Friday, May 18, 2012

No one really sat down and said "he's a sick guy, let's see what we can do to make him better"

BROOKLIN — Oddly enough, it was often a relief to Gail Angell when she heard her son was in jail.
At least, she said, she knew where he was and that he was safe.
Her son, Chris Angell, died from burns last month when he tried to asphyxiate himself in his car and the motor overheated and ignited.
And although jail could be somewhat of a haven, Gail and her husband, Chip, say it was no place for someone who is mentally ill.
Angell, like many schizophrenics, was diagnosed as a young man soon after he graduated from Clemson University.
“A sick person is square,” said Chip. “All their holes [jail] are round. He’s sick. He’s not a criminal. Someone who’s mentally ill cannot go through the court system. He needs to be diverted right away.”
His mother, a registered nurse, said Chris’s illness was complicated by anosognosia, a condition that rendered him incapable of realizing he was sick. For that reason, she said, he often refused medication and hospitalization.
Despite his illness, Chris was a gifted tennis player and pro. And a caring father. But the mental illness constantly derailed his life, his parents said.
The Angells say Chris would have fared better with adequate treatment.
They have filed a grievance against Riverview Psychiatric Center, which is run by the Maine Department of Health and Human Services.
The other treatment provider whose care of their son they are questioning is a Bangor psychiatrist who also sees patients at Community Health and Counseling in Ellsworth.
“Very few of his providers followed the law or their own procedures in treating someone who was very sick,” said Chip. “They didn’t have the guts to put him in the hospital.”
Riverview Superintendent Mary Louise McEwen said she could not say anything about Chris’s care because of privacy laws.
The psychiatrist did not return a call left at his Bangor office. A Community Health and Counseling employee told the American, “He will not be speaking with you.”
The one institution that provided proper treatment, the Angells said, was the Dorothea Dix Psychiatric Hospital, where Chris spent some time in 2006.
But there was no room there for Chris. Two wings have closed at the mental hospital in recent years.
It was the Bangor hospital’s namesake, Dorothea Dix, who fought in the 19th century to get mentally ill people out of jail cells and into hospitals.
But hospitalization of the mentally ill shifted direction during the 1960s.
A recent report by the National Sheriff’s Association and the Treatment Advocacy Center states that “deinstitutionalization, the emptying of state mental hospitals, has been one of the most well-meaning but poorly planned social changes ever carried out in the United States.”
The report said the change did not take into account the fact that many of the sickest patients are not able to make sound decisions about their need for medication.
The Treatment Advocacy Center says that only one state —
Mississippi — meets what the center considers a minimal standard of 50 psychiatric beds per 100,000 residents.
The center lists Maine and 20 other states as having a severe shortage at 12 psychiatric beds per 100,000 residents.
Hancock County Sheriff Bill Clark said it is difficult to estimate how many inmates are mentally ill because they don’t always know themselves or haven’t had medical care.
Clark did say as many as 60 to 70 percent of Hancock County drug court clients show symptoms of mental illness.
“That could be serious depression all the way up to schizophrenia,” he said. “They come in with an addiction problem, then we find out they become more difficult to rehabilitate because of a co-occurring mental health illness.”
Chip Angell said his son’s schizophrenia would lead Chris to self-medicate with alcohol.
When he was “raging” the family would call the police for help.
Eventually, they took out a protection order to keep Chris away from the family business, the Brooklin Inn.
The idea, they say, was to protect not only employees and customers but Chris himself.
Chip said that during one psychotic episode, Chris told two women at the inn’s pub that he was going to cut them with a knife. He could have been hurt if a few patrons had overheard that comment, they said.
During a police intervention at the inn in early February, the police told Chip they could take Chris to the hospital, “but he’ll be home before we are.”
Instead, the deputies arrested Chris on a charge of violating the protection order with the hope he would be sent from jail to the psychiatric hospital.
The jail did send Chris to Riverview, which, despite his long established history of schizophrenia, classified him as a forensic patient, which meant he would be evaluated to see if he was fit to stand trial.
During Chris’s five weeks at Riverview, the state’s forensic psychiatrist found Chris competent to stand trial.
“She sent him back to the jail,” said Chip. “The court had no charges of any significance to keep him.”
A judge then had Chris plead guilty to violating the protection order, sentenced him to a year’s probation and let him go, Chip said.
“It’s very clear they didn’t follow any logic with regard to a patient but they used all kinds of paperwork excuses,” Chip said. “Nobody really sat down and said, ‘He’s a sick guy, let’s see what we can do to make him better.’”
The discharge plan for Chris after his release from jail was to spend a night at Jasper’s Motel in Ellsworth, at his expense, and then go to Augusta to pick up his medication.
The Angells were told a case worker would be available for Chris in a few weeks. It was the case worker who arrived in Brooklin the morning of April 24, saw Chris’s car on fire and called 911.
“To turn a guy, medicated, out in the public, that’s not a discharge plan,” Chip said. “It’s just incompetent or careless.”
Gail said that while her son could be a raging psychotic one moment, he could be calm enough the next to talk his way out of a hospital.
A year ago, after an episode in which Chris was “raging,” police escorted Gail and Chris to the emergency room at Eastern Maine Medical Center (EMMC).
Gail went home. In the process of being admitted Chris just walked out, she said.
In November 2011, Chris was taken again to EMMC, which kept him overnight.
Chip went to talk to the hospital the next morning.
“A guy from Acadia [mental hospital] lectured him about being nicer to his dad and off he goes home again,” said Chip.
Angell said that medical professionals and social workers are not following Maine rules and laws with regard to persons with mental illness.
In the past, patients needed to be in danger of harming themselves or others in order to be forcibly hospitalized.
Today medical professionals also must consider a patient’s past history and testimony from other people as well.
“A social worker must get testimony from others to help in her evaluation,” Chip said. “But, it’s not happening.”
Of 29,000 suicides in the United States each year, about 5,000 are believed to be persons with schizophrenia or bipolar disorder and most were not receiving adequate psychiatric treatment, according to the Treatment Advocacy Center.

