closing would spend one Wednesday night under the bridge, they would see the future of those whom they are closing Lakeshore's doors to.

Did you know a database of preventable tragedies in Tennessee exits?


The Treatment Advocacy Center’s Preventable Tragedies Database is a product of its times – and its times keep changing.
preventable-tragedies-databaseAvailable from virtually every page of our website, the Database initially was a collection of newspaper articles kept in file folders. Founder E. Fuller Torrey, MD, started clipping the stories in the early ‘80s as he saw “symptoms of things going wrong” as state hospitals closed and patients were discharged into communities that were unequipped to meet their needs.
“It was very random because it just consisted of what I could see for myself,” he says of the initial collection.
Not long after he founded the Treatment Advocacy Center in 1998, a dedicated system was created to track the "preventable tragedies" he had been tracking. Its purpose was to catalogue incidents that were reported in the news and involved either a victim or a perpetrator of a violent episode who suffered from severe mental illness (usually untreated). Ever since then, advocates of treatment law reform have used the system as a tool for illustrating to public officials that not treating severe mental illness has consequencies; media, researchers and legislative staff have consulted it as a source of state-specific information and a barometer of the systemic problems behind sensational headlines. 
In its early days, entries for the Database were identified by using a computer-assisted legal research service. Eventually, Google took over as the search engine of choice. Essentially every weekday – then and now – a designated staff member searches the Internet for stories about preventable tragedies. Each story is then added to the Database either as a new incident or as an update to an existing one; website visitors can search the system by name or type of incident.  
The information we're able to mine in this way has changed over time.
For several years, the long reach of Google made the Database more comprehenensive. But now an increasing number of newspapers are erecting “pay walls” to reserve their material for paying subscribers, and some newspaper stories are no longer available. When TV and radio stations began publishing transcripts of their stories online, broadcast news reports became more available to us. But when transcripts aren’t published, those broadcasts are out of sight and outside the Database. Another variable: If law enforcement doesn't identify mental illness as a factor in an incident, our search parameters won't find the event at all.
The practical impact of factors like these was illustrated by the Minnesota Star Gazette’s recent announcement that it is reversing a longstanding policy and will begin reporting suicide and mental illness-related calls to police (without revealing names). When media don’t report that mental illness is involved in a local tragedy, we don't see it, and we can't include it. If a news organization decides to ignore an entire class of incidents, such as suicides, we will not be able to find them, and the Database will be without them.
Despite challenges like these, we have catalogued more than 5,600 incidents, and we continue to track news for the Preventable Tragedies Database almost daily and update the system routinely. In explaining its policy change, the Gazette's editors wrote that leaving suicides off its pages constituted “sweeping the problem” of mental illness and its impact on law enforcement “under the rug” (“Star Gazette plans change in how it reports mental health and suicide calls,” Jan. 20).
We agree. A lot of things involving severe mental illness have gone wrong – and are going more wrong – as treatment options are eliminated or reduced for those with the most serious mental illnesses. As long as these consequences are swept under the rug, there is little hope they will be addressed or – in the case of problems the government doesn’t track at all, including the role of mental illness in police shootings – even recognized.
Anecdotal though it may be, the Preventable Tragedies Database is one of the ways we keep issues that result from not treating mental illness in public view – and make it harder for the public and policy makers to ignore them. It is also a way to memorialize those whose lives were lost in tragedies that could have been prevented.

Monday, February 6, 2012

LSU system planning on severe mental health cuts

LSU system planning on severe mental health cuts
“This is going to cut in half our crisis beds in the emergency department, so we are going to be in a situation where patients are going to be languishing in the emergency rooms in medical beds, where other folks who are coming in with heart disease would normally be,” said DeSalvo. “We are also loosing with these cuts, about a quarter of the impatient psychiatric beds that we have at DePaul hospital.”

Thursday, February 2, 2012

How many are overlooked right here in Knoxville? Spend an evening under the I-40 bridge downtown and you will see.

D.C. report: Efforts to help troubled White House retiree James fell short. 
Common sense should have raised an alarm, but it didn't.
 Washington, DC’s inspector general has released a damning examination of the city’s neglect of Theodoric James, an elegant White House retiree who worked under 10 presidents before dying in squalor last summer. Family and neighbors reported his alarming deterioration for more than two years to a host of city officials who repeatedly declined to intervene.

In an 81-page report, Inspector General Charles J. Willoughby said 70 DC employees participated “in some manner” in “saving the offending property” where James lived “but not the property owner.”

