Thursday, April 19, 2012

Two Landmarks on April 19, 2012: Second Anniversary of the Parkwest Hospital Shootings & AOT Finally Comes to Knoxville as a Pilot Program

Reprinted from the Knoxville News Sentinel
May 23,  2010

Abdo Ibssa was not a monster. But the man who shot three staff members at Parkwest Hospital last month, killing one before taking his own life, lived in the grip of a monstrous disease. Severe mental illness made Mr. Ibssa believe that a doctor at Parkwest had implanted a tracking chip in his body, and propelled him to the hospital on a violent rampage.
How did we as a community allow this to happen? One might assume that Mr. Ibssa somehow slipped under the radar of an overburdened mental health care system. But the truth is even sadder.
Far from being under the radar, Mr. Ibssa was known to local authorities. According to news reports, Ibssa was accused of violently attacking a man last year, and earlier in 2010 was committed by his family to a Knoxville mental hospital. When he was deemed stable, he was released with a prescription for medication and (tragically) nothing more. After the shooting, police found the pills in his home, apparently un-utilized.
It is a pattern all too familiar to people like me, who struggle endlessly to keep a mentally ill family member out of harm's way. Our loved ones reject outpatient care, and the system does nothing to stop them until they do something to prove they are "dangerous to self and others," the standard for involuntary hospitalization.
Eventually they are released to repeat the heartbreaking cycle, unless of course their dangerous behavior included a violent crime. Then they get years of free mental health care in a prison cell.
The root of the problem is that many people with severe mental illness are incapable of recognizing that they are sick and in need of treatment. The clinical term is anosognosia, or lack of insight. In the minds of those who suffer from it, there is nothing wrong with them. When left on their own in the community, they stop taking medication.
While people with mental illness on the whole are no more violent than the general population, untreated severely mentally ill individuals are a different story. Studies show that untreated severe mental illness is among the most reliable predictors of future violence. And yet when an outpatient goes "off meds" in Tennessee, families and caregivers must stand by helplessly, knowing with certainty that dangerous behavior is around the corner, but legally powerless to prevent it.
In most states, a legal tool known as "assisted outpatient treatment" (AOT) is a potential solution. Under an AOT law, a mental health official or family member can seek a court order, requiring a severely mentally ill person to comply with treatment as a condition of remaining in the community. The purpose of the court order is not to punish the person if they should happen to stray off treatment. Quite the contrary. It is to ensure that the person's condition is constantly monitored, and to give authorities the legal right to help as soon as treatment non-compliance is detected.
These laws have been found to dramatically improve outcomes for patients. In New York, researchers have documented steep declines in rates of homelessness, hospitalization and incarceration.
Tennessee is one of only six states without some form of AOT on the books. In recent years, attempts by legislators to pass an AOT law have been stymied by the state Department of Mental Health, which has cited concern for the civil liberties of the mentally ill and the cost of comprehensive outpatient care.
The civil liberties objection is absurd to me, as it should be to anyone who has spent time in the company of an actively psychotic person. This condition is a living hell that no one would ever rationally choose for himself. These individuals are crying out for our help, even if their words and actions say the opposite.
The cost objection is incredibly short-sighted. Want to talk high cost? Look at what the state spends to hospitalize, prosecute and incarcerate people who we currently permit to become dangerous. The opportunity to spend a little up front to avoid these bills down the line should be seized by even the most hard-hearted fiscal conservative.
The time has come for Tennessee to leave the Dark Ages of mental health care and enact an AOT law. Some of us on the front lines of this issue have been saying so for years. But if the Parkwest tragedy doesn't wake up our legislators and mental health officials to this urgent need, I can't imagine what will.

Karen Easter

Bill Makes Knox a 'Pilot Project' for Mental Health Outpatient Treatment | Humphrey on the Hill |

Good News:  AOT is coming to Knoxville, Tennessee!
Bill Makes Knox a 'Pilot Project' for Mental Health Outpatient Treatment | Humphrey on the Hill |

Thursday, April 5, 2012

Voices is a feature length documentary about the mentally ill who live in the shadows of society.

In the 1950's and 1960's, inhumane treatment in mental asylums, the advent of promising new medications, and increasing budgetary concerns led to the widespread deinstitutionalization and release of over half a million mentally ill individuals from psychiatric hospitals around the United States.  The hope was that mental health clinics would be able to provide treatment and support for these vulnerable individuals.  However, community resources were vastly insufficient to meet the needs of this population.  While some have benefited from this cultural shift in care, others have slipped through the cracks.  

"One of the greatest diseases is to be nobody to anybody." -  Mother Teresa
As resident psychiatrists, we were amazed by the number of seriously ill individuals who end up homeless and forgotten. Even more fascinating were the narratives we heard about their life journeys. We are convinced that these stories are powerful, compelling, and have the potential to change the way society views mental health and illness.
This documentary film will be told through the eyes of several individuals who live in San Francisco and who we have grown to know personally over the past year. Some have been living on the streets for decades, others are now housed, but all are connected by their struggles, and successes, with serious mental illness. Teaming up with a filmmaker based in New York City, we wanted to shine a light on these individuals and give viewers a unique, honest, and detailed glimpse into their lives. In doing so, we aspire to give them a voice and to humanize their experiences so that they are defined not by their disability or homelessness, but by their unique and compelling stories.

We need your help!

Our anticipated completion date is Spring 2013. Please help us finish our film by pledging via Kickstarter. All funds raised will go directly toward the film to help pay for equipment, editing/video/audio services, and other production costs. Importantly, if we don't reach our goal of $10,000 within 30 days, we don't get to keep any of the money raised, so contributions of any amount are much appreciated and will come with our heartfelt thanks, and great rewards! The funding goal we have set is the absolute minimum amount we need to complete this project. Additional money collected beyond our goal would be immensely helpful and allow us to enhance the reach and quality of this film.
We also encourage you to support us by liking our Facebook page or by sharing this project with friends, family, co-workers, or anyone else you know who may be interested in supporting this project.
Thank you for your contributions and support!
Gary Tsai is an Indiana-born and California-raised resident psychiatrist who is fascinated by the narratives of people's lives. He was fortunate enough to team up with several talented co-residents, Rachel Lapidus and Karthik Sivashanker, as well as award-winning filmmaker, Hiroshi Hara, to collaborate on the documentary film, Voices.

For more information:

Sunday, April 1, 2012