Saturday, May 12, 2012

Spring ...

This comes from GG, an amazing mother, blogger and mental health advocate in Kentucky.  She's also my good friend.  Her story is a reminder that Spring "could be" a new beginning for many of our adult children who suffer from persistent and severe untreated mental illness.  Yet "could be" is not acceptable to us as mothers.  Here's to continued, persistent advocacy because that's what it takes to effectively change our mental health laws.  Happy Mother's Day to mothers everywhere who are fighting for better access to mental health treatment for their adult children.

Spring ...

It may be a drop in the bucket, but at least it's a start in the right direction!

In case you missed it, the Knoxville News Sentinel featured an editorial this week highlighting Tennessee's new AOT pilot program:

In 2011, three men plunged to their deaths from Summit Towers, the 12-story subsidized apartment building in downtown Knoxville. Two other residents committed suicide by other means last year.
The deaths have raised concerns about the adequacy of mental health care in the area, especially in light of the pending closure of the state-operated Lakeshore Mental Health Institute. The rash of suicides underscores the desperate need for the state's plan for the area's mentally ill to succeed.
The state Legislature has begun to give the effort a boost, approving during this year's session a pilot program that would make it possible for a judge to order supervised outpatient treatment under certain circumstances. Patterned on Kendra's Law in New York and laws in numerous other states, the measure would give families a way to get help for mentally ill relatives who are resistant to following treatment regimens on their own.
People being treated for mental illnesses sometimes turn violent toward others when they stop taking medications. Others sink into despair so great they see no way out other than death.
Apparently that was the case with Summit Towers resident Francis "Scotty" Zingheim, who had been diagnosed with paranoid schizophrenia. He was enrolled in an outpatient program through the Helen Ross McNabb Center that provided intensive case management but lost access to the program when he was removed from the state's TennCare rolls. Zingheim sought other treatment but apparently jumped from a 12th-floor window at Summit Towers on March 31, 2011. His parents later found six months' worth of medication in his apartment.
Lakeshore is closing June 30, and as Clif Tennison, chief clinical officer at Helen Ross McNabb, told the News Sentinel, the "deinstitutionalization" of mental health services won't be reversed. That means the state must pay for programs at private providers to treat patients while preventing them from harming themselves or others.
A handful of long-term patients who cannot be placed in community settings and "forensic" patients ordered into treatment by the court system are slated to be housed at Chattanooga's Moccasin Bend Regional Mental Health Institute, which will add a 25-bed unit. Gov. Bill Haslam's budget shifts $6.6 million in funds from Lakeshore into programs at private providers such as Helen Ross McNabb, Peninsula and Ridgeview Psychiatric Hospital. Officials at those facilities say they are certain they can provide the needed services.
The mental health pilot program based on Kendra's Law will cost $125,000 per year. It was included as an amendment to a bill sponsored by state Sen. Becky Duncan Massey and Rep. Ryan Haynes, both Knoxville Republicans. State Sen. Doug Overbey, R-Maryville, and former Sen. Tim Burchett, now Knox County's mayor, have been trying unsuccessfully to get a statewide law passed for six years. Overbey has predicted the pilot program will be successful and expanded to cover the entire state.
The program might not have saved Zingheim from his demons, but it could give the families of other troubled patients hope for the future.
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Friday, May 4, 2012