Willoughby’s description exposes a dutiful bureaucracy that meticulously communicated and collaborated to visit, clean up and repair James’s DC rowhouse – where buckets of feces and urine filled the front porch and rats ruled – but failed to help the desperately ill man inside.

“Unfortunately, neither (Executive Office of the Mayor) employees nor most of the mental health and social service professionals seemed willing to look beyond the most conservative interpretation of the terms ‘mental illness’ and ‘self-neglect,’ despite what they observed and what common sense must have signaled to them about the ineluctable ramifications of his aberrant behavior,” Willoughby wrote in “Sufficiency of District Agency Services Provided to a District Resident" (Jan. 2012).

“As one agency participant noted, given (James’s) behavior, common sense should have raised an alarm.”

But it didn’t.

At least 34 visits were made to the house by representatives from different DC departments, who managed to dispatch a hazmat crew to remove wastes, clear out trash and vegetation, make structural repairs and bill thousands of dollars for their efforts before James, 71, died of heat exposure on Aug. 1, 2011.

Willoughby offers four recommendations to avoid a repeat of such uncommon sense. One is modification of the city’s civil commitment law “where existing language impedes efforts to provide the type of assistance called for by the severity of the conditions.”

We have no objections to the inspector general's recommendation, but wordsmithing alone isn’t going to remedy the neglect that characterized DC's response to James and that characterizes innumerable other cities' responses to countless others suffering from untreated severe mental illness. Until government jurisdictions start acknowledging that some people are too ill to save themselves and stop ignoring the civil commitment laws they could use to intervene in psychiatric crisis, men and women like Theodoric James will continue to suffer needlessly and to die alone.

And don't even get us started on how many of these people could be treated for the dollars spent paying for 70 bureaucrats, 34 house calls, a hazmat crew and an 81-page report.

See "Efforts to help troubled White House retiree James fell short" in the Washington Post (Feb. 1).C
See "10 buckets of feces but no 'danger' to self or others?" from our blog archive.
Go to:

Wednesday, February 1, 2012

Not Tried But Sentenced for Insanity

From the website of the Treatment Advocacy Center
Conditions for prison inmates with severe mental illness are so unspeakable in some places that courts have declared them in violation of the US constitution, but the treatment of those under arrest but too ill to be brought to trial is no less “cruel and unusual.”
Tina Funderburk, a 37-year-old mother diagnosed with paranoid schizophrenia spent most of the last eight years behind bars without being tried because she never was sane enough to stand trial for killing her 3-year-old daughter. She had been offered a plea bargain of four years – half as long as she spent waiting to go to trial – back in 2004 but refused it in her delusional state. Charges were dropped recently only after the Mississippi Clarion Ledger published investigative reporter Jerry Mitchell’s story about her plight (“Woman locked up 8 years without trial,” Jan. 1). Since then, she has been sent to a Mississippi state hospital for treatment.
seth-winderNo such fate for Seth Winder, 31. Diagnosed with paranoid schizophrenia at the age of 16, he has been shuttling between jail and the Texas state hospital in Vernon since 2008, when he allegedly killed his partner (“Can accused killer Seth Winder stay sane long enough to stand trial?” Dallas Observer, Jan. 12). Winder’s stepmother wrote a book about the case, and A&E's The First 48 filmed Winder undergoing police questioning. But, so far, Winder remains in the same purgatory Funderburk occupied for so long – charged with a crime he is too disordered to stand trial for, intermittently hospitalized. At last report, he was in jail waiting for a bed at the state hospital bed, where the state presumably will again try to induce “a state of synthetic sanity” so he can stand trial “for a crime that he allegedly committed while unmedicated.”
“Synthetic sanity” reportedly already has been created for Mary Nguyen, 44, of Minden, Louisiana. She’s been shuttled from jail to hospital and back to jail since 2007 on charges of felony theft and criminal mischief. KTBS in Shreveport reported last week that she’s “heavily medicated,” and the court has now found her “mentally fit” to stand trial (“Minden woman jailed nearly five years without trial," Jan. 25). She’ll be tried next month unless another case with “higher priority” bumps her to May.
Stories like this reach us every day – sometimes more than once a day. Each one is a multiple tragedy: A person suffering from a brain disease that responds to treatment doesn’t get treatment, commits a criminal act while in the condition that results from non-treatment – and then is essentially sentenced to an indeterminate sentence behind bars as long as he or she remains ill. In the process, victims suffer and sometimes die, and family members agonize, often over how their efforts to get treatment and prevent tragedy were thwarted. 
Inexcusably cruel – but not nearly unusual enough.