Anosognosia explained

The inability to recognize one's own illness is the leading reason that people with severe mental illness do not adhere to treatment. In this video, learn about the condition, see how it looks and hear what is needed.

Tuesday, May 1, 2012

Opportunity "Knox" for AOT in Tennessee

Reprinted from the Treatment Advocacy Center blog
(April 30, 2012) Tennessee is one of six remaining states without a law authorizing assisted outpatient treatment (AOT). But you can’t blame that on a lack of effort by the state’s mental health advocates. Over the years the Treatment Advocacy Center has supported repeated attempts to enact AOT in Tennessee, only to be frustrated each time by opposition – both ideological and fiscal -- from the state’s Department of Mental Health (DMH).
This is the year frustration at last gave way to success.
tennesseeThe latest campaign began in early 2011 with a re-tooled, Treatment Advocacy Center-drafted AOT bill introduced by Sen. Doug Overbey (R-Maryville). By the end of the year, history appeared to be repeating itself. The bill seemed moribund after a DMH report concluded it could not be implemented without an infusion of state cash into mental health services – an obvious non-starter in the current budgetary climate.
But Sen. Overbey did not fold. At a Senate committee hearing in December, he politely but firmly pressed DMH officials with points from the Treatment Advocacy Center’s methodological critique of their report. The agency agreed to some reevaluation and continuing dialogue on the issue.
And now Sen. Overbey’s strategy of constructive engagement has borne fruit. DMH has agreed to support and fund a modest AOT pilot program at the Helen Ross McNabb Center in Knoxville, to serve no more than ten patients at a time over two years. The authorizing legislation passed the Tennessee House unanimously last Friday, as it did in the Senate the week before, and is now headed to Gov. Bill Haslam’s desk.
Knoxville is a particularly appropriate location for the pilot, for many reasons. It has been the site of numerous senseless tragedies that AOT might have prevented. Mayor Tim Burchett is a key supporter, having sponsored an AOT bill when he served in the state Senate. The Knoxville News-Sentinel has editorialized forcefully on the need for AOT. The city is about to lose Lakeshore State Hospital, a 100-bed facility slated for closure by DMH this year, ratcheting up the need for quality outpatient care. And of course, Knoxville is the home of blogger/mother/mental health activist Karen Easter, Tennessee’s most dogged AOT champion. We can’t imagine having anyone better on the scene to monitor the creation and operation of the pilot program.
Excited as we are to finally have a foot in Tennessee’s door, we are mindful that this is only a provisional victory. A pilot program is a testing ground, and we want this one to yield proof that AOT is a wise investment of the state’s scarce mental health resources. We look forward to offering our assistance (including our forthcoming "Guide for Implemeting Assisted Outpatient Treatment" in Knoxville. If this pilot is afforded a real chance to succeed, 2014 just might be the year that AOT finally reaches folks across the state who struggle with severe mental illness and treatment adherence.
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